Preparing to Live
SYNOPSIS
Illustration by Eva Vázquez
Hospitalist PJ Lally reflects on a time he got a second chance at life.
LISTEN
Storyteller
PJ Lally works as a hospitalist and hospice doc in Northern California, and recently completed a Masters in Divinity in Spirituality and Peacemaking. His family has 28 chickens, 3 paddleboards, and a penchant for espresso and vacations.
CREDITS
Hosted by Emily Silverman
Produced by Emily Silverman, Jon Oliver, and Carly Besser
Edited and mixed by Jon Oliver
PJ’s story was coached by Kristin Moe, with support from The Nocturnists’ Head of Story Development, Molly Rose-Williams. His story was performed live at The Nocturnists’ show “Together Again” at the Brava Theater in San Francisco in June of 2022. Motoko Honda improvised and performed on piano.
The Nocturnists original theme music by Yosef Munro
Additional music by Blue Dot Sessions
Illustration by Eva Vázquez
Season 5 of The Nocturnists is sponsored by The Physicians Foundation.
The Nocturnists is made possible by the California Medical Association, and people like you who have donated through our website and Patreon page.
TRANSCRIPT
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The Nocturnists: Stories from the World of Medicine
Season 5 Episode 3: “Preparing to Live”
Episode 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
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today we speak with Dr. PJ Lally, who brings us into the earth-shattering moment when he received a new diagnosis, and all the events that followed. It's a story he told on stage at The Nocturnists live show in San Francisco at the Brava Theater in June of 2022. And it's one that's really stayed with me ever since, I think because it has this immediacy to it that is really special. PJ is a hospital medicine doctor and hospice physician in Northern California, and recently completed a master's degree in divinity and spirituality and peacemaking, which we'll hear about toward the end of my conversation with him. But first, take a listen to PJ's story.
PJ Lally
I know, about thirty seconds into the test, that something isn't right. I'm in an optometrist's office, presumably to get some stylish glasses. Y'know – gray hair, turning 40. I'm sitting down in a dark room. I have a patch over one eye, and I'm in front of this machine, clicking every single time I see a white flashing light on the back of the screen. And I'm not seeing the same flashes on the right side, that I am on the left. A few moments later, I'm brought into the optometrist's room. It's a little fancier. He walks in, really kind-appearing, gray hair, fancy spectacles, and these kind of stylish alligator shoes. (I live in Napa). And he sits down in his doctor chair and turns to face me, and pauses just a fraction of a second. And that's when I really know something isn't right. I've done that move thousands of times as a Doc. It's like this turning to yourself to face someone, and then dropping bad news. He slides this white sheet of paper in front of me, small, and says, "As you can see, this is the results of your visual field test. There's some damage on the right side of both of your eyes. You're a doctor; you know that this isn't a problem with your eyes. This is something with your brain."
An MRI, later that day: maybe swelling or fullness; might be something... It ends up I have a 1 x 2 centimeter brain tumor. It's called an optic pathway glioma – very rare. And, in adults, malignant. In six months, I will be blind, and in a year I will be dead. I cry and cry, and completely fall apart. I tell my wife and she holds me as I cry in bed, and it feels so good to be held as you fall apart. But life isn't that simple. It comes raging back at me. Wills: we don't have one. Beneficiaries: I'm not even sure what that is. (But I am waking up at night having panic attacks). Life insurance: I don't know the name of the company; I'm not sure if I've been paying my premiums. I keep freaking out that I am going to leave my family bankrupt, and I'm not sure what I've even accomplished in my life.
There's still, somehow, this softness too. I go for walks through our curvy-streeted neighborhood. I see a mom with a stroller walking her child, and a little dog, and the sun is shining. The dentist calls. I'm, like, "Oh. Teeth cleaning." I don't answer; I never have to answer. I never have to get a teeth cleaning again in my life. Celebration! A week later, I go for a walk with my daughter. It's our nightly ritual – a dog walk at dusk. Walk down the front steps, and moments later we're walking along the sidewalk and it's a really gorgeous night. There's these dry golden California grasses, a breeze on my face, and the sunset is purples and reds and blues. And my incredible daughter is just a few steps ahead of me, almost giddy, and just walking along. And she suddenly turns around and says, "Hey, Dad, can I use your phone for a second? I want to listen to this song: 7 Years, by Lukas Graham. The kids at school have been listening to it, and I want to practice the lyrics."
