About Our Guest
Natasha Spottiswoode is an infectious disease physician-scientist with a love of outdoor adventure. She grew up in California, studied malaria and iron metabolism in the UK, and moved to New York for medical school before coming back to UCSF for residency and now infectious disease fellowship. Storytelling is how she processes medicine, in all its tragedies, frustrations, and epiphanies.
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
Natasha Spottiswoode is an infectious disease physician-scientist with a love of outdoor adventure. She grew up in California, studied malaria and iron metabolism in the UK, and moved to New York for medical school before coming back to UCSF for residency and now infectious disease fellowship. Storytelling is how she processes medicine, in all its tragedies, frustrations, and epiphanies.
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
Natasha Spottiswoode is an infectious disease physician-scientist with a love of outdoor adventure. She grew up in California, studied malaria and iron metabolism in the UK, and moved to New York for medical school before coming back to UCSF for residency and now infectious disease fellowship. Storytelling is how she processes medicine, in all its tragedies, frustrations, and epiphanies.
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
The Nocturnists is made possible by the California Medical Association, the Patrick J. McGovern Foundation, and people like you who have donated through our website and Patreon page.
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.
Emily Silverman
Learning medicine is tough. It requires a lot of reading, understanding, memorizing, but there are other parts of medicine that we learned differently: more body-based learning, which is grounded in feel, in instinct, in spidey-senses. How do we think about that type of learning?You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman.Today I speak with Natasha Spottiswoode, an infectious disease physician-scientist with a love of outdoor adventure. She grew up in California, studied malaria and iron metabolism in the UK, and moved to New York for medical school before coming back to UCSF for residency and now infectious disease fellowship. Outside of work, she loves to rock climb, backpack, cook new recipes, and explore new places with her partner and friends. Before I speak with Natasha, we're gonna hear the story that she told live at The Nocturnists in January 2020:
Natasha Spottiswoode
It was a dark and stormy night.I actually don't mean that literally. This is San Francisco. It's beautiful weather usually. But that night, it was clinically dark and stormy. I was brand new to being a senior resident, my intern was new to being an intern, and I think even my third year medical student was also new to being a third year medical student. And we were in the middle of the busiest call day that we had ever had. We'd taken so many patients, and they were all so sick. And I was super worried about being a senior resident, and doing my job well, and keeping the patient safe, but also giving everyone on the team the independence that they needed to grow. And I didn't know them very well. I knew my intern, George, well enough to know that I could trust him to take a thorough and sensitive history and to see patients as people, and not just collections of illnesses. But I didn't know how good his clinical acumen was. And I worried that in our newness, we might miss the forest for the trees.So that night, we got a call from the emergency room that they had an admit for us, who was a gentleman with alcohol use disorder, who had been found down, and then we hear that he has a low hemoglobin, which is bad. And then we hear that he has a fast heart rate, which is much worse. And in that context, suggested that he was bleeding somewhere. So as we're walking to the ER to get this patient, I said to George, "What's the first thing we're going to look at when we go into the room?" And he says, "Well, this man has drunk a lot of alcohol over many years. I'm worried about his brain and his memory. We should know if he knows where we are and what year it is". And I said, "Yes, George. That's right, we will do that. But I'm really worried he's bleeding. So the first thing we're going to look at is how many IVs he has in case we have to give him blood."So we get to the room, and the patient does indeed look quite sick. And I said, "Actually, I'll take this patient, you'll take the next one." So I got to work, and my pager was going off. And the next thing I know we have a second patient. And the second patient has metastatic cancer and is coming in confused. And I remember hearing that and thinking, "This person is sick. And I don't quite know why. And that's scary." But I couldn't leave the first patient. So I said, "George, can you go take a history, find out what's happening. And if they look bad, or their vital signs change, just call me and I'll be there." So he goes off, and I go back to work on my first patient. And I was trying to keep track of everything that was happening that day. And I was thinking about someone's insulin level and an anion gap and a heart rate, and things were just stacking, and my pager kept going off. And somewhere in the emergency room, somebody was just screaming this long, unconnected string of expletives. And it didn't help. And at some point, I was talking to the emergency room doctors, and I was kind of worked up and gesticulating, and I knocked my coffee over, and it went all over my medical student.So then I had to stop for like, at least two minutes, and apologize, because I was now the resident who had thrown coffee on a medical student, no matter how accidental and eventually, I got that cleaned up. And I got my patient sorted out, and I sent him to the ICU. And I could think, and I could breathe.And as soon as I could, I went to go and see George, my intern. And so I get to the room where he is and the patient with metastatic cancer and confusion. And from the door, I saw two things.Firstly, I saw George taking a meticulous and comprehensive and thoughtful history, asking the patient who they are and where they lived outside the hospital and how many children and I