Enjoy Your Life
Synopsis
When caring for a young woman with a new brain cancer diagnosis, medicine resident Colleen Farrell comes to grips with her own mortality.
Listen
Resources
Mentioned in the episode:
Noonday Demon by Andrew Solomon
"Intensive Care" by Jane O. Wayne
CREDITS
Hosted by Emily Silverman.
Produced by Emily Silverman and Marina Poole.
Story Development by Adelaide Papazoglou.
Sound Engineering by Alberto Hernandez.
Assistant Producing by Kirk Klocke.
Illustrations by Lindsay Mound.
Original theme music by Yosef Munro. Additional music by Blue Dot Sessions.
Transcript
click to expand
The Nocturnists: Stories from the World of Medicine
Season 2 | Ep 4 – "Enjoy Your Life"
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
Practicing medicine means exposure to mortality early and often. Sometimes we're right there with our patients when they get a new, devastating diagnosis. And this can bring up our own fears of illness and mortality. Because while death is inevitable, being at peace with it is not. I'm Emily Silverman, and this is The Nocturnists: Stories from the World of Medicine. In this episode, internal medicine resident and founder of Twitter's "#MedHumChat," Colleen Farrell, comes to grips with a young woman's new brain cancer diagnosis. New to medicine, Colleen feels unprepared to handle this news. And in the conversation that follows, she and I muse about the lifelong task of coming to terms with our own mortality. But first, here is Colleen Farrell.
Colleen Farrell
It's the end of summer, and I'm working in the emergency department. I've just finished my first two years of medical school, which means I've been learning medicine from textbooks. But the hospital is totally new to me and I have no idea, really, how it works.
I meet a patient that night, who I'm going to call Ellen. She tells me that she's been having some double vision and nausea for a few months. I noticed on her physical exam that, when she looks to the side, her eyes wiggle back and forth in this way that's definitely not normal. And so we decided to get an MRI of her head. And on the MRI, we see a big mass inside her skull. We talk with radiologists and neurologists and surgeons, and everybody agrees that Ellen has a malignant, inoperable brain tumor.
Growing up, I knew this kid named Billy. When we were about 10, Billy was diagnosed with brain cancer. I can still picture him in the gym of our elementary school playing basketball, with this enormous scar on the side of his head. Each one of our classes in my school made a quilt square for him, and we put them together into a blanket that we sent him home with. “You Are My Sunshine” is a song that they played at his funeral.
My mom says I was really curious about death growing up, that I asked all kinds of questions about it. What I remember is that I thought a lot about Billy. I used to picture him laying in bed surrounded by his family members, and I would wonder what was going on inside his head. “What is it like to know that you're going to die? What do you think about?”
And it was in thinking about Billy that I had my first inclination that I wanted to become a doctor. What's kind of interesting to me looking back, is that I didn't have this hope of becoming the heroic surgeon who would cut open his brain or remove the cancer and save his life. I think I just wanted to be with him and be able to provide some kind of comfort, while having those scary thoughts about death.
Ellen was admitted to the hospital for a few days for further tests and to be seen by more specialists. As a medical student on her team, I would see her really early in the morning and I’d wake her up and say, "Oh, I'm so sorry to bother you." And I would make sure that she'd been getting enough medication for her nausea and that she wasn't in pain. But I never really talked to her about what was happening, about this diagnosis that she had received.
One day I'm leaving the hospital and I have my backpack on and I'm walking towards the elevators and I walk past Ellen's room. Somehow seeing her room, I remember that it's the day that she's supposed to be discharged from the hospital—she's going to go home with her husband. And so if I want to talk with her, like really talk with her, now's my chance.
As soon as I think of having a real conversation with Ellen, my stomach is in a knot and I think about all the ways that it could go wrong. Like, “Does she really want to talk to the medical student? And what if I say something that just makes it worse, or makes her upset?” And so I go through this whole line of thinking and convince myself that maybe I should just go to the elevator and go home. But I catch myself, and I think about Billy and the kind of doctor that I want to be, and I force myself to at least try to be that kind of doctor. And so I walk back to Ellen's room, and outside her door, I put my backpack down. I unzip it, and from inside, I pull out my crumpled up white coat that I had taken off for the day, and I put it on me.
Looking back, I realized that I wanted that white coat as a shield. I needed it to separate me from Ellen and the reality that she was now facing her death. I walked in her room and saw her laying in bed, her husband sitting next to her. He was hunched over, had this pensive look on his face, and his beard had grown out longer. Immediately this big lump swelled up in my throat, and I knew that as soon as I tried to speak, I would begin to cry.
