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Emily Silverman

You are listening to The Nocturnists: Conversations. I'm Emily Silverman. When was the last time you thought about how you move your body? How do you sit? How do you stand? How do you walk? How do you interact with others? And what kind of information is transmitted in those movements?Today's guest is here to talk all about this. Her name is Nina Shevzov-Zebrun. She's a Massachusetts native who grew up training pre-professionally for a career in ballet. She earned her Bachelor's in chemistry at Harvard, where she also served as the Director of the Harvard Ballet Company, and carried her passion for movement into medical school at the NYU Grossman School of Medicine. At NYU she spearheaded multiple projects, including the Ten Tensions Project, which lives at the intersection of medicine, dance, and other humanistic disciplines. Currently, she's a resident in pediatrics at Stanford.I was blown away by Nina–by her intelligence, her creativity, and the skill with which she executed the Ten Tensions Project, which was a super-interdisciplinary project, where she basically identified these ten tensions that exist in medicine, and used dance and photography to create an image and a description for each one. I have no doubt she's a rising star in the medical humanities world. And I can't wait to see how she impacts the field, particularly how she raises awareness of how physicians are embodied, or aren't embodied, and how bringing attention to our bodies and to our movements can impact our well being and impact our relationships with our patients. Before we sat down to chat, I asked Nina to read an excerpt from her artist's statement. Here's Nina.

Nina Shevzov-Zebrun

I entered my Manhattan apartment around midnight, roughly an hour after observing a transplant team recover kidneys and the liver from a young patient newly pronounced dead. Still wearing scrubs, I sat down on my bed and, like a ghostly twin or guardian angel, watched myself spill tears. The scene I witnessed in the operating room that evening as a second-year medical student was at once grotesque and hallowed, shocking and valiant, in its intensity. Surgeons fought time for organs capable of saving life, while a life bled free before them, a body turned cold to my touch. In its rawness and severity this experience served, among other things, as an initiation, an initiation into the inner emotional world of medical providers.Over the next several years, my familiarity with this world grew. I explored its depths and shallows in the capacity of student doctor. Quickly I recognized how significantly this world shapes physicians’ day-to-day existence and, by extension, patient care. Though diversely lived, certain internal struggles seemed ubiquitous among trainees and clinicians. A set of emotional experiences appear to bind providers in a mutual, but muted, understanding. Indeed, it was rare for me to hear physicians openly discuss the emotional experience of medical practice. The weekly debrief sessions required on my internal medicine clerkship, however, were designed for precisely such conversation. I was grateful to hear choruses of “Same here!” and “Me too!” following peers’ anecdotes and reflections. The stories my classmates told unveiled the range of emotional conflicts and frustrations encountered in the clinical setting, from unrelenting pressures of limited time to feelings of helplessness in the face of bureaucratic legal obstacles. Their experiences were consistently recognizable and relatable. I felt heard, safe, and unlonely. But I wondered, “Were we alone in this unloneliness? Did other trainees and clinicians have sufficient opportunities to unpack whatever internal tensions rattled their day, week, year? Could they name those tensions aloud, tease them apart with trusted others? How might such tensions, especially if unacknowledged or pent, negatively affect physicians’ mental health?”

Emily Silverman

Thank you so much for that reading, Nina, and for being here today.

Nina Shevzov-Zebrun

Absolutely. Thank you so much.

Emily Silverman

So, Nina, you grew up training for a career in ballet. Tell us about your life as a ballerina.

Nina Shevzov-Zebrun

So, I initially got into dance because my mother was working as a professor, and she put me in dance class so that I had something to do in the afternoons. And I just fell in love with it and continued doing it as intensively as possible throughout my entire childhood and teenage years. You know, I joke that I didn't really have a lot of friends in high school because I was always dancing, but it's really true. I spent every day after school in the studio, went to summer programs in the summers in New York, and American Ballet Theater in Juilliard, and was just wholeheartedly devoted to this art form. And in the end, obviously, I am not a professional ballerina, but I'm really happy that dance is factored into my life still, in some way.

