When his younger sister, Victoria, died from leukemia, Dr. Joseph Stern stepped out of his white coat, becoming more than a physician. He was a patient’s loved one — his sister’s caretaker and advocate.

In this episode of Back Talk Doc, host Dr. Sanjiv Lakhia talks with Dr. Stern about how his experience with his sister led him to reexamine what it means to be a physician, which he chronicles for readers in his book Grief Connects Us: A Neurosurgeon’s Lessons on Love, Loss, and Compassion. 

“I saw, as if for the first time: what it was like to be a patient and what it's like to be a patient's family member. It really had a tremendous impact on me personally in terms of my relationship with her and family, but also how I take care of patients and the whole notion of passion in medicine,” says Dr. Stern. “I realized that, in many ways, I had never really been as empathetic as I needed to be or as compassionate, and hadn't really understood what it was like to be a patient [going] through this kind of illness.”

Dr. Stern explains how physicians can become better doctors by practicing more patience, understanding, empathy, and compassion. He references multiple resources, in addition to his own book, so listeners can learn more about the power of connection between patient and physician. 

💡 Featured Expert 💡

Name: Joseph Stern, MD

What he does: Dr. Stern is a neurosurgeon, author, and inventor. He is a partner at Carolina Neurosurgery & Spine Associates and practices neurosurgery at the Moses H. Cone Hospital. 

Company: Carolina Neurosurgery & Spine Associates

Words of wisdom: “Have patience and the ability to listen — not being hurried — being present and listening and appreciating the [patient’s] experience is of vital importance. It makes you a better doctor, but it also takes your care to a whole different level in terms of the relationship you establish with a patient and family members.”

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at CNSA.com.

Welcome. You are listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery and Spine Associates, where cutting edge nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

Happy New Year everyone. Welcome back to the podcast. It's great to have everyone tuning in to Back Talk Doc. Again, this is almost third year of the podcast and those of you that have been following me and the episodes for some time know that I like to bounce around between some hardcore pain and spine topics. Then every now and then we jump into some of, what I call, the heart side of medicine.

If you haven't had a chance, I've had discussions on healthcare and spirituality with my partner John Welshofer, that was one of my early episodes and one of the more popular ones. Take a listen to that. I've done an episode before on how pain can affect your relationship with your spouse, and there's plenty of tools there that people can benefit from. In 2022, I was able to do some episodes discussing some techniques on how to release the emotional side of pain and trauma when we talked to Dr. David Berceli about his trauma release exercise program. And today starting out the new year, I'm delighted and privileged to be speaking with Dr. Jody Stern. Dr. Stern's one of my partners and colleagues at Carolina Neurosurgery and Spine Associates, and he holds down the fort in our Greensboro location. Jody, welcome to the show.

Thanks very much, Sanjiv.

Today we're going to dive into a topic that probably through no desire of your own you have really become an authority on, and that is the idea of compassion in medicine, empathy, communication, and that whole relationship side of the doctor patient relationship. For those who don't know Jody's story, Jody is the author of his book that he published, have it sitting right here. And this is a book that Jody put out, this was 2021, Jody?

Yes. Right.

Yeah. And it's where he details and documents the journey that he went on both personally and professionally while caring for his sister Victoria, who was battling leukemia. He details her journey and his journey as both a physician and a brother and really gives us some tremendous insight, unique insight, I would say, into that journey.

So Jody, before we jump into that, I've heard some of your podcast interviews about the book and I'd be remiss if I didn't acknowledge the fact that this is a real life story that happened, and I want to tell you that I'm sorry for the loss that you have gone through, you and your family. And I just feel like that needs to be acknowledged upfront that it is very, very courageous to put forth that journey on paper to share with the world. So first of all, we appreciate everything that you've done, and thank you for being here.

