podcast – medhum.org https://medhum.org Cultivating empathy & critical thinking in health, culture & the arts Tue, 24 Mar 2026 04:12:24 +0000 en hourly 1 https://wordpress.org/?v=7.0 https://medhum.org/wp-content/uploads/2024/05/cropped-medhum-logo-300-e1715809791117-32x32.png podcast – medhum.org https://medhum.org 32 32 The Tennis Partner by Abraham Verghese https://medhum.org/review/book-review/dave_hsu/the-tennis-partner-by-abraham-verghese-a-podcast/ https://medhum.org/review/book-review/dave_hsu/the-tennis-partner-by-abraham-verghese-a-podcast/#respond Tue, 10 Jun 2025 14:04:21 +0000 https://medhum.org/?p=10737

Sports Literati X Apollo On Call 

This month, on Apollo On Call, we have a special collaboration podcast to share with you. My guest co-host for this episode is Dr. Dave Bryant.  We usually meet up to podcast about sports books on the Sports Literati podcast. But this month, I managed to find a sports book that deals with medical humanities that is perfect collaboration material! 

The Tennis Partner is a 1998 memoir by Abraham Verghese that talks about his friendship with a troubled former professional tennis player turned medical trainee named David Smith. At the time, Verghese was an infectious disease specialist in El Paso, Texas, where David was a medical student.  Verghese’s marriage was also coming apart at the seams. Into this void enters David. Determined to test his own tennis skills against a former pro, Abraham ends up befriending David over tennis and the two become close friends. As their lives unravel, we get a multi-layered story about friendship, medicine and tennis. 

Have a listen and let us know what you think! And if you are interested in more sports booksdiscussions, check us out on the Sports Literati podcast. 

TRANSCRIPT FROM THIS EPISODE

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

]]> https://medhum.org/review/book-review/dave_hsu/the-tennis-partner-by-abraham-verghese-a-podcast/feed/ 0 How Real is the Pitt?  https://medhum.org/review/film-review/dave_hsu/how-real-is-the-pitt/ https://medhum.org/review/film-review/dave_hsu/how-real-is-the-pitt/#respond Mon, 05 May 2025 17:20:08 +0000 https://medhum.org/?p=10190 From Apollo on Call–a Medhum Podcast

On the latest episode of Apollo On Call, I am pleased to welcome my good friend and pop culture expert Dr. Stuart Harman, a paediatric emergency room physician from Ottawa, Canada, to discuss the breakout TV medical drama of the moment: The PITT. 

Both Stu and I have watched about three quarters of the show’s 15 episode first season at the time of recording this podcast, enough that we are ready to weigh in on some important medical humanities questions. Is The PITT realistic? Does it reflect the reality of life as an emergency room physician? Which parts of the show make sense and which don’t? What does it say about the hierarchal world of a teaching hospital? 

If you haven’t watched The PITT yet or are considering whether you should watch it, this is the episode for you. We deliberately avoid any spoilers and instead talk big picture about the show’s themes and place in medical humanities. 

Have a listen, and then come back in a month or two, when Stu and I catch up after we’ve finished the season. Next time, spoilers will be on so you better come prepared! 

David Hsu 

TRANSCRIPT FROM THIS EPISODE

The Pitt Part 1 

DH 00:00 

You know, when I went through med school, I had this whole imposter syndrome thing, and it took me, like, 17 years as a professional to get over it. Now it’s back. I’m watching these clerks outperform me, and I feel like I don’t belong as a doctor again. 

DH 00:18 

Welcome to Apollo On Call, the podcast of MedHum.org 

DH 00:22 

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

DH 00:30 

All right. Welcome back to Apollo On Call. And if I sound really excited, it is because I am excited to talk to my buddy today about The Pitt, all right, and so first I’ve got to introduce my co-host for this episode. It’s Dr. Stuart Harman. He’s a pediatric emergency room physician and the director of the pediatrics residency training program at the University of Ottawa. More importantly, he co-hosts the Medical Dads podcast with me, so people who want to check out a discussion about parenting can head over there. And why is he appearing on Apollo On Call and why is he here with MedHum is because all those things I said about Dr. Harman are true and accurate, but most importantly, he is an expert on comic books, cartoons, sitcoms. So really, he is the guru of pop culture, and that’s what we’re going to do. He’s going to be a recurring person on MedHum whenever we have something about pop culture that we need to discuss. So, Dr. Harman, welcome to the show.  

SH 01:34 

Thank you for having me on the show. That description you gave is exactly how they introduced me the last time I presented at the Canadian Paediatric Society. 

DH 01:42 

Excellent, excellent. All right, and so that’s why here today. We’re going to talk about The Pitt, which is the show that everyone in medicine seems to be talking about lately, but it’s also appearing everywhere, like, it’s been in the news. This is a big thing, and for people who haven’t heard about it, The Pitt is a medical TV drama. It is airing on HBO Max, which in Canada is available on Crave. And it’s sort of maybe kind of a sequel to ER, but not officially. So all of these things combined to make it something that everyone in medicine is talking about it. So at Apollo On Call and MedHum, we need to talk about it, right? Because this is a medical humanity site. We’re trying to talk about the intersection of medicine, literature, the arts and, quite frankly, TV doesn’t get enough attention as a version of the arts, right? It’s generally considered a little bit too low brow, probably for academic medical humanities discussion, but we’re gonna change that today, because we need to talk about this. We need to bring medical humanities to the masses.  

SH 02:50 

You know, I was worried when you asked me to come on to this podcast, that I wouldn’t be able to handle the increased level of sophistication that I expect on this compared to when we’re doing our Medical Dads podcast talking about just our lives but now I realize we’re talking about television. Okay, I’m up to speed. 

DH 03:06 

Exactly, exactly. We invited you here for a reason, so let me just tell for people who don’t know what The Pitt is, The Pitt is a 15-hour television series. It’s the first season of this series that has just recently aired on HBO Max, so there’s one episode per week, and it’s a little bit different than what most fancy TV dramas are in this day and age. First of all, the length of the show is very long. There’s 15 hours. Most shows kind of cap it at seven or 13 hours, so it’s a little bit longer than most shows. So I had to ask Dr. Harman, are you in? You gotta watch The Pitt with me, okay? 15 hours. We gotta commit this amount of time to it, which is a little bit hard, we haven’t even started the show. We don’t know if we’re gonna like it. 15 hours seems like it could be a big ask, but we are getting there. 

SH 03:54 

There’s so many other aspects of our lives that if we just committed to doing 15 hours of we’d be such better people. 

DH 04:01 

Not necessarily, okay, because this podcast is gonna be really good. It’s hard to imagine that something would make us better than the 15 hours we spent watching this show.  

SH 04:10 

That’s right, you heard it here first, that watching this show is better than 15 hours of volunteer work. We’ve done more for the world than we could have with 15 hours of cleaning the environment.  

DH 04:20 

Hey, this is volunteer work, man, last I checked you were not getting paid for it, I’m not getting paid for it. We are doing medical humanities for the love of medical humanities and TV. 

SH 04:30 

Excellent observation.  

DH 04:31 

We’re gonna do at least two episodes talking about The Pitt, right? So today, the first episode, we’re gonna give a bit of background about the show. We’re going to talk around the show, but we’re not going to talk too much about the actual content of the specific plot developments. So in regular terms, this means there’s going to be no spoilers today, because so far, neither Dr. Harman nor I have finished the entire season. We’ve only watched part of it.  

SH 05:03 

That’s right.  

DH 05:03 

I’m about three-quarters of the way through. I think you’re about two-thirds to three-quarters of the way through, yeah, so we don’t know how it ends.  

SH 05:10 

Yeah, right.  

DH 05:11 

And so we’re approaching this as we’re gonna talk to you guys and gals out there who have not watched the show yet, and we’ll give you an opinion on how we feel about the show as medical doctors, and how we feel about it from a medical humanities point of view. And if you do end up taking us up on the offer and watching the rest of the show, you can come back in a little while, when we’ve had our follow-up discussion where we break down the thing in more detail, all right, with spoilers. 

SH 05:36 

That’s right, we’ll spoil the heck out of it.  

DH 05:38 

Okay, so now I have to tell you to start this conversation how I got into this thing called The Pitt, because actually, people who listen to me or talk to me know that I don’t watch a ton of TV anymore, right? And so I was happy, 

SH 05:53 

I will say that that’s not necessarily generally known.  

DH 05:57 

Okay, I don’t watch a ton of TV, right? I don’t have an active television show that I’m super into. I’m not a person who knows what’s coming up next, you know, for the new season on TV. But a few months ago, my sister was like, have you heard of The Pitt? I’m like, Yeah, whatever, The Pitt what is that? And she doesn’t ask me these type of questions very often, so I clicked on the link she sent me. I’m like, What? It sort of felt like a reboot of ER which instantly made my whole body go soft, right? Like, I didn’t know what to do. 

SH 06:31 

Yeah, so obviously, was the great density that parts of your body work, because it sounds like you’re really excited about this. 

DH 06:37 

Yeah, no, like you’re weak-kneed, right? Like you’re about to faint, right? So the reason for this is because the original show, ER, was this seminal thing that happened to me in high school, that television show probably led to me becoming a doctor more than any other thing in the world. And I hate to admit it, because sometimes my mom, people will be like, Oh, why did he end up getting into medicine? And she’ll say to her friends, well, there used to be this TV show called ER, that he was really into, and it just sounds like the hokiest thing ever and I really hate it when she prefaces this story by telling people about how I used to stay up on Thursday nights to watch ER, but it actually is kind of true, right? So what actually happened was, if you remember, in the early 90s, there was this crazy, big movie about dinosaurs on an island that were genetically re-modified, called Jurassic Park. So that movie came out, and I was super hyped, loved it, and it was based on a novel written by Michael Crichton. So then I got really into Michael Crichton, and I realized, Oh, he’s a medical doctor, and there’s a new show coming out on NBC. Because Jurassic Park was so popular, they took some of his other stuff and said, Okay, let’s finally put this on the air. So he had an old script for a medical movie called ER. They spun it into the pilot episode of what turned out to be a really, really successful television series. So I was there right at the beginning, the first episode of ER came on Thursday night. I think it might have been 1993 or 1994 and I was there watching it, and within 20 minutes, 40 minutes, I was hooked, right? And so I was a huge ER fan. And this was not a show that a lot of my friends were watching in 10th grade. A few of us watched it so, so I was really into this show. I watched it consistently for five or six years through university. I remember freshman year at Cornell University, Thursday night, 10pm. This was back in the day when people didn’t have streaming. There wasn’t anything on your computer that you could watch. You had to go down in the dorm, in the res to the TV lounge, right? And there’d be these two TVs mounted up high, two TVs for the entire dorm.  

SH 08:46 

Wow.  

DH 08:47 

And Thursday night, felt like the room was packed, right? I would go down sometimes to watch football or basketball, and there’d be nobody there. But Thursday night, 10pm tons of people were there. Everyone was watching ER, I did that a few times. Loved the show. Gradually, the show kind of petered out for me because the original cast started leaving. So if people who follow TV, they know George Clooney got his big break on ER, he went from being just another face on TV to, you know, megastar.  

SH 09:20 

You’re forgetting his seminal role on the TV series, The Facts of Life?  

DH 09:24 

It wasn’t The Facts of Life, he was on Roseanne. So you even forgot it yourself. 

SH 09:29 

Before Roseanne, before the later seasons, The Facts of Life, George Clooney. 

DH 09:34 

Really?  

SH 09:35 

Yeah, this is after the girls left the boarding school and they owned a restaurant with Mrs. Edna. See, that’s why you got me here on the show. That’s what I’m here for.  

DH 09:47 

I did not know he was there. Okay, so there, I stand corrected. But either way, he ends up leapfrogging into Hollywood. And then most of the original cast eventually, they move on to other things, and the show becomes a bit too soapy, too sensationalized, and I gradually lost interest in it. I did discover, though, as I went through my medical training, I went through medical school, I went into residency. At some point in residency, I realized, Hey, these guys are still watching, ER. My residency buddies, some of them, would meet up on Thursday night at 10pm to watch, ER, I’m like, What? You guys are still watching that show that I used to watch back in high school, it’s not even good anymore, right? But at that point, I think there was this draw that if you’re a medical trainee, that a lot of the things that are happening on the show are very realistic, so that so these doctors in training would stand, would sit there, trying to figure out what’s the next thing you would do in this case, which test would you order? There was this whole procedural aspect to the show which I was oblivious to.  

SH 10:43 

Yeah, you know, for our generation, we, you and I ,are probably at the edge of that age group of physicians who were inspired to go into medicine largely because of ER, I feel like people who are just a little bit older than us, who would have been the right age when that show was newer, and really just taking off a lot of people in that cohort, I remember coming from med school interviews, and some of the upper-year students meeting me and saying to me, Okay, yeah, so there’s pretty much two groups of people here, those who are really into ER and those who don’t really watch it. So which group are you in?  

DH 11:17 

Wow, yeah. So the crazy thing is, it’s been many years, and now I’m teaching med students. I’m teaching residents. Sometimes they’ll be like, Well, why did you get into medicine? I’ll be like, Well, there used to be this show called ER, and then they’ll kind of look at me blankly, and I’ll realize, I guess they weren’t even born when ER started, which just makes me feel so old. And then I’ll mention something like, you know who George Clooney is, right? And they’ll be like, they’ll look at me blankly, like they don’t know who George Clooney is, which I just find unbelievable. To me, he’s, like, one of the five biggest male movie stars in the world. But maybe I’m just really old now, right? So nothing dates a thing more than their understanding. Nothing dates a person more than their understanding of pop culture, because pop culture just rebirths itself so quickly that what’s hot today is gone tomorrow, but it is really nice that suddenly, in 2024, I caught wind that this sort of remake of the show has come on. It’s not really a remake because, because there’s this whole legal thing happening, right? So I don’t know if you’ve heard about this, but basically, apparently, they were supposed to make a sequel to ER, but the talks between Michael Crichton’s wife, because Michael Crichton has since passed away, his wife, who manages his estate, and the producers of the original ER, including the actor, Noah Wyle, who’s the star of the show, talks broke down, so they went off and made this new show called The Pitt, and she found that the show was a little bit too similar to ER, so there’s this whole controversy, and she’s suing them for making a clone of ER, but they’re saying, Well, this show is actually quite different, and it is a little bit different, right, other than the fact that the main character is the same actor from ER, but he’s playing a different person, and it is set in an emergency room, and the pacing is kind of similar. The other big difference is the show set in a different city, and the show is set over 15 consecutive hours. So each episode of the show is intended to be one hour of real-time drama, right? So we’re gonna go through a 15-hour shift. And so all of that’s set up a little bit like the old action show 24 right, where every episode was one hour of a season. So it has enough differences for me, and that’s where we land on the show. 

