State of the Human: Learning Medicine

We visit five places on campus where future doctors are learning how to practice medicine. We’re going to real classrooms: anatomy lab and wet lab, lecture halls, we visit a Stanford Free Clinic, bike across campus to the mausoleum, and head down the road to Webb Ranch. We’re asking: How are students learning to practice medicine, thoughtfully?

Transcript for Learning Medicine (Full Episode)

Gaby Li: [00:00:00] "[Words in Korean]," my grandma said in Korean, her words rushing together in panic. I stopped in my tracks. It was 3:00 AM, and we were just getting ready to leave the ER after rushing Grandma to the hospital and getting antidepressants for her sudden spike in severe headaches.

"I can't see, I can't see," she repeated urgently.

I remember rushing to her side as mom rushed out to find a doctor. Grandma kept rubbing her right eye saying she could only see with her left. What happened next shocked me to the core.

Because the doctor didn't cover up her good eye completely, she was able to say the correct number of fingers he was holding up.

"See, she's fine," the doctor had said, turning swiftly to leave.

Grandma, confused and anxious, clamored and panicked to my mom and I, saying she didn't know she was supposed to close her good eye when testing the other.

We tried to explain what happened to the doctor and asked for a more thorough eye exam, but this miscommunication quickly devolved into a fiery exchange. Our pleas fell against deaf ears and the distressing encounter ended with grandma forced home, untreated.

Far too many people have had an experience in healthcare like my grandma and I. Maybe you have, too. Failing to listen and empathize with patients isn't something that should be overlooked. It has serious consequences in both the emotional and physical parts of treatment and recovery. And the quality of patient provider communication continues to deteriorate as doctors face increasing time constraints from burdensome technology, administrative demands, and grueling schedules.

But as much as I want to direct all my fury and frustration at the doctors that [00:02:00] have mistreated me and my family, I realize that these problems stem from more deeply rooted issues in the institution.

These experiences are part of what draws me to studying cross-cultural issues and patient advocacy as a sophomore at Stanford. I see the ways in which our medical education system has failed to foster humanism in medicine.

You are listening to State of the Human, the podcast of the Stanford Storytelling Project. Each episode, we take a common human experience, like datafying or promising, and bringing you stories that explore and deepen our understanding of that experience.

I'm Gaby Li, a pre-med, a cellist, and an outdoor enthusiast.

This episode: Learning Medicine.

We know in medicine that something is happening. Research and patient stories show that medicine can no longer just be about treating a disease or performing a surgical procedure. The way we treat the whole person changes the outcome.

There's a lot of discussion about medical training in the US as medicine begins to change.

Today on our show, we're looking at the current ways students are learning medicine amid all the problems, and the promises of medicine.

We visit five places on campus where future doctors are learning how to practice. We're going to real classrooms, anatomy lab, lecture halls. We visit a Stanford free clinic, bike across campus to a mausoleum, and head down the road to web branch. We're asking, "How are students learning how to practice medicine, thoughtfully?"

Sometimes, a word can help identify exactly what's missing. Urban Dictionary says [00:04:00] to be "stoked" is to be "completely and intensely enthusiastic, accelerated, or excited about something. Those who are stoked all the time know this. Being stoked is the epitome of all being."

I'm reading this definition of stoked on Urban Dictionary because I'm from the East Coast, and I never heard anyone use "stoked" until I came to Stanford.

In our next story, state of the human producer JJ Kapur learns the healing power of getting stoked.

JJ Kapur: When my grandmother felt a lump in her neck in 2014, we prayed that it would be harmless. After numerous tests and scans, we learned that she had cancer. We were not ready for that diagnosis. I remember the day my family gathered in a hospital room in Des Moines to learn what would happen next.

I could feel the tension in the room. My mother did her best to make small talk with my grandmother about groceries they would need to purchase later that day while my grandmother stared down at her shoes. I remember just looking at a painting on the wall depicting the most generic bouquet of flowers I'd ever seen before I heard a knock on the door.

The radiation oncologist, Dr. Richard Deming, entered the room. He had gentle eyes and a kind smile. His warmth seemed out of place in the dull, artificially lit hospital room. When he first approached my grandmother, he did not feel her forehead, check her pulse, read her blood pressure, or pull out her scans on the computer.

Those were at least the stuff I thought doctors were supposed to do. Instead, he did something none of us expected. [00:06:00] He gave my grandmother a hug.

That hug lifted the immense fear and distress off of our shoulders after my grandmother's surgery, which removed half of the lymph nodes in her neck after months of radiation treatment, which left her with a painful pink scar and a small, scratchy voice.

