Storytelling Group Fills Void Left By Modern Heathcare Professionals' Flagging Faith

By Kirk Klocke
editor’s note: this author contributes to The Nocturnists as a producer.

High intelligence is a gift and a curse. The gift part is the part everyone sees – and envies. Talented people test well, create beautiful music and art, and unwittingly leave a big Google footprint in their wake, because they represent the creative class. And with academic success, material success often follows. These seemingly lucky people and their worldly lifestyles make for great Instagram fodder, and for that, we love to hate them.

Mellody Hayes, M.D., rehearses a story before a March 28, 2019 performance of The Nocturnists. Hayes is building a community clinic in San Francisco with a mission of treating depression and PTSD related illness. (photo/Kirk Klocke)

Mellody Hayes, M.D., rehearses a story before a March 28, 2019 performance of The Nocturnists. Hayes is building a community clinic in San Francisco with a mission of treating depression and PTSD related illness. (photo/Kirk Klocke)

But behind the fancy degrees, prestigious titles, and sunset photos taken from 34,000 feet, there is often profound suffering and loneliness. The more we have, the less we have in common with most people. And by “more,” I don’t mean material things. Highly-intelligent people hustle for intangible status symbols, like speaking at TEDx, publishing in top-tier journals, and just being able to make people laugh. Shankar Vedantam, host of NPR’s celebrated Hidden Brain podcast on science and culture, coins this generation’s immaterial prestige status seekers “the aspirational class.”  They aim for the respect of their chosen peers, but more than that, they seek validation from themselves.

In a culture that increasingly worships work more and faith traditions less, few classes of people fall higher on the hard work totem pole than doctors – especially rising academic physicians, who sacrifice their scarce free time to be productive enough to be taken seriously among the medical elite. The efforts that propel them closer to those who they venerate further remove them from the everyday world, driving a cycle of isolation and loneliness that them with an outsize risk of depression, substance abuse, and suicide.

I’ve seen the fallout among physicians and other high-functioning professionals firsthand. They come to community support group meetings, sometimes too exhausted to remember to take off their hospital name tags. A few years ago, I befriended a young woman at a meeting who was both a writer and a medical student, and we hit it off. She died a couple years later at 32. Two recent University of Minnesota medical trainees died of suicide in the past year, prompting school officials to make sweeping structural changes meant to alleviate burnout and reduce barriers to getting help for mental health issues.

And unlike the other over-the-top hard work professions – investment banking, law, engineering, managing tech startups, and C-suite level corporate administration – doctors have the added stress of watching sick people die and then having to tell their families the bad news. Physicians with a nascent academic career decidedly have two jobs – taking care of patients in hospitals and clinics, and serving as teachers who [must] contribute to their institution’s research.

The demands of the clinical side of doctoring keep growing, too. Hospitals often push for the maximum allowable case load per provider to make ends meet. Growing up, I watched as my father, an accomplished hospital internal medicine physician, regularly came home after 12+ hour shifts, having had to take care of 17 patients at a time. The docs who can swing this are heroes, to be sure, but is it safe? His general advice growing up was, if you work as hard as I’ve worked as a doctor doing just about anything else, you’ll be just- if not more- successful – probably sooner than I was. In other words, don’t do what I did, unless it’s the medicine itself that you really, truly care about, not the material rewards of becoming a doctor.

By the time a lot of rising physicians fully grasp what they’ve gotten themselves into, they’re in too deep to turn around and choose another path – or at least that’s how they feel. Feeling like you’re both suffering and stuck is a perfect recipe for depression. The long-term remedy to that looming, hard-to-define emotional dark cloud has historically been participating in a faith community – usually the one of one’s upbringing. The other way is drugs and alcohol, which, of course, work great – until they don’t.

The March 28 performance of The Nocturnists was themed “Mistakes.”

The March 28 performance of The Nocturnists was themed “Mistakes.”