I haven't told my daughter yet, It's... I have no idea what I would say. It's only been a week. I kind of hand her my phone, in a fog. And a little bit later, she's skipping in front of me singing, "Soon I'll be 60 years old; my daddy got 61. Remember life and your life will be a better one." I leave my body and want to become a bird and just fly and sing on her shoulder and be with her and love her and sing of the joys of life and never let her forget how beautiful she is.
A week later, we're downstairs in the office. Wooden desk. My wife is next to me; the sun is shining. We're in front of the computer. We have an appointment with my UCSF neurosurgeon, ostensibly to talk about my diagnosis and... I'm freaking out about what it's going to be like to be blind, in a matter of months. And, the headaches I've been having, I am terrified are going to get worse. I open the screen and click on the link. "Your host will admit you shortly."
I hold my breath in anticipation, and grab my wife's hand. His face pops up and he's smiling. And says, "Good news. Yeah, good news! You actually have a benign tumor." That's a real celebration.
"Yes, this, these sometimes don't change for 5...10...15...20 years. We're gonna get an MRI every six months and we will follow this with you." And, you know, he's right: here I am. I am… It's nine months after my diagnosis. I have an MRI scheduled every six months, to ostensibly tell me if I'm living or dying. I still have this ticking time bomb in my head. But there's sort of a tedious stability. Coming back to life. I'm back at work. I'm a, you know, a doctor. And I'm... got these new fancy glasses from my optometrist friend.
And I'm giving terminal diagnoses again to patients and feeling so much the proximity of death. I go for walks with my daughter and our fluffy dog Benny. You know, each night ostensibly the same through the curvy streets but really special and unique. My wife and I slowly start turning towards the future again. Getting into cautiously mundane things like home repairs, and starting to look and try to see what healing would look like in this place, together.
And the dentist keeps calling me, every couple of weeks, like clockwork. And the next time, I'll answer the phone and schedule my teeth-cleaning.
(Piano interlude by Motoko Honda)
Emily Silverman
So I am sitting here with Dr. PJ Lally. PJ, thank you so much for being here today.
PJ Lally
Thanks, Emily. It’s an absolute pleasure.
Emily Silverman
So, PJ, I think it was a friend of ours, a mutual friend, Dr. Mark Shapiro, who suggested that you submit your story for The Nocturnists. So can you tell us a little bit about that? What did Mark say?
PJ Lally
True. So I've been listening to The Nocturnists for a while and love the show. And Mark Shapiro is a hospitalist who works on the same team as I do up in Northern California. And he sent me the link and said, “You should write something for this prompt.” And I thought about it. And in the context of my story, my diagnosis, I thought I'd use that story to tell, and the rest is history.
Emily Silverman
So I want to get into the story. But before we do, tell us a little bit about your path to medicine. What kind of doctor are you? How did you come to become a doctor and tell us a bit about your practice.
PJ Lally
I'm a family practice doctor. About half of my job is as a hospitalist. About half of my job is administration-ish. So I'm a medical director for Northern California hospitalist teams for Providence. And then, since I kind of have functional ADD, the other quarter of my job is I do per diem hospice work as an outpatient too. So I do a little bit of, actually, inpatient palliative coverage too. So, kind of a little bit of everything.
Emily Silverman
And did you always want to be a doctor from the time you were a little kid? Or did it come later?
