A doctor’s journey through grief and writing [PODCAST]

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In this episode, we have Ryan McCarthy, an internal medicine physician, who discovered writing as a way to cope with grief. His journey started with the death of his friend Dan from pancreatic cancer, which led him to write an essay chronicling Dan’s life and his own grief process. During the pandemic, Ryan started jotting down his thoughts and observations on his phone’s Notes app to cope with COVID trauma.

Writing helped Ryan process his emotions, gain self-awareness, and become emotionally lighter and more capable. He shares how writing also affected his medical practice and allowed him to connect with patients in a profound way, giving him a glimpse of health care’s magic. Join us for Ryan’s inspiring story of how writing transformed him into a better doctor.

Ryan McCarthy is an internal medicine physician.

He shares his story and discusses his KevinMD article, “From grief to gratitude: How writing changed my life.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today on the show we welcome Ryan McCarthy. He’s an internal medicine physician. His KevinMD article is titled “From grief to gratitude: How writing changed my life.” Ryan, welcome to the show.

Ryan McCarthy: Hey, Kevin. Thanks so much for having me.

Kevin Pho: We’ll get into the article in a little bit, but first off, just briefly share your story and journey to where you are today.

Ryan McCarthy: I’m joining you from my office in Martinsburg, West Virginia. It’s my hometown. I feel like my medical journey over the last two-plus decades has been a big walk in a circle to come back to the community that, you know, made me a doctor. I do primary care internal medicine, so office practice, but I also go to the hospital, and it’s kind of a duality of things together that most people don’t do, that combination. So it definitely gives me a unique perspective on our health care ecosystem.

Kevin Pho: We were talking offline about how we’re both dinosaurs, per se, because we’re both doing primary care internal medicine. And as you know, fewer and fewer medical students are choosing primary care as a career. So let me ask you, what keeps you going in primary care and internal medicine?

Ryan McCarthy: Yeah, that’s pretty easy to answer. What keeps me going is relationships. This is a relationship-based specialty, as you know. Over time, not only do we get better at what we do, but we get better at knowing the patient. And I think when you combine competence with an understanding of who the patient is, what they want, and how to live their life, we as internal medicine doctors can really provide trusted counsel and life-changing advice and be present for situations. Patients know that deep down.

And so over time, that’s why I find that internal medicine is so satisfying, because the relationship gets deeper and deeper, more and more comfortable on a personal level, at the same time that you’re getting better at what you do. So it’s the love of the patient. They come back, and they know my kids, and I know their family. And, you know, I’m sure it’s the same with you. People are just so generous. The amount of homemade jam that gets put on my desk, and cookies, and the expressions of love from patients, it’s deeper and richer in my professional life than ever.

Kevin Pho: As you know, there are so many things that threaten that relationship that you talk about. There are so many things that threaten our time: more check boxes that we have to do, prior authorizations, a focus on revenue, shorter time in the exam room or in the office with that patient. So how do you maintain that relationship despite everything that surrounds us that threatens it?

Ryan McCarthy: Yeah, that’s a great question, and like you, I ask myself that, you know, every day when I come to work. I think it takes more and more out of me to do this job. I freely tell my patients that I feel like I go to bed earlier, and I do fewer and fewer things outside the office, just because it requires more energy for me to perform, to type on a computer and address the patient. That’s a real challenge.

And so I think I’m constantly bending away from the computer to focus on that human being, and at the end of the day, I feel mentally and emotionally really kind of trashed. And while that’s hard, that also feels like what I’m supposed to do in this landscape that is, as you pointed out, very hard. I don’t like the check boxes and all those pressures and the technology, but I just constantly go back to: Who is this person here? What can I do for them? What can we do today? On bad days, it’s hard for me to hear my own self-talk and believe it, but on good days, I know it’s true. I mean, that’s why we’re here, and that mission to me has not changed.

Kevin Pho: We have a lot of medical students who listen to this podcast. Give them reasons why they should consider internal medicine and primary care as a career.

Ryan McCarthy: Internal medicine and primary care is a career that’s satisfying. I told medical students before the pandemic, jokingly, but at the same time I was serious, “Listen, I’m the most important person in health care.” And I didn’t mean that in a boastful way. I meant that in a way of influence. I said, “We’re going to walk into an exam room, and this patient will trust my judgment for where she should get a mammogram, for where he should get a colonoscopy, for whether they should have something done or not.” And so that influence comes from trust, and the trust in the relationship is so satisfying. With the headaches I have with our health care system, none of it is the relationship with the patient.