In Indian culture, a hug means a lot. It signifies kinship. Dr. Deming was no longer just a doctor. Now, he was family.

As the treatment went on, my grandmother started calling Dr. Deming her brother. When she'd come in for radiation treatments, she'd bring with her homemade Punjabi rotis and dah for him to take home.

She would wag her finger affectionately at him, cackling with amusement, a playful smile and twinkle in her eye, saying to him in a voice that was now thinner from her treatments, "You are too skinny! Eat this." I remember something being awakened in me, but then again, I was 14. Tons of things were being awakened in me. High school. Friendships. AP biology. Eventually, Dr. Deming and my curiosity about medicine became a distant memory. That changed when I came to Stanford.

I came thinking I'd be a political science major, or at least that's what I told everyone I wanted to study. To be honest, a little part of me always dreamed of becoming the first Sikh president, but as soon as I started taking actual poli sci classes, I quickly realized I didn't [00:08:00] quite fit into the major. And I was bored.

While scrolling through the course catalog in the winter, I stumbled upon a list of intro stems, also called introductory seminars-- super small classes only freshmen and sophomores can apply for. One particular introsem caught my eye: The Psychology of Stoked?

As an Iowan who had only ever heard the word "stoked" in the context of surfers catching waves, and well, The Beach Boys, I was intrigued. Plus I just felt like, yeah, I needed to get stoked... whatever that meant. So I signed up.

I will never forget my first day taking the Psychology of Stoked. It was a cold and rainy evening. Dr. Joshi and Dr. Reicheter, our class professors, walked with us to the mausoleum. I felt safe in their presence, but I also felt on edge as if one of the statues we were walking past on our way to the mausoleum were ready to come alive at any moment.

At the mausoleum, I learned that this was the site that stores the remains of the university's namesake, Leland Stanford Junior. I remember just stopping and thinking, "Wow, our entire education was built on the death of a child."

While the cement sparkled as the sun set, we all gathered in a circle. Each of us read a portion of Nietzsche's thought experiment, the heaviest burden.[00:10:00] 

"What if someday or night a demon were to steal after you into your loneliest loneliness and say to you, 'This life as you now live it and have lived it, you will have to live once more and innumerable times more. And there will be nothing new in it, but every pain and every joy and every thought and every sigh must return to.

The question in each and everything: What are you doing right now? Would you want to do that thing again and again and again for eternity? 'Do you want this life once more and innumerable times more' would lie upon your actions as the greatest weight."

While listening to this thought experiment, I was taken aback. And I don't think I was the only one. I looked around at the other dozen or so freshmen, standing around in a circle, some of them nervously laughing, others with eyebrows raised, but it seemed like everyone in the class was totally engaged. I could feel Nietzsche's eternal return, bringing a sense of urgency and clarity into the decisions, big and small I made every day.

Do I take this boring [bleep] class because it's required for my major again and again for the rest of my life? Or do I audition for a play I think is pretty cool?

Do I spend Friday night studying for a midterm again and again for the rest of my life? Or do I camp outside and stare at the stars while having a deep conversation with my best friend?

As this was only my second quarter at Stanford, I wondered, is this what classes are like here? I felt something light up [00:12:00] inside me. It felt like the same spark when I first met Dr. Deming. Just as Dr. Deming delivering a cancer diagnosis to my grandmother made my family aware of her mortality and the fragility of life, Dr. Reicheter and Dr. Joshi were doing the same thing, except for a bunch of college freshmen.

I had a lot of questions. I was curious about my professor's unconventional teaching methods, so I sat down with Dr. Reicheter and Dr. Joshi over a cup of coffee, where this class began.

For Dr. Reicheter, a trauma psychiatrist who works across cultures, the stoke has more to do with California, where he was born and raised than anything else. And finding a sense of meaning in our work and even in our relationships is critical to getting stoked.

Daryn Reicheter: I think when you think about stoked, you think about big wave surfer with a, you know, double overhead wave crashing all around him.

And yeah, that can get you real stoked. But, you know, one of the things that we really want to bring out with this class is you can get real stoked by sitting by the fire with your wife and not doing anything. Just sitting there. There's a, there's a million ways to get stoked. Not, not just surfing. Though surfing's a darn good way to get stoked, I must say.

JJ Kapur: For Dr. Reicheter, teaching the Psychology of Stoked is a nice change of pace from his schedule.

