Stories from the World of Medicine
Season
6
Episode
2
|
Feb 22, 2024
Love in Practice
When Anthony’s wife got sick, he believed the way to best support her was by getting stuff done. Over time though, he discovered that in order to become a better caregiver, he was going to need to unlearn some lessons from growing up about what love looks like in practice.
0:00/1:34
Illustration by Stephanie Singleton
Stories from the World of Medicine
Season
6
Episode
2
|
Feb 22, 2024
Love in Practice
When Anthony’s wife got sick, he believed the way to best support her was by getting stuff done. Over time though, he discovered that in order to become a better caregiver, he was going to need to unlearn some lessons from growing up about what love looks like in practice.
0:00/1:34
Illustration by Stephanie Singleton
Stories from the World of Medicine
Season
6
Episode
2
|
2/22/24
Love in Practice
When Anthony’s wife got sick, he believed the way to best support her was by getting stuff done. Over time though, he discovered that in order to become a better caregiver, he was going to need to unlearn some lessons from growing up about what love looks like in practice.
0:00/1:34
Illustration by Stephanie Singleton
About Our Guest
Dr. Anthony Williams is a Med-Peds hospitalist at HealthPartners who splits his clinical time between Regions and Children's Minnesota. He is an Associate Program Director of the Med-Peds residency program at the University of Minnesota and an Associate Director for the Center for the Art of Medicine. He is passionate about creative writing and the power of narrative expression to cultivate resilience.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Dr. Anthony Williams is a Med-Peds hospitalist at HealthPartners who splits his clinical time between Regions and Children's Minnesota. He is an Associate Program Director of the Med-Peds residency program at the University of Minnesota and an Associate Director for the Center for the Art of Medicine. He is passionate about creative writing and the power of narrative expression to cultivate resilience.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Dr. Anthony Williams is a Med-Peds hospitalist at HealthPartners who splits his clinical time between Regions and Children's Minnesota. He is an Associate Program Director of the Med-Peds residency program at the University of Minnesota and an Associate Director for the Center for the Art of Medicine. He is passionate about creative writing and the power of narrative expression to cultivate resilience.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
This season of The Nocturnists is sponsored by The Physicians FoundationThe Nocturnists is made possible by the California Medical Association, and donations from people like you!
Transcript
*Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.***TRANSCRIPT:**
Emily Silverman
You're listening to The Nocturnists “Stories from the World of Medicine.” I'm Emily Silverman. As clinicians, it can be tough to snap out of “medical mode” when our loved ones get sick. Our brains get wired a certain way, wired toward diagnosis and treatment and problem solving and action. But sometimes that's not what our loved ones need. Sometimes a pause, a breath, and a listening ear is just what the doctor ordered. In today's episode, Dr. Anthony Williams** **talks about the lessons he learned and unlearned about how to handle life's hardest challenges, and how this all came to a head when his partner developed a mysterious chronic disease. In the conversation that follows. Anthony and I talk about uncertainty in medicine, masculinity as it pertains to caregiving, and how a simple change in language can dramatically shift one's mindset. Anthony is a med-peds hospitalist at HealthPartners, who splits his clinical time between Regions and Children's Minnesota. He's an associate program director of the med-peds residency program at the University of Minnesota and an associate director for the Center for the Art of Medicine. Let's listen to Anthony telling his story live in Minnesota in 2023. It's called Love in Practice.
Anthony Williams
It is complete chaos in this gym right now. Kids are slipping and sliding all over the dusty court. Coaches are yelling and the parents, the supposedly responsible adults here are just up in the stands losing it. And even for a second grader, I am tiny. So my bar for success here is pretty low. I'm just trying to survive this YMCA basketball game. Now, my pregame lecture from my dad, who's also one of the coaches, centered around me shooting the ball more and being tough. It is the third quarter and I am busy failing spectacularly at both of these things when a kid from the other team comes out of nowhere and shoves me to the ground. Now for good measure, this kid makes sure to take the time to stomp on me several times before running away. So I get up and I limped to the bench crying about my scraped knee and bruised elbow. And for the life of me, I cannot meet my dad's eyes as I tell him that I don't want to go back into the game. Now, he doesn't force me to. He doesn't make me go back in. But in that moment, I can feel his disappointment with me. So later that night at our family talk table, which is just our dinner table after the food gets cleared, my parents are sitting at either end, my younger sisters to my left, my older brothers across me. And there is this pleasant aroma of spaghetti and garlic bread hanging in the air. But we all know that dinner ain't over until the analysis of the game is done. So it's not long before my dad leans forward to rest his interlaced hands on the table. And I get a spike of anxiety at this because I know that it is time for the lessons that start at basketball but always seem to generalize to the rest of life. So for my dad, it's, "Anthony, you need to be more aggressive and impose your will out there. When it's game time, you got to figure out how to flip that switch and handle your business." And from my mom, it's, "Everybody gets hurt sometimes and that's okay. But don't make yourself a target by announcing it to the world." Now, the talk table is a huge part of our upbringing. It's where we learn how to survive street fights, how to interact with the police, and how to stay out of trouble with teachers. And these are some of the crucial lessons that I leaned heavily on to make it through med school and residency. But these are also the lessons that I carry into my marriage. So in 2016, my second year of residency, my partner starts having these episodes of unexplained hypoxia which is just low oxygen in the body. She's actually on home oxygen for eight months. And over the next year, there are all these tests and specialists and hospitalizations, but she never really gets a diagnosis. We fast track our wedding, both for the health benefits and because we don't know how much longer she's going to be alive. And it's not until July 2018, over two years later, that any kind of acceptance finally arrives for us.
The smells of late summer and life washed through the open windows of our small apartment, only to be swept away by the somber currents of goals of care. It's been three hours of heavy, heavy conversation and a box of Kleenex later, but we're finally here. No more ERs and no more hospitals. She tells me the next time I have an episode, I want to manage it at home. And despite the palpable sense of unease, bordering on dread that I feel, I agree to this. Now it's August 2018, barely a month later. It is a Thursday night and my entire body is just taut with tension. I've gotten her as comfortable as I can in our queen size bed tucked under her favorite weighted blanket and a thick blue comforter. But our home pulse ox is still reading in the upper 70s. She's just not bouncing back like she usually would. She can't talk to me, but she can still communicate with her eyes. They're this beautiful hazel color with scattered speckles of dark brown. And they seem to be asking me, begging me, please remember our deal. Please remember what we agreed to. They're the same eyes that I fell in love with when we were 20. And they were just so full of anger and righteous indignation because she wanted me to apply to the scholarship or something. And me and my infinite 20-year-old wisdom was like, "Nah, not doing it. That is a complete waste of time." We argued about this for weeks and weeks and weeks until finally with the deadline looming, she did my entire application for me in addition to her own, and on the due date, she stormed into my room, slams the paperwork onto my desk and says, "All you need to do is sign I've done everything else for you. And if you're too stubborn or too stupid to do even this, then no one can help you." I was so pissed. But I signed because I'm not 100% foolish. And that's how we both became McNair Scholars, she's always, always had my back and her behavior, It aligns with the most important lesson from the talk table: Life is not about your emotions, or what you want to do. Life is about what you need to do to survive, and what you need to do to protect your family. And with that, there is this switch inside of me that flips. This terrible situation is no different than being pushed down on a basketball court. I can give up, go to the bench and potentially let the most important person in my world die. Or I can man up and handle my business, just like I was taught. So I tell her, I'm gonna call 911. And when I do this, I see something that I've never seen before. I see a light leave her eyes as they tear up. And the person who is looking back at me in this moment, she's different than the one I married. She's muted and less vibrant. Fast forward through another hospitalization and another discharge, which are all things we've done before. But what's different this time, that was her. After this admission, she's just withdrawn and distant all the time. This plays out over and over again, for the next two years, she refused to go to the hospital, and I'd override her. And if she got stubborn and dug in her heels, I'd switch it up and fight dirty, I'd rat her out in a second to her sisters and her mom and they'd call her up and they'd attack her in ways that only family knows how to do. Everybody wants her to go to the hospital. Everybody wants her to listen to me, her doctor husband.
And before we know it, it is 2020. And we're sitting down to have the conversation. In the years that it's taken us to grapple with the realities of her chronic illness, our entire relationship has crumbled beneath us. She wants us to do marriage counseling and me to do individual therapy. And so that is how I find myself in my first therapy session. Even though, in my opinion, I don't really need to be here. And on the off chance that I do need to be here, I don't think I would have chosen this particular guy to help me. Now, don't get me wrong, he seems a very nice, like a very lovely human. But he's also extremely white, even by Minnesota standards. He has long kind of long hair that stops just shy of being disheveled and a really open and flowy way of talking about things that makes my analytical brain just cramp up, because I can't really understand what he's trying to say or asking me to say. We're nearing the end of our first virtual session when he asked me kind of the first real concrete question. "So Anthony, how do you feel?" And I'm thinking to myself, "I know a trap question when I hear one." And I was wondering when this hippie was gonna try to read my soul. "I'm fine," I tell him. He looks thoughtful and gives the very therapist-y “Hmm” before saying, "Okay, to recap, you're a hospitalist working during the worst pandemic of our lifetime. You're also a black man living in the city where George Floyd was murdered, and your marriage is on the rocks. But you're fine?" Suddenly, I'm aware of blurry vision from unshed tears. But all I feel inside is hollow. And this pervasive emptiness is really what plants the first seeds of doubt in my mind that maybe this therapy thing isn't exactly what I thought it was going to be. But I'm not about to admit that to a stranger at this point. So all I tell him is, "Yeah, man, I'm doing great."