PJ Lally
No, my mom is a marriage and family therapist. She was my therapy-side of medicine, because there's a part of medicine that just is connecting with people. And then my dad was the science guy. And it's a rather banal story in that I was in high school when I twisted my ankle and was wandering around the hospital with my dad, and he's a very social person. So when he was at the hospital, he'd be, like, waving at people as he walked down to the hall and I thought, “Oh my gosh, you know, this is kind of fun. You just get to hang out with people.” And since I love people, that was essentially the beginning. I was, like, “All right, well, take a couple science classes, and then I get to hang out with people and become a doctor.”
Emily Silverman
So the story that you told on stage was a pretty heavy story about your own medical adventure. Tell us a little bit about the process of getting the story ready for the stage. I know you worked with one of our amazing story coaches, Kristin. So talk to us about that.
PJ Lally
It was way different than I expected and a lot more intense, and a pretty beautiful process, too. Kristin is such a wonderful guide for this story. Because it was relatively recent, like I’d just had my diagnosis within the last six to nine months. So, a lot of the feelings and experiences were still raw for me, like in a pretty unfiltered state. And when I wanted to tell the story, I kind of had an intellectual understanding of where I wanted to go, but I didn't really have a combined emotional-spiritual version of it, too. They were almost two different stories. And so I spent some time trying to articulate, in an outward way, what my inward experience had been. And Kristin was really a guide through that. You guys pulled in some extra teachers and some extra mentor coaches for one of my sessions about part of the way through, and I remember, in that time in particular, almost stumbling through some scenes, because they were just so palpably strong to me. Part of it was talking in the present tense and learning how to tell a story from the actual moment of it without it being overwhelming. That was a huge shift for me, because I had previously thought of sharing a story as I, sort of, would recount something that happened. And having it be from a lived place, you're really articulating the experience and how it hit you and what was moving in the moment. And really bringing people in involved a lot more heart work that involved a lot more emotional intelligence. And it was also just a practice skill of talking in the present tense and saying, “This is what's happening, and this is what's happening, and this is what's happening,” because I'm really reliving standing in the optometrist office, as I'm grokking, “Oh, my God, he's telling me I have a brain tumor, as like, “Alright, you know, let me know how it goes.” It was just such a palpable experience in the moment telling it from that present tense of living it, is very different than saying, “Oh, you know, a while ago I went to this thing, and then this thing happened,” where I can be with it from a distance, rather than being up so close to it.
Emily Silverman
Yeah, I still remember one of the coaching sessions that we did together, and how you were telling the story in the past tense. And then it was I think, Molly, who said, “Why don't we try flipping to the present tense?” And suddenly, it was, like, you went from reporting what had happened to living it and all the emotion just came up. And we had to work through that together as a group. And for me, it was just such a humbling moment. And just such a reminder of the power of storytelling. And I think one thing it raised for me is just some thoughts about timing and storytelling. So like you said, you weren't talking about something that had happened five, ten years ago, this was something that had happened nine months ago, and, as you said, was still pretty raw. And I know that there's a lot of people out there who want to submit stories to The Nocturnists, but aren't sure if they're ready to talk about things. So I'm wondering, like, how did you navigate that? How did you figure out, like, “How much do I want to put out there? How much do I want to keep for myself? How do I walk that tight wire of giving the gift to the audience, but also not telling the story in such a way that I just, like, fall apart, because it's still so fresh.”
PJ Lally
I remember in one of the sessions, I felt like I was literally falling apart and you kind of leaned across and were like, “If you're not ready for this, you don't have to tell the story. Like we can literally bail from the whole thing, if that's what you're really needing.” I love that you guys are doing the current narration on “Shame in Medicine” and how it exists. A lot of my diagnosis was a journey through shame for me, interestingly enough, just thinking about, “If I’m dying, what am I worth, and what have I accomplished, and who am I to other people?” And it really put into such a stark contrast my relationships and what I'm doing in life, these really important relationships, do they feel the same way about me as I feel about them? Part of what I came to with the coaching was being able to understand that you can walk up to those feelings of shame and be present to them, but not necessarily fall into them. But there was also so much of that story that was a story of strength for me and resolve and relationship-building and deep introspection about who I am as a physician and how I show up in the world and who I am as a human being and how I show up for my daughter or my wife and for my family.