Daryn Reicheter: Both of us have what a lot of people would think of as a very sad, dark aspect to our career. Shashank, uh, Dr. Joshi thinks about suicide and suicide prevention, and I, I do work with survivors of torture and survivors of human rights violations.

JJ Kapur: I, I don't see this work as dark or [00:14:00] down. I mean, it's a buzzkill at a party. If someone asks me, "Hey man, what do you do over at Stanford?" I love what I do. I see it as a, I see it as the light. Having that in the same week that I do the stoked class is, is a nice balance.

For Dr. Joshi, a child and adolescent psychiatrist, teaching a class about wellbeing to college freshmen is also about the prevention of mental illness.

Shashank Joshi: We have learned that psychiatry absolutely should be involved as a field with using the concepts that we teach about in the stoke seminar. Positive emotion and engagement. Meaningful relationships, right? Meaningful work. The concept of flow, accomplishment, and achievement. And that we didn't wanna wait for someone to come to a clinic to learn about those things.

JJ Kapur: A friend of mine recently told me a symbol formula for the best way to cultivate personal growth. He said, growth equals experience plus reflection. To me, this formula perfectly captures why the stoked class was so formative. Weekly challenges paired with opportunities to reflect in seminar helped me realize the things in life that matter the most.

Both Dr. Joshi and Dr. Reicheter taught me a lot about life, but they also taught me a lot about medicine. To them, a doctor's job is not just fixing the broken machine, it's also about tuning up the good parts. After taking the Psychology of Stoked, I [00:16:00] finally realized what it was about Dr. Deming that made him so special.

He didn't just treat the cancer. He saw my grandmother as a whole human. He knew that giving her a hug each time he saw her, or encouraging her to cook a Punjabi meal for him, wouldn't cure her cancer. But it would get her stoked. It would bring her a sense of comfort and purpose and joy.

Now, I am no longer a poli sci major. I'm a theater and performance studies major, who is also pre-med. I'm a theater pre-med because that's what gets me the most stoked.

Every once in a while, I'll take the long way to class and bike by the mausoleum for old time's sake. And if I'm not running late, I hit the brakes, step off my bike, look at the grave in front of me. Remember that first day of class, and for a few moments contemplate the fact that my grave site will probably not be marble and surrounded by palm trees and Egyptian goddesses. I'll probably be cremated, but anyway-- when I stand there and contemplate death, I am always reminded of life.

Gaby Li: That story was produced by JJ Kapur and [00:18:00] Esha Dhawan.

For many doctors, it takes four years to complete their degree. But for physician-scientists, doctors who have an MD and a PhD have eight years of school. These physician-scientists treat patients and conduct cutting edge medical research. 

This producer tries to figure out if learning medicine and learning how to conduct medical research is the path for her.

To make things more complicated, Victoria grew up in an Eastern medicine household, so pursuing an MD in the Western tradition is already lifting a few eyebrows.

Victoria Yuan: They say that mother's always right, and my mom tells me, "Victoria, Western doctors, they treat the human body like it's a cheat sheet, like it's a robot."

It's what she said to convince me to get acupuncture. Six years ago during a soccer tournament, I pulled a lower back muscle. Our team nurse prescribed me heat packs and rest, but my parents substituted Icy Hot with needles.

When it comes to medicine, my parents and I don't always agree. I want to go to medical school, but my parents think it's too "shinku" for a woman to be a doctor.

"Shinku" translates to bitter suffering. My parents think there's an easier path for a woman. And God forbid Western medical schools teach a kind of healing that is not what my parents raised me with.

When I was a kid and got sick, my parents didn't give me Tylenol. They gave me black bitter brews.

In traditional Chinese medicine, the body's life force is called Qi. When your Qi is out of balance, you get sick. And this brew restores your Qi. As a kid, traditional Chinese medicine was fun. I [00:20:00] pretended the black soups were witches' brews, and my dad was the warlock who made them.

But being the daughter of a warlock doesn't get you into medical school. You have to be a great scientist. It's why medical schools require a year of biology, a year of math and statistics, a year of physics, two years of chemistry.

So, in my senior year at Stanford, I'm taking an advanced genetics class. With the boom in DNA sequencing and computer science, medicine is being transformed. In genetics lecture, we learned that people can be represented by their DNA.

We're all a series of molecular symbols. We're A's and G's, C's and T'S neatly strung together. And when it comes to disease, medical treatment can be personalized based on your DNA. The order of your A's, G's, C's, and T's influence how your body responds to medicine. When my genetics professor starts describing how parents pass genes to children, I start to wonder what I'll inherit from my parents.