Emily Silverman

How so?

Nina Shevzov-Zebrun

When I was in late high school, I really had to think about, sort of, my career, my career choices at that time. And for ballet, you know, I haven't been in that world for ten years now, actively, but at the time, and I'm not sure how it is now, but at the time, there really were, sort of, physical requirements for, sort of, how you looked, but more how, internally, your body worked–the flexibility of your hips, you know, just how essentially flexible and loose you were, to achieve the, the shapes that choreographers were demanding. And I just, unfortunately, was not given that, that structure. So I knew that I would never make it in a classical professional ballet world to the advanced level that I would hope to achieve. And I ended up finding a similar appreciation of technique and method in science, in high school and in college. And then I pivoted towards that. And that led me down a path to medicine, which I can get into later. But I really always wanted to keep dance somehow present in my life, because it was such a huge part of my identity that, without it, I feel like there's a gap in who I am. And where I am right now doesn't really make sense without, without dance and ballet.

Emily Silverman

Well, let's get into your pivot to medicine. You said you had an appreciation for the structural elements of science and medicine. Tell us more about that. And about your decision to go down the path.

Nina Shevzov-Zebrun

Well, my father is a psychiatrist. And so I was always exposed to medicine growing up. And you know, from his stories, actually, when I was younger, he would tell me patients’ stories, but the patients were animals. So he would have, like, an alligator who came to see him that day. And a weasel. Those were some of my favorite characters. And so it was always, sort of, there as a fifth person in our family for, say, the medical field. And, as I mentioned, sort of, the structure, technique, methodology of science really appealed to me in high school. And so when I started to think about how I could turn that into a career, I obviously thought about medicine, because I had been exposed to it. And medicine eventually became the thing I focused on, because I'm someone of a huge array of interests. As you can see, I love dance, I love science, I'm not someone who has one specific fixed interest. And medicine was the one field I found that allowed you to think–from the most micro level of molecules, atoms, all the way to the most macro level of, you know, questions of policy, psychology, things of that nature–on a daily basis. And you engage that spectrum to help other people. And there was really no other thing I could think of that allowed me to have such a broad scope in my work on a day-to-day basis. And so that was just very much a good fit for me in terms of my personality.

Emily Silverman

So you go to medical school at NYU. On your website, you write, “Building on years of pre- professional ballet training, I started my medical school career with a project formally establishing a novel subfield within the medical-humanities movement and medicine, at the intersection of medicine and dance. This work emphasized clinically relevant skills, such as physical self-awareness, observation, communication, and mindfulness that learners across the medical education spectrum stand to gain from engagement with movement arts.”Tell us about movement and medicine. I highlighted the term “physical self awareness” there. I just thought that was so interesting. How do the movement arts help us as clinicians

?Nina Shevzov-Zebrun

So movement medicine is a term that I came up with to describe a novel area within the medical humanities, similar to literature and medicine, or visual arts and medicine–fields that I found were far more developed and mature than the intersection of medicine and dance. And movement medicine is really the study and practice of how self-awareness of your own body and your own movement tendencies–how you hold a motion, how you hold energy–allows you to have a deeper connection to yourself, and build on that awareness to understand the emotions and experiences of others. What I mean by that on a basic level is, is that our bodies are vessels for emotions, for energy, for experiences, and they embody them in certain ways. And so once you understand that about yourself, you can start to read that in other people. And even if it's not a direct reading, as in a word, like reading, you know, “angry” on someone's forehead–it's never going to be that clear–that energetic appreciation of interactions between you and another person can be super valuable in the clinical setting, as well as in a host of other settings, obviously. But it's something that's not really developed in medicine. And I spent a lot of time thinking about why that is.And one reason, I think, is because it really takes a leap of imagination to think about that. Like, it's not like with, for instance, bioethics. Bioethical principles are present every day in medicine. It's very clear why doctors engage with bioethics and why people are physicians and bioethicists. Similarly, it's almost clear why doctors are also often writers, you know, you engage writing in medicine. Medical knowledge is conveyed by writing. You read literature on the web all the time when you're thinking about how to treat a patient, how to formulate a plan. You don't dance. It's not there, it's not present in your day-to-day. You even look at images, you even look at xrays, you look at, you know, things that could be art, but you don't engage in movement the same way in your day-to-day. And so it takes a bit of a leap of faith, a leap of imagination, to explore this. But I think there's so much to gain from just understanding how you are in your own body. And then, therefore, how others are in their bodies, and then how your interactions can kind of come together in ways that are beneficial.