I'm about six months into therapy, the next time we're back in the emergency department again. This time, my partner has a fever, headache, neck pain, and a very painful rash, it's getting worse. And my mind it's doing what it usually does in these situations. It is racing through all the clinical stuff in the logistics, thinking about the CT and the MRI and the LP and the blood work and who needs to be called and getting back home to get our go bags, and on and on, and on and on. And this is the first time that a part of me, a small part, is able to step back and just watch this internal process with a dawning sense of alarm. So finally, I pause and I look, I just look at my partner. And for the first time I see it, I see the sadness and the loneliness that's there. And this sudden awareness, this new awareness, causes all of these painful truths that I've been having to admit out loud in therapy for the last six months to come bubbling up to the surface. I use responsibility and duty to dissociate from what I'm feeling. And this stress response, it smothers the human connection and makes her feel isolated, and utterly alone at a time when she's most vulnerable. So I take that truth, and I hold it. And I use it to choke out the words, "Baby, I'm worried. Please talk to me about what's going on with you." And there's a flicker of surprise in her eyes. But she talks. We talk. Not about her symptoms, or what tests are coming or who needs to be called or anything like that. We just talk about us. And it is so different than what's happened before. And as the MRI and the LP and the blood work all start to come back relatively normal. We get a choice, get admitted to Obs or continue monitoring at home. I look over at her again. But now her shoulders are slumped and she won't meet my eyes. She doesn't have the strength anymore to fight this foregone conclusion. More hard questions from therapy fill the silence between us. How do I balance my fear of losing her with the necessity of respecting her autonomy? Her expression changes from what it was to this look of this mixed look of surprise and weariness when I asked her, "So what do you want to do?" When we finally get back home, we collapse on the couch wrung out and defeated. She curls up next to me and says, "Thank you. That's the first time I didn't feel alone there." And then she falls asleep.
Emily Silverman
I am sitting here with the wonderful Anthony Williams. Anthony, thanks for being here today.
Anthony Williams
Thank you so much for having me, Emily. It's a pleasure to be here.
Emily Silverman
So Anthony, what a gift that story was, I have to say it was just such an intimate story and so touching. I was wondering if to begin, you could just tell us a bit about your marriage and how you and your partner met.
Anthony Williams
So we actually met when we were both freshmen in our undergraduate education at the University of Oklahoma. We dated for a while for a few years when we were both much younger and then we broke up but we stayed friends for many years. And I think when you're friends with somebody, you get to see them through a lot of different life phases and we both kind of matured alongside each other within that friendship that grew. And then in residency, we got back together as romantic partners. And she was in California at the time, and I was in Minnesota doing my residency, she was doing a PhD. And then she moved here, I think right at the beginning of my second year of residency.
Emily Silverman
And so I'm wondering with you and your partner, at what point along the journey did we fall into this world of mystery diagnosis, chronic disease that science doesn't understand? It sounds like that's been a huge part of your relationship and just trying to navigate that, when did that all start and maybe tell us a bit about what it was like to navigate that or what it is like to navigate that.
Anthony Williams
It started pretty suddenly, in my second year of residency, she was relatively healthy. And then there was just one evening where she was really having sudden increased work of breathing and just feeling really uncomfortable laying down flat. And it had coincided with the viral illness that it coincided with us doing kind of a different workout regimen. And so being physician-minded, I was thinking in terms of like, okay, "Is this a PE, is this a pneumo, is this something that we can just go and kind of get this sorted out?" But either way, it's a sudden acute change. And so I'm pretty concerned. And so the sudden flip from healthy to this is something that needs to be worked up was startling. But I don't think either of us was really prepared for the journey of having a lot of these scary symptoms, recurrent symptoms happen over the next months to years, and then ending in a place where we are now where we kind of have accepted a lot of just living with unknowns after seeing so many different specialists that go along with a chronic disorder, especially when you don't really have the closure of a specific diagnosis.
Emily Silverman
Yeah, The Nocturnists is working on a series on the topic of uncertainty, which is such an important topic in medicine, and one that we talk about somewhat, but maybe not as much as we should. I'm curious, if you want to say more about that, both from the perspective of a husband and a partner, but also, like, has that changed the way that you practice or the way that you think about American medicine or Western medicine in general?
Anthony Williams
Over time, I've come to understand a little bit better how I deal with uncertainty. And the kicker, for me was the realization that from the outside looking in, I appear to deal with uncertainty very well. And I think I do in a lot of cases, but the question is at the expense of what? So what lessons am I carrying that I learned from childhood? What trade-offs am I making to navigate through chaotic, uncertain environments? And so one of those trade-offs is a certain suppression of discomfort of a lot of other things that go along with that. And so walking into the hospital, trying to figure out a clinical diagnosis, operating as a resident, I think my external presentation in terms of how I navigate uncertainty would say, "Okay, yeah, does a good job, doesn't appear distressed a lot by uncertainty." But what happens when a person who is close to you needs the real you during uncertain periods as a support, as evidence that they're not alone, as somebody to walk hand in hand with? I think that is where a lot of the conflict came in with uncertainty. And so when I think about that, personally, it starts to make me reflect also professionally, and particularly, my mind always comes back to one on one patient encounters. Am I thinking critically, insightfully, carefully about how I'm communicating and how my therapeutic relationship is being built within these boundaries of uncertainty?
Emily Silverman
Yeah, you describe from the outside, I may seem like I'm handling the uncertainty, but on the inside, maybe there is some distress? Can you give us an example, it could be from your personal life, or it could be from your professional life? As a physician, you're taking care of a patient, you don't know what's wrong with them. Do you feel like you have to project certainty? Or are you projecting a comfort with uncertainty? Bring us into that, inside outside-- I look like I'm okay and I'm not difference.
Anthony Williams
If I am walking into a clinical space, and I don't know, I may have a lot of anxiety about an unstable patient. I may be spinning my wheels about is there a diagnosis that I'm missing? There may be because I don't know what's going on right now. So there's something I'm missing here, right? Do I need to consult someone to talk to a specialist and am I missing something obvious? There's a lot of this that's going on inside me that's really like really, really spinning it up. But not a lot of that is going to come out in the patient encounter. If there is a person that I feel would benefit from having their doctor admit that we're still doing some of the workup, I don't know what's going on with you. But if I run into a wall, I'm going to get other people and their brains involved on the case. If there's patients that benefit from that, then that's the route I go. Some patients need a little bit more certainty. But all of this is kind of beyond what's actually happening inside of me at any given moment. So the long-winded way of answering your question would be to say that there is a chasm, essentially, between what's happening inside, and then what actually comes out after you do all these operations on that uncertainty.
Emily Silverman
In your family, do you feel like the doctors did a good job communicating that uncertainty to you and your partner? Do you feel like they tried to pretend like they knew more than they did? Or like you said, the word transparency, how did we do, being on the receiving end as a, as a patient or as a family?
Anthony Williams
Overall, I was actually really happy with how it transpired. Now, there are some asterisks there, because for many of these admissions, she was in hospitals that I worked in. And so it's different when you know a lot of the physicians that you're working with, and it was by no means, you know, A-plus, across the board, there were some encounters that, you know, I was not happy with, and she was not happy with. But by and large, the communication of uncertainty was well done, compassionate. And as you're probably aware, there's also the other side of, you know, being on the text chains with my, you know, co residents and friends and so on, those are blowing up with like, "Hey, did they check this? Did they check that? You know, what about this? What are we thinking about that?" And so there was a lot of that going on in the background, too, especially in the earlier years.
Emily Silverman
Yeah, you talk about how, as the years went on, she got tired, and she didn't want to go to the ER anymore. And that conflicting desire, on the one hand, wanting to honor her choice and her autonomy, but on the other hand, like wanting to save her, wanting to protect her, wanting to fight. And I feel like this comes up a lot in clinical medicine, when you have a person who is expressing, you know, that they don't want to come to the hospital anymore, or something like that. And the family members resist. And I think sometimes as the physician on the team, there can be this feeling of like, "You know, just let go, just, you know, just let the person who is sick, guide the care, make the decisions." And I think it's really easy to say that and to think that when you're like outside of, of the love and the family dynamic, but I imagine when you're inside of that, and you love this person so much, that that letting go is just a lot easier said than done. And so can you speak to that?
Anthony Williams
It is a lot more difficult to do that when it's your person, in some ways, when there is a diagnosis that can offer a bit of closure. And so in the case of me and my partner and watching her go through an ill-defined, undetermined illness that's chronic, it stacked a lot of assumptions and biases that I carried. One we've already talked about, which is my response to uncertainty. Another one is the idea that a lot of our opinions about how much to do, when to do it, when to let go, are based off of things like age. So it can give you the same story. And if we're both 90, that's a very different thing than mid 30s with a person who is otherwise healthy, there was always the sense of, if we just go, this may be the time that they figure it out, and then we can figure out what to do about it. And so these are the little stepping stones that take me from wanting to be supportive to basically being domineering and stepping on her agency, whether I intended to do that or not. And I think those are some of the things that it took me a long time to see.
Emily Silverman
Yeah, you talk about some of the family lessons that you internalize from growing up, you know things about defending yourself, handling your business, so on and so forth. Talk about how that made its way into your marriage because it was really interesting to hear the translation of like the basketball court to this like tender caregiving relationship like on their face, they seem like really different moments. And on the other hand, I can see how a lot of those lessons would then translate into the interpersonal relationships.
Anthony Williams
On the surface. I would agree with you that the you know, the basketball story and relationships are seem disparate. What they have in common is and how my parents and our family used sports, when we were younger, we all played me my brother, my sister, we played from really young to we graduated high school. Sports was used as a testing ground, training ground, its own sort of school for the types of lessons you need to learn when facing adversity. And so this adversity, yes, for the moment is on the basketball court. It's on the football field, it's, you know, on the baseball circuit, whatever, wherever, wherever it is, there's adversity, but how does that those lessons that you learn generalize to the rest of life, because wherever you go, there's going to be adversity. And so coming from basketball, being my primary sport, and playing that, all the way through graduating high school, playing at a competitive level for many years, you start to pick up these ideas, and you start to learn about what it means to put time in to be able to embrace discomfort, to be able to suppress certain types of desires, like not wanting to do another set, you know, not wanting to practice for the essentially the greater good, you're trying to get somewhere and to get somewhere takes a certain amount of sacrifice in the moment. And so there were a lot of principles abstracted from basketball that I drew from when life got tough. That was in medical school, that was in residency, and that was in marriage. But I never really took the time to interrogate when those are applicable. And when they're not, until I had to wake up and see that whatever I was doing, it just wasn't working. It was just making things worse, even though I felt like I was doing what I was supposed to be doing as a doctor and a husband and things like that. And eventually you have to kind of open your eyes to that and maybe get outside perspectives.