When we get to know those folks over years, that is so satisfying. Students have even told me, they walk out of an exam room and they say, “Dr. McCarthy, these people love you.” And I said, “Well, yeah. You’re seeing a fan club after years.” People stay with you if you’re their cup of tea and you meet their needs. And I think for those of us who are committed to doing this, and doing it well, in internal medicine, over time we have a fan club, and it really is still satisfying. So that part gets better and better. I tell students that all the time.

Kevin Pho: All right, let’s talk about your KevinMD article. It’s titled “From grief to gratitude: How writing changed my life.” Now, tell us, how did this article come together?

Ryan McCarthy: Yeah, I really appreciate the opportunity to write it for you, and readers can check it out. It really just started accidentally. A dear friend of mine, I diagnosed what ultimately was his metastatic pancreatic cancer, and needless to say, for a man in his 40s, Dan died within about six months of me diagnosing him. It was a whirlwind of pain, and out of that experience, that was the kernel for me starting a journey of writing, writing about it. I had no time or place to process what had happened to me. I mean, Dan and I were friends. My whole family was friends with his wife and his kids, and you can just, you know, see this kind of pot of pain.

Writing for me became a way that I started to make sense of who I was through this experience. How do I process? How do I help Dan’s family? And so that was the beginning, and then so many years later, writing has become even more important to who I am.

Kevin Pho: So tell me about that initial story with Dan. What exactly did you write about, and what came of that piece?

Ryan McCarthy: I initially didn’t have any agenda, and I think that was one of the beautiful things. Kevin, it was truly just a piece of therapy. I just opened up my second screen on my desktop, and I had no agenda, and I just wrote it to make sense of it. I’m grateful for that. If nothing had ever come of it, it would have done what it needed to do for me, which was help me heal.

And then, as is so often the case in health care, I think I got a call for stories from a publication, and really for the first time ever in my career, I was like, “Oh, I might have something like that.” And suddenly this whole universe of opportunities came up. But I thought, “I’ll submit this.” I didn’t think anything would come of it, and then it ultimately ended up published as a literary piece. And, you know, that was pre-pandemic, and then, funny enough, I didn’t think about it much after that, because we were together in a tsunami of COVID.

Kevin Pho: Now, when you said that writing was therapeutic for you, go into more detail. How exactly did it help you?

Ryan McCarthy: Yeah, for me, and, you know, there are a lot of ways to write, and I think it doesn’t matter how somebody does it, whether they do it with pen and paper, a notebook. I now do a lot of writing on the Notes app on my phone, because it’s accessible. So I find that I write out of convenience now. If I’m sitting somewhere and I have 15 minutes while I’m waiting for one of my kids to come out from somewhere, I’m like, “I’m going to flip open the Notes app and jot down some thoughts.”

Kevin Pho: So what are some examples? What kind of thoughts would be an example that you would jot down?

Ryan McCarthy: Yeah, sure. So I mentioned the Notes app because in the pandemic, when I wasn’t thinking about writing, I was thinking about surviving and serving patients. I flipped open my Notes app one day to look at a grocery list, and at the end of my list, I added the editorial comment, “Today is terrible. I don’t know how I’m going to survive this day.” And that was kind of, I think, the second beginning of writing for me, Kevin, because suddenly I had this piece of technology where I was jotting down things that were on my mind.

I found that in the pandemic, when I was sitting in my car a lot, eating my lunch as I was about to go back into the hospital or coming back to my office, after that first comment in my Notes app, I started going to it and just, you know, writing down some free-form thoughts about stress or pain. And what was really nice, and I think to go back and answer your question about why it was therapeutic, is it was a private place. I’m not the type of person who wants to unload my problems on other people, and during the pandemic, I couldn’t do that to my wife. She’s a dentist who had her own practice shut down, and my kids were at home. They didn’t want to hear their doctor dad complain, and I didn’t want to do that to them. But here was a space for me, and I could just pour stuff onto this page. And if it never went anywhere, it still really helped me organize: What am I angry about? What am I sad about? Who am I grieving for? All of that, you know what I mean? It kind of took an emotional yard sale and put it into some useful piles.

Kevin Pho: Now, does a lot of your writing have its genesis in the exam room with patients that you see?

