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Psychiatrist and author Arthur Lazarus discusses his article, “Finding integrity at the end of a career.” Arthur shares the poignant narrative of Dr. Raul Morales, a community internist facing retirement with a deep sense of despair, questioning if his forty-year medical career truly mattered. Through the powerful fable of the “cracked pot,” Arthur explores how a physician’s perceived failures, regrets, and “leaks” are often the unrecognized source of their greatest impact and legacy. This episode reframes the concept of professional integrity: moving it away from perfection and toward the simple, profound act of presence. Learn how to find meaning in a long medical career and see the flowers that grew from your own “cracked pot.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Arthur Lazarus. He is a psychiatrist and author. Today’s KevinMD article is an excerpt from his book, Born to Heal: Medical Narratives Set to the Soundtrack of Classic Rock. The title of this excerpt is “Finding integrity at the end of a career.” Arthur, welcome back to the show.

Arthur Lazarus: It is great to be back, Kevin. Thanks for having me on your show.

Kevin Pho: All right. We will talk about the excerpt first, and then we can zoom out and talk about the book itself. Tell us about this latest excerpt from your book on KevinMD.

Arthur Lazarus: The excerpt is one of about 50 very short, flash fiction-type stories that are in the book. Several of them dwell on retirement or approaching retirement. I still work full-time, but I am at the age where I suppose retirement is on my mind perhaps more than other physicians. This particular story, even though it is fiction, I must admit has some autobiographical components in it.

The story is based on an old fable. Actually, that is an oxymoron of sorts; all fables are old. It is based on a fable where a physician decides to retire. He has made his decision to retire. It is his last day. Not unexpectedly, he is reflecting on his career. That is where the fable of the cracked pot comes in. That was the original title, but I think you more aptly retitled it having to do with retirement at the end of one’s career.

Let me go to the fable first. The fable briefly involves a farmer who lives at the top of a hill. He needs water for his plants and his vegetable garden. He has to walk every day down a very steep path to a natural stream and carry the water back to his farmhouse. He only has two pots. One is in rather good condition, but the other pot, unfortunately, is a leaky pot. He reaches the bottom of the path, gathers the water in the pots, and walks back up the path. By the time he gets home, the leaky pot is virtually empty, and he has one good pot to use for his plants and his vegetables.

That is half the fable. Then it ties into the physician reflecting on his career near the age of retirement. He has doubts. I invoke the well-known psychologist Erik Erikson and the last stage of his psychosocial stages of development: integrity versus despair. Actually, in writing this short story and thinking about the fable and retirement, I began to think of Erikson’s last stage not as a stage of peace as much as a stage of perspective. So, this story is all about the perspective of one’s career near retirement.

There is a young resident who joins the physician in the story to congratulate him on his retirement and finds him in a rather glum mood. He says: “I am not sure I did any good really. I think about all the people whom I have lost, not due to medical error, but due to the progression of natural causes and diseases that cannot be stopped.” He is really doubting his career. He is on the spectrum of despair rather than integrity.

The young resident reminds him of all the good that he has done, for example, mentoring her. There was one of his patients for whom he became a role model, and who became an ICU nurse. There was another patient who, although he didn’t cure her cancer, he managed to increase the number of years and quality of life at the last stages of her life.

She is the one who tells him about the fable. The moral of the story has to do with how it ends. As the farmer was walking back up the dirt trail every day, he realized that one side of the trail had actually grown into lush green grass, and the other side was barren. Of course, the side that grew the green grass was the side that the farmer carried the leaky pot on.

She says in the story to the physician: “You were like the leaky pot.” He says: “Oh, you mean a cracked pot?” She didn’t mean it in that sense. She meant it in the sense that along the way of his career, he nurtured other people and his patients, and they grew into something special, just like the water from the cracked pot. The physician, on hearing that, turns to the integrity aspect of Erikson’s development and finds a newer perspective. It is kind of a happy ending.

That is the essence of it, except for one other small but important detail. This will dovetail into the book about music and medicine. In each of the stories in this book, including the story that we are presently discussing, the young resident says to the physician: “You know, it is sort of like the James Taylor song.” It comes in out of left field because there is no mention of music in this story up until that line. He asks: “What do you mean?” She says: “Well, his song, ‘Shower the People.’ That is what you have done your whole career. You have showered them with love. To be concrete, you have showered them with water and nutrients and nourishment that will help them realize their own potential and grow into something special.”

That is really the only mention of the James Taylor song, “Shower the People.” In the other stories, there is always a reference to a song, usually from the rock and roll era, which is the era that I grew up with. That particular story weaves in a fable, a real occurrence of near retirement, as well as a rock and roll song from someone special himself, James Taylor, that just about everybody would recognize.

Kevin Pho: For those mid-career, younger physicians who read your book and listen to the story and the fable of the cracked pot, what are some of the things that they could do to start practicing that mindset before they reach that proverbial quiet exam room at the end of their careers?