Emily Silverman
Yeah, you talk about masculinity, or I don't know if you said that word in your story. But I think that word came up at some point along the coaching process, you know, this question of what it is to be a man what it is to be a husband and re examining that. And I thought that was so powerful, and was wondering if that still resonates with you, and how you think about masculinity these days after kind of re crunching the numbers and recalibrating, like when is this approach appropriate? And when is it actually counterproductive?
Anthony Williams
So one of the takeaways, I think, for me, was this idea of being a little bit more thoughtful and intentional about the words and the roles that I take on or that I use, even within my own self, even if I don't speak them out loud. Because there are words, there are roles, there are titles that are really sneaky about importing more meaning than you thought was there. So if I say I want to be a good husband versus I want to be a good partner. And realizing that though the husband and the partner are importing slightly different or sometimes drastically different meanings with them with just with the words and thinking in terms of this is what a good husband would do. Or this is what a doctor husband would do, limits the types of solutions that I can see. Because they're importing certain ideas of masculinity, certain ideas of caretaking certain ideas, of just being able to handle one's business. A lot of these things are imported, that I didn't really think about before. And so whether it's husband-partner, whether it's doctor-provider, there's a lot of ways that you can you can look at different words and then see how they sit with you and see how that impacts the way that you look at the world and the way that you look at possible solutions. And so, this understanding of the importance of language in the thoughtful approach to, "Okay what lessons am I really bringing here, when I when I say that? What am I really saying when I when I use this terminology?"
Emily Silverman
So when you switch the word from husband to partner or doctor to partner like I'm just thinking about the word partner, it does have a different flavor to it.
Anthony Williams
Yeah, it does. For me, it was the difference between a partner for me, was more flexible, it was less constricting for me than husband. And I had never thought about that before. As a partner, there can be a discussion of going back to the hospital versus not of managing at home. And I think similarly about, you know, doctor-provider, right, like, you know, if I use the term, you know, "I'm the doctor", is it easier for me to think about things being my job versus not my job, right, versus maybe a provider means, "I still have a job, I still have a responsibility," but in any given moment, maybe I would do something that isn't typically what I would do, because it needs to be done. This is this is a unique situation. And so I think this change in terminology for me improved her perception and sense that I was truly present in this relationship, especially when times were hard.
Emily Silverman
Yeah, that moment at the end of the story, where she looks up at you, and she says, "Thanks for that. That was the first time I didn't feel alone." And then she falls asleep in your lap. It's such a small thing, such a small moment, but also so big, like such a big difference. And it wasn't a huge shift. It was just taking a beat, you know, pausing and asking, like what do you think or you know, I guess, releasing the wheel a bit, or I don't know how you would describe it.
Anthony Williams
Just as you said, it's, it's a small moment. But it is an inflection point. It is a ray of hope that says perhaps the trajectory of what's been happening will change. And the work is ongoing, right? Like there's no wrapping this up neatly with a bow. You don't undo years of trauma and all this stuff, just with one time that you happen to not be crappy at it. And then we're all good. This is, you know, this is this is a daily practice.
Emily Silverman
Yeah, it really represented, I think, for me as a listener, like a shift in mindset and the beginning of something new. And as I was re-listening to your story, this morning, to prepare for this conversation, I was reminded of an internal medicine resident that I worked with in the hospital. And he had always wanted to do ICU medicine, from medical school on and even through the beginning of residency, he was going to do pulmonary critical care, he was going to work in the ICU, he was going to save lives, he was going to intubate, he was going to throw in lines, he was going to you know, do chest compressions and, you know, do do do all these things, and did a bunch of ICU rotations and realized that there was something missing. And he didn't actually like it as much as he thought he did. And that he was feeling more drawn to the end of life conversations, and the deep listening and their family meetings and that environment than he was to the acute phase of like stabilizing people once they were admitted to the ICU. And he was really thinking about transitioning his career plan, from ICU to palliative care. But he was really afraid to announce this to his friends and family. And when we were talking about it, he brought up this example of another sports analogy of being in Little League and swinging and missing the ball a few times, and then his coach yelling at him and he was sitting in the dugout, and he was crying. And you know, then the coach saw him cry and said, you know, why are you crying, you know, kind of shaming him for crying basically. And he was linking that memory to part of why he was struggling to come out, so to speak as wanting to do palliative care. And so I was just thinking about that story today. And then thinking about your story, because it's kind of a similar shift. It's like going from an action based mode to more of a listening and receptive mode. And it ties in with, as we said, masculinity and things like that. So I'm just curious if that resonates with you at all.
Anthony Williams
When we're, you know, young when I was young, there were so many lessons to be learned. And a lot of them were immediately applicable. So you know, the kid in the baseball story, he's going to keep playing baseball presumably or T ball or sports, that's going to be reinforced over and over and over again. What they're teaching us is to help us survive and be successful now and to go as far as they can see. But once we get to that edge, then it's on us to figure out what else you can see when you get to that next mountain top, what do you see in you, me, kind of us as individuals, have to be able to do that work if we want to continue to progress. So, at a certain point, these lessons that were given to us that we learned at some point, and I don't know when there's this transition in terms of responsibility in terms of like, "Hey, okay, now I've got this, and this has carried me as far as it can carry me." It may carry, you know, the person in your story all the way to figuring out he doesn't want to do ICU and wants to do palliative care, it may carry me all the way into residency and into marriage with a partner I love very much. And then that may be the plateau with what I have. And that doesn't mean you jettison everything. But that does mean that to continue to move forward, you have to start to kind of go through your chest of stuff that you brought, and started like, "Okay, gotta throw that out. I can keep this, I gotta fiddle with this to make it useful." And I think that is how I start to think about kind of over the big arc.
Emily Silverman
So, you went on stage and told this amazing story. And I'm just curious if you received any thoughts, comments, feedback from your peers and colleagues and family and friends? Like how, how did people receive your story?
Anthony Williams
I got a lot of support, a lot of support, a lot of hugs, a lot of texts, just a lot of support. And immediately after telling the story, there was just this endorphin rush. I just felt like so good. And I was like that was amazing. It also felt a little bit like I had a dissociative fugue, because I was like, "Was that me up there who told that story and like, shared some, some really vulnerable things on that stage?"
Emily Silverman
So you are in Minneapolis, and your hospital has the Center for the Art of Medicine, CFAM, which is an incredibly vibrant community of like medical arts, medical storytelling, you know, all that good stuff. It's so fantastic. You seem to be in the right place for this. So I'm just curious, do you have any plans to to keep storytelling in any way shape, or form or stay connected to that community? And what does the future hold for you not just as a physician and a husband/partner, but also as a storyteller, as a creator.
Anthony Williams
Being a part of the Center for the Art of Medicine is just one of those things that is so awesome. I could have never predicted that would be a thing, right? If you told me 10 years ago that I would be a part of this, working with amazing people, getting to, you know, write, create and support other creators. I don't even know I would have had a place to put that information. That seems like that's ridiculous. I don't see myself in that vein. So yes, I see myself continuing to be a part of this because not only do I enjoy it, but I also think that it is so integral to the work that we do as physicians, and it's also really an important part of physician development, in terms of being tapped in with medical students and residents and attendings from early career to late you know, seasoned attendings. Right, like, there's something for everyone under this umbrella of humanities, creativity, blended with medicine, patient stories. I see this as part and parcel to who I am. And one of the things that everybody else all the other amazing people that I get to work with in CFAM have in common is that we all would be doing this even if there was no umbrella for us to fall under. And I think that's what makes it so amazing. We'd be writing, we'd be trying to create TV shows, we'd be out there pursuing, you know, social justice. There's all there's just so much stuff there that we would do, even if there was no umbrella. But now there is an umbrella and there's a framework and then we get to feed off each other. And that's, that's really that's really, really cool. And I am, you know, just ecstatic to be a part of that.
Emily Silverman
I have been speaking with Anthony Williams, about the story that he told in Minneapolis in 2023. Anthony, thank you so much for sharing your story with The Nocturnists audience and for coming on to speak with me today.
Anthony Williams
Thank you so much for having me, Emily. It's been a pleasure.
*Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.***TRANSCRIPT:**
Emily Silverman
You're listening to The Nocturnists “Stories from the World of Medicine.” I'm Emily Silverman. As clinicians, it can be tough to snap out of “medical mode” when our loved ones get sick. Our brains get wired a certain way, wired toward diagnosis and treatment and problem solving and action. But sometimes that's not what our loved ones need. Sometimes a pause, a breath, and a listening ear is just what the doctor ordered. In today's episode, Dr. Anthony Williams** **talks about the lessons he learned and unlearned about how to handle life's hardest challenges, and how this all came to a head when his partner developed a mysterious chronic disease. In the conversation that follows. Anthony and I talk about uncertainty in medicine, masculinity as it pertains to caregiving, and how a simple change in language can dramatically shift one's mindset. Anthony is a med-peds hospitalist at HealthPartners, who splits his clinical time between Regions and Children's Minnesota. He's an associate program director of the med-peds residency program at the University of Minnesota and an associate director for the Center for the Art of Medicine. Let's listen to Anthony telling his story live in Minnesota in 2023. It's called Love in Practice.
