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.

Emily Silverman

You're listening to The Nocturnists: Conversations. I'm Emily Silverman. What does it mean to push your own limits? Can we make art out of failure? How do we think about the balance between light and shadow, presence and absence? These are just a few of the questions that our next guest has been thinking about for a long time. He's an Emergency Medicine physician who suffered a spinal cord injury a few years ago while surfing, and used painting to aid in and also to document his recovery. His name is Matthew Wetschler. And I heard Matthew speak at a retreat a few months ago, and as you'll hear in the interview, knew right away that I had to have him on the show to talk about his paintings, which are really more like performance art pieces. In addition to being a doctor and an artist, Matthew is the CEO of a digital health company called Plume, which offers world-class health care to transgender people. Matthew and I cover a lot of ground in this interview. But before we dive in, I want to play an audio excerpt from the short film Resurrection Artist, which documents Matthew’s near death experience and recovery. Let's roll the clip.

Matthew Wetschler

I woke up floating in the ocean. I couldn't move. With the last remaining air in my lungs, I screamed into the ocean. I probably had been dead for about ten minutes. While body surfing, I had hit my head, and had fractured my neck and injured my spinal cord. I was an artist, a surfer and a medical doctor. Even before this, I sought out challenging experiences. What's going to happen with my body? Will I go back to practicing medicine? Will I get back in the water? I don't know what's next.Emily SilvermanI am sitting here with Matthew Wetschler. Matthew, thank you so much for coming onto the podcast.

Matthew Wetschler

Thanks, Emily. It's good to see you again. And I really appreciate you inviting me to join you.

Emily Silverman

So Matthew, I think I told you this, but I heard about you, and your story, before we met at the Teravana retreat, which, for the audience, was this wonderful physician well-being retreat that we went on. But I didn't put two and two together until I saw you sitting up there on this panel, and then you launched into your story, and my mind just exploded. Twofold. One, because I was, like, "Oh, that's that guy that I've heard about," and then Two, the stuff that you were saying was just so deep and profound. You just, like, casually dropped all these truth bombs. So anyway, I was, like, "I have to get Matthew onto the podcast." So, I'm so glad you're here.

Matthew Wetschler

Can I just keep that, so I can hype myself up sometime, when I'm not feeling so deep and profound? That’s good. No pressure. All right, let's do it. Let the profundity begin.

Emily Silverman

You are a physician. Tell us about your path to medicine and your physician life before the accident.

Matthew Wetschler

So, I had a... "non-traditional" path. I was actually an Art and Philosophy major. I'd never taken a science class in my entire life - except for maybe geology. And, my dad was a doctor, and so I actually didn't want to be a doctor. After college, I hopped in the car and drove across the country, and I lived in Wyoming for several years, and I lived in the mountains and was living out of the back of a car, and living out of a hostel, and generally just being in the mountains, and being in nature. And that's always been something extremely important to me. But, about three years in, I had an injury. Nothing too crazy, just blew out a knee. But it was enough for me to pause, and break the momentum of the life I was living then. And, funny enough, I was, at that time, working as a maid in a hostel, and my co-worker was this radical anarchist and handed me this book on anarchy. And, there's a lot that you can take with a grain of salt, but one of the fundamental principles that's always stuck with me is: the major capital of one's life is one's own time. And that it's fine, however you spend it. What's most important is that you spend it intentionally. And, at that time, I was very serious about athletics, and then this injury. And after that, I went back into my art. I was painting; I ran an art nonprofit, and started doing a lot of volunteerism. Got back into philosophy; I was reading a lot of Eastern philosophy and these principles of selfless compassion. And, never one to go halfway, I met a woman in an elevator, and a two-minute conversation turned into a three-hour conversation. The next thing you know, I was living in the slums of New Delhi for nearly a year, working with women and children, and decided there that I wanted to find a career that had, at its core, a sense of service. And medicine seemed compelling. I'd had a lot of exposure to it, but I've met so many people that have the destiny narrative of medicine, like "I knew since I was eight." I'm not that person. I found it slowly, over time, and it was less of a passionate decision, and one that seemed aligned with a lot of my values. And so I cut my stay short, and I had to start from scratch with a post-Bacc, and went into medical school.