Ryan McCarthy: Oh, definitely, yeah. I think because my writing is about my health care journey and experiences I’ve had, I would say yes, because that’s where so much of my time and meaningful conversations are, and hard things. It’s where people confess things to me that happened to them: fears, worries, painful past, you know, divorces, affairs, transgressions, phobias, all of the things that you get in primary care. And a lot of that weighs on me privately, you know, and obviously I don’t share that with anybody. But writing down experiences of how it makes me feel has definitely given me more sustenance for this journey.

Early in our conversation, you talked about, you know, what I tell medical students, what’s meaningful about internal medicine. This self-care mechanism that I’m doing now, this idea of narrative medicine, really starts with me, where I use these stories and these arts and humanities skills to care for myself. And sure, it feels so right and so good, in a way that I wish I’d had 20 years ago.

Kevin Pho: Yeah. So give us an example of how your writing, since you’ve been doing this for a while now, has changed you as a physician. Give us kind of a before-and-after picture, would you say.

Ryan McCarthy: When I think about it distinctly, it’s made me more attentive to the details, yeah, being present in the moment, you know? To write, you have to turn off distractions. For me, I turn off the radio. I don’t want things around. I want to get into my thoughts and really engage in this moment. And I think that type of attention is something that I’m now very mindful of when I go into an exam room, because if you want to create something, you have to get into that flow state, that Zen, where everything goes away. I know that’s where beauty happens in the writing, but I also know that that’s not distinctly unique to writing. I can bring that beautiful and creative state of mind to somebody who’s with me. So if I bring that mindful presence of, “All right, let’s put the world aside and let me focus on this human in front of me,” I think writing is giving me that attention to my patients, and in a more profound way.

Kevin Pho: Not a lot of physicians have these secondary careers or hobbies as writers. Now, for those doctors who want to break into writing, what are some tips that you can share with them in terms of summarizing their thoughts? Because I talk to a lot of doctors, and, you know, they want to write, but they never quite know what exactly they should write about. So share some tips that you have with them.

Ryan McCarthy: I think things that are meaningful. So, you know, my personal experience is to write about things that have happened to me or things that I’m now thinking about. And so I encourage people to keep it simple. Start with how you feel, you know, even if you just throw onto the paper, “Today I’m angry. Today I’m sad. Today was horrible.” And then if the next line is, “And it’s because of this thing that happened,” OK, now we have the genesis for why you’ve taken pen to paper. And then maybe throw down a thought or two about, “I need to learn something from this,” or, “I remember the last time this happened to me.” Now we’re starting to tease out that that person is trying to make sense of their experience.

That, for me, is kind of how I go about it and how I encourage others: Don’t overthink it. Just kind of start throwing out the rough ideas, and if it’s coming, keep going. If it’s not, put it down, and, you know, go do whatever. Go cut the grass or go to the grocery store or whatever, and come back at a time that is good for you. I encourage people to access the times of day or the place where they have an effective mindset, you know? For some people, that’s at home. Some people have to work early or late, whatever. I think the time of day, you know, is variable from person to person. So recognizing that is one of my tips.

Kevin Pho: How easily do the stories come to you?

Ryan McCarthy: I would say very easily, and the reason I say that is, as you know, in primary care, I mean, the sky’s the limit. And given that I didn’t start this for 20 years, the bank of experiences, I mean, if I never saw another patient, I could spend the rest of my life just writing about real things that happened to me that I’m digesting now. So I’m eternally grateful for having a job that has just such a variety of human experiences kind of baked into the crust. And given that I’m writing about that, they come easily. I couldn’t imagine trying to write a novel and create a world, a narrative story, you know, invent people. I’m just reporting and commenting and editorializing on things that happened to me.

Kevin Pho: Now, you mentioned that you have had some literary journals, or some literary opportunities, open up because of your writing. So talk more about that.

Ryan McCarthy: Yeah. So some of the writing that I did, I’ve paired with some artists in the last three years, and I’ve developed a project called Health Care Is Human, which has become a narrative medicine project. At the beginning of the pandemic, I invited a photographer, and actually the photographer who took the photos that are here in my office, to come photograph health care workers during the pandemic, and that project is still ongoing. And so I’ve recorded interviews with health care workers to chronicle their stories, working with photographer Molly Humphries.