I've got my dad's nose and my mom's nearsightedness. But what else will I take from them? My family and I have different ideas of what medicine is and what women's roles are, but when it comes to our heritage, it's where my parents and I connect, where we build our home.

I don't believe in traditional Chinese medicine, but I still wrap dumplings with my mom and lose at Chinese board games to my dad. The only thing my family and I have in common is that we're all Chinese. I know our culture is what I want to inherit, but this genetics lecture is the approach to healing that my parents don't believe in.

[00:22:00] Western medicine requires a sacrifice, but I can't renounce my family and the traditions that hold us together. How do I reconcile being a daughter with being a doctor? I'm trying to find the answers, so I'm going to someone who bridged their culture with science.

Ann Ming Yeh: My name is Dr. Ann Ming Yeh. I'm a pediatric gastroenterologist at Stanford.

I use acupuncture for patients with belly pain, irritable bowel syndrome, and you know, sometimes even Crohn's disease or ulcerative colitis to help with their inflammation.

Victoria Yuan: I decided to meet with Dr. Yeh, who works a 10-minute bike ride away from me. Dr. Yeh and I walk through a plantation of gray cubicles to a small conference room.

We're surrounded by dark wooden chairs and white walls. In this sterile room, the only color I can see are Dr. Yeh's bright, red earrings. They're the color of the red packets my dad gives me at Lunar New Year. They're the color of his lucky tie and my favorite dress. As these red earrings wink at me, I asked Dr. Yeh, how did she learn Western medicine while staying true to her heritage?

Ann Ming Yeh: I really thought I was white. For the radio audience, I am Asian American, Chinese American [laughs].

Victoria Yuan: But it turns out, as a teenager growing up in New York, Dr. Yeh was more in touch with her Western culture than her eastern roots.

Ann Ming Yeh: In a way, it was a little bit rebellious in not really loving to learn Chinese, in general, language, and also culture.

I very much identified with the Caucasian population, and my parents who are both PhDs in physics and material science.

Yeah, from a health standpoint, really believed in, in, um, traditional Chinese medicine. Herbs and acupuncture and things like that. Energy circuits and five elements and life force and your [00:24:00] essential energy meridians and spleen Chi stagnation.

When I, um, went to visit some family members in Taipei, um, Taiwan is-- I think I might have had a cold or something, and they brought me to an acupuncturist. And I adamantly refused. I was like, "No way. I am not doing this. I don't want anybody to stick needles into me." I had one needle, and I nearly passed out [laughs].

Victoria Yuan: But when Dr. Yeh was older, she visited China, and it changed her perception of Chinese medicine.

Ann Ming Yeh: I studied abroad in Beijing, um, my junior year in college, and I, um, had an opportunity to do a one-month internship. And my internship was at a traditional Chinese medicine college. And they basically were like, "Oh, [unclear], you wanna learn about acupuncture. So today, you can practice on this orange. Here's how you do it. Tomorrow, see that lady of-- a row of ladies with swollen knees over there? Yeah, those are your patients tomorrow."

So they're all just sitting there like drinking their tea and getting acupuncture on their knees. They love that community and connecting in a way that's meaningful.

I realized that talking to little old ladies was much more interesting than like, working with lab rats and computer chips.

Victoria Yuan: Being a doctor is more than just science. It isn't just DNA and biology. It's tea. It's connection and community. But that's definitely not in my genetics lecture notes.

As Dr. Yeh reminisces about the acupuncture clinic, I can almost hear the clinking cups and the cadences of Mandarin. It's a comfort that I've heard before when I visited a hospital in China. Two weeks into a trip to visit family, my [00:26:00] dad's ankle got infected during a hike.

It swelled to the size of an apple, and it was a sickly yellow color. So my five aunts and I had to take him to the hospital. Every day, he spent an hour in a large, dimly lit room, where a nurse would attach an IV drip to his arm. But, like those little old ladies at the acupuncture clinic, my aunts and I sat with him.

We brought old family pictures, mostly of grandpa. My dad told me stories of him and grandpa smoking cigarettes out in the yard of weeds, while grandpa would tell dad to explore the world. To see America. After three days in that Chinese hospital, I realized no one was alone. This is what medicine can look like, and talking to Dr. Yeh reminds me of that.

Ann Ming Yeh: Western medicine, or all-- allopathic conventional medicine, we're very reductionistic, where pediatrician's gonna do some basic exam and laboratory studies. Traditional Chinese medicine, we still really believe that the soul and the, um, the wellness of the person is very tied to the wellness of the body.

And it's a little bit of a different approach. Looking at, you know, how, um, their disease might affect their whole, um-- whole existence, really.