Anthony Williams
It is complete chaos in this gym right now. Kids are slipping and sliding all over the dusty court. Coaches are yelling and the parents, the supposedly responsible adults here are just up in the stands losing it. And even for a second grader, I am tiny. So my bar for success here is pretty low. I'm just trying to survive this YMCA basketball game. Now, my pregame lecture from my dad, who's also one of the coaches, centered around me shooting the ball more and being tough. It is the third quarter and I am busy failing spectacularly at both of these things when a kid from the other team comes out of nowhere and shoves me to the ground. Now for good measure, this kid makes sure to take the time to stomp on me several times before running away. So I get up and I limped to the bench crying about my scraped knee and bruised elbow. And for the life of me, I cannot meet my dad's eyes as I tell him that I don't want to go back into the game. Now, he doesn't force me to. He doesn't make me go back in. But in that moment, I can feel his disappointment with me. So later that night at our family talk table, which is just our dinner table after the food gets cleared, my parents are sitting at either end, my younger sisters to my left, my older brothers across me. And there is this pleasant aroma of spaghetti and garlic bread hanging in the air. But we all know that dinner ain't over until the analysis of the game is done. So it's not long before my dad leans forward to rest his interlaced hands on the table. And I get a spike of anxiety at this because I know that it is time for the lessons that start at basketball but always seem to generalize to the rest of life. So for my dad, it's, "Anthony, you need to be more aggressive and impose your will out there. When it's game time, you got to figure out how to flip that switch and handle your business." And from my mom, it's, "Everybody gets hurt sometimes and that's okay. But don't make yourself a target by announcing it to the world." Now, the talk table is a huge part of our upbringing. It's where we learn how to survive street fights, how to interact with the police, and how to stay out of trouble with teachers. And these are some of the crucial lessons that I leaned heavily on to make it through med school and residency. But these are also the lessons that I carry into my marriage. So in 2016, my second year of residency, my partner starts having these episodes of unexplained hypoxia which is just low oxygen in the body. She's actually on home oxygen for eight months. And over the next year, there are all these tests and specialists and hospitalizations, but she never really gets a diagnosis. We fast track our wedding, both for the health benefits and because we don't know how much longer she's going to be alive. And it's not until July 2018, over two years later, that any kind of acceptance finally arrives for us.
The smells of late summer and life washed through the open windows of our small apartment, only to be swept away by the somber currents of goals of care. It's been three hours of heavy, heavy conversation and a box of Kleenex later, but we're finally here. No more ERs and no more hospitals. She tells me the next time I have an episode, I want to manage it at home. And despite the palpable sense of unease, bordering on dread that I feel, I agree to this. Now it's August 2018, barely a month later. It is a Thursday night and my entire body is just taut with tension. I've gotten her as comfortable as I can in our queen size bed tucked under her favorite weighted blanket and a thick blue comforter. But our home pulse ox is still reading in the upper 70s. She's just not bouncing back like she usually would. She can't talk to me, but she can still communicate with her eyes. They're this beautiful hazel color with scattered speckles of dark brown. And they seem to be asking me, begging me, please remember our deal. Please remember what we agreed to. They're the same eyes that I fell in love with when we were 20. And they were just so full of anger and righteous indignation because she wanted me to apply to the scholarship or something. And me and my infinite 20-year-old wisdom was like, "Nah, not doing it. That is a complete waste of time." We argued about this for weeks and weeks and weeks until finally with the deadline looming, she did my entire application for me in addition to her own, and on the due date, she stormed into my room, slams the paperwork onto my desk and says, "All you need to do is sign I've done everything else for you. And if you're too stubborn or too stupid to do even this, then no one can help you." I was so pissed. But I signed because I'm not 100% foolish. And that's how we both became McNair Scholars, she's always, always had my back and her behavior, It aligns with the most important lesson from the talk table: Life is not about your emotions, or what you want to do. Life is about what you need to do to survive, and what you need to do to protect your family. And with that, there is this switch inside of me that flips. This terrible situation is no different than being pushed down on a basketball court. I can give up, go to the bench and potentially let the most important person in my world die. Or I can man up and handle my business, just like I was taught. So I tell her, I'm gonna call 911. And when I do this, I see something that I've never seen before. I see a light leave her eyes as they tear up. And the person who is looking back at me in this moment, she's different than the one I married. She's muted and less vibrant. Fast forward through another hospitalization and another discharge, which are all things we've done before. But what's different this time, that was her. After this admission, she's just withdrawn and distant all the time. This plays out over and over again, for the next two years, she refused to go to the hospital, and I'd override her. And if she got stubborn and dug in her heels, I'd switch it up and fight dirty, I'd rat her out in a second to her sisters and her mom and they'd call her up and they'd attack her in ways that only family knows how to do. Everybody wants her to go to the hospital. Everybody wants her to listen to me, her doctor husband.
And before we know it, it is 2020. And we're sitting down to have the conversation. In the years that it's taken us to grapple with the realities of her chronic illness, our entire relationship has crumbled beneath us. She wants us to do marriage counseling and me to do individual therapy. And so that is how I find myself in my first therapy session. Even though, in my opinion, I don't really need to be here. And on the off chance that I do need to be here, I don't think I would have chosen this particular guy to help me. Now, don't get me wrong, he seems a very nice, like a very lovely human. But he's also extremely white, even by Minnesota standards. He has long kind of long hair that stops just shy of being disheveled and a really open and flowy way of talking about things that makes my analytical brain just cramp up, because I can't really understand what he's trying to say or asking me to say. We're nearing the end of our first virtual session when he asked me kind of the first real concrete question. "So Anthony, how do you feel?" And I'm thinking to myself, "I know a trap question when I hear one." And I was wondering when this hippie was gonna try to read my soul. "I'm fine," I tell him. He looks thoughtful and gives the very therapist-y “Hmm” before saying, "Okay, to recap, you're a hospitalist working during the worst pandemic of our lifetime. You're also a black man living in the city where George Floyd was murdered, and your marriage is on the rocks. But you're fine?" Suddenly, I'm aware of blurry vision from unshed tears. But all I feel inside is hollow. And this pervasive emptiness is really what plants the first seeds of doubt in my mind that maybe this therapy thing isn't exactly what I thought it was going to be. But I'm not about to admit that to a stranger at this point. So all I tell him is, "Yeah, man, I'm doing great."
I'm about six months into therapy, the next time we're back in the emergency department again. This time, my partner has a fever, headache, neck pain, and a very painful rash, it's getting worse. And my mind it's doing what it usually does in these situations. It is racing through all the clinical stuff in the logistics, thinking about the CT and the MRI and the LP and the blood work and who needs to be called and getting back home to get our go bags, and on and on, and on and on. And this is the first time that a part of me, a small part, is able to step back and just watch this internal process with a dawning sense of alarm. So finally, I pause and I look, I just look at my partner. And for the first time I see it, I see the sadness and the loneliness that's there. And this sudden awareness, this new awareness, causes all of these painful truths that I've been having to admit out loud in therapy for the last six months to come bubbling up to the surface. I use responsibility and duty to dissociate from what I'm feeling. And this stress response, it smothers the human connection and makes her feel isolated, and utterly alone at a time when she's most vulnerable. So I take that truth, and I hold it. And I use it to choke out the words, "Baby, I'm worried. Please talk to me about what's going on with you." And there's a flicker of surprise in her eyes. But she talks. We talk. Not about her symptoms, or what tests are coming or who needs to be called or anything like that. We just talk about us. And it is so different than what's happened before. And as the MRI and the LP and the blood work all start to come back relatively normal. We get a choice, get admitted to Obs or continue monitoring at home. I look over at her again. But now her shoulders are slumped and she won't meet my eyes. She doesn't have the strength anymore to fight this foregone conclusion. More hard questions from therapy fill the silence between us. How do I balance my fear of losing her with the necessity of respecting her autonomy? Her expression changes from what it was to this look of this mixed look of surprise and weariness when I asked her, "So what do you want to do?" When we finally get back home, we collapse on the couch wrung out and defeated. She curls up next to me and says, "Thank you. That's the first time I didn't feel alone there." And then she falls asleep.
Emily Silverman
I am sitting here with the wonderful Anthony Williams. Anthony, thanks for being here today.
Anthony Williams
Thank you so much for having me, Emily. It's a pleasure to be here.
Emily Silverman
So Anthony, what a gift that story was, I have to say it was just such an intimate story and so touching. I was wondering if to begin, you could just tell us a bit about your marriage and how you and your partner met.
Anthony Williams
So we actually met when we were both freshmen in our undergraduate education at the University of Oklahoma. We dated for a while for a few years when we were both much younger and then we broke up but we stayed friends for many years. And I think when you're friends with somebody, you get to see them through a lot of different life phases and we both kind of matured alongside each other within that friendship that grew. And then in residency, we got back together as romantic partners. And she was in California at the time, and I was in Minnesota doing my residency, she was doing a PhD. And then she moved here, I think right at the beginning of my second year of residency.
Emily Silverman
And so I'm wondering with you and your partner, at what point along the journey did we fall into this world of mystery diagnosis, chronic disease that science doesn't understand? It sounds like that's been a huge part of your relationship and just trying to navigate that, when did that all start and maybe tell us a bit about what it was like to navigate that or what it is like to navigate that.
Anthony Williams
It started pretty suddenly, in my second year of residency, she was relatively healthy. And then there was just one evening where she was really having sudden increased work of breathing and just feeling really uncomfortable laying down flat. And it had coincided with the viral illness that it coincided with us doing kind of a different workout regimen. And so being physician-minded, I was thinking in terms of like, okay, "Is this a PE, is this a pneumo, is this something that we can just go and kind of get this sorted out?" But either way, it's a sudden acute change. And so I'm pretty concerned. And so the sudden flip from healthy to this is something that needs to be worked up was startling. But I don't think either of us was really prepared for the journey of having a lot of these scary symptoms, recurrent symptoms happen over the next months to years, and then ending in a place where we are now where we kind of have accepted a lot of just living with unknowns after seeing so many different specialists that go along with a chronic disorder, especially when you don't really have the closure of a specific diagnosis.
Emily Silverman
Yeah, The Nocturnists is working on a series on the topic of uncertainty, which is such an important topic in medicine, and one that we talk about somewhat, but maybe not as much as we should. I'm curious, if you want to say more about that, both from the perspective of a husband and a partner, but also, like, has that changed the way that you practice or the way that you think about American medicine or Western medicine in general?