Emily Silverman
We hear about these stories sometimes of people who get a diagnosis and they're told they have three weeks to live or six months to live. And then later we find out it was a mistake. And actually, they have a lot longer to live. And we imagine, I guess, like the whiplash of that, and almost like a near death experience, and suddenly everything's brighter. And all of these thoughts are coming up. Is it really like that? Or do you feel like you're kind of back to normal now? Or does that last, that feeling of everyday could be my last? Does that go away once you realize that you actually aren't about to die? Or, I don't know, like, what is it really like?
PJ Lally
I'm, one, just so thankful that I'm not dying. I mean, there's just so many people who get absolutely horrible diagnoses all the time and don't get to walk out. And so I just want to first create space for folks who don't have that door, who have a terminal diagnosis. I think the part that was the most palpable for me was so much of a nonverbal, almost, like, existential experience. But I just remember being flooded with a sense of warmth or contentedness that I didn't have the need to go out and vacation or do the amazing thing like, “Oh, my gosh,” you know, “I did my bucket list items.” it was more a sense of having faced something that's really, really intense, like your own mortality, and been like, “Okay,” like, “Now I know what it's like to think I'm dying.” And to recognize that I did have a worry about, like, “Oh, my God, if my brain goes through the base of my skull from extra space, or, like, my CSF stops flowing from a tumor, am I going to have massive headaches?” Because I've seen people on hospice die of brain cancer, and it's an ugly death. So I had some amount of that terror. That was like, “Okay, phew.” But it was for me that bigger place of being called into relationship with other people and getting to open my heart really intentionally in those places, and then say, “Okay, I can really live from a place of connecting in in a way that I've dreamed of and wanted to live into, and use that as a catapult for trying to live into that more intentional space.”
Emily Silverman
And in the meantime, you're a physician. So you're getting up, you're going to work every day, you're taking care of people, in some cases, you say in the story, you're even delivering terminal diagnoses to other people. So what is it like to be moving through the hospital with that frame of mind, in a place that's so filled with people who are struggling with illness?
PJ Lally
There were two moments. One was actually in the original version of my story. There was this day not too long after I had gotten diagnosed. And it was a patient who had COVID, and she was this little old, adorable lady. And I was wearing, like, the COVID gear, and since I have a beard, I had, like, the capper mask on, and, you know, the big blue shield. And I remember walking into the room, and we were talking about our day and smiling and she was totally deaf. And when I went up to her to ask her how she was, she just reached up and pulled me in for this incredibly tender and warm embrace. It was just about her, in my experience, just being an amazingly tender, wonderful old lady, who just was a friendly person. So I walked into that room, and rather than comforting or talking about it, she just gives me a hug. And we almost share a cup of tea about her life in the hospital. And that was a really complete interaction for her. But that's like one little snippet of what I think just is my version of practicing medicine–it’s trying to be with people's humanity and not necessarily force the medicine upon either of us.
And a separate story was I had a patient with interstitial lung disease, who just walked in the room, and she just looked scared. She was on high-flow nasal cannula and just looked scared. And you know, there's a lot of ways that you can open a conversation you can say, “Hi, I'm Dr. Lally, I'm a hospitalist. I'm going to be with you this number of minutes.” And there's all the formulae that you can follow. You can sit down, maintain eye contact. And rather than doing all of that, I just said, like, “Oh my God, are you feeling really scared right now?” And she just immediately started crying. And then we talked about what her fears were, and what it was like in her body, and, you know, what was her biggest fear for the day. And then we worked our way into talking about grounded stuff about her hospitalization. But I didn't have to have the pretext of being a doctor. She was just scared. And just like all of us have felt fear before, she wanted someone who could acknowledge and be with her in her humanity.
Emily Silverman
You just said her biggest fear for the day and I had this image in my mind of a whiteboard in every patient's room. And what if every day we had to identify the patient's biggest fear for the day and then, like, address that and orient ourselves to the patients in that way, how would that change the way that we practice medicine? It's kind of a funny thought.