Emily Silverman

And you pop out the other side of your medical training, more, equal, or less excited about medicine, as you were when you went in?

Matthew Wetschler

I would say that I had a passion for the medical field. I had a great degree of ambivalence around the practice of clinical medicine, not because I had lost a passion, but because I found a significant amount of conflict between my values and a lot of the circumstances that I was placed in trying to practice medicine within a larger system. And, I had actually felt that pretty early on, even second-year of medical school, I just saw that how systems were designed, how medicine is paid for, drastically shapes how patients and clinicians experience the clinical interaction. And I actually took a year away. I did a Master's in Public Health, focused on technology, new models of care, entrepreneurship. And, really, from those early days, had a firm commitment that I wanted to do something to change how the system of medicine was organized. Even in a small way, like even in a small corner. And that's what really continued to inspire me. But I'm sure everybody that practices clinically knows, like, some days are good, and some days are really hard. And the system can be very challenging to operate in, full-time.

Emily Silverman

And when you had your accident in 2017, were you an attending? And what kind of medicine were you practicing?

Matthew Wetschler

Yeah, so I was board-certified, Emergency Medicine. And, I was an attending. I had been working, mostly as a locums doc, traveling to rural hospitals, but then I'd just actually started full-time down at Santa Clara Valley Medical Center in the Bay Area, which is one of the hospitals I trained at. It was the County hospital, which is sort of my flavor. I loved that style of medicine, and that patient population. And I had actually worked just a few shifts as an attending in the hospital before I got injured, and then, funny enough, that's where I did my rehab. So just full-spectrum engagement with Santa Clara Valley Medical Center.

Emily Silverman

I want to hear about the accident, but before we get into that, what kind of art were you doing before the accident? Were you a painter? And how were you thinking about that part of your life and it fitting into medicine, or not fitting into medicine?

Matthew Wetschler

I've been painting since I was 12. And it's always been an expression of what has been going on in my life. I'm not a realistic painter. I don't do portraits. I do a lot of abstract and conceptual work. And, when I was in college, I was doing art and philosophy, and so a lot of my artwork were visual interpretations of philosophical principles that I had been studying. And then, when I was in Wyoming, my painting had reference to the natural world, which was pretty central to where I was spending my energy. And then, nearing my last year of residency, I actually got to a pretty dark place. And I think now, it's increasingly common to talk about burnout and depression, and I definitely experienced that, to the point that I needed to take some time away. I just was not well. After just getting out of the grind of training, I realized that what I hadn't done in nearly 10 years was make art. Since I started medical training, it's something that I'd just, kind of, tucked away and ignored. And that was just always so important to me. And so, during my time off, I actually got a studio again; I started painting. Painted, I think, 50 hours a week for several months. And that was, again, abstract work, very related to my experiences of medicine. A lot were like textual landscapes that looked like human tissue, almost; it was not pretty. But it was provocative, you know. I think it reflected some of the challenges and, as I mentioned before, this degree of ambivalence I was having with my experience with the medical system. And, at the end of that, I had put together a show, and ended up selling pretty much all of my work, which was a pleasant surprise, not something I expected. But I came away from that experience with a recognition that's like: Okay. One, this is extremely important to me, and I just can't ignore that. And the others, this is something that I actually can do quite well, and I would love to have this as a part of my... Not just as a hobby, but as a professional identity.

Emily Silverman

We've had a lot of book authors on the podcast. We recently had a ballerina, who talked about dance and movement in medicine. We've had a couple of documentary filmmakers. You are our first painter. So, why painting? What do you love about painting?

Matthew Wetschler

I would say that painting has some, probably, preconceptions that might come up in people's minds of what does a painting look like: Is it representative? Is it a landscape? Is it a portrait, etc. And we'll go into it later, I'm sure... just these concepts of physical limitation, and the way that it's ultimately captured is through paint. I guess. I do like the fluidity of the medium. I think it's quite responsive; it's very flexible. Sculpture is just a bit more methodical, or it can take much longer, and painting has this balance of the ability to be improvisational; yet also you can create a lot of textures and physical qualities that give it a sense of gravitas and weight and substance. And it has an interplay with light, that I think is quite beautiful. And, I can't sing a note, so music's out.