Ellen looked at me with this remarkable, loving, kindness in her eyes that I will never forget. She could tell that I was on the verge of tears. And she said to me, "Enjoy your life. And don't lose your empathy."
I went home that night, and I fell to pieces. I was crying on the floor of my apartment. I didn't want Ellen to die. And I was also overwhelmed by the gulf between the doctor I wanted to become, and who I felt I was. I knew that to be a great doctor, I would have to be able to face mortality. And I didn't know how to do that. And trying was terrifying.
I didn't know what to do. So I went to bed, and I got up the next day, and I went back to the hospital. And I came home and I went to bed. And I got up, and I went to the hospital. And I went to the hospital, day after day, for a year. And every day in the hospital, I met patients who were in very dark moments in their stories. And I didn't know what to do with all those stories that hurt so much. I didn't know how to process them. So they kind of just lived inside me. And when I finished that year, I was really, really depressed. I started having thoughts of wanting to kill myself. And what's kind of interesting to me about those thoughts is the way my patient stories wove themselves into them.
I spent a lot of time in the operating room as a medical student, where I learned how to hold a scalpel. I learned the locations of the most important blood vessels in our bodies. I touched somebody's aorta with my gloved fingers. And so in my own difficult moments, I would imagine taking a scalpel to my own arteries.
I met several patients that year who were dying of liver failure. Their bodies were swollen and yellow and often bleeding. And I would think about the medications that I could take that would make my liver fail—that would make my body swell, and turn yellow, and bleed.
I would think about Ellen, and how one day you could be going on a hike with your family, and then the next day you could find out that this cancer was growing inside your head all along. I couldn't make sense of that. Like, “How does that happen? And what do you do with that?”
Once I had time away from the hospital, I could focus on my own healing. I would go for these long walks each morning along the Charles River. It was fall, and I loved looking at the leaves. Now, first they were yellow, and then they would start to turn orange, and by the end of fall they were brown and crispy.
I would watch as the wind whipped through the branches of the trees. The leaves would dance on the wind and then when I looked closely, I would see their little stems clinging with dear life to their branches. And then randomly, some of them would fall to the ground.
Later that fall, something really unexpected happened. I was in a coffee shop. I was perched on a high countertop, enjoying a latte and a pastry, when across the way, I noticed somebody who looked familiar. I racked my brain, trying to place him and eventually realized that it was Ellen's husband. I immediately was so curious, I had to know if he was alone or if he was with her. So I got up like I had to go to the bathroom, and walked across the coffee shop until I could get a better view. And across from this man, I saw Ellen. Her cancer had definitely taken its toll. But there she was—alive, enjoying her coffee.
Seeing Ellen that day really changed something for me. It had been over a year since I met her when I saw her in that coffee shop. And I realized that that entire year, whenever I thought of her, all I thought about was that she was dying, and I hadn't thought at all about how she was also living. I realized I had gotten so consumed by these dark moments in my patients' stories that I was missing all the light.
I thought about those leaves on the trees and how, before they fall to the ground, they are their most beautiful colors and they dance in the wind. And just like that, in my patients' lives as they were facing so much pain and uncertainty and loss, there was often so much beauty, so much resilience, and so much connectedness.
I watched as Ellen and her husband got up from the coffee shop. They walked outside holding hands into a beautiful fall day, with brown leaves at their feet and the trees glowing all around them. Thank you.
Emily Silverman
Hi, Colleen.
Colleen Farrell
Hi, Emily.
Emily Silverman
It's so good to hear your voice. How are you?
Colleen Farrell
Likewise. I'm good. How are you?
Emily Silverman
Good, good. I'm so excited to talk to you about the story that you told at our show in New York City, back in October. Maybe you could just briefly introduce yourself to the listeners.
Colleen Farrell Sure. I'm Colleen Farrell. I grew up in upstate New York, and I'm now an internal medicine resident at NYU in New York City.
Emily Silverman
Colleen is also the illustrious creator of the very popular new Twitter chat called “#MedHumChat,” and I'd love to touch a little bit about that later. But first, I would love to hear a bit about your path to medicine.