PJ Lally
I love that! That's kind of, I mean, honestly, how I like to practice medicine. Some of my most human interactions with people, you know, might be bringing them candy if they're having a bad day. People who are struggling for very real reasons, whether it be drug use and mental illness in the setting of an infection, who are everyday trying to leave AMA, and trying to have a connected conversation about, like, “Do you understand that you have really horrible cellulitis, and you broke your arm, and you could lose your arm, and, you know, we're going to use this antibiotic,” and, you know, just trying to reach them in that place. And most of the time I've had the luck of it’s like, “Hey, are you feeling really hungry? And jumpy? Like, do you just want me to grab you some food right now?” And they're like, “Oh, my God, yes! I, like, hate being here!” I’m like, “Yes, every person who's five days in the hospital wants to gouge out their eyes with a spoon! I'm so proud of you for staying. Any day that you can stay is going to be better for your health. And if you just let me know what I can do to try to make this the least horrible possible, I'm really happy to do that.” And then they'll just open up and they'll share, “Oh,” you know, “I have a dog and my friend has been taking care of him,, and I'm just not sure if the dog’s safe. If someone could figure that out, I'll be happy.” Or, “Oh, yeah, it's just my boyfriend, you know, he just gets really terrified when I'm in the hospital, and I have to see him. I'm gonna go, but I'll come back.” And it's very clear what the conversation is and what the boundaries are and what their needs are. And then I can try to build a care plan around those needs. And it's just different seeing them as human beings working to make their own decisions, regardless of what I think they should do or shouldn't do. So yeah, whiteboard for that. I'm on it. That sounds great.
Emily Silverman
You strike me as a really just thoughtful and compassionate physician. So were you approaching medicine this way before your diagnosis, anyway? Or did you start doing more of this after your diagnosis? Or did anything really change? Or was it more the internal felt experience that changed?
PJ Lally
Going back to your original question about how I got into medicine, I think–because I knew you were going to ask that question because I listened to your other guests–I was trying
Emily Silverman
I love physician origin stories. It's like one of
PJ Lally
Oh, my gosh, I'm gonna give you my longer physician origin story. And I'll try to do it in the present tense so I can embody my Nocturnists self. So I'm in the third year of med school. And I'm doing my longitudinal family practice course, which at the University of Minnesota is a combination of, I think, family medicine, internal medicine, and maybe OB all into a nine month curriculum. And I had this just amazing mentor. Tim Rumsey was his name. And to give a flavor for people, he worked in a homeless shelter in the 70s, right out of med school, and then created an office with himself and one other person from that homeless shelter, where he would see primarily disadvantaged populations. So a lot of homeless patients–as he called it, multi-generational poverty, where you have a combination of abuse and mental illness and drug use and poverty–really complex medicine. And so those two people started a clinic and then they became four people in a clinic. And then that clinic became an actual brick and mortar clinic that they built, which became an FQHC, and then became a residency for a family practice program in Minnesota. So this is a forty-year career of someone who is a spectacular physician, as well as just an absolute gem of a human being, and who I really, really looked up to. So entering third year, I was not really stellar, I was not a good first or second year med student. Sure, I have horrible ADD, slash, I call it Functional Doctor ADD. So my version of second year and first year med school was biking across town to a coffee shop to attempt to study neuroanatomy for 45 minutes. And so it just didn't come easy. I was not the person who could remember 1,282 different anatomical points on a scale. You know, I kind of knew that I wasn't winning the game, I guess. And it kind of became evident about two weeks in, that Tim Ramsey also knew I wasn't winning the game. Like, I could see when I would do my presentation, and in that core curriculum, your whole job is to, like, basically, at the end be able to present an H&P in a coherent format–plus all the other stuff, but that's the thing you have to walk out with. And I wasn't doing that, I wasn't really a form-built person. So I come in after meeting the patient and give my, “Oh, well, they're this, and they're that, and they're this, and this is happening.” And you can just see him following the bouncing ball of my logic, but not necessarily saying “Oh, they have these four things in the past medical history and there's this and this and this. Two weeks and he sat me down and he says,”You're just you're not really getting it. I just need you to be able to come and do an H&P and do nothing else. Just walk right through this system. And for some reason, it clicked. I went home and I was, like, “Oh, like, you don't want to hear anything, except for just this blurb. It's, like, how, like, just literally, the blurb. And so the next day I came in and was like, “Okay, well, I guess I can just do a blurb if that's just all you want me to do. You don't want me to think about who the person is, you don't want me to think about all these other pieces, you just want me to say, ‘This is Mrs. Rice. Her past medical history is hypertension, she is on Lisinopril, in, like, a stuffy, suited way, just do the blurb.”