Well, I really appreciate that and thank you very much. The thing that I did with this book and was hoping to accomplish was first of all lay out my personal journey, but also my sister's experience because she wrote a journal of her illness. She was a very vital, vibrant actress, mother, lived in Los Angeles and she was determined to write a journal about her illness with the intention of creating a one woman show about it. And in fact, she wasn't able to do that because she died after her bone marrow transplant. But in the process, I saw as if for the first time what it was like to be a patient and what it's like to be a patient's family member. It really had a tremendous impact on me personally in terms of my relationship with her and family, but also how I take care of patients and the whole notion of passion in medicine and [inaudible 00:04:27].

I think that I've been an empathetic person, but I realized that in many ways I had never really been as empathetic as I needed to be or as compassionate, and hadn't really understood what it was like to be a patient, what it's like to go through this kind of illness. First of all, the depth of fear and terror that people feel, the helplessness, the desire, the trust that they have in their doctors. It was a profound moment for me. And I realized that a lot of our education in medicine is very task oriented and in the process of our training, we kind of get the grief and the empathy part of it squeezed out of us, and we're taught to suppress that. I recognized early on that in that process of suppressing grief and trying to distance ourselves from our emotions, that's actually a corrosive moment and it ends up working against us. And I really think in a strange way, our not experiencing our grief and allowing ourselves to feel the emotional impact of our jobs ends up contributing to burnout because we try to suppress the emotional side of our jobs and move through our relationships in a transactional manner and ignore the impacts it has on us and also it has on other people.

Yeah, I didn't know if you two had spoke just about the journal she was writing and if you guys had planned to do anything with that.

She had planned to have it published. That was her goal. And one of the reasons I wrote the book is I just didn't want it to sit and go to waste.

Absolutely. The book is, and we exchanged some emails, it's got a tremendous amount of depth and you can go in many different directions discussing what you wrote about. We can talk about it from the physician side and what that experience was like for you. And you could talk about it from the patient side or you can talk about what are some of the common ground between the two. And I know what someone gets out of your book is going to depend upon their life circumstance and where they come from. So maybe let's start a little bit about I'd love for you to share the patient side where you took off your neurosurgical white coat and you put on your loving, caring, concerning brother hat. What are some things that you learned during this process that you might have been surprised or shocked to find out?

First of all, one of the things that's become brutally honest to me is that we're all going to become patients. So we are all on somewhat similar journeys. One of the things I really strove in the book was to kind of create that universal point of view. And it was interesting because when I was trying to get it published, the publishers would say, or agents would say, "Well, it has to be toward a patient or it has to be for a doctor." And I said, "It's for both." And what I was trying to do was to bridge the gap between physicians and patients and say, "We're really not that different. We're really not that separate."

That's why in addition to my sister's journal, there are a bunch of interviews with patients. I had interviews with patients and physicians and physicians who became patients. And it's an amazing transformation that you go through when you check your doctor identity at the door. And the passage of time is totally different. If you're a patient waiting for information, waiting for test results, trying to understand things, it's as if time stops. And when you're a doctor, you compartmentalize and you say, "Well, I'm going to meet with this person for 15 minutes now and then in six weeks I'll meet with them again."

I'll tell you what, being a patient and going through six weeks of waiting or uncertainty feels like an eternity. And things that I took for granted, "Well, the pathology result isn't back yet. I'll call it in a week or two." Well, you basically have a patient clinging to their chair trying to survive waiting and not understanding and not knowing and waiting for those test results. And you tend to read silence. Silence creates more anxiety. You think, "Well, is this negative? Is it bad news? What's going on?" And it's a very different experience to be living it and not fully appreciating all maybe the subtleties that you kind of take for granted as a doctor.

So when I'm working as a physician, I'm seeing a lot of patients and juggling a lot of people's needs. And if you take some time to step back and look and kind of peel the onion a little bit, find out what people are experiencing, what they're worried about, what it is that they're going through, it's an amazing journey. A lot of times I felt that I wasn't really as aware as I should or could have been about just how deep an experience and troubling and scary being sick is. And take it out of braining tumors is what I have dealt with a lot. But in something as relatively not fatal as spinal disease, it can be the anxiety of it, the uncertainty of what this does to your life, of how it affects your career going forward, what your life looks like. It is really a powerful impact. And I just think a lot of times physicians don't think about that or recognize that and are often reluctant to explore that with people.