Anthony Williams
Over time, I've come to understand a little bit better how I deal with uncertainty. And the kicker, for me was the realization that from the outside looking in, I appear to deal with uncertainty very well. And I think I do in a lot of cases, but the question is at the expense of what? So what lessons am I carrying that I learned from childhood? What trade-offs am I making to navigate through chaotic, uncertain environments? And so one of those trade-offs is a certain suppression of discomfort of a lot of other things that go along with that. And so walking into the hospital, trying to figure out a clinical diagnosis, operating as a resident, I think my external presentation in terms of how I navigate uncertainty would say, "Okay, yeah, does a good job, doesn't appear distressed a lot by uncertainty." But what happens when a person who is close to you needs the real you during uncertain periods as a support, as evidence that they're not alone, as somebody to walk hand in hand with? I think that is where a lot of the conflict came in with uncertainty. And so when I think about that, personally, it starts to make me reflect also professionally, and particularly, my mind always comes back to one on one patient encounters. Am I thinking critically, insightfully, carefully about how I'm communicating and how my therapeutic relationship is being built within these boundaries of uncertainty?
Emily Silverman
Yeah, you describe from the outside, I may seem like I'm handling the uncertainty, but on the inside, maybe there is some distress? Can you give us an example, it could be from your personal life, or it could be from your professional life? As a physician, you're taking care of a patient, you don't know what's wrong with them. Do you feel like you have to project certainty? Or are you projecting a comfort with uncertainty? Bring us into that, inside outside-- I look like I'm okay and I'm not difference.
Anthony Williams
If I am walking into a clinical space, and I don't know, I may have a lot of anxiety about an unstable patient. I may be spinning my wheels about is there a diagnosis that I'm missing? There may be because I don't know what's going on right now. So there's something I'm missing here, right? Do I need to consult someone to talk to a specialist and am I missing something obvious? There's a lot of this that's going on inside me that's really like really, really spinning it up. But not a lot of that is going to come out in the patient encounter. If there is a person that I feel would benefit from having their doctor admit that we're still doing some of the workup, I don't know what's going on with you. But if I run into a wall, I'm going to get other people and their brains involved on the case. If there's patients that benefit from that, then that's the route I go. Some patients need a little bit more certainty. But all of this is kind of beyond what's actually happening inside of me at any given moment. So the long-winded way of answering your question would be to say that there is a chasm, essentially, between what's happening inside, and then what actually comes out after you do all these operations on that uncertainty.
Emily Silverman
In your family, do you feel like the doctors did a good job communicating that uncertainty to you and your partner? Do you feel like they tried to pretend like they knew more than they did? Or like you said, the word transparency, how did we do, being on the receiving end as a, as a patient or as a family?
Anthony Williams
Overall, I was actually really happy with how it transpired. Now, there are some asterisks there, because for many of these admissions, she was in hospitals that I worked in. And so it's different when you know a lot of the physicians that you're working with, and it was by no means, you know, A-plus, across the board, there were some encounters that, you know, I was not happy with, and she was not happy with. But by and large, the communication of uncertainty was well done, compassionate. And as you're probably aware, there's also the other side of, you know, being on the text chains with my, you know, co residents and friends and so on, those are blowing up with like, "Hey, did they check this? Did they check that? You know, what about this? What are we thinking about that?" And so there was a lot of that going on in the background, too, especially in the earlier years.
Emily Silverman
Yeah, you talk about how, as the years went on, she got tired, and she didn't want to go to the ER anymore. And that conflicting desire, on the one hand, wanting to honor her choice and her autonomy, but on the other hand, like wanting to save her, wanting to protect her, wanting to fight. And I feel like this comes up a lot in clinical medicine, when you have a person who is expressing, you know, that they don't want to come to the hospital anymore, or something like that. And the family members resist. And I think sometimes as the physician on the team, there can be this feeling of like, "You know, just let go, just, you know, just let the person who is sick, guide the care, make the decisions." And I think it's really easy to say that and to think that when you're like outside of, of the love and the family dynamic, but I imagine when you're inside of that, and you love this person so much, that that letting go is just a lot easier said than done. And so can you speak to that?
Anthony Williams
It is a lot more difficult to do that when it's your person, in some ways, when there is a diagnosis that can offer a bit of closure. And so in the case of me and my partner and watching her go through an ill-defined, undetermined illness that's chronic, it stacked a lot of assumptions and biases that I carried. One we've already talked about, which is my response to uncertainty. Another one is the idea that a lot of our opinions about how much to do, when to do it, when to let go, are based off of things like age. So it can give you the same story. And if we're both 90, that's a very different thing than mid 30s with a person who is otherwise healthy, there was always the sense of, if we just go, this may be the time that they figure it out, and then we can figure out what to do about it. And so these are the little stepping stones that take me from wanting to be supportive to basically being domineering and stepping on her agency, whether I intended to do that or not. And I think those are some of the things that it took me a long time to see.
Emily Silverman
Yeah, you talk about some of the family lessons that you internalize from growing up, you know things about defending yourself, handling your business, so on and so forth. Talk about how that made its way into your marriage because it was really interesting to hear the translation of like the basketball court to this like tender caregiving relationship like on their face, they seem like really different moments. And on the other hand, I can see how a lot of those lessons would then translate into the interpersonal relationships.
Anthony Williams
On the surface. I would agree with you that the you know, the basketball story and relationships are seem disparate. What they have in common is and how my parents and our family used sports, when we were younger, we all played me my brother, my sister, we played from really young to we graduated high school. Sports was used as a testing ground, training ground, its own sort of school for the types of lessons you need to learn when facing adversity. And so this adversity, yes, for the moment is on the basketball court. It's on the football field, it's, you know, on the baseball circuit, whatever, wherever, wherever it is, there's adversity, but how does that those lessons that you learn generalize to the rest of life, because wherever you go, there's going to be adversity. And so coming from basketball, being my primary sport, and playing that, all the way through graduating high school, playing at a competitive level for many years, you start to pick up these ideas, and you start to learn about what it means to put time in to be able to embrace discomfort, to be able to suppress certain types of desires, like not wanting to do another set, you know, not wanting to practice for the essentially the greater good, you're trying to get somewhere and to get somewhere takes a certain amount of sacrifice in the moment. And so there were a lot of principles abstracted from basketball that I drew from when life got tough. That was in medical school, that was in residency, and that was in marriage. But I never really took the time to interrogate when those are applicable. And when they're not, until I had to wake up and see that whatever I was doing, it just wasn't working. It was just making things worse, even though I felt like I was doing what I was supposed to be doing as a doctor and a husband and things like that. And eventually you have to kind of open your eyes to that and maybe get outside perspectives.
Emily Silverman
Yeah, you talk about masculinity, or I don't know if you said that word in your story. But I think that word came up at some point along the coaching process, you know, this question of what it is to be a man what it is to be a husband and re examining that. And I thought that was so powerful, and was wondering if that still resonates with you, and how you think about masculinity these days after kind of re crunching the numbers and recalibrating, like when is this approach appropriate? And when is it actually counterproductive?
Anthony Williams
So one of the takeaways, I think, for me, was this idea of being a little bit more thoughtful and intentional about the words and the roles that I take on or that I use, even within my own self, even if I don't speak them out loud. Because there are words, there are roles, there are titles that are really sneaky about importing more meaning than you thought was there. So if I say I want to be a good husband versus I want to be a good partner. And realizing that though the husband and the partner are importing slightly different or sometimes drastically different meanings with them with just with the words and thinking in terms of this is what a good husband would do. Or this is what a doctor husband would do, limits the types of solutions that I can see. Because they're importing certain ideas of masculinity, certain ideas of caretaking certain ideas, of just being able to handle one's business. A lot of these things are imported, that I didn't really think about before. And so whether it's husband-partner, whether it's doctor-provider, there's a lot of ways that you can you can look at different words and then see how they sit with you and see how that impacts the way that you look at the world and the way that you look at possible solutions. And so, this understanding of the importance of language in the thoughtful approach to, "Okay what lessons am I really bringing here, when I when I say that? What am I really saying when I when I use this terminology?"
Emily Silverman
So when you switch the word from husband to partner or doctor to partner like I'm just thinking about the word partner, it does have a different flavor to it.
Anthony Williams
Yeah, it does. For me, it was the difference between a partner for me, was more flexible, it was less constricting for me than husband. And I had never thought about that before. As a partner, there can be a discussion of going back to the hospital versus not of managing at home. And I think similarly about, you know, doctor-provider, right, like, you know, if I use the term, you know, "I'm the doctor", is it easier for me to think about things being my job versus not my job, right, versus maybe a provider means, "I still have a job, I still have a responsibility," but in any given moment, maybe I would do something that isn't typically what I would do, because it needs to be done. This is this is a unique situation. And so I think this change in terminology for me improved her perception and sense that I was truly present in this relationship, especially when times were hard.
Emily Silverman
Yeah, that moment at the end of the story, where she looks up at you, and she says, "Thanks for that. That was the first time I didn't feel alone." And then she falls asleep in your lap. It's such a small thing, such a small moment, but also so big, like such a big difference. And it wasn't a huge shift. It was just taking a beat, you know, pausing and asking, like what do you think or you know, I guess, releasing the wheel a bit, or I don't know how you would describe it.
Anthony Williams
Just as you said, it's, it's a small moment. But it is an inflection point. It is a ray of hope that says perhaps the trajectory of what's been happening will change. And the work is ongoing, right? Like there's no wrapping this up neatly with a bow. You don't undo years of trauma and all this stuff, just with one time that you happen to not be crappy at it. And then we're all good. This is, you know, this is this is a daily practice.
Emily Silverman
Yeah, it really represented, I think, for me as a listener, like a shift in mindset and the beginning of something new. And as I was re-listening to your story, this morning, to prepare for this conversation, I was reminded of an internal medicine resident that I worked with in the hospital. And he had always wanted to do ICU medicine, from medical school on and even through the beginning of residency, he was going to do pulmonary critical care, he was going to work in the ICU, he was going to save lives, he was going to intubate, he was going to throw in lines, he was going to you know, do chest compressions and, you know, do do do all these things, and did a bunch of ICU rotations and realized that there was something missing. And he didn't actually like it as much as he thought he did. And that he was feeling more drawn to the end of life conversations, and the deep listening and their family meetings and that environment than he was to the acute phase of like stabilizing people once they were admitted to the ICU. And he was really thinking about transitioning his career plan, from ICU to palliative care. But he was really afraid to announce this to his friends and family. And when we were talking about it, he brought up this example of another sports analogy of being in Little League and swinging and missing the ball a few times, and then his coach yelling at him and he was sitting in the dugout, and he was crying. And you know, then the coach saw him cry and said, you know, why are you crying, you know, kind of shaming him for crying basically. And he was linking that memory to part of why he was struggling to come out, so to speak as wanting to do palliative care. And so I was just thinking about that story today. And then thinking about your story, because it's kind of a similar shift. It's like going from an action based mode to more of a listening and receptive mode. And it ties in with, as we said, masculinity and things like that. So I'm just curious if that resonates with you at all.