also saw that his pager was going off as mine had been, and that he was triaging: that he looked down, see what it said, look at the patient, look down, look at the patient.And then also, from my bird's eye view in the doorway, I saw the numbers on the screen: I saw the blood pressure lowering, and the heart rate going higher. And I just remember taking that moment and breaking it and saying, "Stop everything. This is unstable." And then I just—I took control. And I did all the things that you do to stabilize someone who's in septic shock—the fluids and the blood cultures, and the lactate, and the antibiotics. And I called the ICU again.And then when the urgency was done, I looked at George, who looked horrified, because he knew what he'd missed...that this person was decompensating. And in the busyness, he hadn't seen it.And I felt terrible, because I was so worried that in our collective busyness and the chaos of that night, and our collective inexperience that perhaps we had not been fast enough. And also, I had done exactly what I shouldn't have done and just taken control of the situation instead of talking through it. And I was kind of thinking about what to say, and trying to put a name to what it is that a new intern didn't yet have, but was going to learn.And the word I kept coming up with was "airmanship," which is a very old concept from a very different part of my life.Before I was a doctor here in San Francisco, I used to be an amateur pilot in England. I didn't know I wanted to be a doctor when I was a kid. I actually thought I wanted to be a pilot, or an astronaut, or Amelia Earhart except less dead.And then I got the chance to go to graduate school at the University of Oxford. And I found out that they had a flying team. So, of course, I joined. And I called up my parents and I said, "I'm at Oxford, I have a robe, and I wear it to dinner, and I'm learning how to fly. I think I'm actually at Hogwarts. It's pretty great." And the things I was learning how to fly are called gliders and their little planes without motors. And, as you can imagine, they're actually kind of harder than planes with motors, which are sort of 3D cars.For example, for a glider to go up, you have to find a thermal column of rising air and circle for height. If you've ever seen like a hawk, or a big bird of prey doing that—same thing. And I really quickly found that I was actually bad at it.I could do the book learning, I could learn the principles, but I had no innate sense for how a plane should move. And I couldn't plan ahead. And I couldn't anticipate dangers. And I really, really couldn't do landings..like could not stick landings, just couldn't get it right.And I—I watched all these people who had started with me, like go on and get their solo licenses and, like, take part in competitions. And I was just stuck. And the pilots didn't make this super easy on me. We learn to fly on old planes. And the pilots who taught us were as old and as cantankerous as the planes themselves.And the one I flew with most—his name is Fred, and he was among the oldest and most cantankerous of the bunch. His thing was to hang out at the clubhouse between flights and eat these filthy sandwiches...like fried bread, butter, bacon, eggs, butter, and fried bread. He looked as though at any moment, he might have a heart attack. And he sometimes made jokes about women on the airfield that didn't quite land.But I knew that every time he got into the plane with me, he was quite literally putting his life in my really inexperienced hands. The thing about gliders is that they're dual control. But there is no override. So if the junior pilot—that's me—screws up, you both crash.And so for that reason, they teach us a command before we ever leave the ground that we must always obey. And the command is, "I have control." And what it means is that I as a junior pilot should take my hands off the stick and my feet off the rudders, and do nothing until the senior pilot sorts it out.And so I'd be practicing a landing and going in, and I hear, "Spottiswoode, I have control," or going for a stall, "Too slow, so I have control."I hated it.And there came a day that I was flying with Fred, and he was really putting me through my paces: we'd done stalls, and we'd done spins, and we'd done a loop. And finally, we were going in for the end, which was a landing, and this time I was going to get it right. And I remember, I was thinking about so many things. The wind was kind of gusty, and I was compensating for it. And I was keeping the nose down, and I was keeping the speed on. And I was adjusting the trim. And I was going in, and it was gonna work.And then I heard, "Spottiswoode, I have control." And I thought, "What?!" But I—I took my hands off the stick and my feet off the rudders as I'd been taught.And I watched in dawning horror, as Fred steered us out of the way of a tree.I had been about to hit a tree.And we landed, and I was sitting there. And I remember thinking, "I'm going to be yelled at." And then I thought, "I deserve to be yelled at." And then I thought, "What am I doing? I just put two people at risk. I'm bad at this. I've never been good. I have no business here."And we got out of the plane, and he lights up one of his filthy cigarettes. And then instead of yelling, he said, "What do you think happened?" And I said, "I don't know. I just did not see it." And he said, "I know. That's why there are two of us in this cockpit. Take half an hour, and we'll try again."So then there I am in the hospital, looking at my intern, who in his newness has missed something which is, in its way, as deadly as a tree.And I said, "What do you think happened?" And he said, "I don't know. I didn't realize how sick they were." And I said, "I know. It's gonna be okay. They're gonna be okay. We'll take this. We'll learn from it. And we'll do better next time."In case you're wondering, I did eventually get my license. I did eventually learn to fly. And on one of my first solo flights, I found one of those thermals I told you about, and I was flying in it circling for height. And I happen to look out the window. And I saw a hawk...a big hawk. And it was just circling right along with me.And the two of us were just sharing the air.