Doctors fall widely on the faith spectrum, with atheism so fierce on one end that itself is a sort of religious community, with devout Catholics, Orthodox Jews, and followers of Islam rounding out the other end. Celebrated doctor-author Oliver Sacks was famously atheist, but his passion for neurology and writing were that of a deeply spiritual human, whose work was his faith. It’s not that he didn’t believe in anything, he just didn’t subscribe to supernatural explanations for unexplainable phenomena.

Even among docs who enter the profession well grounded in the faith of their upbringing, the daily grind of seeing people in their darkest hour can chip away at their spirit. Add the expectation of 24-hour shifts, working holidays, missing weddings and other important family events, and in some cases staggering six-figure medical school debt, and it’s no wonder physician disillusionment, burnout, and even suicide are on the rise.

There is, however, a shimmering light of hope amid the collective suffering. A movement is afoot to alleviate burnout among physicians and other healthcare workers by infusing humanities back into medicine, marking a sea change that is an intellectual shift closer to arts and humanities. With the discovery of antibiotics, imaging, cancer treatments, and most recently, immunologic drugs, mid- to late-20th and early-21st-century doctors have ridden a wave of rising invincibility. Who needs faith and the “soft” disciplines, when we can fix almost anything?

The sobering fact is that despite these advances, one way or another, we still reach the end of the road. Sometimes way too soon. We can often use these tools to fight nature for a few more days or weeks or months, but doing so causes profound suffering for both the patient and their family, and cost the patient their entire life savings in the process.

So no matter what science does, we’re still left with the facts of life and the vast unknown. That’s where the emerging field of narrative medicine has begun to gain traction. Humanities practitioners have long been undervalued, but now they’re finally getting a place at the table in medicine. The field bridges this intangible gap among patient, provider, and the decision-making space that needs more breathing room.

There is a growing humanities and medicine movement outside the increasingly structured realm of narrative medicine, too. This is perhaps the most intriguing and exciting news of all.

At the nexus of this formerly underground, but now more mainstream medical humanities movement is a woman I met by chance while navigating my own personal struggles and grasping for something meaningful to do.

Emily Silverman, M.D., a Bay Area academic hospitalist, introduces the live Nocturnists performance held March 28, 2019 themed “Mistakes.” (photo/Kirk Klocke)

Emily Silverman, M.D., a Bay Area academic hospitalist, introduces the live Nocturnists performance held March 28, 2019 themed “Mistakes.” (photo/Kirk Klocke)

Emily Silverman grew up in the Miami, Florida area, a creative writer and precocious science nerd who avidly read The Magic School Bus series of illustrated children’s books on human anatomy. The Magic School Bus was her early-life connection to medical storytelling, and her visits to her pediatrician were a prelude to being a future medical podcast host, in which she grilled her doctor on the nuanced ins and outs of her body and health. After a few of those visits, her doctor probably learned to keep the next slot in her schedule open.

Emily was a fan of architecture, writing, and nature’s beauty in general. Ultimately her heart and undergraduate studies at Brown University led her toward the path of medicine, and she landed at Johns Hopkins, which consistently ranks as a top U.S. medical school and is regarded as a peer to Harvard. She won’t tell you any of this in-person, because she practices humility and deference to other experts, perhaps an outward homage her early Jewish grammar school pedigree. Emily is taller than average, has a serious affect when meeting new people, and has a muted yet commanding presence when she enters a room, like Obama. And like Obama, she’s deeply introverted and has to retreat into her own inner world for a day or two after big, people-intensive events.

Her personality and thought process is like that of so many other famously-effective leaders. She avoids forging ahead without a group consensus, but she also knows when to cut her losses and unilaterally manage. Emily is honest, straightforward – a perfectionist who does exactly what she says she’s going to do exactly when she says she’s going to do it, and she at times finds it difficult to work with people who don’t measure up to those standards. She manages her time meticulously to fit everything in.