Anthony Williams
When we're, you know, young when I was young, there were so many lessons to be learned. And a lot of them were immediately applicable. So you know, the kid in the baseball story, he's going to keep playing baseball presumably or T ball or sports, that's going to be reinforced over and over and over again. What they're teaching us is to help us survive and be successful now and to go as far as they can see. But once we get to that edge, then it's on us to figure out what else you can see when you get to that next mountain top, what do you see in you, me, kind of us as individuals, have to be able to do that work if we want to continue to progress. So, at a certain point, these lessons that were given to us that we learned at some point, and I don't know when there's this transition in terms of responsibility in terms of like, "Hey, okay, now I've got this, and this has carried me as far as it can carry me." It may carry, you know, the person in your story all the way to figuring out he doesn't want to do ICU and wants to do palliative care, it may carry me all the way into residency and into marriage with a partner I love very much. And then that may be the plateau with what I have. And that doesn't mean you jettison everything. But that does mean that to continue to move forward, you have to start to kind of go through your chest of stuff that you brought, and started like, "Okay, gotta throw that out. I can keep this, I gotta fiddle with this to make it useful." And I think that is how I start to think about kind of over the big arc.
Emily Silverman
So, you went on stage and told this amazing story. And I'm just curious if you received any thoughts, comments, feedback from your peers and colleagues and family and friends? Like how, how did people receive your story?
Anthony Williams
I got a lot of support, a lot of support, a lot of hugs, a lot of texts, just a lot of support. And immediately after telling the story, there was just this endorphin rush. I just felt like so good. And I was like that was amazing. It also felt a little bit like I had a dissociative fugue, because I was like, "Was that me up there who told that story and like, shared some, some really vulnerable things on that stage?"
Emily Silverman
So you are in Minneapolis, and your hospital has the Center for the Art of Medicine, CFAM, which is an incredibly vibrant community of like medical arts, medical storytelling, you know, all that good stuff. It's so fantastic. You seem to be in the right place for this. So I'm just curious, do you have any plans to to keep storytelling in any way shape, or form or stay connected to that community? And what does the future hold for you not just as a physician and a husband/partner, but also as a storyteller, as a creator.
Anthony Williams
Being a part of the Center for the Art of Medicine is just one of those things that is so awesome. I could have never predicted that would be a thing, right? If you told me 10 years ago that I would be a part of this, working with amazing people, getting to, you know, write, create and support other creators. I don't even know I would have had a place to put that information. That seems like that's ridiculous. I don't see myself in that vein. So yes, I see myself continuing to be a part of this because not only do I enjoy it, but I also think that it is so integral to the work that we do as physicians, and it's also really an important part of physician development, in terms of being tapped in with medical students and residents and attendings from early career to late you know, seasoned attendings. Right, like, there's something for everyone under this umbrella of humanities, creativity, blended with medicine, patient stories. I see this as part and parcel to who I am. And one of the things that everybody else all the other amazing people that I get to work with in CFAM have in common is that we all would be doing this even if there was no umbrella for us to fall under. And I think that's what makes it so amazing. We'd be writing, we'd be trying to create TV shows, we'd be out there pursuing, you know, social justice. There's all there's just so much stuff there that we would do, even if there was no umbrella. But now there is an umbrella and there's a framework and then we get to feed off each other. And that's, that's really that's really, really cool. And I am, you know, just ecstatic to be a part of that.
Emily Silverman
I have been speaking with Anthony Williams, about the story that he told in Minneapolis in 2023. Anthony, thank you so much for sharing your story with The Nocturnists audience and for coming on to speak with me today.
Anthony Williams
Thank you so much for having me, Emily. It's been a pleasure.
Transcript
*Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.***TRANSCRIPT:**
Emily Silverman
You're listening to The Nocturnists “Stories from the World of Medicine.” I'm Emily Silverman. As clinicians, it can be tough to snap out of “medical mode” when our loved ones get sick. Our brains get wired a certain way, wired toward diagnosis and treatment and problem solving and action. But sometimes that's not what our loved ones need. Sometimes a pause, a breath, and a listening ear is just what the doctor ordered. In today's episode, Dr. Anthony Williams** **talks about the lessons he learned and unlearned about how to handle life's hardest challenges, and how this all came to a head when his partner developed a mysterious chronic disease. In the conversation that follows. Anthony and I talk about uncertainty in medicine, masculinity as it pertains to caregiving, and how a simple change in language can dramatically shift one's mindset. Anthony is a med-peds hospitalist at HealthPartners, who splits his clinical time between Regions and Children's Minnesota. He's an associate program director of the med-peds residency program at the University of Minnesota and an associate director for the Center for the Art of Medicine. Let's listen to Anthony telling his story live in Minnesota in 2023. It's called Love in Practice.
Anthony Williams
It is complete chaos in this gym right now. Kids are slipping and sliding all over the dusty court. Coaches are yelling and the parents, the supposedly responsible adults here are just up in the stands losing it. And even for a second grader, I am tiny. So my bar for success here is pretty low. I'm just trying to survive this YMCA basketball game. Now, my pregame lecture from my dad, who's also one of the coaches, centered around me shooting the ball more and being tough. It is the third quarter and I am busy failing spectacularly at both of these things when a kid from the other team comes out of nowhere and shoves me to the ground. Now for good measure, this kid makes sure to take the time to stomp on me several times before running away. So I get up and I limped to the bench crying about my scraped knee and bruised elbow. And for the life of me, I cannot meet my dad's eyes as I tell him that I don't want to go back into the game. Now, he doesn't force me to. He doesn't make me go back in. But in that moment, I can feel his disappointment with me. So later that night at our family talk table, which is just our dinner table after the food gets cleared, my parents are sitting at either end, my younger sisters to my left, my older brothers across me. And there is this pleasant aroma of spaghetti and garlic bread hanging in the air. But we all know that dinner ain't over until the analysis of the game is done. So it's not long before my dad leans forward to rest his interlaced hands on the table. And I get a spike of anxiety at this because I know that it is time for the lessons that start at basketball but always seem to generalize to the rest of life. So for my dad, it's, "Anthony, you need to be more aggressive and impose your will out there. When it's game time, you got to figure out how to flip that switch and handle your business." And from my mom, it's, "Everybody gets hurt sometimes and that's okay. But don't make yourself a target by announcing it to the world." Now, the talk table is a huge part of our upbringing. It's where we learn how to survive street fights, how to interact with the police, and how to stay out of trouble with teachers. And these are some of the crucial lessons that I leaned heavily on to make it through med school and residency. But these are also the lessons that I carry into my marriage. So in 2016, my second year of residency, my partner starts having these episodes of unexplained hypoxia which is just low oxygen in the body. She's actually on home oxygen for eight months. And over the next year, there are all these tests and specialists and hospitalizations, but she never really gets a diagnosis. We fast track our wedding, both for the health benefits and because we don't know how much longer she's going to be alive. And it's not until July 2018, over two years later, that any kind of acceptance finally arrives for us.
The smells of late summer and life washed through the open windows of our small apartment, only to be swept away by the somber currents of goals of care. It's been three hours of heavy, heavy conversation and a box of Kleenex later, but we're finally here. No more ERs and no more hospitals. She tells me the next time I have an episode, I want to manage it at home. And despite the palpable sense of unease, bordering on dread that I feel, I agree to this. Now it's August 2018, barely a month later. It is a Thursday night and my entire body is just taut with tension. I've gotten her as comfortable as I can in our queen size bed tucked under her favorite weighted blanket and a thick blue comforter. But our home pulse ox is still reading in the upper 70s. She's just not bouncing back like she usually would. She can't talk to me, but she can still communicate with her eyes. They're this beautiful hazel color with scattered speckles of dark brown. And they seem to be asking me, begging me, please remember our deal. Please remember what we agreed to. They're the same eyes that I fell in love with when we were 20. And they were just so full of anger and righteous indignation because she wanted me to apply to the scholarship or something. And me and my infinite 20-year-old wisdom was like, "Nah, not doing it. That is a complete waste of time." We argued about this for weeks and weeks and weeks until finally with the deadline looming, she did my entire application for me in addition to her own, and on the due date, she stormed into my room, slams the paperwork onto my desk and says, "All you need to do is sign I've done everything else for you. And if you're too stubborn or too stupid to do even this, then no one can help you." I was so pissed. But I signed because I'm not 100% foolish. And that's how we both became McNair Scholars, she's always, always had my back and her behavior, It aligns with the most important lesson from the talk table: Life is not about your emotions, or what you want to do. Life is about what you need to do to survive, and what you need to do to protect your family. And with that, there is this switch inside of me that flips. This terrible situation is no different than being pushed down on a basketball court. I can give up, go to the bench and potentially let the most important person in my world die. Or I can man up and handle my business, just like I was taught. So I tell her, I'm gonna call 911. And when I do this, I see something that I've never seen before. I see a light leave her eyes as they tear up. And the person who is looking back at me in this moment, she's different than the one I married. She's muted and less vibrant. Fast forward through another hospitalization and another discharge, which are all things we've done before. But what's different this time, that was her. After this admission, she's just withdrawn and distant all the time. This plays out over and over again, for the next two years, she refused to go to the hospital, and I'd override her. And if she got stubborn and dug in her heels, I'd switch it up and fight dirty, I'd rat her out in a second to her sisters and her mom and they'd call her up and they'd attack her in ways that only family knows how to do. Everybody wants her to go to the hospital. Everybody wants her to listen to me, her doctor husband.