Emily Silverman

I want to talk about the accident. And I'm conscious of the fact that this is a story you've probably told hundreds, if not thousands of times, and we heard a little bit about the accident in the opening audio clip. So, I'm not sure whether to ask you to just briefly tell us about the accident? Or, if I should ask it in a more "meta" way, which is, like, how do you think about telling the story about the accident? So maybe I'll leave it up to you how you want to answer.

Matthew Wetschler

I have told it a lot of times. I... In some ways, I guess it's just a bit matter-of-fact now; there isn't really a lot of emotional resonance with it. I'm fortunate to have a lot of distance between me and that time, but even just saying the cold hard facts...it just makes you think. I was swimming out there. The ocean was relatively empty. I must have hit my head. But I did wake up face-down, completely paralyzed, and ended up drowning. And then, my heart had stopped and somebody just randomly found me in the water, pulled me ashore. And the first two people that found me were an ICU nurse and a resident, which, you know,... got very lucky and, yeah, picture-perfect CPR, so by the time the ambulance got there, I had a heartbeat again. Basically, I had a decompressive laminectomy, pretty much C2 to C5, within hours. And I'd say that, in telling the story, what's interesting is, you... What I have found is, that story is a canvas upon which people can place their own ways of making meaning in the world. I mean, that story could be evidence of divinity. It's like I've had people tell me that it's God's plan, and I'm not a religious person. To others, it could be a humanistic story of the belief of the ability of each, of our capacity to do something for others, you know. I mean, I was very dead-looking, but I had multiple people just step out of whatever their routine was, and into my life. And that's why I'm here. Or, you could also say it's a story of the capacity of science: I'm actually Patient Zero in a post-operative care study around intrathecal pressure management, using a delta between your art line, and a sort of a live-feed of intrathecal pressure within the spinal cord. And also, I'm on the board of another study, which is now advocating for emergent, timely, decompressive surgeries for spinal cord injuries, much like you would do a craniotomy. The idea of the tissue swelling within a closed space, causing ischemic damage, is something that's well-accepted as far as brain injury, but actually is still not as well-accepted within the spinal cord injury community. My neuro-surgeon; he's down at UCLA now, and this has been his thing that he's been advocating for a long time.

Emily Silverman

And before the accident, you were a highly intelligent, creative, thoughtful guy. You're creating paintings that correspond with different philosophical frameworks. And so I'm wondering, when you take somebody like that, and you put them through a near-death experience, and then they wake up? Do you wake up with that philosophical lens of, like: This has happened to me. What does this mean? Or, do you wake up with a, like, holy fuck! Does all of that go out the window? What was that like?

Matthew Wetschler

People often ask how you change when you go through a really life-altering injury. And I think what's surprising, is not how much you change, but how little you change. That you... and this is almost rote wisdom, like: You are who you are, where you are. You know, if you've got that friend that's got issues, and they're, like, "I'm moving to another city." You're, like, "Uh,... I don't know if that's gonna...that's probably not gonna...but if you need to... go for it...." It's kind of the same thing. You wake up as the same person. And I was paralyzed, basically, from the neck down. I was a full quad for a little while. And what I would say is that, that intellectual fire, that desire to be curious, to find personal edges to push, and also to self-express; it was just as potent as ever. And, then the challenge became, "Well, okay, well, what's the way that this energy can get out, because it can't take the same shape anymore." You have to find a different conduit to express that energy. When crisis does find us, which it will, because things break, and people die, and life is impermanent, you fall back on what you have made habits of. I was a longtime competitive athlete, and I've, again, always been a creative and generative individual, as far as what feels right for my mind, and, like, what feels really satisfying. And those were two facets of my personality that became extremely important to me.

Emily Silverman

And the paint and canvas came into the hospital room. So, it sounds like the decision happened pretty early on that you wanted to paint. Walk me through that thought process. Did you already know what type of painting you wanted to do? And how did that all happen?