My practice is predominantly spine care and I do a fair number of spinal injections. Years ago when I was in practice in Cincinnati and I hurt my own back, and I always kid that would much rather just learn from the book than experience. But in reality, what I learned from experience is not in a book. And in fact, there was a moment when I was sitting in the wheelchair waiting for my epidural steroid injection and I looked to my left and there was one of my patients and she said, "What are you doing here?" And I said, "Quality control." It was very humbling. And that type of crisis keeps you grounded as a provider and there's just things that you can't learn in medicine just through reading and journal articles and such. So you've absolutely hit the nail on the head. Are there things that you have been able to take away from that experience as a family member and adjust how you treat patients?

Well, I've written a few articles that appeared in the New York Times on that topic, and I think that patients really want to know that you care. They really want to know that you're interested in them. So this kind of empathetic connection that a lot of times we avoid or skirt around is of such vital importance to people that taking a few seconds and it really doesn't take very long much time at all, it takes 17 seconds to create an empathetic bond with someone looking in their eyes, talking with them, listening. We interrupt people a lot, we tell them what's going on, we give them a plan of care before they've even been able to tell us what's going on with them. So I think having some patience, having the ability to listen, not being hurried, being present and listening and appreciating their experience is a vital importance. It makes you a better doctor, but it also takes your care to a whole different level in terms of the relationship that you establish with a patient and family members.

So one of the things that I'm really curious to talk to you about is your idea and belief that as providers when we show more compassion, we suffer less burnout. And I think you've cited some research supporting that and even from your personal experience. I'd like to ask you a question turning that around a little bit and get your thoughts. I believe there are some of us in the medical space who can take that too far, almost have too much empathy that it can be a little bit harmful. So for example, I do integrated medicine and I have a big connection with the integrated health community and there are people who call themselves empaths who have to practice meditation techniques and what they call energy clearing techniques just to protect their own energy. So what are your thoughts on that?

Well, I think that's extremely important. I think you have to compartmentalize as a physician. And one of the things I advocate for in my book is emotional agility, which is a flexibility. You can hold contradictory things in your head and heart at the same time. You have to. If you look at the enormous emotional range that we have to have as physicians and particularly as neurosurgeons, I have to wall off my emotional state, or at least make it less upfront, to be able to cut someone open and do surgery on them and take on that job. I think I would argue that you have to be emotionally connected to that person even while they're sleeping under anesthesia to be able to serve them well. Because otherwise if you don't or you objectify people, I think that's when bad things happen.

But I definitely think that you can't allow yourself to be overwhelmed by emotional experiences. So I think that the whole idea of emotional agility and being able to be flexible and protect yourself is really important. So I think that if you just open the floodgates and become an empathic sponge, I think you'll be destroyed. But if you also just close everything off and objectify people and don't connect with them emotionally, you're going to be a lousy doctor.

Absolutely. Two simple things that I try and do with everyone that I see, well, maybe three, I have really found that my state of mind as a provider is critical to that encounter. So I try and center myself before I walk in the room. And sometimes that can be as simple as a couple of deep breaths because I feel like patients can pick up on it if I am feeling depressed or if I'm feeling anxious or rushed. So the breathing technique is very helpful for me. Then two things, I took a little inventory one day and I realized I just wasn't doing enough of. And that was number one, good eye contact and number two, smiling more. And it's amazing. And during my fellowship, I don't know if you're familiar with the concept of mirror neurons, but there's literature that essentially explains how whenever you see someone and you say they've got bad energy or you walk in the room, you can already feel that that person is not doing well without talking to them, just some literature to the effect that our physiology can basically mirror the emotional state of someone who's in front of us. And I think that plays out every day in the office.

