Noshing With David Weill – June 20, 2024

Ira Sternberg: Welcome to Ira's Everything Bagel, where I talk with intriguing people about everything — their passions, pursuits, and points of view. So how does someone go from being a transplant surgeon to an author? Well, it’s a fascinating story, and we’ll hear about it from my guest, David Weill. He is the former director of the Center for Advanced Lung Disease and the Lung and Heart-Lung Transplant Program at Stanford Medical Center. He is currently the principal of the Weill Consulting Group, which focuses on improving the delivery of pulmonary ICU and transplant care. But also important, he is the author of All That Really Matters. It’s a novel about Joe Bosco, an arrogant, hard-charging transplant surgeon whose ambition knows no bounds. It’s available on Amazon, Barnes & Noble, and all the usual places. For everything about David Weill, go to davidweill.com — that’s spelled W-E-I-L-L, davidweill.com — and you can follow him on LinkedIn, Instagram, and Facebook. David, welcome to the show.

David Weill: Thank you, thank you for having me.

Ira: Absolutely. You have, of course, written before — the memoir — but now you’re into novel writing. But why in the world did you leave the fast-paced, I would imagine it’s fast-paced, world of transplants and get into writing, which is a very slow, laborious, and sometimes frustrating process?

David: I was ready for a change. It was the fast pace that probably got me out of it. I had a 20-year run in the hospital, leading the transplant program at Stanford, and I wanted a career change at a relatively young age. I was 52 when I left the front lines of medicine and decided to take a different career course in consulting and writing.

Ira: Do a lot of people do that, or are some so focused that they wake up one day, and they’re 65 and still doing transplants, and they think, "Oh, okay, I better retire now," and then there's nothing?

David: I think that’s more common, you know, to do it as long as you can. In my field, it takes a long time to get good at it, so a lot of people hang around for a long time. I never planned that. Even when I was younger, I always thought I was going to have a second chapter to my career, and so here it is.

Ira: Is there an emotional component to what you did as a transplant surgeon? Does it reach a point emotionally where you say, "Okay, now I am going to retire"? Was that part of the factor?

David: That was a big decision, and I wrote about that quite a bit in my memoir, my first book, about the emotional ups and downs. I was clearly, when I left Stanford, "leaking oil," if you will. I had seen a lot of great things happen, but also some pretty devastating things. It got to the point where it was time for me to step away and do something different. I think I did suffer from some compassion fatigue and empathy depletion, the kind of things you’re seeing in some of the healthcare workforce that dealt with COVID. I saw it during the course of my entire career. So, for me and my family, it was time for me to step away.

Ira: Is there a solution to that fatigue in such an essential profession?

David: I go around talking about that right now. I talk to a lot of different medical centers and healthcare groups about how to keep the healthcare workforce healthy because that’s very important to all of us who are going to eventually be patients. I think the key is to stay connected to one another. I think my generation of physicians did not do a great job of that. We were very reluctant to tell our colleagues that we were struggling from an emotional standpoint, or we were sad or down about a particular outcome in a patient. I think the next generation is probably going to be better at it because we’re talking about it a lot more than we used to. That’s the key: to stay connected to each other emotionally.

Ira: You’re right. A previous guest, Dr. Desai, wrote about that in his book, about the challenges during COVID and how you just get burned out and how you deal with it. It is a certain generational approach — that doctors from one generation don’t necessarily do what they should have done in terms of that interconnection and emotional support, not just from fellow professionals but from family and friends and others.

David: I think so. I think my generation of physicians was trained in a pretty simple way: whatever problem you were facing, just work harder, try harder. And that was it; we had one tool in the toolbox, and that was it. I think that hurt many of us as our careers went on.

Ira: Is there one case in your story about your time as a transplant surgeon that struck you either positively or negatively and made you start thinking about becoming a full-time writer or doing something else entirely?

David: You know, I think there were so many successes, and I don’t want anyone to think that all of it was a downer and difficult and emotionally devastating. There were not as many of those cases, thank God. Most of the patients did really well. But I remember writing about and thinking about a patient we lost on the waiting list. She had two small daughters in the room with her when she passed away, and I was there with her. We were desperately trying to find new lungs for her and couldn’t. As is often the case, one in five patients on our waiting list wouldn’t make it to the transplant. This young lady passed away with two young daughters at her bedside. I remember getting down on one knee — I had daughters at that time about the same age — so I went into father mode and tried to talk to them about what was going on and how brave and courageous their mother was. That was the first time I ever cried in a hospital. I went across the hall into a supply closet and broke down. That was the beginning of a break in that armor I had around me while I was practicing.