Emily Silverman
So I am sitting here with Natasha Spottiswoode. Thanks for coming into the studio today.
Natasha Spottiswoode
Oh, thanks so much for having me.
Emily Silverman
You told this story in January 2020, which is now a couple years ago. How does it feel to reflect back on that night on that performance—pre-COVID, pre-chaos?
Natasha Spottiswoode
It's funny that you say that because my first thought listening again to my performance was, "Wow, that was a long time ago. A lot has gone down."
Emily Silverman
That's what everybody says, and you became an infectious disease fellow during a pandemic. So tell us about that.
Natasha Spottiswoode
I did. I was a internal medicine doctor during I'd say most of COVID. And then in July of 2021, transition to being an infectious disease fellow, which is my current job. In terms of how that fed into my life decisions and path, I think I'd always had this worry that academic medicine was very far away from the lived experiences of patients and physicians and healthcare workers. And then suddenly, it was so viscerally front and center in all of our lives. And it reinforced the idea that this was something which really, really could matter.
Emily Silverman
So listening back to the story, other than reflecting on how much time has passed, did you see the story differently at all? Did it change? Or did it feel like it rang true just as much as it did the night of?
Natasha Spottiswoode
I guess one thing that came up was—I think a lot of the story is about the idea of not being good at things and being new and being scared. And I think that the year of the pandemic was a time where we were all kind of new and scared and didn't really have a playbook for it. And so it felt very familiar to me, not just because, of course, I lived that story, but also because I feel like I kept experiencing it. And I was reflecting that maybe, in some ways, it was helpful to have had a lot of experience at being bad, and persevering at hard—sometimes scary—things. And maybe, in a way, that was good practice for me.
Emily Silverman
In the story, you use this word "airmanship," which I love. And you go into it a bit in the story—what is airmanship, how does it work. But I was wondering if you could expand on that a bit. How do you think about airmanship? And I'm curious, after what you just said around COVID, how did airmanship play into the pandemic, if at all, for you and your colleagues?
Natasha Spottiswoode
Well, I think the idea of airmanship, as used in the piece, is the gut feel—a sense of a situation and what is going on and what should be going on. And I'd call that the part of medicine that you don't learn from memorizing books, which is super important too. So in terms of the last year in the pandemic, I'd say that it was an experience for me of no one having that at first, because none of us had done that. It was all new. And I think the closest I got to someone having really had that was a lot of the older docs who had worked during the 80s and experienced a really different pandemic...but one that was also marked by fear, and stigma, and lack of understanding, and inequity.
Emily Silverman
I'm just wondering about this concept of airmanship. Do you have any sense of how that happens? Like for example, with flying...is it the case that one day you can't fly...and then the next day, you can't fly, and then the next day, you can't fly, and you don't know what you're doing, and then you don't know what you're doing—and then you just like wake up one day and something clicks, and then you can? Like a sigmoidal shape? Or do you feel like it's more gradual where the gut instinct develops incrementally over time? I'm just interested in almost like the kinetics of how people develop airmanship?
Natasha Spottiswoode
Well, I think it is both nonlinear and highly variable between people. Like one of the hardest things for me was that I was really bad at it. And, like, genuinely, I was watching a lot of people do what looked like sigmoidal curves, and I felt as though mine was linear—if linear. But I don't think it's easy to quantify like that. But I'd say that it's highly variable, and different parts may come at different times. I don't think I was particularly fast at learning medicine either, actually, as a med student, or even as an intern. There were certainly long periods where I thought, "Oh, God, it's linear, and it's almost flat."