As a result of that project, I’m now working with our Humanities Center at West Virginia University, pairing with the director there, Renee Nicholson, and she’s a humanities expert, you know? So suddenly, you know, being a fumbling amateur and then having somebody kind of, you know, pay attention, who was like, “Hey, Ryan, there are a lot of stories here,” you know, I feel very grateful to have good creative partners. I never, never dreamed of any of this. I never saw it coming. But yeah, we’ve really hit, I think, a deep vein of desire by health care workers, doctors specifically in my case, to want to process. You know, the pandemic was so intense and such a concentrated microcosm that it definitely, I think, took my creativity to a level that I never would have dreamed of, you know?

Kevin Pho: I think one of the things that we talked about earlier was how sometimes the relationship between physicians and their patients gets stifled by all the bureaucracy that’s out there. We can say the same thing about the humanity in medicine, our creativity in medicine. So why is it so important to maintain that art of medicine despite everything else that goes on around us that threatens it?

Ryan McCarthy: Kevin, I think that’s the key question, and I think the pandemic forced me to really ask that. And I think if I hadn’t started or continued writing, and if I hadn’t found some creative artists to work with, you know, is it entirely possible that the humanity inside of me could have been defeated by COVID? Absolutely. You know, could I have left in despair and loneliness and just exited health care for something else, or gone nonclinical? It could have defeated me. I am well aware that I could have been one of our hundreds of thousands of colleagues who have left because of burnout.

And so I think these humanities endeavors, the writing, the poems, the photography, the artistic things, speak to us, and specifically speak to me. It keeps me coming back. It just rekindles the fire inside of me, because it requires a level of renewal that it didn’t at the beginning of our careers. And I think it takes more from me, but I don’t feel defeated, and I think these arts things, I’m so appreciative of, because they keep me alive to take care of my patients.

Kevin Pho: Now, give us some other examples of physicians that you’re in contact with. How do the arts intersect with their careers?

Ryan McCarthy: Now that I’ve stepped into the narrative medicine space, I’m seeing, and I work for West Virginia University, that we’re starting to take steps now to develop a narrative medicine curriculum. Because, you know, you said before, when people say, “Hey, I want to write, I’m not sure what to do,” we hear that very loudly and clearly. And so some of us on our Health Care Is Human project really want to be mentors and leaders and start teaching in the medical school, or developing a fourth-year elective. We’re really looking to develop a graduate certificate in narrative medicine, to really provide a way so that people can access these skills when they say, “I have this hunger, but I’m not sure where to start.”

And, you know, health care workers are smart and capable people, and we think with some training and some skills, they can tap into creative things that have been maybe on the back burner, and I’m a perfect example of that. So I’m really hoping to have this work be a big part of the second half of my career.

Kevin Pho: What kind of resources would you recommend for people who are interested in doing more narrative medicine?

Ryan McCarthy: There are, you know, so many great books out there. I’d recommend any of the books that have, you know, reduced me to tears over the years, you know, Atul Gawande, you know, When Breath Becomes Air. These are personal accounts. And I think, to speak to our doctor colleagues, you know, sometimes we’re stubborn, and we need to hear it from another doctor. So some of the great doctor writing is a way for doctors to say, “Oh, I can be technically capable and vulnerable. I can be, you know, precise and a leader and at the same time have a complete cry-with-my-patient kind of moment.” Some of those writers really helped me see that all of those emotions and characteristics are on the buffet for me.

So I think accessing really good writing is one. I like to start with that. I also like for people to really just look at what inspires them creatively outside of medicine, because anything that speaks to you, even if it has nothing to do with medicine, it speaks to you. And so if that’s, you know, listening to music or playing your violin, or, you know, painting watercolors, or baking, or needlepoint, you know, we discount some of the crafts around the house and those creative things. Anything that’s creative allows you to tap into that part of your humanity.

Kevin Pho: And my final question, Ryan: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Ryan McCarthy: I think my take-home message is that it is a challenging time in health care right now, but I’m feeling strong for the next phase, and I think the arts and humanities for me are going to be the key to keeping my humanity alive, so I can be well myself and take care of my patients. I also think that these humanities skills of narrative medicine are entirely teachable, and I think that we in medicine really need to make it a priority, because that’s how we’re going to serve each other and figure out together, one step at a time, how we’re going to navigate this post-COVID landscape.

Kevin Pho: Ryan, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Ryan McCarthy: Thank you.

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