Emily Silverman

Ah, I want to take a few minutes and really go down the rabbit hole with this, because…

Nina Shevzov-Zebrun

Sure. That’s why I’m here.

Emily Silverman

That's why you're here. Maybe I'll just tell you a little bit of my reactions and reflections to this. And I think I've said this before on the podcast, but when I was practicing medicine as a hospitalist, especially when I was a resident, I was very, very out of my body. I felt like my energetic body, whatever that means, was basically, like, head and neck. And that was it. I ignored a lot of the bodily sensations that came up. And you know, we're taught to do this by the culture, to ignore our hunger, to ignore our feeling of having to go to the bathroom, and so on and so forth. We're kind of taught the opposite of embodiment. And then later, as I was practicing, I recognized this and I started the process of coming back into my body, which was a really wonderful, but also kind of painful process. And I started to notice things just as you're saying, like, how am I in my body? How am I using my body language to interact with patients? How am I picking up on other people's emotions through their body language or expressing myself through mine? And so you say “dance” and you laugh. And it is dance. But it's more than dance. I don't know, can you give us an example of a scenario or a story or maybe something from your experience, about how movement and embodiment can impact experiences at the bedside or even just impact experiences that clinicians have in their own lives?

Nina Shevzov-Zebrun

So, one story I can share, and this one really sticks out in my mind. I think about it all the time because it was one of those times where, as a medical student, I caught something that other people hadn't caught. And I really think it had to do with physical awareness and reading the room in a different way than people might without a background in movement arts. And so there was a patient situation where I was on the neurology service, and it was a patient who just had a very complex history, no one could really figure out what was happening. He kept re-presenting to care. He and his wife were in the room. And he was someone who she was describing at home very different from the way we saw him. He was, you know, not really verbal, not really communicating with us, barely tracking movement. But she was saying how at home, you know, just the other day he was reading the newspaper, having coffee. And that clinical picture just did not match up for us, and just kind of kept happening. I was in the room and I was looking at everyone and how everyone interacted–how the wife was speaking to us, how she was looking at her husband–and I left the room and I turned to the attending and I asked, “Do we think there's any potential, you know, Munchausen by proxy?” or whatever the other name for that is right now, I can never forget, I never remember what the new name is. “But is there a situation like that that we've thought of?” And she steps back and she goes, “Wait, how did you know? His surgeon actually just messaged me this morning that this was on his mind.” And this is someone who had known him for 20 years as a provider. And she was like, “How did you know that?”And for me, it wasn't, I can't point to one thing. But it was the physical presence of everyone in the room, how they interacted, whose back was to where, little subtleties like that. Yes, it was voice and yes, it was content of what she said. But it was also more than that. And I think it comes down to that just energetic physical awareness that you have when you're a dancer or someone who's, you know, trained in some sort of sport or something that's really in your body. Because you learn how to be aware of everything from your fingertip all the way down to your, the tip of your toe, and everything can have a meaning. You know, the speed at which you move, the quality with which you move, the energy and movement, all that means something and you can manipulate it. And people do that subconsciously. And so when you can start looking at that and understanding it, and even, you know, using it in your clinical practice, things might come up that you don't expect.