Ira: Do you think that hospitals need an internal therapist, for lack of a better term, or an internal person whose shoulder you could lean on or talk to without fear of HR getting involved or some professional issue?

David: I think so. One silver lining to this horrible tragedy of COVID has been that we’re paying more attention to the workforce. Just what you said is happening in certain hospitals where it’s a safe zone to talk to somebody about what’s troubling them. But I think even more important than having a formal counselor is to be able to rely on each other. I worked on a team of 55 people at Stanford; I led that team. I didn’t have really anybody on the team that I could turn to reliably, that I could talk to openly. That’s not their fault; that’s my fault. We have to share those experiences, and we have to feel like we’re safe in doing so. I think that culture in medicine has to change, and I think it is changing, but it’s slowly changing.

Ira: How much of what you learned and what we’re talking about informed your decision to write this novel, All That Really Matters?

David: I think the reason I switched to fiction writing is that I went to a certain extent in my memoir and opened up, as they say, "an artery" and really got deep into what was going on with me. But the thing that I wasn’t able to do is make commentary in the same way about the hospital ecosystem and healthcare environment in a way that I thought was fully transparent, because I didn’t want to offend anybody and I didn’t want institutions calling me out. So, what I did instead is write a novel that gets deep into the themes of love and loss and sacrifice and redemption, and some of the ethics and morality about medicine and healthcare. I felt liberated to do that in fiction, whereas in my memoir I had to stick to the facts of what really happened and had to be careful about what I said.

Ira: Sure, with fiction you don’t have to worry about a lawsuit unless someone totally identifies with your character. So, Joe Bosco is an interesting name. How did you come up with that name?

David: Naming characters seems very simple, but it’s sort of infuriating in a way because you can’t really figure out what to call anybody. Because of his heritage — his father was a Holocaust survivor, he was Jewish — I wanted to take a name that could easily be shortened, as some folks did when they moved to America. His original family name was "Bosowicz," and it became "Bosco."

Ira: How much of you is invested in that character, and how much of what you would like to be is invested in that character?

David: You’re wholly invested in the character. He and I share certain traits, characteristics, but not all of them. I think readers will be glad to know — or your listeners — he spent some time in New Orleans; I grew up there. He liked to ride his bike. He was obviously a transplant doctor, so was I.

Ira: Hard-charging?

David: I’ve been accused of that, yeah.

Ira: Type-A?

David: Type-A, definitely. I met so many rich characters in my professional life. Our field attracts some really interesting people — brilliant, driven, flawed people. The characters in the book, not just Joe Bosco, but the other characters, are combinations of people I met along the way. It wasn’t difficult to develop those characters because I knew these people really well.

Ira: How important is a sense of humor in your field?

David: I think it’s vital. I used it all the time with my colleagues, patients, and myself. I made fun of myself all the time. It’s critical to keep your head screwed on.

Ira: When you wrote All That Really Matters and created Joe Bosco, did you run the character by either colleagues or family?

David: I really didn’t do that, but I can assure you that this character is very close to a lot of people I worked with. I don’t think medical professionals who read this are going to say this could never happen. Everything in the book either did happen or could happen. I did show it to my wife, who is a nurse and an ICU nurse. She said, “Nope, you’re right on the mark.”

Ira: What are a couple of things you want people to take away from the novel?

David: One thing about the novel — everybody likes a love story. The character grows; he loses some things, he sacrifices, and looks for redemption. I think the title, All That Really Matters, captures it all. This guy, and all of us, are looking for what really matters. We have tons of ways to distract ourselves from the things that matter. The title came from a question I asked every transplant recipient: "What would you do if today was your last day?" I was trying to figure out why they wanted a transplant, why they wanted to keep living. I think that’s the central theme of the book: trying to figure out what’s most important to us.

Ira: Well, that’s a great way to leave it. My guest has been David Weill, author of All That Really Matters. It’s available on Amazon, Barnes & Noble, and all the usual places. For everything about David Weill, go to davidweill.com, spelled W-E-I-L-L. You can follow him on LinkedIn, Instagram, and Facebook. David, thanks for being on the show.

David: I enjoyed it. Thank you for having me.

Ira: I did too. And join us every Thursday for a new schmear on Ira's Everything Bagel.