Colleen Farrell
In some ways, my path in medicine is very straightforward. I went to college, intending to be pre-med, and I became a doctor. That's the story. But in another way, it was like a kind of winding path where there were moments when I really wasn't sure I would do it. And the decision became a lot more complex than I had anticipated, largely because I started studying bioethics and gender studies and medical history. And I realized that medicine is way messier than learning science and using it to help people—you can actually do a lot of harm. And there's some really, really hard, messy decisions we have to make. So I spent a lot of time trying to convince myself that…or trying to believe that I could become a doctor and be a good doctor, as in the sense of being a good person.
Emily Silverman
I would love to walk it back a little bit if that's all right. And just hear a bit more about Billy—you say that he was an acquaintance—he wasn't somebody who was super close to you, but was in your circle and in the community. Can you remind me, how old were you when that happened?
Colleen Farrell
Well, I'm not entirely sure. You know, I say 10 in the story. I recall going to his wake when I was in the sixth grade.
Emily Silverman
So pretty young.
Colleen Farrell
Yeah.
Emily Silverman
Some people have exposure to death at that age, but usually it's more in the form of a grandparent dying or something like that. But to have a peer die, you know, at age 10, or in sixth grade, or whatever it is, it's pretty early to be exposed to this question of mortality. And so I was wondering, even back then, being the thoughtful kind of person with the expansive mind that we all know that you have, did it cross your mind? Like, "Wow, that could have been me?" Or, you know, "He's my age!" Or, “How did that frame your perspective on death at that young age?”
Colleen Farrell
Yeah. You know, I don't recall having the thoughts so consciously, or with such self awareness. But I do recall crying in bed one night, and my parents hearing me and coming to my room. And I remember telling them that I thought I had a brain tumor. So of course it was on my mind. And these were the kinds of things that I would do that my mom would attribute to my curiosity about death—but it wasn't just curiosity. I think it was also enormous fear—but fear I kind of wanted to look at and then cover my eyes, and look at and cover my eyes.
Emily Silverman
Yeah, I think some young people have this feeling that they're invincible. And some people when they see others get sick or die, have the opposite reaction, which is like, "Oh, that could just totally be me."
Colleen Farrell
Definitely, I mean, I think there's this whole thing in neuroscience about mirror neurons. And our program director in my primary care residency, he has this thing where he asks us, you know, “When the patient points to say their left arm and they say this hurts, do you say it's their left arm or their right arm?” And if you mirror really strongly, if their left arm hurts, you'll point to your right arm because you're standing across from them and you feel that side hurting.
Emily Silverman
There are some thoughts that you mentioned in this story about, you know, these people in your life who have become sick and died…going to medical school and seeing your patients start to be struck almost as if by lightning by these random diseases. You know, they could be 85, they could be 25, it could happen to anyone at any time. And really grappling with that…I think you even say in the story, or at least in the version that you performed live, you said you didn't have the time or the space, or the skills to deal with…. And I really want to zoom in on that word, “skill,” because it really struck me. I just started wondering, like exploring the darkness and coming to terms with our own mortality and our own vulnerability—Is that a skill? And if so, should we be teaching it to medical students, in preparation for what they're going to see? And if so, how would we even begin to do that? And I'm just curious if you've ever thought about that.
Colleen Farrell
Right. I love this question. I have observed in conversations in medical education around empathy, that there's this idea that you have two options. On the one hand, you can feel a lot, and you can get really close to your patients. And then you're going to get messed up, and you're going to get too close, and you're not going to be able to be rational, or you're going to fall apart, or you're going to become mentally ill. So that's one option. And then on the other hand, you protect yourself, and you keep appropriate professional distance. And the danger there is that you become too cold and uncaring. So there's supposed to be these two poles, and you find some happy medium. And I was completely unsatisfied with these options. I was just like, "There is no way that that's the only way to exist in the world." I just refuse to believe it. And so this is where I sometimes get frustrated, too. And when people are like, "Oh, well, how should we teach this to medical students?" And I think, “Well, forget medical students! How do we teach this to human beings? How do human beings learn this”? These are enormous questions that, yes, are important for doctors. But doctors aren't the only ones facing these questions. I mean, these are the questions of parenting. These are the questions of religion and spirituality—for centuries, for millennia. These are, in many ways, questions of, I think activist and social movements, like “How do we face suffering?” And, and so I kind of made a decision to look elsewhere for moral and spiritual guidance. Because at some level, you know, we treat these questions of “How do you face death?,” as like, this is like another medical school competency. But like, I just say...
Emily Silverman
As a skill.