If I have a family that really believed in traditional Chinese medicine, herbs and acupuncture and things like that, and so I will say, "Okay, I'm looking at your child's labs. They all look great. And then I'm looking at their tongue and it looks ,like the coating on your tongue from a traditional Chinese medicine standpoint means that you need to eat a certain way or move a certain way, or... you know, take these herbs."

I've always been straddling the science and the traditional healing.

There's a little bit of that teenager in me, still. It's always east versus [00:28:00] west, no [laughs]. In a way, yes, but there's always a little bit of a conflict.

Victoria Yuan: In America, the hospital is nothing like in China. It's a quiet room with only you and your doctor. And maybe a poster telling you to eat broccoli. I think because of that emptiness, my dad always brings me to his doctor appointments.

He trusts me to help him understand the basic science of medicine.

At times, my dad is doubtful of western medicine, the same way I'm doubtful of traditional Chinese healing. But I make Western medicine familiar for my dad. No matter what strange things the doctor tells him, I translate to him in Mandarin, in those relaxed tones that we use when we play board games.

Ann Ming Yeh: I, um, run the elective for the pediatric residents in integrative medicines. Most of the time they're feeling like a provider. They have a checklist of things to do, consults to call, orders to write, laboratories to check, and a lot of times, the residents will come back to me and say, "Oh, I felt like a healer when I sat down and played Uno with my super sick patient who is dying of cancer." That's where a lot of the humanism comes in, and I think that can very quickly be, not necessarily lost, but, um, put on the back burner.

Victoria Yuan: On Sunday from 8:00 AM to 3:00 PM, my name isn't Victoria my. Name is Yuan Yuan. When I volunteer at Stanford's free clinic, I introduce myself to my patients with my Chinese name.

I'm an interpreter, so I translate for my patient who speaks Mandarin and their physician who speaks English.

Last Sunday, I saw my patient in the small linoleum, tiled rooms of our clinic. I took their patient [00:30:00] history and asked them, "[Speaking in Chinese]? Do you live in the US?" They told me that they live in China, in the same city as my dad. In the city where hospitals are like living rooms. Where family surround patients. Where my aunts taught me Chinese folk songs, and my dad brought me to my grandparents' graves.

I explained to my patient that their doctor ordered a blood test. I started to walk out of the room, but my patient looked uncomfortable, so I stayed.

We sat side-by-side on faded red chairs while the nurse tied a tourniquet around their bicep. And when they frowned at me, I asked about their hometown.

Together, we reminisced about spicy sesame sauce noodles. We laughed at the memory of popping red firecrackers in the street for Chinese New Year. A frying rice cakes in the kitchen of-- "There. All done." The nurse jarred us back to California. My patient was finished with their blood draw.

Medicine is not just about the physical healing. It's about listening and learning.

At clinic, I have the privilege to understand how intimately lives can touch each other. How my favorite spicy noodle dish when I was eight years old and sitting in my aunt's kitchen comes back to me now. I am 21, and sitting in the clinic with my patient, I don't think I'll ever be a warlock, like my dad. Or practice acupuncture like Dr. Yeh. But I see how eastern and western medicine come together. It's IV drips and family portraits, blood tests and bitter brews, cultures and connection.[00:32:00] 

Gaby Li: That story was produced by Victoria Yuan and Sarah Griffin.

In our next story, State of the Human producer Aparna Verma visits Dr. Beverley Kane at Web Ranch to observe equanimity. Did you catch that? A equine-imity. Precisely: Somatic Horsemanship Stress Reduction and Emotional Self-regulation in the Company of Horses.

Formerly a practicing doctor at Apple, Dr. Kane now teaches these courses at the Stanford School of Medicine.

She also teaches other classes called Medicine and Horsemanship, which trains medical students and practitioners to develop an awareness of the subtleties of communication that are necessary for provider-patient relationship.

State of the Human producer Aparna Verma is on the Stanford Polo Team. But this stuff Dr. Kane does with horses sounded pretty different from sitting atop a polo pony and galloping around an arena with a mallet.

Hey, Aparna.

Aparna Verma: Hey, Gaby. You're right. Dr. Kane and her classes are very, very different from fast-paced polo games. When I first heard about Dr. Kane, I wanted to know: What can you possibly learn about medicine from horses?

I mean, we're talking about those creatures who eat hay all day and roll around in mud as soon as you brush them. What can they possibly know about doctor and patient relationships?