And I think the transformation of that moment is I started to realize that you needed to show up and perform. And without that you couldn't play the game. It's like, if you call your consultant and just ramble on about your day, they're not going to track you, they're gonna judge you. If you walk into a station and put in the wrong order, people are just not going to respect you. And I wasn't playing a game, I was kind of trying to do it my own way, I was trying to talk about people and all these other pieces. And once that really settled in for me, I think it allowed me to play the game, but also be myself, I finally have been able to essentially let go and can play the game when I need to. But in front of that person, I don't have to have any pretenses, it's just me just trying to care for them as a human being. And that is, to me, it's just the absolute ecstatic joy of practicing medicine where you just get to be with people.
Emily Silverman
I think what you're describing is related to the fact that so much of medicine these days has been reduced to a machine-like efficiency. And so sometimes when you're trying to communicate, and people are telling you, “No, no, no, we don't want to hear it like that. We want to hear it like this,” it can feel dehumanizing. Like, “Oh, why are we communicating in this hyper- efficient, sterile way?” But at the same time, we need to standardize communication so we can do the work. It actually reminds me a bit of storytelling. There's a very classic traditional story structure, where there's the status quo, there's the inciting incident– which is almost like the chief concern–and then there's rising action, there's obstacle one, obstacle two, all the way through, and then you have this climax with a death-rebirth moment, maybe an epiphany–doesn't have to be big. And then there's a feeling of de-escalating conflict, de-escalating tension, and then you end up somewhere new. And some people will map this as a triangle. Some people will map this as a circle. This is like ancient, ancient storytelling all the way back to Aristotle. But then there are people out there who are really experimenting with storytelling formats. And so they're saying, “What if we did it in a different way? What if we told the story like a spiral? Or what if we told the story like a patchwork, like a mosaic where it's just a bunch of little vignettes?” There's a great book by Jane Allison, that's called, Meander, Spiral, Explode. She looks to nature for different shapes, to think about how we might innovate on the storytelling practice and tell things differently. But I think you're right, I think if you're gonna go out there and innovate and riff and do the jazz and all of that, you kind of have to know what you're deviating from, you have to have mastered the scales. And then once you've mastered that, you can kind of be liberated and be able to riff on it if you want.
PJ Lally
It took me a while to understand, because it is super constraining. You know, it's like you want to be able to do it your own way. And you want to be able to say, “Medicine is so hierarchical and domineering, we need to take down that system.” And in any system, there is an intelligence and a form for why it is that way. Like in emergencies, we all get that a code has to be regimented in order to be run well. But then, is it always a code? No, it's of course, not always a code? Well, we're in the OR, you always have to have a sterile field. But there's also, you hear from surgeons who will talk about the art and the mystery of the decisions they're making in the moment, and how they solve complex problems, and all the dynamism that's in that stodgy, constricted environment–the real joy that they're able to practice. And for me, it's like, there's so much of that even in the story about my death, thinking of it as a story. We're all going to have our own death, and we're going to be able to write it in whatever way we're going to be able to write it. So I've experienced patients whose death is a lot about the physical suffering, and they're really into the things that are happening in their body and they're just really attentive to that, or their families will connect really well with the individual pieces of an ICU stay. And then there are other families who will come in and just be with the grief process. And each arc is just like these different sways of an art form–this color versus this color. And like the story about my daughter, thinking of that as an example of this, you know, she's walking down the street, but then the song comes on with a person singing about their own life and how short it is, while I'm thinking about how my life is short. That's really gorgeous. I mean, horrifically, but also super beautiful.