Well, it's funny because I have a friend who is actually quite helpful. Her name is Helen Rice and she is a professor of psychiatry at Harvard, and she was very helpful to me navigating this because this didn't come as a kind of clear package, a clearer understanding. This was sort of a crisis. It actually came about because when I started on this journey, and I'd written this in the book, but I was doing surgery on a young man's brain and he didn't exactly have a complication, but he had postoperative weakness. We took out the tumor from what's called the supplementary motor area of his brain, and initially he had some weakness in his leg that subsequently got better. But because I was so emotionally connected with my sister, I found what would normally be upsetting to be almost devastating to me, and I had to go and see her.

Helen has been able to help me navigate or give me some advice to navigate towards greater emotional agility. And it's a different way of thinking, but you really have to, I think part of it, as you said, is being present is being connected in the moment. A lot of times people do pick up on the fact that you're rushed or that you are distracted or that you've got a million things going on. When I look at the impact of care on patients, the thing that they remember, and do you know the book Compassionomics? Is that a book you've seen?

It's one I've bookmarked based upon your recommendation. I haven't gone through it yet.

It's really good. But the thing is, the whole idea is that what people remember is the compassion of the doctors and that they cared, less than the technical precision or nuance or complexity. You kind of have to do both. You have to be competent and skilled and able as a surgeon or physician, but you also have to be connected and compassionate. So you have to do more, but at the same time, you can't just pile on. It's interesting because I do think your question is what I'm really struggling with, which is okay, so I went from more emotionally distant or less comfortable feeling grief, which I think is super important to feel. And if you go down that path where you're not connected to your grief and you just suppress it, you're headed for burnout. If you totally focus on grief and empathy and that's all that you do, then you're going to get wiped out by your job and what you have to do.

And if you look at the current demands on us as physicians, so now I'm putting not the patient hat on, but the doctor had on, and I'm saying we have the electronic medical record, the fighting with insurance companies, the fighting with hospitals, what's called moral injury, where you are being asked to do things that you either don't think should be done, or the demands are so great on you just to get through your day, that if you don't have some ability to prioritize process, keep some distance from those things, then you run the risk of greater injury yourself. So I do think it's a very complicated path, and it's not as simple as I say, "Oh, well just become emotionally agile." I think it takes a lot of work.

But I do think that one of the reasons that I'm glad that I have done this or set out on this journey is that you don't realize it, but when you clamp down on your emotional life, you actually distance yourself from the highs and lows of life. It's as if you're not really living as richly as you could. So I think that one of the keys is that the beauty of life is inseparable from its fragility. We are doing things with people at moments of crisis and doubt and terror and where their bodies are failing them. And that is scary, but you have to be there with that patient to be able to help them. And if you have patients who die, that's hard. But also there is a certain kind of beauty in being able to render care or being available to people in those moments.

And I think we have to have as physicians tools to create space so we have the awareness of that beauty. The days can get so run with busyness that you can just miss it. You can miss the moment. I had an encounter recently with a patient who literally, I was only really, if I'm honest with myself, I was kind of half listening because I was typing in the EMR and then something she said caught my attention and I turned right at her and I asked her an open-ended question, and then just the floodgates of tears just came out. And I thought to myself, "Oh my gosh, I almost missed that moment for her, which is a real reason why she was here."

So there are tools, I think from a medical side, if we switch the hat, getting to a place that you advocate, which is a bit of heart-centered care, more compassionate care, more connected care, I think as physicians, we resonate with tools that help us achieve that state. Because for many, it's not inherently natural. Talking about emotions is just pretty foreign to a lot of people. But the tools, that's one of the reasons I did the integrated medicine fellowship through Andrew Weil's program is I learned some self-care tools. So tools like breath work, meditation, tapping techniques. So when I have difficult patients or days, I've been shown an emotional tapping technique that takes 90 seconds that literally makes me feel good. Now whether it's placebo or not, I guess I don't really care.

But they're better tools than alcohol. They're better tools than becoming angry and having it sabotage personal relationships. One of my, I guess life coach I would call her uses a phrase that emotion is energy in motion. And if you don't let that motion happen and you hold it in, like you say, Jody, it can be destructive. So showing tears in front of patients, and I know you've definitely done that, and I've done that more as I've gotten out of my career and felt better about it versus holding that stuff in and just not feeling so good.