Emily Silverman
And I was thinking, too, about how sometimes we toggle in and out of that state of airmanship or gut feeling or flow. And it reminded me of this scene from Star Wars. I don't know if you watch the Star Wars movies. But it might even be the first movie, where Luke Skywalker is flying in his machine. And he's trying to fly it through that hallway into the target, which is like the mouth of the Death Star or something. And he's flying the plane, and he's aligning all of the technical equipment and the target and pressing all the buttons and you can see that he's like so in his head and he's just trying so hard to keep the course straight and to hit his target. And you can see that he's kind of flustered and overwhelmed, and then you hear this voice—and I think it might be Obi Wan Kenobi. It's like, "Luke, use the Force." And then he like—I don't know if he turns off the equipment or if he just looks away from it—and it's this moment of just letting go and slipping into his intuition. And then he's able to use that to guide himself right into his target. And then he's successful and things like that.And so...I've noticed this with me—maybe less in medicine, but more in other types of tasks, like creative tasks, like writing—sometimes you sit down to write and you're just like in your head, and it's not flowing. And then there are other times where you get into a flow state, and it almost feels like you're just channeling, like, it's not even coming from you? Does any of this ring true around this idea of airmanship?
Natasha Spottiswoode
I think it brings up a couple things to me, and one of them is that I get really worried and a little suspicious, when doctors say that they're gonna make a decision, because, quote, you know, "It feels right to them." Because to me, the idea of airmanship is you get to the conclusion in a way that you may not understand at the time, like recognizing a syndrome or becoming worried about a developing clinical situation. But then, to me, in order to make sense of that, you should be able to go back and say, "Actually, these are why these things are coming up to me." It shouldn't be that you make decisions purely based on the Force. But I do think... (laughing) It's a protip: don't use the Force to do medicine.
Emily Silverman
Yeah, that makes a lot of sense. You mentioned rock climbing. And so we know that you are a pilot. Now we know that you are a rock climber. And then when you arrived at the studio, I was joking with you about the pictures I saw of you summiting a mountain, and...gosh, that mountain was so tall, it looked like you were in space! So I was wondering if you could tell us a little bit about your penchant for adventure. Where did it come from? Why do you love doing all of these exhilarating activities?
Natasha Spottiswoode
Well, I'll start by saying that I'm really not good at any of them. I don't fly anymore, because it is something that's really not affordable in the States. It's much cheaper in England, for sort of complex, historical reasons. But I do love rock climbing. And I do love mountaineering. Actually, I was never athletic as a kid. And then, when I was living in England, my neighbor found me climbing a tree, and asked if anyone had ever taught me to do it properly.So that's how I ended up rock climbing. And the mountaineering kind of came out of that. And I think what it is, is that it's just a wonderful sense of freedom. And it is a wonderful way to understand other people and to get to know people really well. Because after you've climbed a mountain of someone, you really, really, really know them.I think a good medicine metaphor is like spending a 28-hour shift with someone: you're not going to see them at their best. You're going to see how they make decisions under pressure. You're going to see what they do when they're afraid. You're going to see them without any sort of artifice, because there is nothing you can maintain, whether it's makeup or a coherent speech necessarily over 20 hours. And if you still like and respect each other after that, then you really, really love them.
Emily Silverman
Because a lot of these mountain climbs—you have to forgive me for not knowing the jargon, like the mountain climbs—they're dangerous, right? Talk to us about the reality of what could go wrong. And I imagine that's also similar to medicine, like really thinking ahead, and troubleshooting and managing risk, and things like that.
Natasha Spottiswoode
Yeah, so I would argue that the way that I do this is not particularly risky. I think climbing has had a lot of press recently, especially with Free Solo as a movie, where it looks like this sort of daredevil, free-spirited, slightly crazy feat. I don't do any of that. What I do is, I think, relatively fairly tame. I usually go climbing at well-established crags, or I go up mountains which are mostly hiking with a bit of ice involved—which is not to say that there is zero risk.And I think one thing that a lot of my climbing-medicine friends felt around the pandemic was that, for the first time, the perception of personal risk had come into our work lives. But it was something that we were used to navigating in this other part of our lives, which had suddenly, and unwantedly come in to work. But I would say that I really don't think I'm an adrenaline junkie. I'm sure my parents would disagree.