Matthew Wetschler

I wanted to find a way to express my experience. And I was struggling to find some medium to do so. Art-making seemed to be a place where you can be unstructured, you know, and any type of mark-making... it can be art-making, depending on the intention. And, it was very interesting to me that, pretty much from the moment I woke up, I just felt so compelled to lean into my artistic practice; to make that a part of my experience, and a part of recording my experience. I would say the other thing that art did for me at that time was help me keep a sense of identity. And I think this speaks back to practicing medicine, especially in inpatient environment. It seeks to homogenize us and it seeks to strip us of our own personal narratives. We're all put in scrubs - both patients and clinicians. We are in rooms that are identical. And, we've been on the clinical side: We'll go so far as to not even call people by their name; we'll just refer to them by their diagnosis. Like, "what's going on with Pancreatitis in 204?" And you can feel that as a patient. You can feel yourself being abstracted from your story of, like, who you are, what type of life experiences brought you to where you are. I was painting, and I loved being covered in paint. I have these painting pants that just have, like, colors all over them. I dry my brushes on them. And they're... they're very... they're very conspicuous. They're just, like, obviously some sort of, like, art thing was going on. It looks like paint exploded on me. And I would just roll around in these pants. And what it meant for me is: It was this refusal to be completely separated from who I was outside of the hospital, and who I was outside of my injury.

Emily Silverman

You said you were quadriplegic for a while, so walk us through the mechanics of how you painted.

Matthew Wetschler

Fortunately, I was a ASIA D, which is the lowest grade of spinal cord injury; it's incomplete. Just to be clear, for people listening or not familiar with the ASIA scoring system, my prognosis was good. It was expected that I would have a good recovery and a good outcome. So this isn't a situation where I was never gonna walk again and something crazy happened. But the pace at which it did, I think was remarkable. I was able to, basically, walk again within several months, which is less common. But getting into about four weeks in, some limb movement started coming back - mostly at the, kind of, hip and shoulder girdle, like more proximal joints. And initially, I was working with a art therapist who would prop up my arm and I would move it around. And we would do this in tandem. And, at that point, I was doing this series where, basically, I was just trying to use materials around me, and so I used syringes, catheters, iodine... pretty much anything that was involved in my daily care, and using that to make textures and make images and trying to have this porosity between what my daily lived experience was and these pieces of art I was making, which were kind of, in some ways, artifacts of this experience. Then, from there, I had this idea to start doing rituals on a regular cadence to explore and capture, visually, what my current state of limitation or ability was. And so, the first painting I did in this kind of series - it was the same framing: just a single brushstroke, no assistance, no stopping, just one kind of expressive stroke. And I did that every week for nearly six months, and so it created quite a few canvases. And, you know, that was basically a journal of my body regaining strength. And from there, really what my art is now, which I've been doing for the last five years, came from that. Just all these different ways of exploring and finding personal limitations.

Emily Silverman

You mentioned personal limitations earlier, and I imagine that, as an athlete, that was important to you. As an artist, as a physician, as a recovering patient, talk about this impulse to find one's personal limitations. Where does that impulse come from? Why is that good?

Matthew Wetschler

I think that the most personal growth comes from when we step into liminal spaces and exist in discomfort. And probably one of the most important disciplines we can have as individuals is learning how to be comfortable in discomfort. I feel like that's when I'm most alive. To me, it's like what living is. And it's what I respect most in others - people that operate at the edge of their capacity and push themselves. Perhaps that comes from an athletic background. I mean, I was a rower, which is basically pulling on a stick until you pass out. It's very unforgiving. There's basically no technique and it's just a complete suffer-fest. Not sure if that's what created my mentality or my mentality just worked well with that sport. But I've always just found satisfaction in exploring those personal edges, and I feel like that's where we grow. And I think anybody can do that reality check: When's the last time you shifted your own perspective without major crisis, you know? It is discomfort that causes us to grow and evolve, and become better, whatever better is. Could be physically stronger, or it could be emotionally aware. It could be more self-compassionate. I won't say it's always pretty, but it's how I approach life and it's how I approached my injury, and it's still with me now,

Emily Silverman

When I heard you speak on the panel at Teravana, you said something about reaching for the edge, or the contour, and how that is the ingredients for form, and how that is the starting point for beauty. And so,... I may not be remembering that exactly right, but I think that was the moment where my brain kind of exploded. What's the connection between limitations and form and beauty?