SH 13:35 

Huh, I did not know at all about this. It seems hard to sue for somebody making a medical drama, it seems like there are many, many of those out there that are similar to each other, or just even in general, right? All kinds of genres. Can somebody sue somebody else for making a Western show? Can the makers of Bonanza come and sue you if you  

DH 13:56 

Exactly, well, the jury is still out. We’ll see where that actually goes, but that has been brewing in kind of the background as people talk about the show. But anyways, that’s just the background. Let’s talk a little bit around what we think about the show now that we’re kind of two thirds of the way through.  

SH 14:11 

Yeah, absolutely. And for the makers of that show, please don’t have any characters have sex in a closet, or the makers of Grey’s Anatomy may also come after you, and you’ll have two bosses on your hand.  

DH 14:21 

All right. The thing that everyone wants to know, because you and I are doctors, I’m not an emergency room doctor, you’re not an adult emergency room doctor, but the thing that everyone wants to know is, is this show realistic or not? So as the pediatric emergency room doctor, you’re the closest to that that we can, closest person that can answer this question, yeah, what do you think? Is it realistic? 

SH 14:44 

Overall no, well, actually, that’s not fair for me to say. I hate giving an answer that’s sort of an in between answer, right? But the cases that are happening in the show, you could tell are very much based off of somebody’s stories. That someone like me has a wacky case that came in, and I told that story to somebody who made it into a show. When you’re watching the cases, it’s very much like that. Especially for me as a pediatrician, I mostly pay attention when the when the pediatric cases come in, and some of those cases, like, as soon as the patient comes in, I’m thinking to myself, Okay, what’s a wacky story that I could think of, that maybe I didn’t have, but that circulates amongst pediatricians. What’s a wacky story that I can think of, and just based on that alone, it’s, oh, yeah, it’s going to be this, not necessarily because that’s the only possible medical explanation, but because that’s the only possible medical explanation that makes one of my really cool stories. So in that sense, the stories do feel like they are real. 

DH 15:52 

Okay, give me one example. I mean, we’re not gonna spoil the show, but give me one example of a case that walked in the door on the show that you’re kind of like, Okay, that’s a wacky thing that happened.  

SH 16:02 

Okay, I won’t reveal the diagnosis, but there’s a point at which they bring in a five-month-old who’s irritable, and it struck me right away that, wow, they’re bringing this child straight to resuscitation, and they start having characters rhyming off all the craziest, worst case scenario, things that this could be and really having this elevated level of panic.  

DH 16:26 

Oh, right. I called that one. I knew what that case was because of that. And I had never actually seen that specific thing in real life, but I had heard other doctors talking about it at a study meeting. They’re like, Oh, we saw this really cool thing, and they taught us about it, and none of us have ever seen it, yeah. But I was like, It has to be this.  

SH 16:47 

I’ve seen this diagnosis several times, but I’ve never actually seen it present as we thought it was this super serious thing, and we were going down that pathway, and then we realized it was this. For me, when I’ve seen it in real life, it’s more like, Yeah, the parents kind of figured out this thing was wrong and brought in, and we knew what it we knew what it was. But when we tell this story to medical students, when we tell medical students, Okay, you got to look out for this diagnosis, because somebody might think it’s this super serious thing, and then it turns out to be this. We tell students this story of how this could happen, but for the show, it happens the one in 100 ways that it could happen, not the way that it actually. 

DH 17:26 

I think we have to spoil this particular … 

SH 17:29 

No, don’t spoil it, we just promised people. 

DH 17:31 

But it’s not that important.  

SH 17:33 

Oh, that’s what people who give spoilers always say. 

DH 17:36 

Oh, come on. But it’s really weird to be talking to our audience like, Well, this thing happened, and then this and then this, and then but they have no idea what we’re talking about.  

SH 17:42 

They won’t until they watch the show.  

DH 17:43 

All right, fine.  

SH 17:45 

The point is there are a lot of these stories, a lot of these things that happen on the show where you can tell it’s based on somebody’s extreme case, or someone’s really interesting story with a wacky ending. It’s just not that realistic that all those things are happening simultaneously in an hour. 

DH 18:04 

Yeah, right. So I’ve been watching the show with my wife, which is an interesting experience, because she trained as an internist, and now she’s a GI specialist. So she’s actually seen a lot of these things in real life. So as we’re going through the show, I’m like, This isn’t realistic for some reason, and usually my complaint is this is not realistic because of the pace, the pace of this is insane. And she’s like, No, these cases are real. Like that case, I’ve seen that, I’ve seen that. And I know she’s seen it because she can almost predict what the next action is going to be with remarkable clarity, right? So, I will say, I married a real doctor, right? But I do feel like, in terms of reality-wise, the actual individual cases are all based in reality. They’re not making this stuff up at all. Individual-case-wise. 

SH 18:51 

Yeah, at least as far as the medicine goes, there’s a few things where I’m kind of wondering, did they actually make up? There are a few things where I’m wondering is, did this actually happen, or did they just add some drama to it, in terms of just things that happen with characters that are not really medical, but that are, you could sort of see happening. So some of those stories like that, but yeah, you know, to be fair to the people who are making the show, to that question, is this show realistic? I have to say there’s a high degree of realism on this show that it would be an insult to the efforts that have been put in the show for me to just flippantly say, no, it’s not realistic. The medicine is very realistic, and when I compare it to other medical things I’ve seen on TV, it’s extremely realistic, right? On other shows I’ve seen somebody’s looking at a CT scan and saying, Oh yes, you’ve got three concussions, and I’m yelling at the screaming like, You can’t diagnose a concussion from a CT scan. This show has none of that. And in fact, this show sometimes has characters address things that, like, parents will be asking for something that they’ve seen on TV, and the characters are explaining, no, in real life, that’s not how this works. This is how it goes. So the show does have a high degree of realism. I got to give it some serious credit for that. Also pretty impressed by some of the makeup and stuff that they have. Some of it to me, like, there’s an injury, a gruesome leg injury, right? The beginning that my wife in the first episode was like, All right, you’re watching this on your own. But I’m saying like, Oh no, don’t worry, this is not what it looks like in real life, that doesn’t look real, right? But then there’s some other things where they’re cutting flesh or doing a procedure that I’m saying, Yeah that’s better than any of the mannequins I have at the hospital for simulating something. 

DH 20:32 

Right, it does look very realistic to me overall. So it induces this level of cringiness that even I, as a seasoned TV action movie watcher, I have trouble watching every moment of this show. I have to kind of stare at a spot just to the side of my TV at times, which is really weird, right? And then, and of course, then my wife’s making fun of me. She can tell that I’m kind of cringing, but later in the season, she gets her comeuppance. There’s a part where she can’t handle watching it either. 

DH 21:05 

Now, I have a question. So my comment, though, is just that the sheer volume of stuff is not realistic, right? Like, it was just too much of this happening. I’m like, How many of these things can happen within one hour, right? I know it, there’s different characters involved, but this is nuts. If anyone had this job where this amount of volume was happening in any given hour, even once a month, they’re gonna have a nervous breakdown, right? So the volume of the thing is where I think it’s a bit unrealistic.  

SH 21:36 

I would say that if they told me, we’re just making one season. That’s it. There’s just one season. Because the premise of this season is that it’s just one super statistically anomalous day where all these craziest things all happened, of all these stories all happened on the same day, and sometimes all happening in the same hour. Then I would say, All right, I can give that a bit of artistic license that, 

DH 22:01 

Wow, really? So it’s believable, almost believable, then. 

SH 22:05 

Yeah, the part that’s not realistic in terms of volume, is the speed at which a character will come in the room and say, Okay, yeah, you need this test. And then they’ll cut to another character, and then they’ll come back, and the person is back with those test results already done, and you’re saying, No, that just that’s not even a matter of hospital efficiency. It’s not physically possible to wheel the bed down there that fast, inject the dye, do the image, get the image read, and come back to the room. It’s just not that possible.  

DH 22:31 

Well, that might be the Canadian socialist healthcare system that you’re used to at work, but this is America, baby. Anything can happen.  

SH 22:38 

Just a little bit of that but it’s quite possible. It’s funny because they that part of the premise of the show is that it’s a hospital that feels under-resourced, right? And I’m often watching that being so jealous of what they have available in that hospital. 

DH 22:51 

All right, now, you have been, you’re a seasoned emergency room doctor, but it’s a pediatric ER. You’re working in Canada, and we know in Canada there’s no money for anything. One question I have, because this seems unrealistic to me. There’s a recurrent storyline in the show where the hospital admin like the Ms. money bags, the lady with the money bags, comes down to the emerg and asks the staff to like you guys, got to get your patient satisfaction ratings up, right? But she doesn’t just come down once throughout this season, she appears several times. And it’s not a season, it’s one shift. It’s like she has nothing better to do than every two hours, she’s gonna come downstairs and just bust somebody’s balls about wasting money and poor scores, and then the ER doc has to take a stand in front of everyone, say, Listen, we need more money. We need more beds. Is this an actual interaction that happens in the hospital? Because I know, as an entrepreneur, I manage a medical clinic, sometimes my employees come down and, you know, they’d huddle up, and then they come to us like, Yo, we need a raise, right? But that doesn’t happen four times a day, all right? It happens once in a while, and then we’ll go home and think about it. This is happening recurrently. How realistic is that?  

SH 24:03 

You know what I would say, thinking a lot about this, because doctors I know who’ve watched the show, who aren’t even in adult emergency medicine, where, admittedly, that pace that they’re on that show is much more realistic for adult medicine than is for pediatrics, right? Because we just don’t have that many heart attacks and traumas and stuff like that in a day. But people I’ve talked to are watching some of this stuff about hospital admin being focused on these, on these things like patient satisfaction scores instead of actual patient health. That a lot of people are saying, Oh, that’s so real. That feels just like my experience. And what I would say is watching the show that is what it feels like. What’s happening on the show is what it feels like for a lot of physicians. And I’m not saying that it isn’t what it is like for some physicians, but if I’m just looking at my own hospital, that is what it feels like. But when I’m watching it, I’m saying that’s not what it actually is like. What struck me as really odd in just the very first episode is the directness in which somebody in one of these more like, higher positions comes down and, frankly tells somebody you have to do this for the money in the politics. Whereas in real life, you get much more of that people, and I’m not just not criticizing my hospital admin, I just mean like everybody who’s at that higher level, like beyond hospital, even government, all the way top, you get a lot of more of a No, no, on the face of it, we are sympathetic to you. We understand it’s difficult. You get all these things. But then the frustration is that you feel like, Yeah, but from what’s actually happening, it tells me that, no, you’re not actually. 

DH 25:38 

Right.  

SH 25:40 

And this conveniently puts everything into one easily personified villain who’s coming down and saying that. Whereas my hospital admin, if I think of like my hospital CEO, of which we have a new hospital CEO, she’s right in there with me in a lot of ways, you know, she also is mortified by the reality of the system and the problems we’re having with funding and those type of things. She is not sort of evilly cackling saying, Haha, it’s all about whether or not I could, you know, make the books look balanced while the doctors patients get scared. It’s not that. That’s not what it’s like in real life. But I think for a lot of people watching it, this is what they feel like. This is what they feel like the admin is doing to them.  

DH 26:23 

I think that’s a really good point about the show. And when we asked this question about realism, is that the show is realistic in terms of the medicine, maybe the pacing is unrealistic, but the overall feeling is this is exactly what you just said. The overall feeling is how it feels like to be a doctor, and probably how it feels like to be a patient. You know, in the emergency room, I feel like they capture that feeling thing so well on this show that the rest of it, you know, sometimes, yeah, there’s artistic license, and there are things that and that that’s not exactly how it’s done in in terms of the medicine – doesn’t matter, because they hit the tone and the feeling. So right on this show, yeah, that I will stand on a ledge about. 

SH 27:05 

Yeah, I’ve got colleagues who told me that they watched the show and start to cry. I’ve got colleagues who watched the show and said they couldn’t get past the first 15 minutes because it just felt too much like their day at work. And not that I want to ruin the magic or anything like this. But it’s not that for viewers who are watching that show, they should feel like, Oh my gosh, that’s what Dr. Harman is going through every day. No, I’m not going through that. I’m not at the ledge of the hospital contemplating jumping off the beginning of the shift. But, yeah, there’s a lot of sentiments in there that really is not exaggeration to say that we’ve got patients in the wait room longer than actually what they quoted the wait times being on that show, right? They’re talking about patients being in there for six hours. And I’m like, Oh, I got patients waiting way longer than that. And the degree to which that’s a problem and a danger to people is kind of bang on.  

DH 27:58 

Okay, let’s talk a little bit about the characters. One thing that I noticed as the show started, was that the characters seemed kind of like caricatures, right? So a person walks in, you know, this is the doctor. Oh, that’s the grizzled old Obi-Wan Kenobi, right? He’s been through a lot, he’s very kind, but there’s some things that kind of are unsettling about his past. Or, here’s the supergenius, right? Everyone has, like a supergenius got into med school super early, but a little young, right? Or, here’s the here’s the B, I, T, C, H, resident, right? No one mess with her, right? So everyone kind of, at the beginning at least, fits these caricatures and when you’re talking about TV and books, those type of caricatures, generally, we try to avoid them because they just seem so one-dimensional, right? It’s almost like reading a comic book.  

SH 28:56 

You didn’t tell me when I came on the show we’d be dissing comic books. 

DH 29:00 

Well, I’m just saying it’s like reading a comic. Whether it’s good or bad, it’s up to you. But what I will say is that I thought that the caricatures really work in a way, because in real life, when we’re working in a busy hospital, and you and I went to med school together, when we meet people in our class, all of us, as human beings, unfortunately, we just automatically pigeon hole people as caricatures until we get to know them, right? Like, Oh, that’s the pretty girl, right? That’s the annoying guy. Like, we all do this kind of thing, until we get to know them. I feel like this show did a really good job of starting us off that way, because that’s when you’re working in a hospital and you’re rotating through a different rotation every two weeks, and you have to instantly get along with your supervisor and instantly get along with your team. You got to figure out the lay of the land super fast. And the only way to do that, I feel, is to sort of identify people as certain things and then figure out how to get to get on their good side right away. So I feel like this show actually shows us that. On another show, the caricatures would be kind of that’s one-dimensional. These aren’t real people. But I think in this show, it actually works really well, because, again, that’s what being a resident or a medical trainee is actually like.  

SH 30:12 

Well, I’d certainly agree that the show starts off with a lot of people who are the characters we have in our mind, of people that we work with. But then as the show progresses, they start to reveal a little bit more layers to the character, more depths to the character.  

DH 30:27 

Right. 

SH 30:28 

But even when I was watching, by the time I’m on episode four, which is only four hours into the shift, and I’m seeing some characters who don’t get each other, starting to see each other eye to eye open up. I’m thinking that it does not happen in four hours. On top everything else going in the hospital, you somehow had time for this, Nah, that’s not realistic.  