Beverley Kane: So my first horse was a fairytale horse. You'd call her white, technically gray, Arabian with the long fairytale mane. She was a merry-go-round horse. She was so gorgeous. [00:34:00] And, being Arabian, she's considered a hot-blooded horse. Like, they're super, super, super alert. And it was like fighting fire with fire because I'm kind of hyper and alert, too. So it made me have to bring down my emotions to be more calm, to be more confident, to be a good leader for her. I really had to deal with my own anxiety and my own hyper, hyper, hyper reflexive personality.

One thing that was also a big learning point for me-- and, and still is every single day when I watch our herd of 70-- is that it's never about ego.

Every kind of communication they have-- especially when it's about leadership and pecking order and what we would anthropomorphize as dominance-- is about survival, is about personal space. And, and it doesn't go any further.

It is pretty crazy because I didn't come to horses till I was 52 years old, so it was maybe a little bit belated midlife crisis. And what was going on for me, physically, was that having been a marathoner and a solo backpacker and somebody who could swim a mile a day, I felt my physical capacity starting to diminish. And I've always loved animals and I've always loved the outdoors, and somehow-- you don't know where these things come from. It, it's like divine guidance or something like that.

[00:36:00] I decided I wanted to take riding lessons. So I was going to become the centaur with a horse under me, and meld my body to the horse, and get back the strength and the coordination and the grace and the power that I had when I was 20, 30, even 40 years old.

And I heard about this person, Barbara Rector, who's giving a five day workshop near her home in Tucson, Arizona. And I thought, "Well, I'm not that committed." I don't really want to do that. In some ways, I was just making excuses. And I had a dream-- I had what Carl Jung calls "a big dream."

So in this dream, I was in a desert scenario. The title of this dream-- you're always supposed to title your dreams-- was "Red Mustangs and Dancing Shamans." So it was about horses learning to dance in the desert, and in the background, at the end of the dream, there was an old Native American Hopi shaman in a serape and with long braids, walking in the background. And I just went, "[gasps] Oh my God, this is what I have to do." It was just complete revelation. And suddenly, the meaning of the dream was clear and the meaning of what I needed to do with horses and why I was guided there-- it was just all clear. And that started medicine and horsemanship at Stanford in 2005.

Beverley Kane, outside: Summer, childhood summer.

So look straight ahead, kind of at the tops of the trees, [00:38:00] and take a big, deep breath. And exhale into your danche and into your buttocks. Like your head is just a big stack of potatoes...

Beverley Kane: What a, a good doctor is empathic. Emotionally connected, but not emotionally overwhelmed. So one of the things that the horses teach us is to maintain that fine line between being empathic in a healthy way and being such a sponge for other people's emotions that you can't function.

You know how you have to get informed consent for procedures? We have a, an activity-- we call this "uninformed consent" 'cause we ask the horses to do something really scary. We set up an obstacle with balloons and scarecrows and the centerpiece is a space blanket that shines in the sun and that crinkles when they step on it. And we ask the students to lead the horse through the obstacle, particularly on this space blanket.

You can't bully a 1200 pound horse. You have to have a lot of finesse. You have to develop trust, you have to develop a sense of why they should be doing this, how they should be doing this. The um, horse time comes into it. 'Cause you can spend days trying to get a horse to do this. And, of course, we don't have days in class.

You know when you're on "doctor time" or "Silicon Valley time" between Stanford and the hospitals and-- everything is about time being on time, having too little time. [00:40:00] And then you learn to be on "horse time."

You know, they say that if you have five minutes to do something with a horse, it's gonna take an hour.

If you have an hour to do something with a horse, it'll take five minutes. So you really have to slow down. You get into kind of a time warp with horses. When I teach medicine and horsemanship to the medical students. That's something they have to learn too or suffer the consequences of being hyper and stressed out all the time.

You have to develop that empathy and see things from the horse's point of view and see when they look at the space blanket, what are they actually seeing? Oh, they're seeing bright shiny lights. They're seeing something that looks like it might eat them.

I've had medical students tell me they go back to, "Oh yeah, the horse was really afraid of that balloon, and it didn't make any sense. And now my patient is really afraid of this needle, and that doesn't make any sense to me either, but I have to get him through this with patience and time and building trust."

There are studies that show that empathic doctors burn out less than detached doctors. They burn out. There's too-- you put so much energy into protecting your emotions into building a wall, as it were, that you burn out.

So if, if students were looking at this class. And they were asking like, "why is this important and why, why should I take this class?" How would you, how would you respond?

Well, two reasons. Their own wellbeing and their patient's wellbeing, and the understanding that those two are not diametrically opposed.