Matthew Wetschler

I think we falsely believe that the lack of limitations is a precondition for happiness. That, one can make it a case that it's like a capitalistic assumption: that more choice is better; that the ideal state is one without limitation, without hardship. And I think that's completely a lie and a false pursuit. To me, that phrase was like a meditation on disability or becoming differently abled. And all of us will encounter that at some point. Basically, I have conversations that really resonate with people in their seventies. I can talk about my bum knee... So we're all going to find it at some point. Having like a very fundamental change in your capacity in some way or another, you realize that the ways that you can express your energy in the world are not unbounded, they are constrained. But that is not necessarily a bad thing. That doesn't preclude you from doing something of real meaning and value in the world, whether for yourself, for the people you care about, more broadly for society, but it does change the shape. And so, this idea that limitation is like boundaries; boundaries are preconditions for form, and form is precondition for beauty. And I think that we have the ability, regardless of our circumstances, to find beauty, and to express ourselves in ways that can be personally fulfilling. And what we distract ourselves with is a excessive weighting on our external circumstances or current context. Now, I mean, there's edge cases: if you're in prison, it can be tough. But, just generally speaking, I think a lot of us fall into a framework where, like, "Okay, well my happiness is based on some delicate house of cards of external circumstances of, like, job, money, career, aspiration, whatever it is, relationship. And sometimes all that stuff just gets swept away. And what that showed me is how independent one's sense of happiness can be from those external circumstances. So that's a little bit of a tangent; a little bit meandering into some other thoughts around this, but I think it's connected.

Emily Silverman

In the photos and the videos, we see you with, I think it's a weight hanging from your wrist. And you're, like, trying to hold up the paintbrush, and you're holding it up as long as you can and then, it's like your arm falls down. And then the mark that is made, it's on this, like, very white gooshy canvas with thick layers of paint. It almost looks like plaster. Are those the types of paintings that you were making later, as you recovered? And is that still the types of paintings that you're making?

Matthew Wetschler

Exactly. Since my injury, I've only painted in all white. I think for nearly five years now. And, you described it quite well. It's this very thick, almost plaster-like medium. And I don't apply paint, I actually pull paint out; I gouge. It's like gouging away from the surface of the painting. And I would use weights. And so my right arm is my most affected by my injury; it's the weakest. And so, I would put weight around this arm and use the weight to essentially induce failure, and then use the process of failure, of, like, physical failure as a mark-making tool, and kind of like exploring the edge of personal capacity, of physical capacity, as a way of making a pattern on the canvas. And so when you actually view the painting, what you're not viewing is paint applied, you're viewing the absence of something. You're viewing these empty spaces, left by where the marks were made. And because it's all white, because it's monochrome, you really don't even pick up lines based on the colors or patterns. You're able to perceive the painting because of shadows. It actually looks quite differently, when it's lit tangentially. And to, like, further that kind of conceptual framework, what you're really perceiving is the absence of light. And so everything about the art that I do is this meditation on the tension between presence and absence.Emily Silverman It sounds like your injury/recovery has stabilized, in a way. So, are you having to find new ways to express those limitations? Different weights, different ways of painting? Have you had to evolve your methods as your body reached a new baseline?

Matthew Wetschler

Where I want to go next is becoming progressively more full body, as everything's become online. And I've been exploring more archetypal rituals that are common across cultures, as a ways of starting to frame these. Ultimately, they're like performance pieces and they inter-relate to a lot of performance art, and what's also known as action art. It came out of the 40s/50s, its post-surrealist movement. And Jackson Pollock was one of the first to really put the canvas on the ground, step onto the canvas and use this, kind of like, more energetic, physical way of interacting. And, there's others like the Fluxus movement in Europe, and the Gutai movement in Japan, were all exploring similar themes at similar times. And then you had a lot of durational art. This is mostly around line-drawing. You'll see people that draw circles 'til failure, or will jump or leap or fall, and trace lines on a wall. And it's all sort of in that lineage. And for me, now, I would say an example of where I would want to take my art is,... I did one piece called Re-entry, where I took this canvas out. (It's 4 foot x 8 foot, and coated in this plaster.) And then brought it out to the section of the beach out in San Francisco, where I had died. And, it was the first time I'd touched the water since my injury. And I walked in these very large circles, and did somewhat of a baptism ritual. And then between every cycle of this ritual, I would lay down on the canvas and make a mark, and did that thirteen times. And it was very cold, and the body starts to break down in different ways. It's San Francisco in the Fall; it's not balmy. And capturing that ritual in an artifact. And so, those are where I would like to push my art: into this, like, larger format, more full-body pieces.