Emily Silverman
Yeah, let's talk about that moment in the story, because I know that was a really important scene for you–this scene where you're walking with your daughter, you have not told her yet about your diagnosis, you still think that you're going to die soon. And she's singing, and she's dancing, and the lyrics of the song feel weirdly pertinent. And I've been thinking a lot about this idea of the synchronicity, which is sort of like a new-agey term. I don't know if you've heard of it, but this idea that, like, maybe you're thinking about a certain topic, and then you walk down the street, and you look, and there's a poster that's on that topic. And it could just be a coincidence. But some people choose to interpret it differently as more of a synchronicity, which is like my attention is being turned by some greater force to this poster or to this graffiti on the wall whose message somehow seems significant. And so I'm wondering how you are thinking about that moment with your daughter and the song that she happened to choose, the lyrics that she happened to be singing? What was it like inside that moment for you.
PJ Lally
I think everyone has the filter you take the world in through. And those moments of, as you call them, synchronicity, for me are those almost crystallized moments of different pieces, overlaying and inviting either deeper questioning or deeper wondering or a sense of connectedness or a sense of awe. And those sort of special moments in life, when you connect with another human being or, you know, walk out into nature, there is something about the specialness that can arise when those things overlay. And so for me, those are things that you could see, so it was the sun setting over the houses, and just the grasses flowing on the side and the white fluffy dogs. So there was the stage in terms of the physical world that was apparent. Then there was also just, like, the mental emotional place, like whether it be my thoughts about my death, or like the words of that song, like when I'll be fifty years old, or whatever it is, and this person doing an active life review and me doing an active life review at the same time. So you, sort of, you're almost like a DJ layering things. You put in the bass beat of the beautiful night, and then you layer on this next sort of line of what you're seeing, “Oh man, there's some things happening here!” And at that moment, to me, the feeling was a sense of beauty, but really short. There was the sense of, like, seeing an ice crystal in your hand, and then it melting. And for me, that moment was just like a sense of such beauty. But such a sense of like, “Oh my god, at any point in time, she could just disappear, and does disappear–she grows up, you know, she changes into a different person. All of those things are always so present and sometimes we're aware of them and sometimes we're not, like sometimes we're not necessarily aware of our mortality. But you know, after you’ve had a brain tumor diagnosis, you get aware of your mortality briefly. And that's what it was like, for me. It was all of those things, just like an instance, the sun setting, her singing, me thinking about who I am as a person, all and just this, like, whoosh, and then it was gone.
Emily Silverman
It reminds me of a conversation I had with a friend of mine who spent some time in the Colombian Amazon rainforest. She was working in, like, forest preservation kind of stuff. And she was in the bush with a bunch of indigenous people there. And just describing how different it was, just the way of life. And one of the examples that she gave was the snakes and the bugs around and she was saying, “Yeah, these people could step on a snake any day, and die.” And she said that that was shining through in their consciousness, that there was this quality to their consciousness that just felt a little bit brighter and a little bit aware that life could end at virtually any moment. And she was comparing that to, you know, how we live in the United States where we're on the couch, we're watching Netflix, we're super safe in general, there aren't as many immediate threats to our life and just what it's like to switch between those two environments and, I don't know, I'm wondering if you have any thoughts about that.