And before we know it, it is 2020. And we're sitting down to have the conversation. In the years that it's taken us to grapple with the realities of her chronic illness, our entire relationship has crumbled beneath us. She wants us to do marriage counseling and me to do individual therapy. And so that is how I find myself in my first therapy session. Even though, in my opinion, I don't really need to be here. And on the off chance that I do need to be here, I don't think I would have chosen this particular guy to help me. Now, don't get me wrong, he seems a very nice, like a very lovely human. But he's also extremely white, even by Minnesota standards. He has long kind of long hair that stops just shy of being disheveled and a really open and flowy way of talking about things that makes my analytical brain just cramp up, because I can't really understand what he's trying to say or asking me to say. We're nearing the end of our first virtual session when he asked me kind of the first real concrete question. "So Anthony, how do you feel?" And I'm thinking to myself, "I know a trap question when I hear one." And I was wondering when this hippie was gonna try to read my soul. "I'm fine," I tell him. He looks thoughtful and gives the very therapist-y “Hmm” before saying, "Okay, to recap, you're a hospitalist working during the worst pandemic of our lifetime. You're also a black man living in the city where George Floyd was murdered, and your marriage is on the rocks. But you're fine?" Suddenly, I'm aware of blurry vision from unshed tears. But all I feel inside is hollow. And this pervasive emptiness is really what plants the first seeds of doubt in my mind that maybe this therapy thing isn't exactly what I thought it was going to be. But I'm not about to admit that to a stranger at this point. So all I tell him is, "Yeah, man, I'm doing great."
I'm about six months into therapy, the next time we're back in the emergency department again. This time, my partner has a fever, headache, neck pain, and a very painful rash, it's getting worse. And my mind it's doing what it usually does in these situations. It is racing through all the clinical stuff in the logistics, thinking about the CT and the MRI and the LP and the blood work and who needs to be called and getting back home to get our go bags, and on and on, and on and on. And this is the first time that a part of me, a small part, is able to step back and just watch this internal process with a dawning sense of alarm. So finally, I pause and I look, I just look at my partner. And for the first time I see it, I see the sadness and the loneliness that's there. And this sudden awareness, this new awareness, causes all of these painful truths that I've been having to admit out loud in therapy for the last six months to come bubbling up to the surface. I use responsibility and duty to dissociate from what I'm feeling. And this stress response, it smothers the human connection and makes her feel isolated, and utterly alone at a time when she's most vulnerable. So I take that truth, and I hold it. And I use it to choke out the words, "Baby, I'm worried. Please talk to me about what's going on with you." And there's a flicker of surprise in her eyes. But she talks. We talk. Not about her symptoms, or what tests are coming or who needs to be called or anything like that. We just talk about us. And it is so different than what's happened before. And as the MRI and the LP and the blood work all start to come back relatively normal. We get a choice, get admitted to Obs or continue monitoring at home. I look over at her again. But now her shoulders are slumped and she won't meet my eyes. She doesn't have the strength anymore to fight this foregone conclusion. More hard questions from therapy fill the silence between us. How do I balance my fear of losing her with the necessity of respecting her autonomy? Her expression changes from what it was to this look of this mixed look of surprise and weariness when I asked her, "So what do you want to do?" When we finally get back home, we collapse on the couch wrung out and defeated. She curls up next to me and says, "Thank you. That's the first time I didn't feel alone there." And then she falls asleep.
Emily Silverman
I am sitting here with the wonderful Anthony Williams. Anthony, thanks for being here today.
Anthony Williams
Thank you so much for having me, Emily. It's a pleasure to be here.
Emily Silverman
So Anthony, what a gift that story was, I have to say it was just such an intimate story and so touching. I was wondering if to begin, you could just tell us a bit about your marriage and how you and your partner met.
Anthony Williams
So we actually met when we were both freshmen in our undergraduate education at the University of Oklahoma. We dated for a while for a few years when we were both much younger and then we broke up but we stayed friends for many years. And I think when you're friends with somebody, you get to see them through a lot of different life phases and we both kind of matured alongside each other within that friendship that grew. And then in residency, we got back together as romantic partners. And she was in California at the time, and I was in Minnesota doing my residency, she was doing a PhD. And then she moved here, I think right at the beginning of my second year of residency.
Emily Silverman
And so I'm wondering with you and your partner, at what point along the journey did we fall into this world of mystery diagnosis, chronic disease that science doesn't understand? It sounds like that's been a huge part of your relationship and just trying to navigate that, when did that all start and maybe tell us a bit about what it was like to navigate that or what it is like to navigate that.
Anthony Williams
It started pretty suddenly, in my second year of residency, she was relatively healthy. And then there was just one evening where she was really having sudden increased work of breathing and just feeling really uncomfortable laying down flat. And it had coincided with the viral illness that it coincided with us doing kind of a different workout regimen. And so being physician-minded, I was thinking in terms of like, okay, "Is this a PE, is this a pneumo, is this something that we can just go and kind of get this sorted out?" But either way, it's a sudden acute change. And so I'm pretty concerned. And so the sudden flip from healthy to this is something that needs to be worked up was startling. But I don't think either of us was really prepared for the journey of having a lot of these scary symptoms, recurrent symptoms happen over the next months to years, and then ending in a place where we are now where we kind of have accepted a lot of just living with unknowns after seeing so many different specialists that go along with a chronic disorder, especially when you don't really have the closure of a specific diagnosis.
Emily Silverman
Yeah, The Nocturnists is working on a series on the topic of uncertainty, which is such an important topic in medicine, and one that we talk about somewhat, but maybe not as much as we should. I'm curious, if you want to say more about that, both from the perspective of a husband and a partner, but also, like, has that changed the way that you practice or the way that you think about American medicine or Western medicine in general?
Anthony Williams
Over time, I've come to understand a little bit better how I deal with uncertainty. And the kicker, for me was the realization that from the outside looking in, I appear to deal with uncertainty very well. And I think I do in a lot of cases, but the question is at the expense of what? So what lessons am I carrying that I learned from childhood? What trade-offs am I making to navigate through chaotic, uncertain environments? And so one of those trade-offs is a certain suppression of discomfort of a lot of other things that go along with that. And so walking into the hospital, trying to figure out a clinical diagnosis, operating as a resident, I think my external presentation in terms of how I navigate uncertainty would say, "Okay, yeah, does a good job, doesn't appear distressed a lot by uncertainty." But what happens when a person who is close to you needs the real you during uncertain periods as a support, as evidence that they're not alone, as somebody to walk hand in hand with? I think that is where a lot of the conflict came in with uncertainty. And so when I think about that, personally, it starts to make me reflect also professionally, and particularly, my mind always comes back to one on one patient encounters. Am I thinking critically, insightfully, carefully about how I'm communicating and how my therapeutic relationship is being built within these boundaries of uncertainty?
Emily Silverman
Yeah, you describe from the outside, I may seem like I'm handling the uncertainty, but on the inside, maybe there is some distress? Can you give us an example, it could be from your personal life, or it could be from your professional life? As a physician, you're taking care of a patient, you don't know what's wrong with them. Do you feel like you have to project certainty? Or are you projecting a comfort with uncertainty? Bring us into that, inside outside-- I look like I'm okay and I'm not difference.
Anthony Williams
If I am walking into a clinical space, and I don't know, I may have a lot of anxiety about an unstable patient. I may be spinning my wheels about is there a diagnosis that I'm missing? There may be because I don't know what's going on right now. So there's something I'm missing here, right? Do I need to consult someone to talk to a specialist and am I missing something obvious? There's a lot of this that's going on inside me that's really like really, really spinning it up. But not a lot of that is going to come out in the patient encounter. If there is a person that I feel would benefit from having their doctor admit that we're still doing some of the workup, I don't know what's going on with you. But if I run into a wall, I'm going to get other people and their brains involved on the case. If there's patients that benefit from that, then that's the route I go. Some patients need a little bit more certainty. But all of this is kind of beyond what's actually happening inside of me at any given moment. So the long-winded way of answering your question would be to say that there is a chasm, essentially, between what's happening inside, and then what actually comes out after you do all these operations on that uncertainty.
Emily Silverman
In your family, do you feel like the doctors did a good job communicating that uncertainty to you and your partner? Do you feel like they tried to pretend like they knew more than they did? Or like you said, the word transparency, how did we do, being on the receiving end as a, as a patient or as a family?
Anthony Williams
Overall, I was actually really happy with how it transpired. Now, there are some asterisks there, because for many of these admissions, she was in hospitals that I worked in. And so it's different when you know a lot of the physicians that you're working with, and it was by no means, you know, A-plus, across the board, there were some encounters that, you know, I was not happy with, and she was not happy with. But by and large, the communication of uncertainty was well done, compassionate. And as you're probably aware, there's also the other side of, you know, being on the text chains with my, you know, co residents and friends and so on, those are blowing up with like, "Hey, did they check this? Did they check that? You know, what about this? What are we thinking about that?" And so there was a lot of that going on in the background, too, especially in the earlier years.
Emily Silverman
Yeah, you talk about how, as the years went on, she got tired, and she didn't want to go to the ER anymore. And that conflicting desire, on the one hand, wanting to honor her choice and her autonomy, but on the other hand, like wanting to save her, wanting to protect her, wanting to fight. And I feel like this comes up a lot in clinical medicine, when you have a person who is expressing, you know, that they don't want to come to the hospital anymore, or something like that. And the family members resist. And I think sometimes as the physician on the team, there can be this feeling of like, "You know, just let go, just, you know, just let the person who is sick, guide the care, make the decisions." And I think it's really easy to say that and to think that when you're like outside of, of the love and the family dynamic, but I imagine when you're inside of that, and you love this person so much, that that letting go is just a lot easier said than done. And so can you speak to that?
Anthony Williams
It is a lot more difficult to do that when it's your person, in some ways, when there is a diagnosis that can offer a bit of closure. And so in the case of me and my partner and watching her go through an ill-defined, undetermined illness that's chronic, it stacked a lot of assumptions and biases that I carried. One we've already talked about, which is my response to uncertainty. Another one is the idea that a lot of our opinions about how much to do, when to do it, when to let go, are based off of things like age. So it can give you the same story. And if we're both 90, that's a very different thing than mid 30s with a person who is otherwise healthy, there was always the sense of, if we just go, this may be the time that they figure it out, and then we can figure out what to do about it. And so these are the little stepping stones that take me from wanting to be supportive to basically being domineering and stepping on her agency, whether I intended to do that or not. And I think those are some of the things that it took me a long time to see.