Emily Silverman

A lot of your work is focused on expanding, and expressing, and pushing against limits. It's a very, like, outward energy. And, I'm wondering, do you ever get exhausted? And is there ever a time to pull back, retract, turn inward? I'm almost thinking just about the breath, like: inhale, exhale, inhale, exhale. How do you think about that? How do you rest and restore in between these, like, expansion events?

Matthew Wetschler

The type of art I make is not personally replenishing. It's actually quite exhausting, physically, but also even mentally. I work quite hard; I research a lot. And I feel like now I've gotten to a point where I can articulate quite clearly some of the concepts that I've been exploring, but that's been a result of a lot of work and a lot of introspection. And, I think... For me, great art, you're sort of in dialogue between the creator and the object being created. It's like you do something that is partially intentional, partially improvisational or intuitive, and then you sit with this object, and you’re like, what's that all about? There's something here, what is it? And I think, for me, it is: What does it mean? And so I found it can be quite exhausting. I would say that I really respect artists that can just continually create. And, I have friends that are full-time professional artists, and seeing the degree to which they can be continuously generative is something I respect very deeply, and also know that I can't match. And so, I've learned over the years, ... and perhaps those that have their own creative pursuits, and maybe they feel dormant right now because of where they are in their training: Yes, okay. Like, these things ebb and flow, and you don't become less creative, because you're not always expressing it. That those pull-back moments can be fine, and also can inform your art later. You also just have to experience life, I think. For me, at least, so much of what I put into my art is related to personal experiences. It's getting out and just experiencing things, and living can be fuel for another round, another push of creative energy. I also tend to work very intensely. Like, I'm fully "on" or fully "off". And so, I'm either in the studio like 60 - 80 hours a week, or I just don't touch it. It's very difficult for me to be balanced about it.

Emily Silverman

How are you thinking about being a doctor? Are you still a doctor? What does that mean? And how is that all shaking out?

Matthew Wetschler

I think the answer to that pivots into something else that's very important to me, that we haven't really talked about is... What I'm doing now is I'm running a company. So just a quick plug. Company is Plume. We're the first digital health platform for the transgender community, and we provide gender-affirming hormone therapy through a fully virtual care model. We're now expanding into gender-affirming virtual primary care, and insurance reimbursement. We started about three years ago, and we're now the largest provider of transgender health care in the world, which has been exciting. My best friend from medical school is my co-founder Jerrica, and she came out as trans, and really right before we started the company. We've been on this journey together. And so, I find entrepreneurship is an immensely creative activity. I mean, you're just pushing something novel out into the world, and tackling unsolved and thorny problems day in, day out. And so that generative, creative, energy has definitely found a conduit in business-building. Also, we're unique in that one of the few digital health companies that's started by two doctors. I don't practice currently, but I went through residency. I practiced as an attending. Like, I've been in the trenches; I definitely know some of the realities of what it's like to deliver health care. And I'm on the business side now; I'm the CEO. But I think that informs how we build our company, how we prioritize the experience of clinicians, how we focus ourselves on some of the ethics and principles of medical care. And for Jerrica and I, it's a place where we were able to build a company around our values that brought us in to medicine. And we've done it in such a way that we, for the last three years really, weren't beholden to trying to operate within a system. You know, it's fully direct-to-consumer. And so, we could build the system exactly how we wanted. And, we built it, really, based on our lived experiences as clinicians and as patients.