Emily Silverman

Here at The Nocturnists we do a lot of live shows and a lot of coaching of clinicians for the stage. And one of the most difficult aspects of that work is really coaching people back into their bodies and having them be embodied as they're telling the story on stage, you know, telling it, really, from a place of re-experiencing it, and then feeling the audience's response, and then responding to that response. And one of our story coaches is Molly Rose-Williams, who comes from the world of theater and movement and dance, and she's fantastic. And it's always so fascinating to see her look at the different storytellers and point out, like, “Wow, that storyteller has such an amazing ability to move energy in the room.” And I kind of have to, like, pause and think, “Well, what does that really mean?” And, “What is she talking about?” And it's this whole different language. And it makes me wonder about what is it like to move through the world as a dancer. As physicians, sometimes, you know, we'll be standing in the line at Starbucks. And, you know, we'll look at someone and say, “Oh, they look like they might have a little bit of thyroid eye disease,” or we look at someone else and we say, “Oh, they have a tremor,” or, “They look like they might have Parkinson's.” And it can be hard to kind of move through the world and take off that physician lens, because you're picking up on all of these different things that other people maybe aren't paying attention to. But as a dancer, what is it like to be in the line at Starbucks? What are you seeing? Is it like, “Oh, he pours his coffee really aggressively and he's more likely to spill, and she pours it more gracefully?” Or, like, what is the, like, Sherlock Holmes dance filter of, like, stuff that you're seeing and picking up on in the world?

Nina Shevzov-Zebrun

Something that came up, actually during the creation of a later project in medical school, that really speaks to this, is the idea of the traces, or byproducts, of someone's movement. So after someone's moved, almost like the dust particles that are left in their wake, and what that movement meant. And I think that that's really what, for me, I notice. Yes, it's the movement. But it's in the seconds after someone's movement–what is the impact of that on the space around them, you know, the ripple effects. One way that I specifically feel this in the clinical setting. And right now I'm working with the pediatric patient population and I'm always thinking about my eye level versus theirs. And I was in a room with a young patient the other day, and he was very, very short. And I towered over him when I was sitting down on my stool, and he was in his chair. And I lowered the stool height and rolled over to him at the exact same time. And I felt this, like, swoop of energy as I got closer to him. And I could feel how that movement actually changed the dynamic in the room. And he ended up opening up some very, very personal things to me. But it was, that's an example of, obviously that wasn't the reason why, but I think it's one ingredient in a whole soup of why, you know, we ended up having a really good rapport.

Emily Silverman

If all physicians were more embodied, what would healthcare look like? What would patient interactions look like? What would the hospital look like? How would that affect us in our practice?

Nina Shevzov-Zebrun

It would probably slow us down, because not being in your body, as you were saying, allows you to ignore a lot of things that your body's telling you. This past spring I trained and ran a marathon during my fourth year of medical school. And I had never done an endurance sport before. I learned so much about pushing yourself, at the same time as listening to your body. I think because of my training–you know, in medical school, and before that to go to medical school, and then also the rigor of ballet training–I'm someone who can push and push and push and you know, ignore the physical signs of injury or anything else happening. I was very tempted to do that in my marathon training. There were times when my body literally told me “No!” Like, my hip flexor flared up with a tendinitis and I could not do the sprints I had planned for that day on my excel sheet. It was just not happening. And that slowed me down. And that made me shave time off of me knowing my final goal. But in the end, it was the safer, better thing for my body. In the healthcare setting, it's hard because often turning off signals about your own embodiment means that you can attend to more things for other people. It's this double-edged sword and I'm not sure how best to answer this, because more embodiment amongst physicians and providers would slow everything down. We talked about the “doorknob questions” when you're about to leave the room as a provider and there's one more question that comes up. And that opens a whole, you know, a whole rabbit hole that you have to then go down. And obviously, it's something that the person was probably, the patient was probably hesitant to bring up for a reason. This is one area where I think that a little more embodiment, being a little more in tune–in addition to obviously saying, you know, “Anything else? Anything else,” and the things that we're trained to do–but a little more embodiment might actually allow you to see when something's happening for someone that you're not addressing with your words.