DH 30:46 

Right, the pacing is weird. Everyone was like, How are you gonna do a season of television over 15 hours straight in real time? Because how much character development can you really have? So they do have to squish everything into this condensed version, but it still feels true, even though there is this thing where you can’t suspend your disbelief that much.  

SH 31:09 

Yeah, I think one could make the criticism. This is stupid, like these episodes, even when you watch them in a lot of ways, the episodes feel like different days, almost like some of the episodes you think they should have just made this a series. And then this happens this day, and this happens that day. But I gotta say that there was some utility in this gimmick of having it go hour by hour. It does give you a little bit more of that sort of feeling of how things change over the course of a day, how the energy level, the attitude, the tolerance of characters, what’s going on around them shifts over the course of the day. And that, even that you start to feel a little bit along with the character of like, Okay, yeah, they just can’t wait for you to get through this day.  

DH 31:54 

Yeah, there’s a moment late, at least it’s relatively late, in the shift where, where one of the characters finally says, Today has just been crazy. And I’m like, finally someone said it, right, because that was my feeling the whole way through like this. This must be the nuttiest day in the history of medicine, yeah.  

SH 32:12 

But actually, if that was the premise of the show, is that they’re calling the show the craziest day ever that you can sort of be like, All right, I can believe that. But if you’re trying to sell me on the idea that they’re going to come back tomorrow and have the same day tomorrow, it’s like, Come on, in fact, they’ll run out of stories.  

DH 32:28 

Well, that’s my problem, is that, I mean, I’m pretty sure this show is going to be green lit for season two, so that means a year from now, there’s going to be another nutty day in the ER, like, how can they top this, right? But okay, we’ll deal with that when they actually get to season two. 

SH 32:43 

In a way I would, I would really kind of hope that they don’t, that it’s just that this stands alone, and it feels much more like a piece of art if it does standalone as like, this is just a slice of the life. This is just this crazy day. These are the characters. Here’s what happened. Inevitably, if they started to make this go on for first like Season 2, 3, 4, 5. First of all, you’re going to run out of these classic medical stories, because already they’ve used up some of the best. If they went to some peds emergency doctors, and we’re like, Okay, what are some of the stories that we could put on the show, that you got them right there, you’re going to be running out of good ones, I feel like.  

DH 33:18 

Hmm I don’t know. I feel like medicine has a well of stories. I mean, medical humanities has a well of stuff to talk about, there could be way more. But you are right, they hit on a lot of the big ones, right, end-of-life care, abuse, when you uncover abuse, what is the role of children’s aid and things like that. They talk about these things on the show, so they do hit on a lot of them, but honestly, in the world of medicine and medical humanities, you can come back to these stories from different angles there. This never ends, right? You’re an emergency room doctor, man, it never gets boring that way.  

SH 33:51 

Yeah, well you know what, that’s fair to say. I guess I was thinking of this more analogous to something like The Avengers, right? You make The Avengers movie, and you use your best superheroes up front, right? Those were the best superheroes Marvel had, in many ways, and Marvel has tons of more superheroes that you can give a show to. But you’re wondering, how come the Moon Knight show isn’t taken away, taken off the way Captain America does. It’s like, yeah, you use your best ones up front. But you’re right, there is a never ending well stories to tell, I suppose. But I mean, even the beloved ER eventually got to the point where a doctor’s arms are getting cut off by helicopters, like, come on. 

DH 34:31 

I mean, every TV show suffers from this. So everything needs to have a finite lifespan. Shows need to figure out a way to end at the right moment, right, and actually Wayne Gretzky, the great Canadian hockey player, he said it best: you always want to go out while your fans think you still have one more year to give. That’s when you need to go out.  

SH 34:52 

Yeah, right.  

DH 34:53 

That’s the perfect moment. When he was about to retire, he was playing for the New York Rangers. He always tells the story. I’ve heard it a few times that his dad was telling him, Wayne, just play another season. He’s like, Dad, I scored, like, 10 goals this year. I used to score that in a good week, I’m not that good anymore. But the fans still thought he could play, and even his dad thought he could still play. That’s the perfect time to go out. Means your level hasn’t really dipped yet, and you’re getting out ahead of the curve. But anyway, that’s just an aside. All right, now, you mentioned something before we started recording that I thought was an interesting point that we should touch on. Was you felt like, in terms of realism, some of the stuff that’s going on, in terms of the hierarchy of the medical training structure was a little bit off, and I think this is worth talking about because I don’t think too many people are talking about this.  

SH 35:40 

Yeah, I think it fits with the general public’s perception of what it’s like to be a medical trainee. And probably that’s partly informed by some of these older shows, and older doctor shows that the medical student can get dumped on, that the resident can get dumped on, that the staff person can speak so harshly to the medical student or that the resident could give another resident a mean nickname or something like that, right off the bat, and that struck me as odd in the first couple of episodes. And this is from the point of view, I guess, that I’m a program director for residents, and 

DH 36:20 

Right. You deal with this every day, right? As soon as someone gives someone a nickname, that issue is bouncing back up the chain of command to Dr. Harman to deal with.  

SH 36:29 

Certainly, some of the way that the more senior characters interact with more the junior characters, it just would be a complete non-starter, no-go and I don’t just necessarily mean that we have rules, because I don’t want people to get the impression that no abuse could possibly happen in a hospital, or that, you know, that if it happened in my hospital, I’d say, Oh, that’s impossible, nothing like that can happen here. But just even the idea that the students would just take it and accept it the way they do on the show seems really out of touch. You would have students quickly pushing back. And maybe this is different, because it’s American and not Canadian, right? And I don’t know what the union is like for medical trainees in the US compared to Canada, but staff would not be able to get away with a lot of the stuff that they’re saying to these to these characters.  

DH 37:20 

Hmm okay, fair. I thought I didn’t really register that. But because I feel like in medicine, there are a fair amount of people grating on each other, getting on each other’s nerves. But now that you spell it out that way, yeah, some of the characters are way over the line at different points, and they never really get called out on it in a real-world kind of way.  

SH 37:41 

Yeah, you know, that’s without giving anything away. There’s like a character who gives another character a nickname and is using it, and the character tells them to stop, and they don’t stop. That would be a problem that maybe it’s they’re too busy and after maybe season two is just 15 hours in real time of the program director having to deal with all these complaints that start arising from the residents who have been treated poorly by other residents and staff. But the other thing that I was going to ask you about: because we’re Canadian doctors, do you have trouble figuring out whose rank is what in that show sometimes? 

DH 38:17 

A little bit. I thought it was kind of odd that, in terms of the rankings, it took me a while to figure out that Noah Wyle is the only attending doctor on the ship. Which, I thought this was kind of crazy. I’m like, so you got one Obi-Wan Kenobi, and everyone below him is a trainee, right. And it’s like this crazy busy hospital, which to the characters, it feels like this is just another one of their days that they would man a hospital with just one experienced person and everyone else as a trainee. I then thought back to the times I’ve done emergency room shifts back as a trainee, and I was like, even those little community ERs had at least two staff or sometimes three at the same time. So, Dr. Harman, is it possible that one guy would be in charge of so many different things at the same time?  

SH 39:02 

Not in any hospital that I’ve ever seen in Canada, I mean during the daytime. If it was overnight, that would make some sense. You know, my hospital, there are periods of the night where there’s just one doctor. But this guy comes in at seven o’clock in the morning, takes over, and that’s it. It’s just him, and he just seems to like go. He seems to go from room to room, overseeing things, and then occasionally, will also seem to have time to spend a significant amount of time talking to a patient himself. And nobody seems to have to do any charting. There’s one point where a character does comment to another character to if they don’t mind charting something, but you never see them doing it. 

DH 39:41 

Right. So, I will agree. It took me a few episodes to figure out, Oh, wait, this person is actually still a resident. Because for a while it’s like, maybe Collins is an attending, because she acts a little bit like an attending. I’m like, maybe there is another attending. My wife and I both thought that, until it was revealed she was just a later year resident. And then the clerks, like, the medical students. These are third or fourth-year med students. The closest I ever got to the show in terms of hierarchy was I was once a third and fourth year clerk in the ER. I couldn’t do 1% of the stuff that the third-year clerk is doing on this show, right? The stuff that those two clerks are doing blows my mind, right? I feel so inferior watching. You know, when I went through med school, I had this whole imposter syndrome thing, and it took me like 17 years as a professional to get over it. Now it’s back. I’m watching these clerks outperform me and I feel like I don’t belong as a doctor again.  

SH 40:36 

Well, you know, where some of my colleagues do say that they watch the show and they can’t take it. I am finding a little bit of inspiration from the way that the efficiency of the characters on the show, even though they’re talking about how their wait times are long, and this kind of stuff, when I can when I see how quickly they’re on top of things and the smoothness with which they do it. I mean, most of my life, I’ve lived by watching what’s happening on TV and then trying to live up to that ideal, right? Never mind what Bill Cosby does in real life, but Dr. Huxtable, I try to try to be what Dr. Huxtable is, even though it’s not realistic. This show makes me feel the same way. It’s like, I can be that doctor. I can try harder to be that doctor.  

DH 41:18 

All right, so if anyone is ever in the Ottawa region, and they have a children’s emergency and you walk in the emergency room and you see this grizzled, scruffy looking version of Dr. Harman, you will know that he has been inspired by Dr. Rock.  

SH 41:31 

It starts with growing the beard of the main character on the show.  

DH 41:34 

Well, that’s the easiest way to emulate your role models in real life. It’s just to wear what they wear.  

SH 41:40 

But I love the way characters, they know doses off the top of their head, even for obscure things, they’re ready to talk through procedures that they probably don’t do every day, and yeah, they just move quickly from thing to thing. I like that. 

DH 41:57 

Now, you mentioned that a lot of people in medicine are being affected by the show. I guess this is what you’re talking about. 

SH 42:03 

Yeah, absolutely. I mean, I just say this because I only heard about the show when you told me about the show, when you said, Okay, I want you to start watching the show so we can talk about it. So then I started saying to people, Oh, have you heard about the show? And sometimes, once you become aware of something, you see it everywhere. Well, that’s what this was like. Once you told me about the show, suddenly I’m realizing all these people are talking about it, and the themes I’m getting are very similar. People I’m working with. I mentioned it before earlier, but someone saying that I was two episodes in and I got tears streaming down my face. And people are saying that about not just the cases, not just this all reminded me of a sad case, but those things, like the waiting room being super crowded and you not being able to do anything about it. You want to get something done, you can’t because you don’t have the resources. Or having a patient who you want something better for but the patient doesn’t buy into it, and you can’t get it for them. Those type of things, the person who represents that character, who represents the hospital or the government, or whatever she represents, who’s the person to tell you, I don’t care about people, I just care about the bottom line. That character, just people see that, and some of them just feel that, even though there’s no one in our hospital that I would point to say, Oh, that’s the person like that in my hospital, but just that sentiment that she represents, that this seems to tag people.  

DH 43:29 

I mean, I guess what we’re saying is that there’s this whole idea of art imitating life, right? So a medical drama, by definition, is like an art imitating real life hospital. But what actually seems to be happening is that life can imitate art imitating life, right? Like the real doctors are getting affected by this show that they’re watching, which is cool. And then I will say also, from a medical humanity standpoint, like most people in the world, do not actively think about medical humanities, right, even doctors are not actively thinking about, we go to work, we do our job, we go home. Yeah, sometimes you’ll read about in the newspaper, you know, someone will write an article about, you know, lack of medical resources, or gun control or abortion, right, and the medical implications of it. So sometimes people start thinking about how medicine and life are starting to interact. This show, through pop culture, is forcing its audience to consider each and every one of these issues that normally you might never think about, right? Which I think is a really good thing. This is exactly what medical humanities is. It’s making us think about, you know, Okay, so we keep talking about poverty and health care. Well, let’s put you into the ER and see what that’s actually like. Make you feel the feels about what happens when people can’t get access to care and bring out that feeling for people. I think this show really does something on the medical humanities level that we don’t get enough. 

SH 45:01 

Yeah, you know, in so many ways, this is very analogous to art, like a painting, right? You know, you take a painting like The Scream, picture where the guys hold this out of his face. So you could criticize that picture and say, Well, that doesn’t look realistic, you know, I don’t have pale, gray skin like the guy in that picture. And when I feel depressed, the background behind me isn’t a bunch of slurred up colors. You could look at this show and say, Oh, all that stuff doesn’t happen in an hour. But I guess it’s more when art works properly, it’s what it sort of represents, and the feeling that it evokes is real, right? And that’s kind of what the show is, there’s a sort of symbolism just in the idea that, Okay, this character just dealt with a patient who’s died, who couldn’t be resuscitated, and all the emotional toll that goes through dealing with it, with the parents. Meanwhile, on the other side of the divider, on that show, there’s all these people in the waiting room, some with very trivial problems in the grand scheme of things, but important problems to them who are getting these impressions and judgments of the doctor without understanding or appreciating what that doctor is actually going through, not just in terms of busy work, but also in terms of just like emotional distress that the doctor has to deal with. And it’s not that it has to have an answer, but just that you watch the show and these things come to your mind and it makes you think about it. I guess that’s what the humanities is about. 

DH 46:26 

Absolutely. Now, last thing then, sounds like you like the show. Sounds like you might love the show. What do you think of the show overall? For people who are thinking about maybe watching it, or who haven’t even heard of it. What do you want to tell them?  

SH 46:41 

Gosh, I will refrain from any of the sort of judgments or expectations that I feel like other physicians might have put on the general public with the show, because I’ve heard people say things like, Well, at least now, when people watch the show, they’ll understand what I’m going through, or they understand how hard it is. I’m not saying you got to get that from the show necessarily, or that you should get that from the show, because it’s still TV. But I think if you are at all curious about what it’s like to be a doctor in an emergency department, at least in this day and age, I’d say give this show a watch, and remember it’s TV, okay, remember it’s not actually real life, but it’s gonna give you some snippets that have a sense of realism that I think are worthwhile, but the show’s not gonna be for everybody. 

DH 47:33 

I will say, as I was watching the show, I had to catch myself several times because I was getting the feels about, you know, something that’s about to happen, one of the patients, or something’s about to happen one of the doctors. And I had to catch myself. I’m like, wait a minute, these are imaginary things. They’re imaginary characters. They’re not real. Why do I care? And I don’t get that feeling that often. You know what it’s like? It’s like, I was watching my children watch a Disney movie a while ago, and this was a few years ago when they were quite small, and when something really dramatic happened on the screen, they got scared, and they stood up, and they had to walk out of the room, and I’m like, kids, it’s not real, relax, right? But I realized this show grabbed me by the throat and made me believe it’s real, it just felt so real that I actually and then emotionally invested in it as a 47-year-old, cynical family doctor, I mean, that says it all, I love this show. And as a former ER fan, like I was gonna get buy-in for this show no matter what, we were gonna watch it whether it was good or bad. From what I’ve seen so far, this show is better than ER. This is just better, and people need to watch it, and then they need to come back and listen to our follow-up discussion about it on MedHum, on Apollo On Call.  