Emily Silverman
Yeah, you talk about some of the family lessons that you internalize from growing up, you know things about defending yourself, handling your business, so on and so forth. Talk about how that made its way into your marriage because it was really interesting to hear the translation of like the basketball court to this like tender caregiving relationship like on their face, they seem like really different moments. And on the other hand, I can see how a lot of those lessons would then translate into the interpersonal relationships.
Anthony Williams
On the surface. I would agree with you that the you know, the basketball story and relationships are seem disparate. What they have in common is and how my parents and our family used sports, when we were younger, we all played me my brother, my sister, we played from really young to we graduated high school. Sports was used as a testing ground, training ground, its own sort of school for the types of lessons you need to learn when facing adversity. And so this adversity, yes, for the moment is on the basketball court. It's on the football field, it's, you know, on the baseball circuit, whatever, wherever, wherever it is, there's adversity, but how does that those lessons that you learn generalize to the rest of life, because wherever you go, there's going to be adversity. And so coming from basketball, being my primary sport, and playing that, all the way through graduating high school, playing at a competitive level for many years, you start to pick up these ideas, and you start to learn about what it means to put time in to be able to embrace discomfort, to be able to suppress certain types of desires, like not wanting to do another set, you know, not wanting to practice for the essentially the greater good, you're trying to get somewhere and to get somewhere takes a certain amount of sacrifice in the moment. And so there were a lot of principles abstracted from basketball that I drew from when life got tough. That was in medical school, that was in residency, and that was in marriage. But I never really took the time to interrogate when those are applicable. And when they're not, until I had to wake up and see that whatever I was doing, it just wasn't working. It was just making things worse, even though I felt like I was doing what I was supposed to be doing as a doctor and a husband and things like that. And eventually you have to kind of open your eyes to that and maybe get outside perspectives.
Emily Silverman
Yeah, you talk about masculinity, or I don't know if you said that word in your story. But I think that word came up at some point along the coaching process, you know, this question of what it is to be a man what it is to be a husband and re examining that. And I thought that was so powerful, and was wondering if that still resonates with you, and how you think about masculinity these days after kind of re crunching the numbers and recalibrating, like when is this approach appropriate? And when is it actually counterproductive?
Anthony Williams
So one of the takeaways, I think, for me, was this idea of being a little bit more thoughtful and intentional about the words and the roles that I take on or that I use, even within my own self, even if I don't speak them out loud. Because there are words, there are roles, there are titles that are really sneaky about importing more meaning than you thought was there. So if I say I want to be a good husband versus I want to be a good partner. And realizing that though the husband and the partner are importing slightly different or sometimes drastically different meanings with them with just with the words and thinking in terms of this is what a good husband would do. Or this is what a doctor husband would do, limits the types of solutions that I can see. Because they're importing certain ideas of masculinity, certain ideas of caretaking certain ideas, of just being able to handle one's business. A lot of these things are imported, that I didn't really think about before. And so whether it's husband-partner, whether it's doctor-provider, there's a lot of ways that you can you can look at different words and then see how they sit with you and see how that impacts the way that you look at the world and the way that you look at possible solutions. And so, this understanding of the importance of language in the thoughtful approach to, "Okay what lessons am I really bringing here, when I when I say that? What am I really saying when I when I use this terminology?"
Emily Silverman
So when you switch the word from husband to partner or doctor to partner like I'm just thinking about the word partner, it does have a different flavor to it.
Anthony Williams
Yeah, it does. For me, it was the difference between a partner for me, was more flexible, it was less constricting for me than husband. And I had never thought about that before. As a partner, there can be a discussion of going back to the hospital versus not of managing at home. And I think similarly about, you know, doctor-provider, right, like, you know, if I use the term, you know, "I'm the doctor", is it easier for me to think about things being my job versus not my job, right, versus maybe a provider means, "I still have a job, I still have a responsibility," but in any given moment, maybe I would do something that isn't typically what I would do, because it needs to be done. This is this is a unique situation. And so I think this change in terminology for me improved her perception and sense that I was truly present in this relationship, especially when times were hard.
Emily Silverman
Yeah, that moment at the end of the story, where she looks up at you, and she says, "Thanks for that. That was the first time I didn't feel alone." And then she falls asleep in your lap. It's such a small thing, such a small moment, but also so big, like such a big difference. And it wasn't a huge shift. It was just taking a beat, you know, pausing and asking, like what do you think or you know, I guess, releasing the wheel a bit, or I don't know how you would describe it.
Anthony Williams
Just as you said, it's, it's a small moment. But it is an inflection point. It is a ray of hope that says perhaps the trajectory of what's been happening will change. And the work is ongoing, right? Like there's no wrapping this up neatly with a bow. You don't undo years of trauma and all this stuff, just with one time that you happen to not be crappy at it. And then we're all good. This is, you know, this is this is a daily practice.
Emily Silverman
Yeah, it really represented, I think, for me as a listener, like a shift in mindset and the beginning of something new. And as I was re-listening to your story, this morning, to prepare for this conversation, I was reminded of an internal medicine resident that I worked with in the hospital. And he had always wanted to do ICU medicine, from medical school on and even through the beginning of residency, he was going to do pulmonary critical care, he was going to work in the ICU, he was going to save lives, he was going to intubate, he was going to throw in lines, he was going to you know, do chest compressions and, you know, do do do all these things, and did a bunch of ICU rotations and realized that there was something missing. And he didn't actually like it as much as he thought he did. And that he was feeling more drawn to the end of life conversations, and the deep listening and their family meetings and that environment than he was to the acute phase of like stabilizing people once they were admitted to the ICU. And he was really thinking about transitioning his career plan, from ICU to palliative care. But he was really afraid to announce this to his friends and family. And when we were talking about it, he brought up this example of another sports analogy of being in Little League and swinging and missing the ball a few times, and then his coach yelling at him and he was sitting in the dugout, and he was crying. And you know, then the coach saw him cry and said, you know, why are you crying, you know, kind of shaming him for crying basically. And he was linking that memory to part of why he was struggling to come out, so to speak as wanting to do palliative care. And so I was just thinking about that story today. And then thinking about your story, because it's kind of a similar shift. It's like going from an action based mode to more of a listening and receptive mode. And it ties in with, as we said, masculinity and things like that. So I'm just curious if that resonates with you at all.
Anthony Williams
When we're, you know, young when I was young, there were so many lessons to be learned. And a lot of them were immediately applicable. So you know, the kid in the baseball story, he's going to keep playing baseball presumably or T ball or sports, that's going to be reinforced over and over and over again. What they're teaching us is to help us survive and be successful now and to go as far as they can see. But once we get to that edge, then it's on us to figure out what else you can see when you get to that next mountain top, what do you see in you, me, kind of us as individuals, have to be able to do that work if we want to continue to progress. So, at a certain point, these lessons that were given to us that we learned at some point, and I don't know when there's this transition in terms of responsibility in terms of like, "Hey, okay, now I've got this, and this has carried me as far as it can carry me." It may carry, you know, the person in your story all the way to figuring out he doesn't want to do ICU and wants to do palliative care, it may carry me all the way into residency and into marriage with a partner I love very much. And then that may be the plateau with what I have. And that doesn't mean you jettison everything. But that does mean that to continue to move forward, you have to start to kind of go through your chest of stuff that you brought, and started like, "Okay, gotta throw that out. I can keep this, I gotta fiddle with this to make it useful." And I think that is how I start to think about kind of over the big arc.
Emily Silverman
So, you went on stage and told this amazing story. And I'm just curious if you received any thoughts, comments, feedback from your peers and colleagues and family and friends? Like how, how did people receive your story?
Anthony Williams
I got a lot of support, a lot of support, a lot of hugs, a lot of texts, just a lot of support. And immediately after telling the story, there was just this endorphin rush. I just felt like so good. And I was like that was amazing. It also felt a little bit like I had a dissociative fugue, because I was like, "Was that me up there who told that story and like, shared some, some really vulnerable things on that stage?"
Emily Silverman
So you are in Minneapolis, and your hospital has the Center for the Art of Medicine, CFAM, which is an incredibly vibrant community of like medical arts, medical storytelling, you know, all that good stuff. It's so fantastic. You seem to be in the right place for this. So I'm just curious, do you have any plans to to keep storytelling in any way shape, or form or stay connected to that community? And what does the future hold for you not just as a physician and a husband/partner, but also as a storyteller, as a creator.
Anthony Williams
Being a part of the Center for the Art of Medicine is just one of those things that is so awesome. I could have never predicted that would be a thing, right? If you told me 10 years ago that I would be a part of this, working with amazing people, getting to, you know, write, create and support other creators. I don't even know I would have had a place to put that information. That seems like that's ridiculous. I don't see myself in that vein. So yes, I see myself continuing to be a part of this because not only do I enjoy it, but I also think that it is so integral to the work that we do as physicians, and it's also really an important part of physician development, in terms of being tapped in with medical students and residents and attendings from early career to late you know, seasoned attendings. Right, like, there's something for everyone under this umbrella of humanities, creativity, blended with medicine, patient stories. I see this as part and parcel to who I am. And one of the things that everybody else all the other amazing people that I get to work with in CFAM have in common is that we all would be doing this even if there was no umbrella for us to fall under. And I think that's what makes it so amazing. We'd be writing, we'd be trying to create TV shows, we'd be out there pursuing, you know, social justice. There's all there's just so much stuff there that we would do, even if there was no umbrella. But now there is an umbrella and there's a framework and then we get to feed off each other. And that's, that's really that's really, really cool. And I am, you know, just ecstatic to be a part of that.
Emily Silverman
I have been speaking with Anthony Williams, about the story that he told in Minneapolis in 2023. Anthony, thank you so much for sharing your story with The Nocturnists audience and for coming on to speak with me today.
Anthony Williams
Thank you so much for having me, Emily. It's been a pleasure.
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