Emily Silverman

I love the anecdote of the marathon. Because when I was growing up I was just so unathletic that I just kind of put sports over here in a box. And it became a thing that I was just never going to do and never going to touch–didn't do sports, didn't really watch sports, didn't really understand, like, sports fans and fantasy football, like, I just, the whole thing was foreign to me. But as part of my journey of coming back into my body after my medical training, I started to really gain a respect and an appreciation for athletes and the work that they do. I remember I was watching the Olympics recently, and it was a girls’ volleyball team. And in addition to every individual player having knowledge of where their body was in space and what was happening around them, there was almost like a hive-mind element, where you could see those stretches of minutes where the whole team was in flow. And it was almost like a psychic ability, where she knew where this player was going to be. And so she decided to move the ball over there. And they're just hitting this rhythm. And it's like, I was gonna use the word ballet, or symphony, no pun intended in your case. But I'm wondering if there could be an element of that that occurs in medical settings as well, like when you have teams working together, maybe in the operating room–it's very physical, it's very tactile–if you've ever thought about movement in medicine and how that could show up in some more of, like, those physical aspects of medicine.

Nina Shevzov-Zebrun

I've thought about this during codes. I've thought about this during traumas that, that come in. When I was on my trauma rotation, that sense of organized chaos that people talk about, it is a dance in many ways, with so many different people. And there is a choreography in terms of the order that things are done in. And if you're not trained in that order, you don't understand what's happening. You think it looks random, but it's not. And if a team is functioning well, there is that hive-mind that, you know, connection between everybody. Obviously, I've thought about–you know, this is very well developed–but dance therapy for patients and movement as medicine in that sense. And that's not really, you know, what I have been focusing on, but the physical movement of the actual providers as care is another dimension. I haven't quite thought about that a lot. So thank you! A new area for exploration.

Emily Silverman

Let's talk about the Ten Tensions Project because it's so fantastic. I'm just blown away by your work. So for the audience, who isn't familiar, perhaps, what is the Ten Tensions Project?

Nina Shevzov-Zebrun

It is a set of ten photographs that are taken in a medical setting. The photographs are of dancers positioned in the medical setting. They are dressed as doctors and patients. And each photograph is designed to embody or capture a specific tension or internal struggle that clinicians may face on a day-to-day basis. So, an example of this–probably the one that everyone would say automatically, “Oh, yes!”--this one is time. So, time constraints. Everyone feels that when they're, you know, faced with their patient list for the day. But how do you take an emotion, how do you take a feeling and give it shape and, sort of, visual structure and contour? And that's what this product really does. And so when you look at one of these photographs–obviously, it's been artistically curated, but the idea is that that tension is brought to life, is brought into vision in some way that will allow you to look at it in a whole new way.

Emily Silverman

And it's really a combination of dance, photography, philosophy, writing. Tell me about, like, the process of selecting each tension and then arranging, like, “Okay, how do I get the dancers? How do I set up this photograph to reflect the essential tension that we're exploring here?”