SH 48:48 

I’m certainly glad the show is not a sequel to ER. I’m glad they did a brand new thing. But you know what? The other thing I’ll add about this show is for doctors to maybe watch it, at least doctors in emergency departments to watch it. Because with ER, I knew the show tangentially because I just know stuff about pop culture, I suppose, but I didn’t really watch it religiously by any means. I didn’t watch even, like a fraction of it. I’ve seen clips here and there, but after I had gotten a certain point in medicine and I saw an episode, I realized, you know what, I think it might have helped or enhanced my education as a physician to have watched some of this show, especially at the beginning. And I feel like this show can enhance your education a little bit as a physician, which is a pretty good compliment for the realism of the show, I gotta say, if you’re asking if it’s realistic. 

DH 49:33 

All right, well, if you’ve enjoyed our conversation about The Pitt, come back to Apollo On Call. Dr. Harman and I are going to be talking about our actual impression having watched the entire show, maybe in a month, two months, all right, we’ll give you some time to digest this thing. But yeah, take that time, enjoy the show. Dr. Harman, it’s always a pleasure to get to talk to you. I know you need to run off to your emerg shift, so have a good shift. But we will see you back on Apollo On Call in not too long. 

SH 50:02 

Thank you very much. I guess after this talk about the show, even if I didn’t have a shift now, I’d have to pretend I do because I have to prove to people I’m as busy as Dr Robby. 

DH 50:13 

Apollo On Call is produced by MedHum.org. Special thanks to my co-host today, Dr. Stuart Harman. To hear some more of Stu and I discussing parenting and comic books, check out the Medical Dads podcast, available on Spotify or Apple or wherever you get your podcasts. The theme song is Un Sospiro, performed by Dr. Justina Sam. For more medical humanities content, please check out MedHum.org. Thanks for listening. 

The Pitt Trailer

Images of Mats Sheen and Ibelin from Mats’ Facebook page and Medieoperatørene / Euforia

]]> https://medhum.org/review/film-review/dave_hsu/how-real-is-the-pitt/feed/ 0 The Remarkable Life of Ibelin https://medhum.org/review/film-review/dave_hsu/the-remarkable-life-of-ibelin/ https://medhum.org/review/film-review/dave_hsu/the-remarkable-life-of-ibelin/#respond Thu, 17 Apr 2025 12:28:42 +0000 https://medhum.org/?p=9971 From Apollo on Call–a Medhum Podcast
Mats Sheen

The Remarkable Life of Ibelin is a 2024 documentary about the life of Mats Steen, a Norwegian man who died from complications of Duchenne Muscular Dystrophy. The movie explores how Mats, unbeknownst to the people around him, adopts a full online persona that allows him to experience the fullness of the human experience through a video game, experiences that were denied to him in the physical world because of his illness. 

I grew up during the nascent age of video games and home computers. While our parents looked at computers as tools that might help us in the future, as children, we looked at computers mostly as a source of fun. We crowded around arcade machines at convenience stores and arcades, throwing away quarters until our pockets emptied. We congregated at our friends’ houses after school and on weekends, befriending whoever was fortunate enough to have a console or a computer powerful enough to support the latest graphics. 

Mats’ online profile image (Ibelin)

Now though, as a parent and physician, my nostalgic view of video games is tempered by a mixture of skepticism and fear when it comes to games and internet technology. To hear the skeptics discuss it, video games are one of the root causes of the obesity epidemic, and online games and social media are part of the teen mental health crisis. Schools bring in experts to teach parents the perils of children spending time online while pediatricians pound out guidelines that describe “healthy limits on screen time.”  

This month, on Apollo On Call, we sit down to talk about video games and how there is another side to this narrative. We look at the story of Ibelin and talk about how video games may add to our lives in ways that many of us have never considered. 

Thank you, Mats, for showing us a different way to think about the online world. 

Luki and Dave 

TRANSCRIPT FROM THIS EPISODE

00:00 

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

00:18 

Alright, we are back on Apollo On Call, the podcast of MedHum.org and I’m your host, Dr. David Hsu, and I’m here with my co-host, Mr. Luki Danukarjanto, who is back, and we’re here to talk about movies.  

00:36 

LD: This is going to be a departure from our normal cadence, because we typically talk about books, but movies are a nice change.  

00:52 

DH: Alright. The movie that we’re talking about is The Remarkable Life of Ibelin, and it’s a really interesting movie. It exists right at the intersection of all the things we’re talking about – about medicine, life, death, technology. So Luki, give us a breakdown of what this movie is about and why we chose it. 

01:14 

LD: One of the reasons we chose it, it’s award winning. It won two awards at the 2024 Sundance Film Festival, was Oscar nominated and, well, it is also available on Netflix. They made it accessible for us. But essentially, this story is about Mats Steen. He is a Norwegian man who has Duchenne’s. And Duchenne’s is a disease of, I guess, the neurological area where it confines him into a wheelchair. So basically, as a young boy, he’s able to walk around, and as he gets older, then he has less and less mobility. The first part of the story goes through his life, His parents try to take care of him the best they can. He becomes a little bit more challenged in terms of being able to live through life. He gets more confined to his wheelchair, and he ends up in the world of video games.[The film] shows his parents talking to him, and basically a little bit upset, because he lives in this video game world, and he misses various life events – I think there was some key outing that they all were looking forward to go to, which he didn’t want to go to, because he had some sort of video game online event. The first part of it ends with him passing away, and his parents understand that he has this blog site where he talks a little bit about his adventures, and they post about his departure and his funeral, and they post it online, and unbeknownst to them, they start getting responses, and not just one response or 10. I think hundreds, if not thousands, of responses of how Mats, or Ibelin, in the game that was his online character, how he touched their lives. And then the second part of the story really talks about how his parents uncover this whole new world and life that Mats Steen or Ibelin lived unbeknownst to them, and how many lives that he touched, what things he did, all in an online world that he wasn’t otherwise able to do in the real world because he was stuck in a wheelchair. So that’s the major premise. And Dave, what else would you add to it? 

03:55 

DH: I think you covered the main arc of the movie very, very well. I mean, that was basically everything that happened. The only thing I’m going to add is the game that he was actually playing was a game that people who know anything about computer games know about, and that’s World of Warcraft, which has been a very, very popular online game for more than 10 years, I think.  

04:14 

LD: I think it still has a following, and they keep releasing updates and things like that. So it probably isn’t as popular as it used to be, but I think it’s still fairly well-played. 

04:26 

DH: Right, now, people might be wondering, what does this movie have to do with MedHum, or medicine in the humanities? And actually, that was my initial take when I heard, you know, people talking about this movie during the MedHum, monthly meeting. But after I watched it, I was like, Okay, I kind of get this now because, you know, I went to medical school and did medical training, and I have this idea in my head that sure, there’s the humanities in medicine, like history of medicine, bioethics, science and society, these kind of topics, right? I didn’t think a movie about a video game or about a gamer would fit into this, but then I watched the movie, and I mean, of course, Mats is dying. He has a terminal illness. It’s a very sad story that way. But that’s definitely the medical angle in terms of how we access the story from a medical standpoint. But then this whole business about how the game can support his emotional well-being, and how the game can add to his mental health, and even so far as the movie continues, it actually doesn’t talk just about Mats. Some of these friends that he meets online enter the story in the second half of the movie, right? And we actually hear from them how much Mats helped them. They tell us about their own troubles, like, why were they on World of Warcraft? Why did they need Mats to help them through their personal life problems? And then you start to realize that the game is a therapeutic tool in a way, right? Which I never would have thought about before, right? I mean, honestly, most days when I think about games as a parent, I’m like, No more games. Turn off the computer to the kids all the time, right? So this presented this whole technology of gaming in a different light, and I thought it was really, really interesting, and made me really challenge my assumptions of what medical humanities is all about. It really broadened my understanding of it. So that’s what we’re here to talk about. 

06:36 

LD: It also puts a bit of a modern spin to it, because traditionally, you wouldn’t have thought video games, but with the prevalence of things like VR, it’s just a matter of time until more people will be sucked into these worlds. And with AI, who knows what’s going to happen with all that as well? So we’re probably just at the iceberg’s tip of all this coming through, and we probably need to watch more of these to be more prepared.  

07:05 

DH: Well I like it from the MedHum point of view, because it shows that we are at the cutting-edge of what is going on. Because there’s this idea that, you know, oh, you’re talking about medicine and the arts. It’s probably like some old book or that you’re going to read, right, some ancient text about something. But no, this is like cutting-edge modern stuff, and we’re here to break it down. Now, before we go any further, I think you and I should declare our bias. You know, people are always declaring their bias before these medical talks. Like, you know, I’m not an employee of this drug company, and so therefore I can give an unbiased opinion about such and such. We rarely will have the opportunity to do that. But regarding this movie, Luki, are you a gamer? Like, what is your stance on video games? 

07:48 

LD: I definitely was a gamer, for sure. I got into my career path, I took computer science as an undergrad because I wanted to code video games. I wanted to do that for a living, and so definitely growing up, it was a fixture of everyday life. Probably spent too many not restless nights on a console in front of a PC. 

08:19 

LH:Okay, so this is in your teens and 20s, I presume.  

08:23 

LD:Yeah. 

08:24 

DH: Okay, how about now? 

08:26 

LD: I’m a casual gamer, so right now I have some, I guess they’re called idle games, like little puzzle games that I probably spend too many hours than I should, right? They are a bit of a time suck, and then I’ll be like, Ah, I spent another hour or two on this stupid thing, and what did I gain from it? Not much. So I definitely have that, but not the hardcore console games. My kids have the Roblox, the Minecraft, the other things that they’re starting to get into. They try to get me to join their Brawl Stars club league or something, and I play with them a little bit, but that’s just more to help be that father figure to make sure they stay out of trouble. But okay, how about you, Dave, are you a gamer?  

09:15 

DH: I used to be a bit of a gamer, but it sounds like if we had to, if we had standings, you would be higher in the standings of gaming than I. I used to play games regularly, I remember growing up, I was fascinated by computers. I loved playing games, but I didn’t spend a ton of time on it, right? Like, yes, long afternoons after school lets out, weekends booting up the computer first thing in the morning, for sure, but I think by the time I got into adult life, you know, as a resident and then working as a physician, I’ve gradually drifted away from games. I know some of my buddies who still play a lot, but I’m definitely someone who has kind of left that. So actually, I’ve never played World of Warcraft. I don’t know, have you played that before?  

10:01 

LD: I have not. I know my younger brother did, and I would watch him play, try to understand his fascination with it. But I could see it, because at a point in time I probably would have jumped into that world. 

10:19 

DH: The World of Warcraft is the sequel to Warcraft II and Warcraft III, which are a couple outstanding classic games. 

10:27 

LD: Absolutely, but it was a little bit more expansive than I was used to, because in Warcraft you create farms and barracks and this giant world of stuff. 

10:41 

DH: Right, an entirely different type of thing, really. 

10:44 

LD: Exactly, so very much during that point in time I was immersed. I remember back in the day when we still had desktops, and laptops were like a luxury, we would bring our whole like tower units to people’s houses and have parties. So, we were of that ilk. But after getting into the adult working world, that kind of fell off a little bit and then kind of picked its way up on occasion when you find the right friends. Hey, we haven’t played blah blah blah in a while. So we play online and connect, but probably not as hardcore as Mr. Mats here. 

11:24 

DH: Definitely not as hardcore as this. Now, before we leave the disclaimer, you are a parent, you mentioned this that your kids do game a bit.  

11:32 

LD: Yeah.  

11:33 

DH: Are you okay with them gaming? Are you one of these reluctant to allow your kids to use technology parents? Where do you stand in that regard? 

11:41 

LD: I like to allow them to play, because kids should play. Now I don’t prefer them being on it, 24/7, that sort of thing, or even for the majority of the time, because I would love them to be outside and playing, doing something a little bit more physical, is definitely my stance, but at the same time, it’s part of the world, right? It’s not like they can avoid playing video games. It’s part of normal childhood nowadays. So do I want to take that away from them? No, but do I want them to be completely immersed and addicted to it? Absolutely not either. So it’s kind of that balance. But right, how about yours?  

12:27 

DH: Same, same. I mean, we’re reformed gamers from our youth, but conveniently we forget that when we talk to our children, we forget how into it we were, right?. The problem is the bells and whistles that come with games these days, it’s so enticing, not just for the kids, even dad wants to play, right? But I’m always the bearer of bad news, like I’m the bucket of cold water. Like these are bad for you. You don’t want to be addicted. You can play, but we’re gonna turn it off in 15 minutes. I’m always issuing these decrees, which, when I look back, are not things I would have wanted to follow as a kid at all. So I get the frustration that my children feel, but I also feel like games these days are a little bit different, like they really can take over your life, in a way. And I think this movie is going to talk about this, but from a different vantage point, because we’re so used to hearing about how bad games are for you and how bad your smartphone is, and how social media gives you anxiety, right? And leads to teen suicide and all these bad things about games. This movie, in its own little way, is telling us the opposite. So I think it’s worth talking about. 

13:36 

LD: I think it’s painting the entire game world with one broad brush, right? To say it’s all bad, but there are pockets which are very helpful for a lot of folks who have certain challenges. So in this particular case, Mats, who was confined to a wheelchair, right? Otherwise, most kids, you’d want them to go to the park and play. Well, that’s not an option for him, right? So he could go to the World of Warcraft and play with other folks there. So that’s kind of his outlet, where he can have his own life. And the movie showcases where he had this other life, right, that his parents didn’t even know. And I think one of the opening scenes was something with his dad talking about the eulogy at his funeral, where he says something to the effect where Mats, being confined to a wheelchair, will never having friends and falling in love and writing all these things. But as the second part of the movie goes through, then you actually recount that he went through all those emotions, but he did all that online, which was quite an interesting achievement. 