PJ Lally
I love that story. And there is something to be said for it, and it sounds so whatever, but the suffering of having it easy, or not having to feel things, or like less sex, drugs and rock and roll concept. You know, you can always just pick up another snickers bar. And it kind of sucks in a way to be able to just live that life, because you don't get the chance to wake up as much. You can just live an entire life very comfortably in that place and not necessarily get to experience the vividness of it. What my spiritual teacher used to talk about, it's an Arabic word, but he called it the Jelal and the Jamal. It's basically the beauty, and then I would almost call it, like, sternness of life. And the beauty of life would be like the ease that can happen when the breezes blow out your back or when things are smooth. And you know, whether it be an easy day at work, or whether it be like a sense of connectedness that you're like, “Oh my God, I just, I need connection with people,” and you're really being fed with connection. That's like the beauty of life. But then there was this concept of, you could translate as severity. I think of sternness as a little bit better, but a sense of, there's a beauty in the sternness, too. And that without thirst, you don't get to have the sense of being quenched. And without snakes about to bite your feet, you can just eat snicker bars your whole life, and live, and you don't necessarily get it. And it sounds like such, like an easy spiritual teaching, but in a harsh way, that's really what I experienced a lot through my diagnosis–was like, “Holy, you know, bleep, you know, who am I, what have I done?” Having a sense of being cut short and thinking, ”Is this fair, like, it isn't really fair, I'm not happy with this or this or this or this. And just like my sense of complaining was brought really intensely forward and I kind of had to be present to my disgruntledness. Otherwise, it was just going to be crappy, like I was just going to have a crappy six months of resentment. But not to say that resentment isn't reasonable. Like, it's a reasonable response to having a life cut short, like forty is young, but twenty-six is younger, but there’s still just, like, a sense of, like, resentment that arises. And so there's the things that can happen with a sense of harshness, and the life really becomes fodder for being able to take those things and examine them and let them go–to have a sense of fulfillment that's more rich and more lasting, that wouldn't otherwise be possible. That teaching was always, like, the severity is actually a more beautiful state than the ease, because the severity is what brings apart your neediness as a human being. It's what literally allows vulnerability. Like if you weren't hungry, how could you be suckled as a baby and satiated by your parent? It's, like, how could you express a need and have it be met, without having had that need in the first place? And that sense of being ripped open as a pathway to be able to say, “Oh, I need help.” And that's like such a profoundly different way to live.
Emily Silverman
So PJ, you just finished a master's degree in divinity? What is a master's in divinity and why did you choose to get one?
PJ Lally
I got a master's in divinity through the school called the University of Spiritual Healing and Sufism. And I studied peacemaking and conflict resolution, of all things. And, to me, med school, like I shared, was a pretty hard experience. And there were lots of times where I wanted to shut down, clap out, be pissed and resentful, and just kind of do all the normal human responses of, like, “This isn't fair, this isn't fun. I think I want to take my bat and ball and go home.” And that program, I started it actually my first year of med school. So I would, like, leave in the middle of biochemistry, and then come back and then finish the rest of biochemistry and be, like, several weeks behind. And I just finished it, actually, I graduated right after our program. So I flew from the night where we did our talk, and then went right to that program and finished graduation. And to me, it was just the thing that kept my heart alive during med school. It was the program that would remind me, when I'm feeling frustrated or resentful about a particular patient or a family who's not listening to me, to think about what are their needs in the situation or where am I coming from that's heavily judgmental or just doesn't like conflict or just wants to be in charge. And it allowed me to stay human in so many ways and try to experience the craziness that is medicine as a human being rather than as just a, myself alone, I guess.
Emily Silverman
Any last words for our listeners, for our audience of healthcare workers, maybe a message you want to leave them with, or anything like that?
PJ Lally
I just want to say thank you to The Nocturnists’ community as a whole. There's not just one or two, there's like ten, or twenty, or thirty of you that seemingly are all amazingly dedicated to the work of sharing stories and building a sense of community and healing through stories and joy of stories. I think that's the biggest thing that I got, was just having a little taster of the community that you've built. And so I just have an invitation for people to keep joining in, to submit your story, to listen to the podcast, to know that every person who's a part of this has their own story and is trying to share it and to help us find our voice, so we can share and be with each other.
Emily Silverman
Fantastic. I have been talking to Dr. PJ Lally. PJ, thank you so much for being here today.
PJ Lally
Emily, thank you so much for the opportunity.