Nina Shevzov-Zebrun

The idea for this came to me, actually, my first year of medical school. And it wasn't until the fourth year that I ended up completing this project as a required scholarly concentration at NYU Grossman School of Medicine. And the idea came to me while I was working on the movement and medicine paper. And I vividly remember the moment that this idea came to me. I was on a train back from visiting my grandma in Connecticut, and I was working on the movement and medicine paper, you know, typing something, and looking out of the window, and looking down at my computer, and back again. And I thought, you know, “Oh, man, I could turn this academic work that I'm doing right now into an actual piece of artwork.” And I think it was literally something about seeing the chaos of the moving world outside in a snapshot, and then looking away, and seeing it again, and looking back, where I was almost getting photographs of this, like, chaotic world. And I actually think that's what inspired this project.In terms of selecting the tensions, quite honestly, it was not challenging, because, you know, I sort of did a brain dump when I first started this work. And I could list far more than ten that I had come across in my own, you know, clinical experience as a medical student. The process is really bringing a whole bucket of tensions to various people with more medical experience. I talked to a number of attendings who I formed good relationships with, and they ended up narrowing it down to these ten. The real struggle came when I realized the scope of this project. Each of these tensions could be a project in and of itself. And within each of those tensions lives ten more projects, and it keeps going down and down and down like that. And that was one of the initial challenges that I had to get over, realizing that I would not be able to dive into each tension in incredible depth. And just like, you know, we have specialists–not everyone in medicine, not every provider is going to know everything about everything–this project was not going to be the end-all, be-all for each tension. But it was an important high-level overview where the scope was part of the art itself.And so once I had my tensions list, I had to start thinking about how to execute this. And I'm fortunate in that I have a very strong network of dancers still, and friends who are dancers right now. And I was in New York, which is obviously a hub for dance in the arts. And so, through a number of connections–actually one dancer, Ingrid Kapteyn, graduate at Julliard, she and I grew up together, dancing. And I reached out to her and she connected me with Danielle Russo, who is faculty at NYU, in the Dance Department at Tisch. And she ended up being my movement consultant, I call her, or my movement specialist. It would not have turned out the way it did without Danielle's input, because she is a specialist in site-specific work. And so this was exactly the kind of person I needed to help me bring these tensions to life.We started working together, and we actually built an entire spreadsheet of every tension. Then the next column was, “What are the emotions associated with this tension?” Then the next column was, “What is the physical response to the emotions that this tension might produce?” Then the next column was, so, “With those physical responses, how might we demonstrate that through movement, and specifically that aftermath of movement?” Because, if you think about it, photography is still. And in dance we're used to having the luxury of movement over time to tell a story. With a photograph you don't have that, you have a snapshot. But we do have all the artistic tools that photography allows, with various exposures and et cetera, which I learned about through this project. And, so, how are we going to capture the emotion of the tension through physical movement in a still moment?And that became a lot of work and a lot of collaboration with Danielle, with a few amazing photographers, Mateo Salcedo and also Nikko Tonolete, both based out of New York, who were so helpful and gracious in helping me with this project. And also I have to mention three other dancers, the three main dancers who are showcased in this work, Ingrid Kapteyn, Antuan Byers, and Roya Carreras. And together in the studio, and then actually on the medical site, which we can talk about, we ended up just experimenting and doing, you know, physical body research through movement, to see how we could capture these tensions. And that for me was so fun. I have to say I, I became a little bit teary at one point in the dance studio. We had rented some studio space in New York. And the coming together of these worlds was so real for me, it was exceptionally moving. I had never imagined that I could do something that was this interdisciplinary and yet relevant. And so it was, it was an incredible experience.

Emily Silverman

I'm getting emotional at the idea of you getting emotional about this amazing interdisciplinary collaboration, because I also love, love, love cross pollination and interdisciplinary things. And I think we need so much more of that in medicine and what a dream to be able to collaborate with photographers and dancers and this person at Tisch and to be thinking about medical questions. And just such an amazing project! The word, “tensions,” for those who aren't familiar with the project may need some unpacking. So what do you mean when you say, “tension,” so you picked ten of them, each one has a photograph associated with it. What is a “tension?”

Nina Shevzov-Zebrun

I think the reason I picked the word “tension” is because it does have some resonance with movement. In dance, we create tension in our bodies to produce certain energetic results, which then convey a certain shape. A common example I would give would be like, if you want to achieve balance on one foot. A way you can do that is by creating internal tension by imagining a string is being pulled up to the top of your head, and then also through the bottom of your foot down. And so you're creating opposition in your body. And you can feel the energetic stabilization of that. And so I used to use that all the time in standing-on-one-foot contests in elementary school, because I had already learned that trick. But it's true, where it, you can create energetic tension that has physical results. And so that was on my mind in sort of a double entendre fashion, when I was thinking about the title for this project, and what I wanted the project to be.So the tensions that I selected are things like boundaries. The tension there is sharing versus not sharing information, as a provider with your patient. The tension with time is spending time versus not spending time. These are at their most bare-bones levels. There's a tension of dislike, which is the most, probably, the most controversial one, which is what happens when you don't like the person that you're treating, or who is your patient for whatever reason. So not-like versus like, you know, treating one way versus another. There's all these oppositions that can be created. And that just parallels the physical idea of tension that I just described really nicely.