14:55 

DH: It’s interesting because if he wasn’t disabled, right, we might look at that and say, That’s kind of weird, right? Like, if you came and told me that, you know, your buddy doesn’t go out of his room, sits at home all day, and fell in love with someone online that he never met and had real feelings and real emotions for someone who he’s never met or seen – we would find this kind of odd, right? In this case, Mats, of course, he gets a pass because he’s ill. He cannot go outside, right? And, because of that, it changes our whole understanding of the things that have happened to him. It allows us to be a little bit more understanding, which I think is really important. One thing I’ll say is that, as a family physician, I have seen in my practice in the last few years, a handful of times patients, young people, usually male, but also a few female – there’s more than one of these in my practice, and I don’t have a huge practice, out of a couple thousand patients, this has happened like four or five times – where a child does not come out of their room. They hit teenagerness, and at some point as a teenager, they’re in their room all day, and the parents come to see me. They’re really frustrated, they think something’s really wrong with their child. Their child doesn’t come down to eat meals. Their child’s on the computer all the time, and when they try to turn off the computer, the child gets very upset, right? They’re smashing things, they’re threatening to kill themselves. The parents are at wit’s end, and this is a really new phenomenon. There’s no medical textbook that explains how to deal with this, because this is a really new thing. It’s happening just in the last couple, maybe just the last decade, or maybe in Asia it’s happening a little bit longer, right? And when parents see their child acting like this, they get scared, and this actually happens in the movie. As the movie progresses, one of Mats’ friends, a woman named Lisette, is part of the story, and she actually befriends Mats in the game. But at some point, she’s the one that he falls in love with. And at some point, she vanishes from the game, just completely disappears. And it turns out, in real life, her parents were fed up with her being on the computer all day, and made her log off and turned off the computer. Classic dictator parents style, right, without understanding why she needed to be there. And then they sent her off to school and she wasn’t allowed to log on, and it was a miserable year or two, I think, where this went on before she finally got allowed back into the game because Mats wrote her parents a letter. But I’ve seen this happen. I’ve seen this story from the angle of those parents. They come into my office at wits end, and no one knows what to do about it, right? The medical system says, Okay, maybe we’ll send them to a psychiatrist, right? Or sometimes, well, if he won’t come out of his room, can we send him to the emergency room for a psychiatric evaluation, right? I’ve seen emergency docs try to tell these kids you’re gonna go start going to school again, right? And then the kid agrees, and then maybe they go for a few days, but within a few weeks, the problem comes back again. So there’s something really insidious about the games, which I will admit this messes with me as a parent, because I see this and I’m like, okay, so these games are that addictive, right? So, son, we’re not gonna buy a Nintendo, sorry, right? But really that’s not fair. We’re drawing this generalization from these specific things that we’re seeing, but these specific things we’re seeing are so frightening, right? And this movie touches on all this and is asking us the question, are games all good or all bad, and if not, where should we stand on it? And why do people get into it? And why are people so addicted to it that they can’t stop playing? All of these questions get addressed to some degree, much more here than in any medical textbook or talk that I’ve ever attended. 

18:54 

LD: These are good questions and conversations to have with yourself, with your parents, your kids, depending on what life stage you are, because I think it’s one where it’s just gonna increase, right, with these games and virtual reality and whatever, there’s probably going to be more augmented reality, There’s another movie called Ready Player One, where he has an immersive set and basically everybody lives in two worlds, like the real world and this virtual one. And, well, I don’t know how long from now where that will be a regular thing, but it wasn’t too long ago when things like E Sports, weren’t around. But now, kids are making millions of dollars and a very good career playing video games.  

19:52 

DH: Now in the movie, Mats’ parents initially reluctantly allow him to become an avid gamer. They basically are like, okay, he’s got this terminal illness. There’s nothing else you can do, so we’re just gonna let him play games. It’s almost like saying this kid has suffered enough, we’ll just let him have some fun, right? And that’s totally cool, right? That makes complete sense as a parent, right? Like, what else are you gonna do as a parent? The funny thing, though, is the parents actually, by doing this, give Mats his whole life, right? They give him the key to humanity, finding emotional and human connection, without realizing. They think they’re just going to give him something to idle away the time, right? Time killer, pass some time, and it turns out to be a lot of time, right? But they’re like, honestly, what else is he gonna do, right? So that’s all that they think it is. And I think that, to me, my favorite part of the movie, is when they’re so startled when people start emailing them when they see that Mats has died, and they start to realize that their son, who had been sitting there on the computer and he could barely move by the end, so he’s just like fiddling with a mouse, staring at the screen. They probably just left him in the room for hours and hours, and didn’t interact with him too much. They probably never asked him what’s actually happening in the game. And in effect, he had this whole alter ego, right, that was like a fully formed adult person in the game that they knew nothing about. He was just sitting there in the room next to them, and they knew nothing about it. I just found that to be such a moving mental image that, to me, made the whole movie worth it, I was like, Luki, we gotta watch this. This is actually outstanding. 

21:36 

LD: I’m wondering how many of your patients might have a similar type of situation, where they might be living this whole new life, or a whole different life, absolutely, and their parents are kind of berating them and saying, like, what are you doing? You’re no good, blah, blah, blah. And meanwhile, they might be having all these amazing relationships and experiences online, and it’s just they’re doing it in a way that they can make sense of it, versus where, quote, unquote, we traditionally do so in the real world.  

22:11 

DH: In the movie, Mats actually gives us a potential answer for this, right? There is a character in the movie who also befriends Ibelin in the game. She’s a lady that has an autistic son. At some point in the game, she starts to share with Mats that she has a really difficult relationship with her son who can’t communicate with her and he is also playing World of Warcraft. So Mats suggests, why don’t you play the game with him? Right? And so they start playing the game together, and this becomes a bonding thing. They actually have a virtual hug and it changes the trajectory of her relationship with her son, right? So that whole thing was really eye opening, right? Because maybe it takes a person who plays the game and has lived the game and knows how therapeutic it is to understand. A patient comes into the medical office and they’re asking me, a reformed gamer, like I played video games 20 years ago. I’m like turn that thing off. Just like you, turn that thing off and get outside and exercise, right? Maybe we’re approaching this problem from the wrong angle. So I think there are some very neat messages that Mats teaches us in this movie. 

23:20 

LD: For sure, and it sounds like you have a new prescription to provide some of your patients as they come in.  

23:25 

DH: Next time, if your kid isn’t talking to you, make an avatar and get in the game and just see what they’re actually up to. A lot of times, I think that probably is true for parenting, right? We and our kids, we kind of veer off. We feel like we know what’s right for our kids without really knowing what’s going on with them. It doesn’t have to be this extreme, like in this game, but sometimes, maybe getting to understand what makes our kids tick is useful. But anyway, I’m just digressing into parenting world. 

23:52 

LD: Well, no, I think that’s an important part of the story. And it reminds me of some of the expressions that my kids talk about. So now they’ve got into the point where the younger one is recounting back in my day, because we say that as we’re talking and explaining why they should or shouldn’t do something, right? So it’s become a thing where he actually turns that type of voice, where he goes, back in my day, and whenever we recount something. So it is that perspective of a parent saying, Well, we know better than you, because when we were growing up, this is how it was. But it’s not how it was. So I think the movie points to having those conversations, taking those different perspectives, and that might be one of the solutions. Okay, play the game and get an understanding of what your kids are doing and well, whether you like it or not, whether you agree or not, but that should open your eyes and give you a slightly different perspective. So I think that’s, again, good messages from the story and to be honest, for me, when I was watching the movie at first, the moment where they post the message on his blog that he had passed away, and then you start getting all the blips for all the emails, and then another one. . 

25:19 

DH:.. and another one of them. I cried I had a bit of teary eyes during that whole part of it, and it was a very touching moment, because, it’s intense. Now I will say, I mean, I might as well just give a bit of a review of the movie. The second half of the movie, to me, was a hard watch, the movie gets, it gets pretty dark, right? He’s getting sick, and it’s not like an uplifting like Saturday night at the movie theater, it’s intense, and I guess we expected it, and there’s some really emotional stuff that happens. It’s not just that he’s getting sick, because we kind of know that’s going to happen, but we’ll talk a bit more about this later, but overall, I think the movie is really, really important, and really looks at this gaming thing from a whole different angle than what we’re used to seeing, but it is not a super easy movie to watch, just so people can brace themselves. Alright, let’s switch up a little bit, because you had written down that you wanted to talk a little bit about this whole concept of disability and terminal illness, so I’m curious what you wanted to talk about here. 

26:22 

LD: Well, for me, one of the bleaker parts of the story is having a child, having a family member that has a terminal illness. So I take a look at some folks, some families, some people, where their lives revolve around this person, right? They can’t travel, they can’t do this, they can’t do whatever, because they have to take care of, or when they do travel, it has to be in a slightly different way, right? So it’s just calling out how people with those types of challenges, they sacrifice a lot, and they’re like mini heroes, I guess, in being able to… 

27:10 

DH: Not mini heroes, mega heroes. 

27:14 

LD: Mega heroes, for being able to basically give up a “normal life” in order to care for someone, right? So that’s a little bit of that, because when growing up, we didn’t really have anybody with any terminal illnesses. But my grandfather, before he passed away, had Alzheimer’s and kidney failure, so we had to go through dialysis. So there were years where basically, our schedules revolved around him, right? Someone always had to be home to change his dialysis bag. Someone had to do whatever, and we couldn’t travel as much. So, and in full honesty, there was my part being a selfish kid, there’s a little bit of resentment. 

DH: You were gaming.  

28:04 

LD: Well, if I was gaming, I’d have to interrupt my game to, like, change my grandfather’s dialysis bag. So again, what an idiot, or what a selfish being I was.  

28:20 

DH: We all are, ultimately, right. 

28:22 

LD: But it’s one of those things where it’s just calling to mind where there are folks who are very privileged, and there are folks that make other sacrifices for the ones they loved, and it’s thinking about at some point, there’s probably going to be aging parents, that some of us are going to have to deal with some of that in life, and, yeah, who knows what sort of challenges. So it’s just putting another perspective, another piece of gratitude, I would say, for folks to just appreciate everybody’s healthy, and everybody’s able to do whatever you want, then, just count your lucky stars. So that’s what I wanted to talk a little bit about terminal illness or disabilities – have you encountered it in your life, or what sort of challenges has it brought forth?  

29:23 

DH: I have not really dealt with this in the form of a child so much. I mean, I’ve seen it with my patients. I know in the families there’s a child that’s really ill, and you see how much pressure it puts parents under. You know, my dad has been ill with dementia for more than a decade, so you kind of see that decline, which many people have seen. I mean, fortunately, Duchenne and muscular dystrophy isn’t that common, so this isn’t something a lot of people encounter. I think the movie does a really good job of showing us, showing everybody, you know, what this illness is like, what the family has to go through, what Mats’ life is like. I think it paints a really nice picture of that, because we need to see that as people. We forget about this stuff too easily, right? Like when we talk about healthcare policy or parenting, or even the role of video games in the world, right? We are always thinking about it from the standpoint of robust, young, healthy kids and their overstressed parents or something, right? But actually, there are people who have to deal with much, much more complicated variations of life, and I think this movie does a really good job of that. And in that sense, I do think it’s actually a movie that people should watch. And, you know, even our children, as they get a little bit older, they should probably see it, and it gives a bit of sense of balance, you know. The things that you’re complaining about, they’re not real issues, right? When you see what Mats has to go through. So on this level, kudos to the movie for showing us this.  

30:53 

LD: I like towards the end that, I think they had a section where he was doing some public service announcements on the use of some of the mobility tools or access tools for someone with handicaps or disabilities and things like that, so the little devices that he can click and access and but that’s another amazing part, where if you have limited mobility, he was still able to navigate an entire world, but he couldn’t really stretch and push or type or all that stuff. And I guess one of the points in the movie is that they didn’t, or he’d never want to join their group calls or group meetings or something, because my guess is that he probably couldn’t have. Couldn’t speak as well.  

DH: If he had to do a group call, and it’s like a video chat, people would see that he looked strange to them, right? He could have turned off his camera, he was being self-conscious about that too, which all makes sense. I don’t think I thought about the gratitude part of this movie until you talked about it just now. But it does really hit me, because I’ve been thinking about it so much from the academic viewpoint, right? Like, what is the video game angle, and the humanities angle, but I think this very basic angle is actually probably the best way to view the movie, because it really gets to the underlying humanity of it, that most of us should actually appreciate where we are and stop worrying about stuff.  

Score one for the non-clinician, yeah. 

32:37 

LD: I have started on this trek to always see if I can pull it back to gratitude, right? Because, to be honest, wherever you are, if you’re able to listen to this podcast, you’re in a good spot, right? Think about that. So I’ve been saying this to a bunch of folks, is that your worst day is someone else’s dream. 

The fact that you have access to a podcast player means you probably have access to some sort of smartphone device, right, and data and stuff, that you’re probably in the first world, right?. And yes, you may have challenges or money problems or whatever, but at least you don’t have Duchenne’s. And for those of you who do, and you’re listening, props to you, but the fact that you’re able to listen here right, and do whatever it is that you can do, there’s so much to be grateful for. 

33:50 

DH: Absolutely. Now, one thing I wanted to talk a little bit about is this whole business of what’s the purpose of life? This movie does get to this in the later part, right? Mats himself says something like, I need to know. I’m just gonna paraphrase, it’s not a direct quote, but he basically says something like, I need to know that I affected other people’s lives so that my life will have meaning. Otherwise, the whole point of it would have been for not, right? And this, to me, is a really interesting take, because this is a kid. I mean, he’s young. I’m gonna call him a kid, but he’s like, 20 something, but he’s a young guy with a terminal illness. He, more than anyone else in the world, probably could just say, screw it, and be selfish and be like, You know what? They gave me a bad hand, I’m miserable, like, I’ll just enjoy my life and whatever. But he actually says, I want to make a difference to people, and he does make a difference. He goes out of his way in the game to get to know people, befriend them, befriend them in a real, in a meaningful way, and does affect their lives. He brings people closer to their families and brings them closer to emotional healing many times, it’s recounted throughout this movie. I found it fascinating that he had such a strong will to do this. And sometimes the rest of us, getting to your point, we forget about gratitude, right? We’re miserable, even though we have the ability to do all this stuff to help people and be part of the community and care. We’re too busy being annoyed about the state of the government or taxes and whatnot, right? So I thought this was a really interesting thing, that he had this ambition to help people. That’s one part. The second thing that I thought was really interesting was that, as the movie goes on, and this is where I think it becomes a bit of a tough watch, because, it’s not just that he’s getting physically ill. The fact that he’s hiding the truth of his actual condition from all the other players in the game starts to take a toll, right? Like, at some point he starts to, he starts to have difficulty, I think it’s with one of his fingers. He can’t push the buttons fast enough. And part of World of Warcraft, you actually have to participate in fights against villains and monsters. He can’t fight in those things where he gets defeated easily, right? And people don’t really understand why, and he can’t explain it. He starts to get testy with the people around him. He sees that his girlfriend in the game is talking to another guy and gets jealous and starts to try to pit people against other people, right? He becomes a little bit of a nasty individual for a while, until the other players in the game decide that we need to have an intervention. Mats, what is going on with you? This stuff was really strange to watch because it was reenacted in the form of the game with the video game character graphics, but all at the same time, it was so real, like, this is actual real life. This happens to people, right? And he’s exhibiting all the classical signs of someone who’s just very angry and emotionally unconnected. And then where he finds healing at the end is when he finally confronts, is confronted by someone, and tells them the truth, and people start to understand that, oh, that’s why he’s being this way. And they start to understand. And I was just like, this is so heavy. This is so heavy and what he needed all along was actual emotional connection, right? And somehow he maybe couldn’t articulate it, but he needed that, even though this is a kid who has a loving family, he’s got a terminal illness, he has no way to articulate, but what he really needs is to be connected to the people around him and to find meaning in his life and to be helping others. I found that the fact that that underlying humanity could come through despite the Duchenne and the fact that he was almost like really end-stage at this point to be really moving.  