One of the things that's been really great about this journey is meeting people like you, because I think you are making a lot of sense. And the thing is, nothing that I am saying is unique or shocking. But the problem is we don't do it. And it's interesting because the people who are interested in what I am saying are more open to it. I think that in medical training we're not taught how to do these things. We're taught very early on how to push away from your emotional state to be so-called objective and disconnect from your emotional state. And we're taught that the technical and anatomic and physiologic, that data, that information is what really matters and the other more subtle things like emotions don't and or compassion doesn't. And I think that's flat out wrong. I think that if you approach patients and yourself with compassion, you are going to be a better human being, you're going to be a better physician, you're going to have a lot happier patients. I would say you're going to have better outcomes.

Yeah, there's no doubt. In fact, the template for documentation, the SOAP note, subjective, objective, assessment and plan, in my opinion, it's so hollow or inadequate. You use the term objectifying patients. I never really heard of that before, but I realize it's so true and it's something that we should certainly try and avoid. Dr. Wayne Jonas, you may have heard of him, I don't know, he's one of the leading authorities in integrative medicine and he has written in a book, a book called How We Heal, where he talks about through surgery, in fact, that much of the healing process through surgery is almost through the ritual and that the actual procedure is a bit of the cherry on top. And this is shown through the literature that if the ritual involves a compassionate, concerning, listening surgeon, that the outcomes are far better, just as you just mentioned.

And he has put out some templates on what he calls the HOPE note where you spend a little bit of time basically taking history with regards to asking questions like, "What are your mechanisms? Do you have friends you can talk to when you're under stress? Is there a place in your environment you can go to when you need peace?" And these sort of questions that we aren't really taught to ask during in medical school. And I would push back a little bit on you when you say that nothing you're saying here is shocking. Let me just make it clear. What you're saying may not be shocking, but the person who's saying it makes it shocking. The fact that you are a well-respected, well-established practicing neurosurgeon who's talking about grief, that's everything. And that'll raise people's eyebrows and garner the attention that you deserve with this. Because historically, surgical field, like you said, I'm not sure it leaves a lot of space for that, and you have actually given us a path where that doesn't have to be the case.

Well, it was funny, I came to the Charlotte office and talked one evening with people, and what was amazing in that experience was how this resonated with people in a very deep and meaningful way. And I'm teaching this evening, I'm actually teaching this it's a called medical humanities program for the UNC medical students who are rotating in Greensboro. And they don't have the opportunity to just sit around and talk about the emotional impacts of their work and their training and what they're going through and doing, and they need it. I'm going to show you this book. I don't know if you know this book?

Yes, I have it.

So this is Rachel.

Rachel Naomi.

Created this program called The Healer's Art, and I'm starting to work with students in that. And one of the things I was blown away because I had not heard of her when I wrote my book and published, but then she talks about grief and the importance of grief. It was like, "Ah, someone really gets this." Not only does she get it, but she's been doing this for 20 plus years and created a program that goes across many medical schools, it's probably 100, talking about grief, talking about one of the things we didn't talk about, which is super important, is a sense of awe. That we lose track of the magic of what we do and the excitement of what we do and the privilege of what we do and what a wonderful opportunity we have to really make a difference in people's lives.

And it's funny, because I go to Honduras and there's an organization I work with called One World Surgery and on the Physician Leadership Council for spine in that organization. And what we do is we do basically free care for people in Honduras. And the thing that's amazing is I can't really speak Spanish that well. And the patients, I see them for very brief times, but the impact that I am able to have or that we are able to have on our trips is just staggering. I saw this man, he had had intractable horrible crippling leg pain and back pain from a simple thing that we would be able to fix here pretty readily for nine years.

Oh wow.