Emily Silverman

Tell me about the photoshoots. Did you shoot these in actual clinic rooms? Hospitals? Was it a set? Bring me into that space? Like, what, what was that like? Because that seems so fun.

Nina Shevzov-Zebrun

Oh, man, it was so fun. So we shot it at the New York Simulation Center for the Health Sciences, which is actually located within Bellevue Hospital. It is an entire floor dedicated to medical learning through simulation. And so they have exam rooms that are set up exactly how an exam room would be set up. They have larger rooms where they kind of look like trauma bays. I actually used that space. It was a many, many hour photoshoot, where we had all the dancers there. I was there. Danielle, the movement director, was there. And, obviously, our photographers. Setting up that photography equipment in those exam rooms and in those trauma-bay-like areas, it just looked so interesting, you know, transforming a space that I work in every single day into something that's like a stage. That is a whole podcast episode in and of itself, in terms of what that means. But it got me thinking a lot. I mean, the dancers are doing all sorts of crazy things all over these rooms, and there are people walking by in the hallway. And they were looking at and seeing, you know, someone, like, doing a somersault over a code cart. And I was, like, “What are they gonna think?”

Emily Silverman

I'm just looking at the photos now. And of course, it's difficult to convey through the medium of audio, just the impact and the beauty of these images. But I'm looking at “Uncertainty, Limits of Knowing,” and I'm looking at an exam room with very dark moody lighting, lots of blues, and there's a patient sitting on a gurney and then there's another figure that I think is a clinician, and it looks like there's been some play with exposure here, and it almost looks like the clinician used to be standing but has collapsed onto the floor and their white coat is covering their head. I would love for you to walk us through, like, how did you decide on this? How did you get from “Uncertainty” to this image, this movement, this emotion, like, the kind of spreadsheet to photograph process.