Emily Silverman

For our health care audience, we have doctors and nurses and other types of health care professionals. We have medical students; we have residents and fellows, early-career attendings, seasoned attendings. It runs the gamut. What message would you like to shout out to folks, before we end?

Matthew Wetschler

I would say that what I experienced in my training, is a fear of deviating from the path. That there is a sense of this tight, narrow line that you need to walk, to become a doctor, to be successful. And your definition of what success is can become quite narrow, to the point that it's very constraining. And it also can be quite taxing to one's own happiness. I took four months off at the end of residency. Like, I was one year away. That was years deep, like a decade plus deep into training, and I,... I stepped away. And to somebody that hasn't done clinical training, that doesn't sound like a big deal. But to those that have done residency, knowing that someone took four months off in their last year of residency, that's just crazy talk. And it felt crazy; it felt really crazy going through it. But at that point, I had realized that I set this expectation for myself, like my bar, that I was trying to get to, was just survival. And there was just some thought... I'm, like, that is just sad; I should expect more for myself. I deserve to be healthy, at the very least. And I refused to go back until I felt that way. And, you know, and then I finished, six months off from my peers. And, I think, if my life is an example of anything, is you can deviate from the path and, like, things still work out. It's why I think medical training is actually emotionally traumatic. It leaves us absent of key emotional tools, that we need, once there isn't the conveyor belt. And I think you see this a lot when people finish training. Many go through, basically, a huge existential crisis, because they don't really have any experience defining what's meaningful for themselves. If you do not have the skills to introspect, to articulate your own personal values, then you will accept whatever the next definition of success is. And, at that point, it's like productivity and money. And when you have, then, a bunch of clinicians, whether overtly or just reactively, responding to the next brass ring, I think it starts to really pervert the medical environment, and it's, like, worse for patients. And that to me is, like, deeply sad.

Emily Silverman

And that's part of what we're working on here, is actually what you've said quite literally, is helping people self-articulate. And our medium of choice, rather than paint or plaster, has been storytelling. And it's been so gratifying just to watch people find their voice again and again, because you can really feel that shift, that moment where the person discovers what it is that they're trying to say. Or, at least, gets closer to it. And so, that's really beautiful to watch. And in some ways, it's a very simple thing, and in other ways, it's a very radical thing.

Matthew Wetschler

Yeah...yeah, I agree. I think it's deeply meaningful. I mean, my path... Like, I deviated against my choice. I'm out in left field, and you can still find a way. Some of my experiences can be a little like food for thought, and you're like, "Oh wow, like maybe I can do something a little, you know, a little off kilter here." And maybe a tool... I'll give out like a tool, for people to use when they're thinking about decisions, and this comes from Annie Duke's, who wrote this book, Thinking in Bets. She was a psychology PhD, turned professional poker player, that lectures on decisional quality. And it's the 10/10/10 rule, which is, what would you think of this, like 10 days, 10 months, 10 years from now? And view your prospective choice, retrospectively as your future self. And that's actually something that helped me gain the confidence to take time away from residency. So I was, like, "Wow, this feels like a really big deal now, but 10 years from now, what will the story be? Like, "Yeah, you know, I was in residency, it was... I got to a dark place. I decided I needed to take some time, took a few months off. I finished a few months later, and I became a doctor." That's it. And, you know, that's my story now. And I say that to most people, and no one even blinks. It's literally a non-story to most people, but it felt so, so significant. I, like, lost so much sleep over making this choice. And so, I would just encourage people, it’s ok to step aside a little bit, to get off the path, like I said, you can find a lot of ways to express your energy in the world and find things that are meaningful.

Emily Silverman

I think that's a beautiful way to end. Anything else you'd like to share?

Matthew Wetschler

No. This has been a wonderful conversation. I really appreciate you allowing me to share my story in this space. I've admired what you've done with The Nocturnists for a long time. And so... it's really a pleasure to be talking with you. Really appreciate it.

Emily Silverman

Thank you. I have been talking to Dr. Matthew Wetschler: Emergency Medicine physician, artist, athlete, CEO, and overall just amazing person. Thank you so much for being here, and have a wonderful day.

Matthew Wetschler

You too.