A, a lot of burnout is caused by this idea that it's either me or you. It's [00:42:00] either your time or my time. If you use the horse-human relationship as a model for the doctor-patient relationship, which is what Medicine and Horsemanship is kind of about, you can appreciate each patient you see as if they were a horse.

One of the chief principles of equanimity, and for medical students, anybody in their career, is this principle called "back to grazing." And I had a, a way spookier horse named Cody. He would see that white plastic bag and, and he would freak. He would just jump out of his skin. And then it would blow by and he would say, "Oh, okay. That was just a plastic bag or something," or however he'd cognitively thought of it. And he would literally go back to grazing. 

Aparna Verma: Hmm. 

Beverley Kane: So "back to grazing" is a metaphor for us to let go of our trauma, to let go of that incident when it's not there. It's a challenge to go back to grazing and especially with a physician where you see so much pain and so much suffering. You really have to be able to let go of that. At the same time, you're maintaining your empathy for the person who's going through it, but physically, physiologically, personally, you have to go back to grazing,

And we have techniques that help them go back to grazing. So just this little gesture of putting your hands together. And then open your hands to shoulder width while you take a deep breath. And push your hands back together in prayer. And go back and forth. Inhale, exhale.[00:44:00] 

I mean, horses are so accepting. They, they truly meet you where you're at. When we go into pasture with my students, we don't have halters, we don't have anything. And it's a whole different attitude. It's about being healthy in your own body, and that's kind of where the horses come in.

Aparna Verma: Yeah.

Beverley Kane: Over the years, we've made Medicine and Horsemanship more like what you saw in Equinimity, where it's about self care.

We do the meditation exercises, we check in, we do the physical healing exercises, the Qigong, and the last class, we get them on the horse.

Beverley Kane, outside: Shoulders are down and relaxed.

Arms are heavy and long.

Beverley Kane: So the energy centers on the horse are big. We have sort of littler ones and the main one that we talk about in Tai Chi is the dantian. Horses have huge ones, and if we're feeling really anxious, we can put our arm around the horse and do a big hug, drop our breath and energy down through the dantian, down through the horse's dantian, down through the horse's legs and our legs into the ground.

And in that way, send our breath and energy and anxiety out of our bodies, into the ground. And we can also feel the horse's body expand against the curve of our waist, and it fills our waist with their breath. And it, it's just a, a very intimate kind of thing to do with the horse.

Aparna Verma: Have you, have you used that in moments of your life, in [00:46:00] which you kind of needed the, the horses?

Beverley Kane: So, when I get on my horse, the very first thing I do is the breath. I, I gather a breath, sink down all my weight, and just blend the dantian.

I've seen people become more confident even in the space of the four weeks. And with this kind of learning, it's kind of self-guided. It's you get out of it what you put in, and you get out of it what you project. I am somebody who has a very low frustration threshold, and you can't be that way around horses.

When you realize that you have to be very, very patient with your horse and very, very tuned in, and very, very accommodating, it makes you a better partner.

I'm Beverly Kane. I'm an integrative medicine physician in the Department of Primary Care and Population Health at Stanford.

Aparna Verma: Without the, the titles-- who, who are you?

Beverley Kane: I'm a spiritual cowgirl.

Aparna Verma: Yeah, I like that. Yay. 

Beverley Kane: Cowgirl up to spirituality.

Gaby Li: That story was produced by Aparna Verma with help from Linda Liu.

Mnemonics use information already stored in long-term memory to make memorization easier. Pre-med student and producer Victoria Yuan visits anatomy lab after hours to ask if learning mnemonics affects the way medical students think about people.

David Altman: Uh, one of your biggest endeavors, especially in the first couple of years of medical school, are gonna be almost like learning a new [00:48:00] language. You're gonna learn like 10,000 something plus new words over three or four years.

Hi, my name is David Altman, and I'm a second year medical student here at Stanford.

Venita Shivakumar: My name is Venita Shivakumar. I'm a second year medical student at Stanford.

Drew Daniel: My name is Drew Daniel, and I'm a second year medical student.

David Altman: Drew, Venita, and I are teaching assistants for undergraduate anatomy.

The whole point of mnemonics is to keep that information in your brain, or at least to be able to come to it very quickly. In clinic, when we're looking at anatomy, thinking about anatomy, and we just remember this silly little phrase, and it really helps us to guide our, uh, our decisions.

I like the, uh, mnemonic for the carpal bones: So Long To Pinky, Here Comes The Thumb.