Not able to walk, not able to stand. Basically in misery. And you look and you say they have no social support. If you can't work in Honduras, there's no social safety net, there's nobody going to look out for you. So take this person to surgery, we fix his back, and he walked out two or three hours afterwards with a smile on his face, super happy. And you just see this that I think we tend to take for granted, and maybe this is partly patients and doctors, but the power and the majesty and the awe of what we do and the privilege of what we do and how what we do is such a wonderful chance to make a difference in people's lives. And we tend to take it for granted. We get so busy with, "I got all these cases to do, I got all this work to do." We look at productivity, we look at expenses and the financial parts that the magic can get squeezed out. So I think that's part of the flip side of the compassion part, which is just as important. One of the other things, I thought it was really interesting, I want to hear about this, but you had said that your brother is a palliative care doc?

So he's anatomist and hospitalist, and he works at the Christ Hospital in Cincinnati. His name's Rajan Lakhia, and he founded their palliative care service line and program. And we don't talk a lot about it, but when we do, I feel like it's probably the most enriching part of what he does. If you know him personally, he's really a grounded person. And I think it might come from that, that he has to cultivate that to have those deep conversations. But I'm glad you brought it up because my familiarity with palliative care was somewhat similar to how you described that it came in kind of late in the ballgame in certain situations. But when you describe how palliative care can really help support that social side, the emotional side, the family side, just quality of life side, my first thought was, "Well, who doesn't need this? What patient indication diagnosis can't benefit from this? Because I can't provide all of that in 15 minutes."

Well, so one of the things I think I haven't mentioned, which I really want to mention is the whole idea of teamwork. And I think that's really the salvation for both one of the features of burnout and also the realization that I can't do everything. I can't take the history and physical and talk about the treatment and do all the social support. That's just not physically possible for me to do. The only way that I'm going to provide quality care is as a member of a team where there are other people who participate. And I saw this recently with my cousin who was diagnosed with lymphoma and he's now getting treatment. But he is being touched by many people in this treatment team. And yes, the oncologist is doing the initial evaluation and setting up the chemotherapy and doing all that. And he's got a lot on his plate, but then he has a supportive team.

And I think that that's one of the integrating care teams and recognizing, because the whole idea of like, "Oh, I'm going to do the palliative care and I'm going to do the medical care and I'm going to do the surgery." It's like, "Eh, you can't really do all that, but we can provide it as a team that works together." And I think built into those team models are, one is consistency because one of the things that bothers me is I look at the care that is rendered to patients varies too much based on the individual giving the care. And if you have a team that's integrated into the care process, I think that will hopefully standardize some of the treatments. But also in that additional layer of support where these other issues are attended to, you also get your support as a doctor. You don't feel like you're alone.

A thing we haven't also talked about is that a statistic I just recently saw, which just blew my mind, is that a third of people over 50 are completely alone. They have no one. They have no one to help them. They have no one to get them through illness. They live alone. They are alone. And I look see this loneliness. So part of countering this is restructuring the way we deliver care and how we support each other. And I think that comes with teamwork. I think that's super important.

Yeah, I would totally agree. We learned about the blue zones across the world that have the highest population density of people living in their 90s and 100s and they studied what do they eat, how do they live their life? And it turns out that one of the most important factors, perhaps even more important than what they eat, is their social connection, their social network. So to hear that statistic you throw out tells me we've got some work to do.

Well, the thing is, it's not as much what you eat, but how you eat. Do you have someone to share your meal with? Do you take the time to have a social interaction? Do you have joy in your life? Do you have companionship? Those things matter more than what your calories are or what you're putting in your mouth. And so I guess I feel that one of the things I did, I'm sorry if I'm all over the board, but I went and took training in palliative care because I was advocating for it in my book, but I felt that I needed to know more about it to be able to advocate with some expertise. And I took a course in palliative care through Harvard Medical School.

Can you define that for people who are listening who aren't medical, what's palliative care?