That ‘everything’ includes her brainchild, a new medical storytelling organization called The Nocturnists, a title that cleverly points to the suffering medical trainees experience. Her medical specialty is hospital internal medicine, or “hospitalist” for short. Hospitalists typically binge-work so their patients have better continuity of care. They work 7 or 10 long days on, followed by an equal number of days off. It’s a rough hustle, but it’s a schedule that in just under four years has allowed her to expand The Nocturnists from being her personal blog to a nationally recognized podcast and live storytelling show.

The event’s success is what she wanted, and the speed at which it became wildly popular among San Francisco Bay Area medical professionals points to a hunger in the profession for a place to process their often difficult experiences and create meaning for themselves. “We’re able to sell out our shows despite the fact that most people [only] know about us from word-of-mouth, and a bit of social media as well,” Silverman said. “So we’re really fortunate to have an engaged audience and just a real hunger in the healthcare community to participate in this kind of community building.”

Storytelling has been a way of processing the human experience and making life more livable since the dawn of time, so it’s not entirely surprising that Emily’s show and podcast have taken root so quickly. As one of her producers and storytelling coaches, I’ve been to several of the events and listened to many of the recorded stories. The sold-out crowds of mostly healthcare workers seem to be getting a hard-to-define need met, not unlike the connectedness religious practitioners get when they attend their Church or Temple’s services.

Emmeline Sun, a Bay Area clinical social worker, performs a story about the bittersweet journey of taking care of a particularly challenging long-term client. (photo/Kirk Klocke)

Emmeline Sun, a Bay Area clinical social worker, performs a story about the bittersweet journey of taking care of a particularly challenging long-term client. (photo/Kirk Klocke)

“When I was coming out of my intern year, I really wanted to get working on something creative as a way to reconnect, not just to my creative side, but also to my human side, because I felt like a lot of the work I was doing in the hospital was really dehumanizing,” Silverman said. Attending a live taping of The Moth, she said, was what inspired her to take The Nocturnists beyond sharing written pieces online into the realm of oral storytelling. About 40 people attended the first show. This spring, The Nocturnists’ event, themed “Mistakes,” sold out the 360-seat Brava Theater in San Francisco’s trendy Mission District.

“I was seeing a lot of really intense things every day at work,” Silverman said of her intern year and first year of residency. “But I never really talked about it with anyone – and I knew other people were having the same experiences, and I just wanted to create an intimate space where we could just talk about it.”

The Nocturnists’ popularity quickly expanded beyond the medical community and has found favor among lay people who are curious to hear about what real, “non-Gray’s Anatomy” life in medicine is like. “…because even if you don’t work in medicine, you have a body, and chances are at some point in your life, you personally have had a health issue or someone you’ve known and loved has had a health issue, so we’ve all interfaced with the healthcare community at one point or another,” she said. “So I feel like these stories – even though they are aimed more at the medical community – really are more universal stories.”

The universal nature of most stories is the glue that binds communities, faith and otherwise, together. So in a sense, whether we identify with a religion or even with generic spirituality, we are all creatures of faith – if in of nothing else, at least each other. The simplicity and elegance with which Emily Silverman has harnessed that universal power of connection is why I’ve chosen to make her one of my up and coming artists to watch. I cannot be objective, because I participate in The Nocturnists, but I can tell you that I watched our storytellers move the audience to laughter and tears this past week. Something about it is working, and I don’t recommend things lightly, but I wholeheartedly recommend you check out The Nocturnists on iTunes or wherever you get your podcasts, and keep an eye out for the next event and consider coming to see the magic of storytelling unfold for yourself. ♦

Nocturnists storytellers, storytelling coaches, and producers - including Executive Producer Ali Block, M.D. - take their final bow following the March 28, 2019 live performance held at Brava Theater in San Francisco, themed Mistakes. (photo/Kirk Klocke)

Nocturnists storytellers, storytelling coaches, and producers - including Executive Producer Ali Block, M.D. - take their final bow following the March 28, 2019 live performance held at Brava Theater in San Francisco, themed Mistakes. (photo/Kirk Klocke)