Nina Shevzov-Zebrun

This photograph, if you look at it, exactly, it's a clinician on the ground with her white coat kind of falling over her head. Her right hand is, has a lot of, again, pun, tension in it, and her left hand is in a fist, and then she's kind of in a ball on the floor, and above her is exactly where she was standing, having just collapsed to the floor. You get that movement trail–seeing what the spatial energetic impact of her movement would have been if we could see it. The way we got to this was thinking about the different kinds of uncertainty that exist in medical settings. And this was part of my initial research, was thinking about, kind of the academic side of each of these tensions. Obviously, there's uncertainty of not knowing, you know, a fact or a dosage or something like that. There's the uncertainty of not knowing if a treatment will work for whatever reason. But there's another kind of uncertainty that links, actually, quite directly with a lot of what I talk about in my movement and medicine paper. And it's this, this differentiation between uncertainty about knowing “how” and knowing “that.” So knowing “that” is like, I know that cells have a nucleus, or whatever. And then knowing “how” has to do with the knowledge you have from firsthand experience. So another word for that, or another term for that, is “acquaintance knowledge,” more philosophically. And it's, so, it's the knowledge that you can't get as a bystander, you can't learn from observation, from reading, anything like that. If you don't have knowledge in that way about something, you're uncertain with how to deal with it.Something that I came across in creating this tension is this concept of “hermeneutical insufficiency,” which, when I first learned that, I was like, “What does that mean?” But what it means is lacking the mental models, or frameworks, to understand someone else's reality. That's really what it comes down to. When you think about the clinical setting, patients come in with their own realities, their own worldviews–just as we all do, because we're all patients, you know–cultural, age-related, whatever. And if you don't have that firsthand experience of someone, which you, by definition, do not, you automatically have some level of hermeneutical insufficiency in your relationship with them, because you lack the framework to appreciate their worldview and their mindset. That can come in different degrees. And oftentimes, it's not a huge degree. So that's when we feel like we're on the same level as someone else. But there are, there are times–and I'm going on a tangent here, but I think it's an important tangent, so I'm gonna keep going. There are times when we're faced with questions that we really do not know how to answer, because our degree of that insufficiency is so big.I once had a patient ask me, or actually it was a patient's mother, ask me if part of their–it was a psychiatric case–part of their presentation could be possession-related. So, like, you know, spiritual, dark energy possession. And I remember sitting there in the hallway of the hospital thinking, “I do not know how to answer this question.” Like, I just do not know, because if I say, “No,” first of all, even though I'm a very, you know, scientific person, I was thinking, “If I say, ‘No,’ I really can't say ‘No,’ because I don't know, like, maybe like, ‘No,’ but also, ‘No,’ I don't know what to do. I can't say, ‘No,’ I literally can't say, ‘No’ to that. But if I say, ‘Maybe, we don't know,’ then to that person, that would mean, ‘Yes.’” I did not have the mental model or the framework to answer that question. And I ended up, I forget, I fumbled through some sort of response being like, “Well, our medical opinion is….”But that really stuck with me when I was crafting this tension, because I had a huge knowing how gap in that moment. And so the emotions associated with that are things like feeling stuck, feeling useless. And I want to get to that word in a second, because there's a very small detail in this photo that's important for that. And feeling like what's inside of you, like you have your worldview, you have your frameworks, but they're not sufficient to connect with someone else. And so in this photo, there's a few things going on. One is this, like, ghostly figure that's rising out of the doctor. That's the trace of her movement. You can view that as what she's certain about. All of her personal acquaintance knowledge, all of her firsthand experience in the world. That's, it's reflective of, you know, what's inside of her, like her soul, for lack of a better word, her brain, her mind, all of that. Then on the ground, her position is meant to really be an embodiment of exasperation, of frustration, of feeling stuck, and that's, you know, that, that hand, one fist in anger, you know, one with tension in it, the, the coat over the head, you know, it's, you can't see her head, you can't see her mind, because for her, it's clouded. And then the feeling of uselessness comes into play, where in the background of this photo, there's actually plastic–a plastic kid's doctor's instrument set on the table there. You can kind of see the green handles of the plastic scissors. And that's the sense of the tools you have been given as a doctor are useless. They're just plastic tools, because you are not equipped to help this person that has their own mental framework. And that's like literally all just in this one image. But it took that much thinking and that much time was put into these images. And I think that there's, there's so much closer reading that couldn't be done with these. And also finding things that I haven't even thought about that I put in these by accident, which is probably how a lot of close reading….

Emily Silverman

Well, I think this project is incredible. I spent some time with the images earlier today. And I encourage our listeners to take a look. They're really powerful. And each one has just a brief, maybe three-paragraph, summary underneath, which summarizes the tension. It's not a whole lot of stuff to get through. You can kind of, you know, go through it and get a flavor for each one. It's an amazing project. Nina, my last question to you is, What is next? You're a resident in pediatrics at Stanford now. Do you have any new projects coming down the pipeline? Or are you busy being a resident as I imagine you are? I'm just envisioning this big, great future for you as, like, the Rita Charon of movement and medicine? Do you have any dreams for where to take this career?

Nina Shevzov-Zebrun

Honestly, that's, that’s the dream in the sense of crafting or originating a new space within the medical humanities that then people take and spin off into all their different directions. Something else that I would love to do is to turn this Ten Tensions Project into a book at some point, where each tension gets a chapter, once I get more experienced as a clinician myself, but keep this framework, maybe leverage the photographs and then use each one with patient stories and then my own, you know, thoughts and reflections. I think it could be a really nice literary project there.

Emily Silverman

I have been speaking to Dr. Nina Shevzov-Zebrun about movement in medicine and her most recent project, The Ten Tensions Project, which you can check out at tentensionsproject.com. Nina, you are amazing. Thank you so much for putting together this incredible work of art and for coming onto the podcast to chat with me.

Nina Shevzov-Zebrun

Thank you. It's been such an honor and pleasure. I really enjoyed it.