Arthur Lazarus: Given the high degree of burnout and disillusionment, I do think that music therapy, used in the broadest sense of the term, could be helpful. I have taken a deeper dive into the beneficial effects of music in general. It doesn’t have to be rock and roll music. It could be classical, it could be country, or any type of music.

There have been numerous studies now over the last several decades, and indeed there has been a whole field that has developed known as music therapy. As a psychiatrist, I am all too familiar with it because even when I was training in the 1980s on the inpatient unit, we had a music therapist. I don’t have any regrets in my career, but I wish I had gotten closer to her and better understood how she was working and interacting with patients. More or less, our patients went into the music therapy room and they came out.

What I didn’t understand was how they could be enriched. It is not only our patients; we ourselves as physicians can be enriched through music, whether it is through singing, playing an instrument, or simply humming. There is a whole lot of neuroscience now with fancy brain imaging studies that show different parts of our brain and circuitry all lighting up when we are immersed in music of some type. I think it is an underutilized medium for physicians, and that is probably the most important point that I want to stress in this podcast.

Kevin Pho: What are some of the ways where we could incorporate music? As you know, physicians are very busy, and a lot of them are burned out. What are some practical ways they could incorporate some of that music during a typical workday or during a typical work week?

Arthur Lazarus: There are many ways. The first thing that comes to my mind, which has been done again for decades, depends on operative-type specialists. Surgeons and gastroenterologists who do colonoscopies have been known to play music during procedures.

I had my own experience about 10 years ago where I had low back pain. I have some degenerative spinal disease. I am doing well now, thank you. But the point is, when I had these spinal injections, the anesthesiologist/pain specialist asked me what I would like to hear because I was awake during the procedure. I said: “Well, how about some Grateful Dead?” He said great. He just turned to Spotify, and the tune “Casey Jones” came on. He happened to like the Grateful Dead, so it helped him to steady his nerves. It was good for me. So, playing music during procedures is one way.

How about playing music on your way into work or home from work? I did that all the time. Again, in the early era, all I had was a cassette tape. Now, more recently, we have SiriusXM at our disposal, and we can find virtually any choice of music. You can find quiet times, perhaps a break between patients, where we can use handheld devices or an iPhone and dial up music. Even for 10 minutes a day, it would be helpful.

I think music is all around us. It is sort of like the other fable of the two fish who are swimming but don’t realize that they are swimming in water because it is all around them. It is like we don’t realize we are breathing because air is all around us. The same is true for music. It is virtually everywhere, and I think there are limitless ways we can take advantage of it.

Kevin Pho: This excerpt, of course, is from your book, Born to Heal: Medical Narratives Set to the Soundtrack of Classic Rock. For those who read your book, tell us some of the key themes that perhaps connect some of these short stories together that physicians should come away with.

Arthur Lazarus: As I said, some of them are centered around nearing the end of a career. Some are centered on the theme of burnout and exhaustion. Others relate to the doctor-patient relationship and things that don’t go quite well, perhaps medical errors, misunderstanding, and miscommunication.

As I was writing these very short stories (I have written literally hundreds of these short flash fiction stories; it only takes five minutes to read one), I didn’t set out to pair them with a musical composition or musical tune. It is just that there was something in the narrative as I was writing it that just felt natural. It invoked a song, again related to rock and roll.

Regarding the story that we are discussing this morning, I didn’t set out to deliberately insert James Taylor into a storyline. It just happened naturally. I would say in only maybe 20 percent of the stories I wrote over the last several years did that actually happen. What I decided to do was go through all these short stories that I have written and collect the ones where there was a reference to some type of a song or musical event. That comprises the majority of the book.

Kevin Pho: We are talking to Arthur Lazarus. He is a psychiatrist and author. Today’s KevinMD article is “Finding integrity at the end of a career,” an excerpt from his book, Born to Heal: Medical Narratives Set to the Soundtrack of Classic Rock. Arthur, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Arthur Lazarus: Absolutely. Just a continuation of what we have been discussing: I would like to leave the message to find a way to relax, to find some brief downtime during the day or even in the evening, and to help boost your spirits. That could be either listening to music or doing some other thing that comes naturally to people, like artwork.

For me, writing has helped me relax and gather my thoughts. You don’t have to write necessarily for a particular audience or write to publish, but just writing for yourself about some inpatient encounters has also been found to be very beneficial.

Lastly, I would like to recommend something that both of us have done in our careers, which is to consider working part-time or even full-time in a nonclinical endeavor. Medicine is an incredibly rich field. It offers so much. Some folks are happy practicing their entire career. Others want to scratch certain itches within the field, and that pertained to my own career. I left clinical practice 20 years ago. I have worked in the pharmaceutical industry and the health insurance industry. There are many career pathways and avenues available to physicians. I would say if you are feeling a little bit like medicine has lost its zest or its appeal to you, but you are still interested in medicine in general, explore nonclinical careers.

Kevin Pho: Arthur, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Arthur Lazarus: Thanks, Kevin. Really appreciate it. Good luck to you.