Colleen Farrell
Yes, but it is a skill, but it's a different kind of skill.
Emily Silverman
Right.
Colleen Farrell
It's like deep wisdom. It's like, I also believe love is a skill. Because I believe love is a verb. And when it comes to verbs, you practice verbs and you get better at doing them…you can get better at loving. And anyway, so in terms of like, “How do we cultivate skills?” Well, I think the people I'm currently looking to most to work on that skill are Buddhist teachers. And I know I'm only dabbling in it, and I really owe it much more of a commitment, but it's so eye opening for me. There’s this incredible place called the Zen Center for Compassionate Care, and it was founded by these two Buddhist monks who actually met in a hospice. And they're particularly interested in working with people in health care—caretakers—and helping them face death. So here's the spiritual tradition that has existed for so long that people devote their lives to. And I think those people will tell you that this is…they call it a practice.
Emily Silverman
I love that you...that that's where your journey led you. And I'm wondering, you know, for you, it sounds like the journey it took…there were some bumps in the road. It took for you to get into a pretty dark place before you came out of it. And then you found that healing path and that healing process. And in my mind, it would be nice if students never had to get to the dark place. Maybe the solution isn't to teach the skill to medical students, but somehow cultivate a culture where students have space to find that answer for themselves.
Colleen Farrell
I think that's really well said. And there was this moment that I got to where I really felt like becoming so depressed in medical school and really having to hit pause for a little while on my medical training…It was like my life went through a sifter, and I was left with only the most essential elements. I had this kind of epiphany in my kitchen one day, when I finally could say to myself, with honesty, I could say honestly to myself, “If I really think I'm going to kill myself if I don't leave medicine, I will leave medicine. This career is not worth my life.” And it took me a really long time to get to that. And then getting to that was so liberating. I also, I just want to respond to one other thing you said about how we can, in medical education and training, give space for students to do that kind of important work. And I think a really important piece is role modeling. And not role modeling, "Oh, look at this epiphany I had," but role modeling vulnerability. That's what really prompted me to start telling my story, because I found that when people were just honest with me, like, when an intern would say, "Third year of med school was really hard," it meant the world to me. Just let down your shield for a second, and let me see you. And that was what helped me the most. And so I started just telling people little side conversations that I'd gotten really depressed. And so many of them said, "Oh me too," or, "My best friend," or, "I think I could use some help." And so, the more I leaned into that, the more I realized what a way of helping people that can be—if we can be courageous in our vulnerability, and I think really being vulnerable, in a true sense. I think that's one of the best ways to teach.
Emily Silverman
And I think role modeling and creating space are really important. But I think they're also, you know, if we're going to accept that as true, if we're going to accept that medical students and residents and doctors are people, are human beings, there's going to have to be some structural changes made in the way that we make doctors. Because, in my experience, the schedule is like walking a tight wire, where if you're in perfect mental and physical health, you can walk that tight wire and probably get from one side to the other, and be okay. But there's just no buffer zone. The minute that something happens, whether it's a bout of depression, or an issue in a relationship, or a family emergency, or in my case…actually, I developed a physical medical issue. And it was like, "Oh, whoa, like, I actually live in a body too." Like, “I actually am a person who could get sick." It's just it's kind of weird, the mental backflips that physicians go through, when they become vulnerable, and how they try to hide it.
Colleen Farrell
Right, that image of the tightrope—how we're really walking this and if any part of human-ness comes out—that your body does normal body things—it is impossible to do it. Like I used to do these visualizations in the operating room where I would imagine the muscular walls of my bladder expanding, you know, so that I could hold my pee for that long. There's this enormous irony that as you're learning to care for other people in their bodies, you become so disconnected from your own body and your very, very basic bodily needs.
Emily Silverman
I do want to touch on two more things before we part. The first is a line that struck me in your story when you are saying goodbye to Ellen in the hospital. And Ellen says to you, "Enjoy your life." And I'm just wondering if you've dived any deeper into that statement? Or how you how you've taken that advice and put it into practice, if at all.