Well, so palliative care is basically supportive care. And the thing we're talking about is it used to be hospice care. Basically, "I'm about to die and then I get someone who helps me with my death or end run kind of treatment decisions." And one of the things I find frustrating in our algorithms is basically we say, "Okay, well, we're going to no longer aggressively treat your cancer. So then we bring in a new team who's going to help you die." And what we're talking about is those palliation are basically support, comfort, giving information, providing a supportive path for people, that has to come a lot earlier. And it shouldn't be sub-divided in your care team like, "Okay, I'm the treatment guy. Now that we're done with that and that's not working, now we're going to switch and we're going to talk about dying."

It's like those discussions and holding someone in your hand and helping them along that path that has to be had from the very beginning. When you get sick, you have to talk about what this might be like. And one of the frustrations I had with my younger sister was she didn't want to hear about dying. So they drew this wall where they weren't going to talk about it. And what that did was it tended to shift care more towards treatments and more towards, "Well, we can do this chemotherapy." And one of my frustrations was, well, she had a very early recurrence of her leukemia after her bone marrow transplant. And that took her survival likelihood to virtually nil. She was too weak to be re-transplant and the likelihood of that being successful was very low, and they couldn't really be aggressive with chemotherapy.

But instead of... And it partly was her, she didn't want to hear that. But what they did was they just tried new chemotherapy or kind of lighter chemotherapy, and they're basically treading water. And I felt that it was a shame because that was really an opportunity that was missed because instead of saying, "Victoria, this isn't working and we need to really think about what your end of life might look like." Which she didn't want to hear, and people, I understand why they avoided it, we ended up just kind of... And I was part of that problem because she said, "I do not want to talk about dying." And so we ended up doing these other things, treatments that didn't work.

And I feel like it's kind of like a magic show where keep a ball in the air and keep everyone distracted and then meanwhile, the life part is going on and we're not paying attention to it. So the idea of palliative care is you bring support to families, to patients, just what you were saying about the HOPE note. You kind of look at, "Well, what are their desires? What do they want?" And what I did when I took this course was it was really all about how to communicate effectively with people, how to listen, how to talk, how touch on difficult topics. Because our tendency of avoiding those topics is we don't really want to, so we just sort of push them away and we end up never having those conversations.

Yeah, and Dr. Jonas's work with the HOPE note, he talks about a fundamental question. He said, "We need to shift from only asking, 'What's the matter?', to what matters."

That's right.

And just a simple, subtle paradigm shift in our thought process can really open up some communication between the doctor and the patient. Well, I feel like I could probably talk with you for three or four hours on this, but I really wanted to bring you on, number one, just to hear what you had to say as a follow-up to the book. And I actually listened to your book. I was able to download the audiobook version through our local library. It's a very different experience I find sometimes the audio versions versus reading it. But then I did go through the book itself, and I'm glad I did because you have a lot of family photos in there. I got to see Victoria's picture. So it really resonated for me. And I would encourage people who are interested, I'm sure this is available, Amazon, typical outlets.

Yeah.

And then also if you want to learn more, he's got his personal website, it is josephsternmd.com. Is that correct?

Correct.

Yeah. And that's a really well done website too, if you want to learn more and even get in touch, I encourage people. We'll link to all of this in the show notes today.

Well, thank you so much.

And I would probably leave you with one last question. How has your life changed since you released the book?

I have found a community. You are part of my community. So I think there's been some validation. And also, I've become more passionate about the need for us to rethink some things and change how we do things. So it's become a driver for me. But I'm very grateful. I have a wonderful agent. It's put me on a path that I find fulfilling. But it was really quite a lot of work to write. I rewrote the book about 10 times.

Wow.

So it took a lot of time, but I'm glad I have done it.

And so are many of us very thankful that you had the courage to put this work out there. And I don't know how you did it in the midst of your busy practice. But once again, thanks for catching up today. I'm sorry we haven't connected sooner than this, but I look forward to future conversations.

Well, you're wonderful. I admire what you're doing, and I completely support your instincts and what you're talking about in terms of care. I think they're spot on. So thank you, Sanjiv.

All right, well talk to you soon. Have a good night.

Take care.

Take care. Bye-bye.

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.