37:54 

LD And I guess going back to your original question about the purpose of life, perhaps he found it.  

And for me, it’s to help others, and it’s the impact. On my side, the people I connect with are always on the career coaching piece, and people are looking for titles and money and moving up. But ultimately, when you get down to it, it’s how am I contributing to others? And what Mats said is like, how am I changing the world? How do I matter? But it’s not about changing the world. It’s about changing your world, right? So impacting the people around you, whether it’s your family, whether it’s the World of Warcraft and people online. I think they had his guild that he joined, and people were helped, and all those messages that he got were because, oh, Mats helped me through a trying time in my life, and he listened, and he paid attention. So sometimes just a sympathetic ear is all it takes to help and being there. It doesn’t necessarily take money or power or fame, but it’s that contribution, it’s that helping out and being there and present. Seems like he found his purpose. Now that doesn’t mean everybody should go online and start becoming a therapist for everybody there, but figuring out what is that purpose for, for you is always a very interesting journey that you’ll have to be on. But yeah, it seems like even someone with Duchenne’s who shouldn’t be able to or has everything stacked against them, still has that ability, then I guess there’s hope for the rest of us.  

39:48 

DH: I would hope so, I would hope so. Now, anything else you want to add about the movie? 

39:56 

LD: No, I think we covered a lot of it. To me, it’s taking away that broad brush to say that all video games are bad. Oftentimes, you don’t understand it as well, because it’s one of those areas where I think people find escape, people find peace, people find connection and relationships in different ways, For most people, it’s real life, meeting people at events, at parties, at school get-togethers but more and more, it’s meeting people online. And that’s more and more the norm. But again, what is the world becoming, right? Over the Christmas holidays, we actually got a VR headset. And there is this world out there. Now, right now, it’s not really that clear, but I could see it eventually. You could actually immerse yourself in this. And maybe something similar to what Ibelin, what Mats had gone through. There’s going to be more and more people lost in that world, where I can picture professional networking events, where you just attend and you have this avatar, and you’re walking to a conference that’s happening, I don’t know, halfway across the world, right? And you meet and “build” relationships there, as if you were there, but you’re online, right? So it’s going to be a different world. And the interesting part, I think you touched on it, is where the medical establishment doesn’t know how to deal with it. 

41:48 

DH: Well not just medical, l the education establishment doesn’t know how to handle it. Parents don’t know how to handle it. Nobody knows how to handle this stuff. It’s too new. 

41:56 

LD: I think you had it right, where, at the end of the day, it’s all about connection. I think that’s the key, whether it’s in real life, whether it’s online, whether it’s wherever, once you find that connection, once you find your tribe, oftentimes that’s where you will spend the most of your time. So I actually had a conversation about Maslow’s hierarchy of needs, where you have, the physiological needs and then safety, and then relationships is somewhere in the middle. Well, maybe he got it wrong, where relationships need to be the foundation. Because if you think about it, for babies, like, what can they do? So it’s the relationships and the parents, and it’s everyone around them that takes care of them. And if you think about it, so Mats’ family, or anybody else who has a strong set of folks that take care of them, they will always be taken care of, right? They will take care of their physiological needs, right? Whereas someone who has all their physiological needs, all the money, all the food, everything set without relationships, it’s a mess. It’s a mess, right? So maybe if we focus on our relationships, and actually, I’ve been talking to more folks where people are focusing on their physical health. Great. You go to the gym, workout three days a week, 60 minutes, all that sort of stuff. Awesome. Now more folks are taking care of their mental health, where I’m meditating 5, 10 minutes every day, right? Cool, awesome. But how many of us actually focus on our social health, right? Do we allocate 30 minutes a week, an hour a week, to reconnect with friends, family, whomever is closest to us, just to say hi? And I’m guilty of that myself, right? Where I kind of wish that I had a better relationship with my siblings, right? So we have, like, a weekly Zoom chat with my family. But all we talk about is superficial stuff. How’s the week? Oh, yeah, we had this, this happen, blah, blah, blah, blah, blah. But what about, like, the more deeper conversations with the ones closest to you, your good friends and stuff like, how much time do we allocate for that? And if that’s as good, or should be as good as our mental or physical health, then I think you hit the nail on the head with that whole connection piece, as you were talking about that. I think that’s the most important part, which I think the movie is highlighting in spades.  

44:42 

DH: Oh, you said it so well, I’m not going to add anything to that point. The last thing that I will add is that this movie did teach me a lot about medical humanities. I never really appreciated the role of technology in medical humanities, right? I guess maybe because I always thought about the history of medicine and I know that medicine is always advancing forward, and that there’s new research and new medical treatments, like we talked about the new treatments for cancer last month. But the world is always changing, and because the world is changing and throwing these new technologies at us, it creates new scenarios. So there’s all this new cutting-edge stuff happening in medical humanities. This stuff is actually very, very fresh, right? And I thought that was eye opening to me, because I had this idea when we started the podcast, you and I would read some old books, and that would be it. But this is actually much more cool than that. We’re talking about tech and tech is a fundamental part of it. It was in the cancer book too, right? The cancer book was all about how the world keeps pushing forward. We’re finding new ways to combat new illnesses that are developing. Here, you know, there’s going to be good and bad for video games, right? It’s going to create some problems. It’s going to solve some other problems. It’s all very convoluted and complex, and it’s good that we’re able to have a conversation to get some of these ideas out there. 

46:09 

LD: I’d echo all that sentiment, and I guess we’re in early days, because this is medical humanities, but as humans, we’re evolving, and technology is helping us to evolve. So if we were to record another podcast like this in a year, in five and 10 years, who knows what the next advancement will be, and yeah, we might have been like, ah, remember back in 2025 when we’re talking about blah blah blah, back in my day, and blah, blah, blah, those types of things. 

46:44 

DH: Absolutely. But overall, I’ve really enjoyed the movie. It is hard. It’s not an easy movie to watch, but it gives you a lot to think about. I think people should try to check it out. There aren’t a lot of movies that jump out at me as being medical humanities things that has this much to say, and I think this is one of them. One thumb up from me. 

47:08 

LD: I’d agree. Well, it’s not a no-brainer popcorn flick on the weekend, so it takes a little bit more of effort and brainpower and just making sure that you’re there and if you have a box of tissues for key moments, that might be helpful too. I agree. I’d give it another thumbs up.  

47:26 

DH: We’re all evolved men. There’s nothing wrong with crying once in a while, it’s all part of the emotional connection thing. So that’s our discussion about Ibelin. Check out the movie. We highly recommend it. There’s a lot to think about. If you have any thoughts, comments about the movie, if you’ve seen it, or just questions for us, hit us up on the MedHum website. There’s a link where you can comment, we’ll try to reply. Otherwise, see you in a month. 

48:18 

Apollo On Call is produced by MedHum.org. Special thanks to my co-host, Mr. Luki Danukarjanto. To hear some more of Luki and I discussing books, please check out the W5H Book Club Podcast available on Spotify and Apple or wherever you get your podcasts. Today’s theme song is Un Sospiro performed by my wife, Dr. Justina Sam. For more medical humanities content, please check out MedHum.org. 

Thanks for listening. 

The Remarkable Life of Ibelin Trailer

Images of Mats Sheen and Ibelin from Mats’ Facebook page and Medieoperatørene / Euforia

]]> https://medhum.org/review/film-review/dave_hsu/the-remarkable-life-of-ibelin/feed/ 0 The Emperor of All Maladies by Siddhartha Mukherjee https://medhum.org/review/book-review/dave_hsu/the-emperor-of-all-maladies-by-siddhartha-mukherjee/ https://medhum.org/review/book-review/dave_hsu/the-emperor-of-all-maladies-by-siddhartha-mukherjee/#respond Fri, 14 Mar 2025 19:20:36 +0000 https://medhum.org/?p=9622 From Apollo on Call–a Medhum Podcast

For more than a decade, I kept running into the Emperor of All Maladies at various bookstores, book shops, and libraries. Siddhartha Mukherjee’s Pulitzer Prize winning biography of cancer would glare at me from its position on the bookshelf, daring me to read it, but each time I saw it, I would mull over the idea of reading a 450 page history of medicine book, shake my head, and move on to something lighter and less strenuous. Mostly, tired from my day job as a family doctor, I just wanted to read something less medical.

Last fall, it happened yet again. I ran into the Emperor of all Maladies once more, this time at my local library’s annual used book sale. For the princely sum of $1, I picked up the book, flipped through it, and thought, why not?

What I discovered was a book that was all that I had expected it to be, and more. Yes, it’s a long, exhaustive read. Yes, it contains long sections of exposition, explaining the details of how protein kinases and mRNA work on a molecular level. But it’s also eye opening and moving and manages to make the connection between what happened in hospitals and clinics a hundred years ago with the state of not just modern oncology, but modern medicine as a whole.

Last fall, I joined MedHum and before long, we realized MedHum needed a podcast. But what would we talk about? And that’s when I realized that Mukherjee’s book, with its vast scope, and comprehensiveness would be the perfect starting point for the show.

Then I thought, I needed to convince someone to read this book with me. And who better than my literary podcast buddy, Mr. Luki Danukarjanto. Luki is a career coach, writer and the founder of Focus Inspired, a service dedicated to helping people achieve meaningful career change. He also lives in Toronto.We’ve been talking about books on the W5H Book Club podcast together for the last several years. Why not read about medical humanities?

The result is two dudes who love to read talking about a great book.

Welcome to the premiere episode of Apollo On Call. Enjoy.

Dr. David Hsu

TRANSCRIPT FROM THIS EPISODE

‘In writing this book, I started off by imagining my project as a history of cancer, but it felt inescapably as if I were writing not about something, but about someone. My subject daily morphed into something that resembled an individual, an enigmatic, if somewhat deranged image in a mirror. This was not so much a medical history of an illness, but something more personal, more visceral: its biography.’

That was an excerpt from The Emperor of All Maladies, A Biography of Cancer by Siddhartha Mukherjee.

(MUSIC)

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

Alright, welcome everyone to the first episode of Apollo On Call. I’m Dr. David Hsu,(DH) a family doctor and your host for this episode, and I’m joined by my buddy, Mr. Luki Danukarjanto, (LD) my reading book buddy, and he’s going to be giving us the non-doctor viewpoint of all the things we talk about on MedHum.

LD: Thanks for having me, Dr. Hsu, and a pleasure to be on this podcast.

DH: As always, as always. People who don’t know us, we’ve been doing other podcasts where we talk about books on a regular basis. So this is kind of our wheelhouse, but we’re shifting gears and talking about medicine and the humanities for the sake of MedHum, and if people don’t know, MedHum.org, our organization, our mission, is to explore the human condition as expressed through medicine, literature, and the arts, which is why we’re calling this podcast Apollo On Call. Because most of you probably know that Apollo is the Greek God of the Sun, but you may not realize he’s also one of the gods of medicine, the arts, and healing. So it fits right into what we’re trying to talk about here today.

LD: Sounds like he’s the subject of the humanities part of it, for sure, and given the medical parts, he’s the patron god of MedHum.

DH: I guess so. We haven’t declared that officially, but I think that is actually what’s going to happen. Now, the quote that you guys heard me read was a quote from The Emperor of All Maladies, by Siddhartha Mukherjee. This is a book that was written about a decade ago, and it’s, as he calls it, the biography of cancer. And I thought this would be a good book for us to pick as we go on our MedHum journey, because this book really encompasses a lot of information about the history of cancer and the history of medicine through that, and so maybe Luki can give us a breakdown of what this book is about. You’ve got two minutes to summarize 478 pages.

LD: Well, let’s start a little bit with the author. So, Siddhartha Mukherjee. He’s a doctor, he’s kind of every Asian parents’ dream. He’s done so much. He’s a trained hematologist and has discovered a whole bunch of different things. He was actually named one of Time’s 100 Most Influential People, and he’s the author of plenty of books. This one is probably the most famous one that he’s responsible for, and a bunch of other ones where he’s had some notable entries. But in terms of the story, it’s basically a biography of cancer, as the subtitle says. So it’s a journey into how cancer, I guess, was put into the normal zeitgeist, and people are aware of it, even all the way from the Egyptians to the Greeks, and as we evolved in our medical training and understanding, how that moved from the black bile in someone, all the way to this evolution in terms of different radiation therapies, chemotherapy, and understanding of how cancer evolved and the treatments as a result of it. So, it’s also view into the medical establishment and how medicine has evolved, how pharmaceuticals have evolved, and how our care of patients has evolved too well, not ‘our’ because I don’t care for patients, but Dave and his crew and how they take care of it. So it’s an interesting view of cancer and an interesting view of how people might see cancer being discovered over the ages.

DH: You mentioned that it traces it all the way back to ancient times, right? So there are reports of people discovering a mass growing on their chest, sticking out of the skin, but not really understanding exactly what’s causing it. But the book does make the point that cancer is a very modern thing, right? That there are mentions of it in these historical documents, but to be sure that what they’re talking about is cancer, we’re only going back a few hundred years. So it was only in the last few hundred years that we start to really categorize these things, and we’re sure that, oh, that mass that was growing is actually a tumor, and not say an abscess or an infection. Not to say that it didn’t exist before that time, but at least that’s now when we recognize it. But then it goes on to talk about the modern history of how modern medicine evolves over the last hundred, hundred and fifty years, and that’s where a lot of interesting things happen, because you start to realize that, oh, cancer is a modern illness. It’s not something that’s exactly a prehistoric illness. It isn’t something we read about in the Bible, right, or in ancient Rome much. It’s something that’s very, you know, 18th century, 19th century, 20th century, especially, right? And it coincides with the rise of certain factors that are also part of modern life, like cigarettes. And so this book goes through this whole biography, beginning to end. Well, maybe not end. There’s no obvious end in sight for cancer. So it’s an unusual biography in that sense. But that’s the basic lay of the book.

Is it because we’re detecting it more and able to do so that we have more instances of it, or did it always exist? But it seems to be that with certain environmental, certain lifestyle and chemical changes, that there is an epidemic of cancer that’s growing, and it’s kind of those leading causes of death that people seem to not know why, but there’s so many signs pointing to potential causes, and the book outlines some of them, and also some of the factors why it’s the case, and sometimes even what we can do about it to some extent, and also how our understanding is actually evolving over time as well, because it’s quite interesting to see how we used to think cancer was this type of thing, and now it’s something totally different.