So would be scaphoid, Long would be lunate, To would be triquetral. P is Pisiform, H is hamate, C is capitate. And then we have T is, uh, trapezoid. And then the last T is trapezium.

So if like, I'm in clinic and this person has a broken bone, right over their, their thumb. So I would go,  "So Long To Pinky, Here Comes The Thumb." And so the bone right in front of the thumb is the trapezium. That was the T for thumb. It's a good map and it's a good, uh, mnemonic for me to really localize different fractures of carpal bones.

I find that like when something's a little bit odd, you know, there's-- it makes it easier to remember. The stuff that's like outrageous and, um, just a funny phrase, just sticks.

And I think Dirty falls under that category.

What can we say on here?

All Physicians Try Meth. That's for where to listen to certain heart sounds on the chest. Another one would be like, "Oh, Oh, Oh, To Touch And Feel Very Good Velvet, Such Heaven."

Drew Daniel: Clean that one up for us.[00:50:00] 

David Altman: Yeah. It could have gone, uh, could have gone very dirty there, but I decided to keep it, you know, keep it PG for the kids.

Drew Daniel: We are preclinical students, so we're spending the vast majority of our time with the science. When you're in the hospital, you may not necessarily be prioritizing the clinical side as much as you should be.

Venita Shivakumar: Most of the curriculum in the United States, now, there's a lot of awareness that keeping that humanity aspect of medicine is really important. It's another mnemonic, in fact, PEARLS, which I'm gonna mess up for sure. P is patient-- patience, empathy, affirmation... something like that.

David Altman: It's not a great mnemonic.

Venita Shivakumar: I don't know. And then the last one is saying, "sorry," I think.

David Altman: There's a reason we don't remember it.

If you are trying to think of a mnemonic to remember specific things that you need to do to be empathetic, you're almost missing the point because that's really a good way to be robotic.

Drew Daniel: Mnemonics are really helpful for memorizing like things, right? Empathy is more of a reaction to somebody. Um, so it, it changes every interaction.

Learning empathy, learning how to talk to patients is like anything else. It's just practice.

Venita Shivakumar: Like, it's practice. Getting feedback, thinking about that feedback, and then coming back with new things to try.

Drew Daniel: For a lot of people, including myself, is cutting filler words out of your speech.

One of my filler words was like, "great." So I would have, like, a patient say, "Yeah, I've been coming in for this stomach pain, and like it feels really bad, and like, I just want to, you know, get some help."

And I'd be like, "Great." But I don't really know if "great" is the, the right word for that.

David Altman: There's a lot of talk about how you get this effect of almost medical students are caring a lot, and then as you go through your education, you lose some of [00:52:00] that cautiousness around not being empathetic.

Venita Shivakumar: You also have to learn how to be objective and not be empathetic because a lot of people, like, feel like their doctors don't tell them the true prognosis. Often, that's because the doctor's so empathetic that they don't wanna give bad news.

It can be the other way sometimes, where like, you're identifying so much with what the patient's feeling that it may hinder you from making what may be the best medical choice.

Drew Daniel: I would probably say that science is more foundational in medicine than empathy is.

David Altman: Without the science, medicine doesn't exist.

You can't have fact-based, evidence-based modern medicine without scientific inquiry. And without empathy, you don't have good medicine-- you have really poorly practiced medicine.

Venita Shivakumar: Maybe the doctor prescribing the med is what makes you better, but like, you also have to be a little broad-minded about what health means and what someone's wellbeing means, too.

I almost think it's a little bit of a useless distinction to be like, "this is science and this is empathy." 'Cause like, medicine is about helping the patient, and you need to build a rapport and have all of those soft skills to deliver whatever hard science message you're trying to give them.

Gaby Li: That piece was produced by Victoria Yuan.

You've been listening to State of the Human, the podcast of the Stanford Storytelling Project. This episode was produced by Victoria Yuan, Maddie Fish, Aparna Verma, JJ Kapur, Sarah Griffin, Esha Dhawan, Linda Liu, Christy Hartman, and me, Gaby Li. With support from Tiffany Naiman, Ali Walner, Jenny [00:54:00] March, and Jonah Willihnganz.

Special thanks to Victoria Gamal and Riley So for logging tape. We so appreciate you.

For their generous financial support, we'd like to thank the Vice Provost for Undergraduate Education, the Program in Writing and Rhetoric, the Office of the Vice President for the Arts, and Bruce Braden.

You can find this and every episode of State of the Human through our website, storytelling.stanford.edu.

This episode is dedicated to my grandma, [00:56:00] Xinzhong Kim.