Colleen Farrell
That's a really interesting question—what do those words, "Enjoy your life," mean to me? I think I just heard her acknowledging how precious life is. And, I don't know, maybe it really stood out working in a medical environment where something so simple often isn't stated. To be honest, they're not words that I have really spent that much time with. But rather just this feeling that… how much went unsaid between us. My recollection of that day is that we really didn't talk about much more than I said in that story—that I came in and tried not to cry, and she said, "Enjoy your life," and, "Don't lose your empathy." That was kind of it. We had met each other pre-diagnosis, like, neither of us knew what was happening. And then she got this diagnosis. And we both heard about it separately. And she was told and had conversations and cried. And I was told, and I looked at the scans, and I pulled up all these articles about it, and I cried about it. And we were doing both those things separately. And so when I came to her and said goodbye, there was so much that didn't have to be said, and I think that's what I care so much about that moment. It made me feel seen by her. And I thought that was such a generous gift.
Emily Silverman
And it seems to me like she may have taken her own advice, or she had lived up to that philosophy, "Enjoy your life." And I think in an earlier version of your story, you make this distinction in your mind between being dead and dying, and how for you those two things used to feel the same, and then they separated a bit in your mind.
Colleen Farrell
Yeah, absolutely. I had this very strong sense of like, that somebody who was dying was fundamentally different. And I think that was why I was so scared to go in that room. I was like, “Well, she's dying. That's like—that's different.” I don't know, I just thought it was this different thing. And, I don't think it was really till I saw Ellen later in that coffee shop that I realized this confusion that I had had between dying and being dead.
Emily Silverman
Yeah, yeah. And I think that's a distinction that I had to make for myself too, as I began to interact with people who had terminal illnesses, or maybe failing organs, and they weren't a candidate for transplants, and just like, almost feeling kind of awkward around them sometimes and not quite knowing how to behave. And, like you said, as if the situation is different, or the interaction is different, or I should treat them different because they are dying.
Colleen Farrell
I don't know if you know, Andrew Solomon's book, Noonday Demon, about depression. In it, he talks about how his mother, I believe, dies from physician assisted suicide. And she plans the day that she's going to die. And Andrew Solomon, the author, and his brother are there. And so it's the day the mother is going to die—and she knows she's going to die—and she scolds his brother for how he has laid these cookies out on a plate. And I just loved that detail so much. I was just like, people live and live and live until they die. Like, there's something so irrational and beautiful about that. I don't know—people care about the way cookies are on plates.
Emily Silverman
Right, they don't lose their little quirks. They don't lose their vanity. They don't lose their, you know, personality. They're just them. Well, I do want to wrap up and talk a little bit about “#MedHumChat,” this amazing movement that you've started on Twitter. Can you tell us a bit about how you got the idea to do this? How you got started? The drivers behind it?
Colleen Farrell
Yeah, totally. Thanks so much. So I love getting small groups of people together—people in medicine—and talking about poetry or stories. People can kind of put parts of themselves on the text and reveal parts of themselves without being too vulnerable. And I experienced that with my co-interns last year. We had this really cool block in my primary care program where we get eight weeks of psychosocial curriculum. And the interns actually designed their own curriculum for a lot of this time. And so I would print out poems, and New Yorker articles, and short stories, and I would carry them around with me. And so sometimes I would give out these poems to my co-interns and people who I don't think identified as particularly interested in poetry, had these incredible things to say. And I was like, "Well, why not do that with medical humanities?" And so I honestly—I tweeted out, "Hey, is anybody doing this? If I had a chat, where we talked about poetry, would people be into it?" And all these people were into it, so I was like, "Well, I guess I'll just do it." And that's, that's kind of it. I have to say, I think, the most meaningful response to it so far, I got from a critical care doctor after our first chat, in which we read this poem called "Intensive Care" by the poet Jane O’Wayne. And the next day this doctor tweeted that because of reading that poem, and reflecting on it, he spent more time with the family members of the patients he was caring for the next day. And I was like, that to me is the magic of poetry, and art, and story, that it helps us find the parts of ourselves that connect with what we're doing and what really matters in what we're doing. And if I can create a space where one person really spends more time connecting because of things that we've talked about, and he's connected with, within himself…that to me is worth so much.
Emily Silverman
I think so, too. And I think what you're doing is what you said earlier—you're role modeling, and the impact of that is rippling out. And it may not be super easily measurable, but it's certainly powerful. And I just want to thank you for putting that community together. And I look forward to participating in many more, "#MedHumeChats."
Colleen Farrell
Well, thank you so much. I am very excited to have you there.
Emily Silverman
All right. Well, I know that you are a busy resident with a busy schedule. So I will let you go.
Colleen Farrell
This was such a really special opportunity for me, Emily. You have clearly created something magical, and it is really a pleasure to be part of it. So, thank you.