Alright, so what do you want to talk about first? Do you want to talk about the patient’s viewpoint of cancer, or the doctor’s viewpoint? Who wants to step up to the plate first? You or me?

LD: I’ll take a second round and just let you take the lead of it. So, and to be truthful, I’m not a patient of it, so I don’t have any firsthand knowledge of cancer, but I am taking the viewpoint of the layperson, so the non-medical practitioner here, just kind of adding my two cents for some color commentaries.

DH: Which is actually a very valid viewpoint, right? We didn’t actually pick Luki out of nowhere for no reason, right, because, in fact, in medicine, every patient-doctor interaction, the patient is exactly 50% of that interaction, right? And most doctors have more than one patient. So actually, patients make up the vast majority of medicine stories. And I feel like sometimes medicine gets written by doctors, which is something that we need to reverse a little bit here.

LD: And just in case people who are listening that know me, know I’m not aware that I have cancer. So when you say patient, it’s from that viewpoint of non-medical professional in there, but you’re absolutely right where I think part of the whole mission of MedHum is to humanize medicine where it is that patient experience that is really lacking. And actually, that’s one really interesting part of the book that I noticed was the whole concept of palliative care, which I thought was just a normal part of medicine, but apparently it’s relatively recent. But we can go through some of our other discoveries as we chat a little bit more.

DH: Alright, so what do you want to know? You wanted me to step up first, so you want to hear the middle-aged doctor’s viewpoint about cancer in this book?

LD: Well, as a medically trained professional, what of this did you know and were aware of, and it was kind of like the normal teachings of a medical professional versus like, that’s news to me too, I had no idea and you’re listening to it for the first time, along with me. So that’s what I was a little bit curious about because doctors are very learned professionals. They know a lot, but at the same time they often don’t know what they don’t know too, right? It’s one of those things that the medical establishment is so vast that there’s so much that nobody knows, or nobody can know about many different areas. So unless you’re really trained in a particular area, what of it do you know? What didn’t you know? So I’m curious, Dr. Hsu.

DH: Okay, so the book is written in the general form. I mean, I know it calls itself a biography, but it is really a history book, right? It’s the history of medicine, talking about our understanding of cancer over a few hundred years. I have to say that I didn’t know that much about it. I’m practicing medicine these days, my patients come to see me. Some of them, you know, we find out on a mammogram that they have breast cancer, or we find on a colonoscopy they have colon cancer. A few times, I’ve noticed someone has, like, a lump growing on their neck, and it turns out to be cancer. So, this is something that I’m interacting with on a fairly regular basis. But just like you, I’ve kind of taken for granted that certain structures exist, and in my head, I’ve sometimes realized they didn’t always exist, but I think of them as if they always existed, right? I think that, oh, everyone probably did mammograms. I mean, obviously we know that’s not true, and at some point a program for screening mammograms must have started. So when did that start? How did it get implemented? These are things that we never really get taught in medicine. And to actually peel back the cover for a lot of these things that I do on a regular basis and see that, oh, so these were the dudes who thought of the idea that everyone should get a mammogram, and then how they were racing around trying to enroll as many women as they could to do it. And it wasn’t really that long ago. Like, I think that particular example was from the 60s, right? Whereas, I’m in my mid 40s now, to me, I feel like, oh, mammogram screening must have been around forever, but really not that old of a thing. All these things are very, very new and I didn’t know a ton about it. Some of it I knew a little bit about. To be honest, when we’re going through medical school, there’s just so much information that’s thrown at you that we only have a few lectures here and there to talk about the history of medicine, a few lectures to talk about ethics. There isn’t time to discuss it. And a lot of times in medicine, we have this idea that the science takes precedence. So we need to understand how the science works today. You know, if you have extra time, yeah, sure, go read about the past. But that’s not as important, right? This book is trying to give us a fuller picture of it, which I really appreciate, because I learned a lot. So a lot of the history of how things came to be was fascinating, and a lot of things about how everything ties together. This book isn’t just about cancer, right? As I read it, I realized this is about the history of all of medicine, right? That without radiology, right, without this ability to take a picture of an x-ray of your bones, we wouldn’t be able to take a picture of a patient’s tumor, right? And without the knowledge that we developed to have surgery, to be able to cut someone open reliably and not kill them, then there’s no treatment for cancer. And all of these things are intertwined. And it keeps going, like these advances even into the 80s, right? Like AIDS gets discovered, and they sort of start to figure out that, oh, it’s caused by a virus, and then that understanding of how the virus works affects the understanding of how people are researching different types of cancer. Everything is tied together in this giant web. It is fascinating to see how it evolves, and it’s crazy to realize how new all of this is. So there’s this element of technology that gets thrown into modern medicine, which is probably different than like, you know, if you and I were sitting there having a podcast 500 years ago, right, or we’re telling oral story traditions about the history of medicine up to that point, there wouldn’t be that element This thing turns into a race, right? And things are happening really quickly and within a person’s lifetime, you know, paradigms are getting shifted and thrown on their heads repeatedly.

LD: I’d be curious to hear about what happened since the publishing of this book, because if you trace back all of the advancements that happened, well, did they come up with a cure for cancer, like yesterday or something, who knows? Or are they really close to it, on the verge of it, any day now?
.
DH: The other thing I will say is that, as a medical student, we have some time to talk about basic sciences, so there’s some understanding of how genes work. So, as Mukherjee starts talking about, you know, proto-oncogenes and, you know, reverse transcriptase, little bells are going off in my head. I don’t know where, like, I’m looking around trying to figure out, okay, I think I knew a little bit about that, or this gene, but a lot of that stuff also, like when we’re in medical school, we’re just trying, we’re scrambling to just understand the basics, right, to be able to interview a patient, figure out basically why the patient’s here, where they need to go, and sometimes the nuts-and-bolts science of it gets lost, right? We’re in over our heads. We don’t have time to master that. So this book actually, not only is it trying to present the details of the history and the past and the humanities aspect, it’s also presenting a very detailed description of science, right, of the new scientific innovations that are happening and trying to present that to the layperson, which is a really impressive, ambitious thing that it’s trying to do. Difficult to read at times, I have to admit, but very ambitious.

LD: For sure, yeah, I would echo that sentiment, where sometimes it’s like, what is this and what is this acronym, or our concept of this and that? But at some point it’s like, okay, I’ll just kind of get through this point. But I’d love if you could comment a little bit where the way that I start the discussion is thinking about how doctors are even engaged in the first place, right? So they’re always these learned folks put on a pedestal, like they know so much, they can help save me, heal me, prolong my life, that sort of thing. And then you have a cancer diagnosis, and they start cutting off all sorts of pieces or giving you these experimental drugs, and you’re just like, okay, the doctor is doing it to the best of their ability, to the best their knowledge, and all of it is going to heal me, and I, through my full being, trust this person, right? So trying to think about doctors in the concept of the whole, world establishment, societal establishment, where they’re all at the top of the knowledge pyramid, and the openness for everybody to take in some of these procedures and just say, okay, my doctor said I’ll do it, so I’ll do it. Wondering if you have any thoughts around that, you being that person who can prescribe and thou shalt whatever.

DH: I’m glad that you think of me as being at the pinnacle of human knowledge. But no,

LD: Always, Dave, always.

DH: I think in this book, a lot of what’s happening in the background is it speaks to the desperation of everything that’s happening. Because, this isn’t a book about, you know, hip fractures. This is a book about death, right? And cancer is something that historically, even now, it’s a very scary word, right? And I don’t think that’s changed Even though I’ve read about all these protein kinases and all these inhibitors and all this progress, none of us wants to hear that word when we go to see the doctor, right? And that didn’t change at all. And I feel like the doctors in this book, who are fighting against cancer, they’re fighting against death all the time, and so they’re willing to do craziness to achieve it. And I think that point gets underscored many times in this narrative. The most interesting I found was in the earliest days, I’m talking turn of the 20th century, you know, early 1900s, very primitive surgical techniques exist. The concept that we can remove a tumor that might buy the person a little bit more time, so maybe we should remove the area around the tumor. So for breast cancer, we’ll remove the entire chest wall. Well, maybe we’ll get into the neck, we’ll just start removing organs in the neck, like these massive surgeries, because people are just desperate. They want to live a little bit longer. They already see that the writing’s on the wall that if you get one of these diagnoses, you’re finished. So the doctors are trying everything. And, as time passes, it gets a little bit more rigorous. It gets a lot more rigorous, and where we become a lot more careful, but the basic premise is still the same. We’re up against death. And I feel like that’s why people are willing to, for the most part, try what the doctors are selling, right? And sometimes it works, and a lot of times it doesn’t. And in the later part of the book, actually, he does this throughout the book, he sprinkles a bit of his own patient narratives into the book, right, of patients that he saw when he was a fellow in oncology. And so we kind of see how some modern-day patients handle this. And it’s sort of the same, you know, people are out there trying everything. They’re on blogs, they’re on message boards, they’re probably on Reddit trying to figure out what the newest options are for their diagnosis. When the metastatic cancer comes back, they’re trying to figure out what to do. It’s the weapons and the tools are a little bit different, but the idea is the same. They’re up against death.

LD: Yeah, and I think they mentioned it in some of the later stories, where there were these groups of patients that were sometimes gathering together and telling their doctors, hey, can you get me on this one because they heard it from another patient somewhere else, right? And it becomes that information exchange at a different level, because historically, it was the doctors, the medical establishment, that knew all this stuff. But now, with the internet and forums and stuff, everybody’s got information and everybody’s got an opinion. So, right, it’s interesting.

DH: I feel like you were asking me, how much of it did I know, much of I don’t know. I came away from this book feeling like we do know a lot about cancer in some ways, but in some other ways, we still don’t know that much at all. I felt like, if we really understood it well, we wouldn’t be so scared of it, but it is still a pretty daunting thing, right? For only a few specific types of cancer, there are some treatments that work really well, and sometimes there are treatments that work well, that prolong mortality for a few years. And with that itself, we call that working really, really well, right? So we’re making some small progress, but there’s still so much we don’t know. That seems to be my takeaway point from this book.

LD: For sure, it’s like a lot of things with the human body or the human condition that we’re only kind of scratching the surface, but I think we’re making good progress, and hopefully we’ll be able to save a lot more people as a result. But if I were to take a stab at saying like, well, how do I understand cancer based on this, if I can make some presumptions. I mean, I have very little experience, right? I might have some friends whose relatives may have had a cancer diagnosis, but I don’t have anybody close to me that has gone through it. So this is coming from almost like a fresh set of eyes, learning about cancer, its history, and all that sort of thing..

DH: Okay, from that vantage point, fresh set of eyes, before you read the book, if you heard the word cancer, what would you presume? What was your understanding of it going into the book?

LD: Well, I was always interested in, like peak performance, and part of it is medicine, right? So I have listened to podcasts and watched some YouTube videos on cancer, just because it’s one of those pervasive diseases that you should probably know about, more on the prevention side, versus what to do when you have it. And we hear the word like, carcinogens, right? We recently figured out what these things are and, well, that makes sense, because they didn’t always, or we didn’t know they existed, right? Someone had to have figured it out. So thinking about what those are, and you mentioning that this is a very like modern-day disease, where a lot of it is, call it the conveniences, like the coal, the energy, all these chemicals that are in our homes to make it more comfortable to live in. A lot of that becomes the cause of cancer. And I mean the way that I understood it, it’s just
cells that don’t want to die, and they pervasively grow much more than others. Now what causes that is probably those carcinogens. This is one case, and then there’s a bit of genetics thrown into it, and the combination of those two, and probably some other factors that we don’t yet know about is what causes it, but those types of things where, to be honest, I didn’t know too much about it, and I’m kind of learning a little bit more. I can’t say I know a lot about it now, but I am a little bit more familiar with it, at least to talk to my fellow lay person.

DH: So coming from that angle, which I think is what most people’s view on cancer is, like a lot of us don’t even realize that cancer isn’t one disease, it’s sort of a term that encompasses anything with unregulated cell growth, right, and so coming from that angle, what are the things from this book that you would take away that were meaningful to you?

LD: I liked one of the sections where it said prevention is the cure.

DH: I knew you would like that, actually,

LD: That’s one of those things where, when you have cancer, it’s, I don’t call it’s too late, but the way that I’ve understood is like our bodies have abnormal growth all the time, but our natural immune systems are able to get rid of it, and it’s this some sort of trigger, some sort of threshold that’s crossed that makes it overwhelming to the body, so that it can’t take over these. Now again, whether it’s genetics and or some environmental factors or lifestyle or whatever it is, that’s still not 100% known, because for people that live in a certain environment with certain genetics, the person right beside them, like their identical twin or whatever, might not ever develop it. So we still don’t know so much about it, but the fact that you can kind of live a good lifestyle and still get cancer and live a bad lifestyle, I think they had people who like smoked till whatever, and they were fine, versus people who get second hand smoke who aren’t so fortunate. Those are kind of the interesting parts of it, and just the genetic progression of it, where you can have, I guess, multiple different contributing factors that will lead to it?. So I don’t know, there’s so many more questions, I guess, as a result of this. But I think one of my curiosities was, to your point, this is really a story of like, death, where they’re given this prognosis, you have cancer, so you need to, and are willing to do pretty much anything and everything in order to avert that prognosis, because you might have months, you might be lucky to have years there, but you’re basically gonna die, right? So how are you gonna arrange your affairs? How are you going to live it to the best of your ability? So things like the concept of radical surgery, where you cut off everything, and cancer might not be here there, but let’s cut it off anyway, just in case. So it’s kind of like, yes, you want to live, but like, at what cost, and people looking like they’re skeletons as they’re going through chemotherapy and all that stuff. And again, at what cost? That’s the interesting thing. But again, this comes from someone who has not gone through it and if I was faced with death, maybe I’ll be like, yeah, bring on any new, novel thing, just test me. Guinea pig, patient number zero, go ahead, because what else do I have to lose?

DH: Desperate times call for desperate measures, that is one of the themes of this story.

LD: Yeah, for sure.

DH: Okay, one question I have for you is, you weren’t really a biology science guy from what I remember.

LD: No.

DH: So what about reading this book? It’s almost 500 pages, and there’s probably a good 250 pages that’s dedicated to, like a hardcore scientific explanation of this stuff. I have to admit that this isn’t my cup of tea. This is the stuff I would have tuned out when I was a student. I tried my best here to plow through this. What did you think of it?

LD: It could have probably been about 200 pages shorter. But a lot of that is somewhat interesting, where, minus some of the super specifics of, like the different chemicals, and genome components and stuff like that, the fundamental components of cell replication, the fact that chromosome breakage probably leads to the activation of certain tumors, and out of control growth and things like that, right? I don’t know that they really talked about it, but the study of epigenetics, I’m familiar with that, where it leads to all the outside conditions, is really what influences your genes, right? Because your genes are your genes, but that doesn’t mean they’re your destiny. It’s one of those things where, with certain lifestyle changes, you can potentially avert cancer, but sometimes it’s just written in the stars, that sort of thing, right?

DH: What I thought was interesting was that he was able, in the narrative, to weave the science with the history of how the science evolved. There’s this whole component of how this research happens, there’s all these scientists in labs around the world, but a lot of is American. So actually, this was one thing I was going to say, is that this is a biography of an American disease, almost, because most of the research is happening in America, and the viewpoint, the perspective of everything seems to be fairly American centric. But I really enjoyed how he was able to tie our understanding of the science with some of these bigger picture, social things that were happening at the same time, right? And for example, cancer research doesn’t happen without fundraising, and that wasn’t the thing, if you go back 200 years ago, people weren’t stumping on hotlines to raise money for your local hospital. We kind of take it for granted that this is a thing now, but this is a thing now because of cancer, right? So this is a part of the story of cancer is that it spun off these industries on the side, so fundraising becomes a thing, or this whole business of pharmaceutical companies now are trying to figure out, well, what should we spend our money on? We can spend research on this disease or that disease. How do we pick the one that we’re going to spend on? Obviously, it’s the one that’s going to make them more money, right? So certain promising research for cancers that aren’t as prevalent maybe doesn’t happen, right? So a lot of weird and interesting little issues arise in this whole narrative, which I thought, that stuff actually, to me, was much more interesting than the cellular level. But I guess the cellular level has to be there.

LD: You can’t extract it if you’re going to call it a true biography of cancer, but I think you alluded to in the introduction, where one area of interest was the whole concept of like cigarettes, how recent they are, and how they came bursting onto the scene and how they’re still around, even though everybody knows that they’re not good for you, but people still smoke.
DH: We were just on a trip in the Caribbean, and I was walking by, like a shop that puts the cigarettes right in the window, and they have these giant boxes, right? The box has a little white box on it, I mean, we’ve all seen those labels. Cigarette smoking can kill you. It’s these block letters. People don’t care. They’re still doing good business. It’s really crazy. I was shocked to learn – this is probably out of this whole book – the thing that shocked me the most that I after I read it, I started messaging people, I started quizzing my kids, when did cigarettes become a thing? And I just assumed that cigarettes were something from medieval times, and has been going on for hundreds and hundreds of years, but it’s really just from around 1850. We created this monster, and we can’t put it back in the box.

LD: You don’t see, like, all the knights in the round table smoking some cigarettes.

DH: I assumed that it was old, because I always had this idea that Sherlock Holmes was smoking all the time with a pipe, but he really is just from the 1800s.This is a really new thing, and it speaks to if, whichever dude it was that rolled that tobacco a new piece of paper and smoked, if he doesn’t do that, maybe we don’t go down this road. But anyways, that was shocking to me. You’ve mentioned that the palliative care bit was kind of shocking to you. So that was also interesting in the sense that so many of these structures that we have in medicine now that we kind of take for granted that this exists, didn’t exist very long ago at all. Our grandparents generation, probably they grew up and got into old age without realizing that palliative care was a thing.

LD: One of the quotes in the book was that death meant failure to any of these doctors. So they would not allow you to say, oh, yeah, just, just die in comfort, die peacefully. It’s like, no, we’re gonna go down trying, and we’re gonna cut more, we’re gonna give you more chemicals, we’re gonna give you more this and that, whatever, and we’re gonna save you, gosh darn it, that sort of thing, right? And to realize that you know what, it’s a terminal disease, and you’re only going to have a few months and let’s make it comfortable. That’s new.

DH: It’s crazy, because I have a feeling that if I was a medical student 40 years earlier, I could very well be one of these cutting guys, right? I’d be like, no, no, we got to keep fighting. And it makes you wonder, like, 50 years from now, when people look back to today, they’re like, you guys were barbarians back there. You did that ? You gave people chemotherapy. You crazy, right? But things change, and I think this book does touch on that, and the speed, and, the scope of all these changes, it’s quite, quite incredible,

LD: One curiosity that I have is recently is AI has jumped on the scene. So how much of this new cutting-edge technology could help? Because a lot of what they mentioned is they find one chemical that will help with this type of cancer, but then it mutates, and now they have to adjust it to this one. It’s well, now can AI build a protein for that and make it so that you can almost have like a custom-developed cancer treatment for you and your particular instance and all through the push of a button. And we’re not there yet, but I think it’s just a matter of time until they really isolate all these things, assuming cancer is what the book is kind of alluding to, because it could be elusive where it actually is something totally different, and what we think it is right now is something totally different, and there’s another plot twist in the book that they don’t consider until the next edition is out, or whatever.

DH: Did you did you feel that cancer sounds more scary to you or less scary to you after reading this thing, given that you didn’t know a lot about it before?

LD: I don’t know if it’s one of those things where, when you read about it you’re like, I have those symptoms, those types of things, where I was like feeling different parts of my body.

DH: Oh, that’s like, a medical student thing. When you’re going through med school, everyone thinks they whatever unit you’re on, you have that symptom for a few days.

LD: So I was cognizant of that because I was, wait, make sure you’re not believing that you’re having these symptoms. Dave, I’m gonna kill you for suggesting this book. At the end of it, I was like, do I think have cancer or maybe I have cancer? But no, to your question, I think towards the end, it actually gave me quite a bit of hope in the sense that they’re starting to understand it. And it’s just a matter of time where, again, they can create that right formula, that right system, where this cocktail of chemicals can be done for a particular one, because they have it for some, and there’s a huge increase in life as a result of and I think they distinguish between life and health, where health span versus life span, where you don’t want to be, like, living to an extra 20 years like an invalid, that sort of thing, you’d rather be living that actually out and about. So it’s given me hope. And it’s one of those things where, I mean, if someone said, hey, I have, I got cancer, it’s like, well, let me pull out the book and see what I can do to help. No, I don’t think it really has answers, but it will be one where you can start looking a little bit more and you’ll have more things to take a look at. I’m a little bit more positive as a result of this book. But how about you as the doctor, knowing more has it made you feel better or feel a little bit more challenged?

DH: I don’t think it changes. I’m still pretty darn afraid of it.

LD: Don’t get me wrong. I’m still afraid of it.

DH: I do think that I understand a little bit better why patients would be super afraid of it because I interact with it tangentially on a regular, semi regular basis. But a lot of patients probably have heard stories, you know, horror stories from their parents, 60s, 70s, right? Or from their grandparents, right? And so, I have seen some of these changes seep down into even like a family doctor’s office in 2024. It’s nice to know that, you know, there is targeted therapy for certain tumors. And not everyone needs chemotherapy.. And it’s changed even from the time I was a student till now. So it’s nice to see that these advances are coming along. And I’m really happy to be living in 2024. I’d rather be here than in 1924 that’s for sure. And so I think this book did present that hope, and I think I think that’s what you’re alluding to.

LD: Yeah, and it’s one where taking a look at little nuggets, that whole chapter on prevention is a cure. One of the things that I thought was interesting was even social networks as strategy for cancer prevention. So the more people and this might be bad, but the likelihood of cancer increases or decreases depending on who’s around you. It’s that notion of you are the average of the five people that you spend the most time with. So if you’re spending time with smokers, right, who end up with cancer, guess what? You’ll probably have it. The scary part to me is that you could be like the healthiest person in the world, but still end up with cancer too. So it’s not necessarily that it’s 100% under your control. There are other factors that could have you go one way or the other. But I did find it interesting how there were kind of nuggets of hope and this is what you can do about it, because you’re not predestined for cancer or whatever your genes or whatever your environment or whatever is laid out in front of you.

DH: Now, before we go, there are a lot of little fun nuggets in this book. Maybe we can just touch on a couple other ones to give people a taste of what they’re in for, if they read this thing. Give me some nuggets that you really enjoyed.

LD: I actually liked the way they created Jimmy.

DH: I didn’t know that story, I didn’t know that either. The notion is to start with the fundraising in order to get monies for the cancer treatment or the research. Then they pretty much invented this character name.

LD: Which is real, he was a guy.

DH: He was real, but his, he wasn’t named Jimmy.

LD: That’s true, he was a kid.

He was a kid, and he was around, but he wasn’t Jimmy. And I think he had a fairly ethnic name, and they made it Jimmy, just to make it so that everybody could relate. And you’d have Jimmy updates and things like that, and Jimmy was a celebrity. I thought that was an interesting bit. What’s one that you well remember?

HD: In line with the Jimmy story, there’s this whole story about Mary Lasker, the fundraising lady. Yes, this lady is just a philanthropist who decides to make cancer her pet cause and donates a ton of money, energy, time, her whole life, to fighting cancer. And you don’t think about philanthropists a lot in terms of when you think about the war on cancer. The first people that pop to mind are probably doctors, these old surgeons. You think about the patient suffering, but there are people in the background doing incredible things. And I’m glad that this gets touched on in the book. It really rounds out the story fuller because it’s showing cancer’s place in the world and how so many of us, in different ways, can do our part to help fight it. That’s cool, I like that part.

LD: Another part which we sort of touched on is all these experimental drug treatments and people who have tried everything. They’re willing to be those guinea pigs. And not only willing, they’re, like, demanding to be part of these trials where it’s experimental, it’s like, yes, sign me up. I found that quite interesting, where they’d get to the point where they would sue people to say, you didn’t open up these trials for us so we couldn’t get access to the latest cutting-edge experimental medicine and all that. And it goes back to the discussion of being close to death and trying anything. I found that interesting where you demand the drug companies to, who cares about all your double-blind, placebo controlled, whatever. Just give me it, if it works, it works, right, just give it to me.

DH: Well, in keeping with that, the other story that I enjoyed in a couple of these stories, was the examples of physicians or scientists doing research on themselves in some wacky way, right? They couldn’t get approval to do the study, and no one else was willing to take the medicine. The one I’m thinking of is the guy who figured out that stomach ulcers and stomach cancer is caused by the H. pylori bacteria. He just got fed up with waiting and just drank the bacteria himself. That was cool. I was like, wow, this guy’s a real martyr for their cause. He deserves, like, a special place in doctor heaven. And then there’s Marie Curie, like those early people who were working with imaging, and the radioactive material that allowed them to be able to see their bones and then would kill them a few years later. Pretty incredible that people were willing to, I mean, they didn’t know it, maybe in the example of the radiologist, but people are putting their lives at risk to advance science. We sometimes lose sight of that in modern times when we think about scientists. But these, these old school people, they were really pushing the boundaries.

LD: And one of the interesting things I found was all of the different like trials of testing where they had conscripted some people, but in some of the earlier ones are just like they put them in the trials. They didn’t really sign up, or the patients, as far as I could understand, they didn’t really sign up for it. They were just given this, and the other group was given that. So were they even consulted? Were they even aware? Did they even know there were options to do this?

DH: The book talks about this. At some point, they started randomizing the groups and trying to figure out statistics. The book even talks about the history of how medical statistics and biostatistics becomes a thing. All of this stuff is so new. It’s all stuff we take for granted. That is, ultimately, what I think is the coolest part of this book. So we’ve read the book, we’ve talked about the book. Do we recommend this book to people who are interested in medical humanities, and if so, who are those people that should read this thing?

LD: Anybody who’s scared of cancer, I think should take a read.

HD: That’s pretty much everyone. That’s a broad net that you’re casting. See, I don’t know if everybody’s afraid of cancer, because it’s one of those things that if it doesn’t really affect you, I don’t know if they’re truly aware. I think it’s one where you hear of one person, you’re like, okay. Then you hear of 2, 3, 4, and then you’re like, oh, okay. And then a little bit more, you’re like, it’s coming for me, I should read this book. It’s probably where I would suggest, because it does have that history and anyone interested in, I guess, medical humanities, because it is that link between the medical establishment and kind of the rest of society, where it’s even turning common assumptions on their head to say, like, this stuff wasn’t common knowledge, like, only a couple of decades ago. And now all of us are, of course, you don’t smoke a cigarette. Why would you want to do that, right? And even still, some people haven’t got the message. I think he does a good job of weaving the science and the humanities together. And that makes it a good read. When you’re in medicine as a physician, and probably when you’re in it as a patient, there aren’t a lot of things that weave these two things together. A lot of times these two things get siloed off, You’re either dealing with the touchy-feely art of everything, or you’re dealing with the numbers. And this book actually brings the two together in an interesting way. I think it’s a good introductory podcast for MedHum, for sure. It is a good read for people, but it is long and it’s not easy. This was what my oncology friend warned me when I said, this is the book we’re gonna do first. And she’s like, you sure? This is not easy to read.

LD: If someone could create a version that’s kind of half the size, then I think it would get way more readers and a lot more adoption. Maybe, but then you would drop the science part, right? You drop a lot of science and keep the funny stories about the fundraising and, you know, a very bare-bones science. But I feel like the book needs that detail, that heft.

HD: I think you could whittle down the science details, but still keep the science behind it, right. So I’m reminded there’s this anime that we were watching, and it’s called Cells At Work, where it basically personifies and like you have this, the main character is like a red blood cell, but it’s basically a character with red hair, and they carry these boxes of oxygen to different parts.

LD: He does this type of thing in this book. I’m just saying, if he had a little bit more of that, I think it would be more. So just maybe turn this into an anime and get the Japanese folks to make it epic, you’ll definitely have an award winner. But I do sense that there was definitely some of that. And I think just for the true lay person like versus the invested person who really wants to do it. I think some of that would help more. But yeah, a lot of great information, a lot of great insights on this, for sure. And he did a good job.

DH: Excellent. So we learned something, which is our goal here. Our goal, every month, we’ll learn a little bit of something on Apollo On Call. So, there you have it. The first episode of Apollo On Call is in the books. I hope Apollo, wherever you are, you’re happy with this podcast. We did our best. We tried to find a book that was dense but entertaining, and tries to tether medicine and the humanities together. I think we did an okay job with it.

LD: Yeah, I think so.

HD: Alright, and if not, we’re gonna keep working on it. So come back in a month, we’ll have some other content just hit us up about once a month. We’re gonna be producing some different types of material on this show. Sometimes it’ll be books, might be films. Sometimes we’ll be interviewing people who work in medical humanities, all of it. The idea is to bring the world of medicine and humanities a little bit closer together to people.

‘Taken to its logical extreme, the cancer cell’s capacity to consistently imitate, corrupt, and pervert normal physiology thus raises the ominous question of what “normalcy” is. ‘Cancer,’ Carla said, ‘is my new normal,’ and quite possibly cancer is our normalcy as well, that we are inherently destined to slouch towards a malignant end. Indeed, as the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal. The question then will not be if we will encounter this immortal illness in our lives, but when.’

Apollo On Call is produced by MedHum.org.

Special thanks to my co-host today, Mr. Luki Danukarjanto. The theme song is Un Sospiro by Franz Liszt and is performed by my wife, Dr. Justina Sam. Thank you all for listening.

Transcript from this episode
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