Emily Silverman
It's funny that you say that about "adrenaline junkie" because I almost was gonna ask why ID and why not...emergency medicine, or critical care medicine, or any of these specialties that we stereotypically associate with adrenaline junkies? How did you land in infectious disease?
Natasha Spottiswoode
I love both of those fields. I think ER is not longitudinal enough for me. I mean, it's super fun. I loved rotating in the emergency room, especially at the General. But that doesn't fit me. Critical care, I very much considered. I think that infectious disease is very central to trying to recognize the inequities in medicine, both in this country and globally.And also, the ways that medicine is changing as our world is changing are very tied up in infectious disease. I think the terrifying challenges of our time do include pandemics and do include things that affect them, like climate change, like biodiversity decreases. A lot of the ways that I think medicine is fundamentally going to change have to do with infectious disease.
Emily Silverman
You mentioned health, medicine, and climate. Obviously, these are intimately connected. And I'm wondering, as somebody who spends so much time in the outdoors and connecting to nature and connecting to the earth, if that has affected at all your understanding of how medicine and health interacts with the environment? I'm a city person. Obviously, I understand the concept of "we all share air, we all share water." But do you find yourself having any unique insights on that topic, having all of these hobbies in the outdoors?
Natasha Spottiswoode
I think it just makes it very visceral. So there's Mount Shasta in the north of California, which is a very special mountain to me, because it's connected to how I met my partner actually. We did it last year; we did it this year. And this year, there's no snow on it. So we did it in May. And we had to do it via a rock route...which is fine. That's fun, too. But there shouldn't be no snow on it in May? It's just very obvious.And then in 2020, I think the hardest part for me, just personally speaking, was when both the pandemic and the fires were really bad in California, because it just felt as though I couldn't be inside and I couldn't be outside, and there was just nowhere I could be. I found dealing with the fires, like just, quite psychologically hard.
Emily Silverman
You mentioned this story of how you weren't very athletic growing up. But then in England one day, your neighbor found you climbing a tree and asked you, "Do you know how to climb a tree properly?" So, can you tell us that story? What does it mean to climb a tree properly?
Natasha Spottiswoode
Oh, that was really funny. I mean, I'll start by saying my dad is reasonably outdoorsy and hikes. But my mom is from New York and grew up in Manhattan. So I grew up hiking, but I didn't know how to camp. I didn't know how to go to the bathroom without, like, a bathroom. Really basic stuff. And then I was living in Oxford, and literally just climbing a tree. And my neighbor, who was this fantastic Welsh scientist, was just like, "Hey, I climb. Have you ever learned how to do this for real?" And I was like, "No, what?" and I was 18 or 19.And so he started taking me to the climbing gym. And I was like, "This is wonderful. I'm so enjoying it." And then I started running to cross-train. And then gradually I got more and more into it. And then I moved back to the States and met some really lovely people who took me under their wing, and taught me to climb. And then in med school, my classmates happened to be good trad climbers, and so they told me how to trad climb.
Emily Silverman
What is “trad climb?”
Natasha Spottiswoode
Oh, it's a different style, which involves different gear. It's very cool.And then I started dating my partner, who's much more of a mountain person. So I started learning a bit of mountaineering. But the fun thing is, there's so much to learn. My new thing is that I really, really want to get anywhere decent at skiing, because I really don't know how to ski. And so my big project for the next couple years is to try to learn how to ski because I'd really love to backcountry ski more.
Emily Silverman
You mentioned how flying in the United States is difficult for a variety of reasons, including cost. But I'm wondering if you hopped on a plane to England tomorrow, could you get in an airplane and fly? Is it like riding a bike? Or would you have to start from the beginning of the curve? Or what would that be like?
Natasha Spottiswoode
You know, it's funny, because every time I go back to England—which hasn't been recently because of the pandemic, obviously—I do try to go flying because I have a few very good friends in England. And all of them fly. And one of them had her wedding when I was an intern. And, at the wedding, they actually had a flying display, which was ridiculously cool. But no, I would say that you certainly are not starting from the beginning. You know how it should feel, even if you can't make it happen. But I wouldn't necessarily trust me to manage a flight takeoff to landing because it has been a hot minute.
Emily Silverman
It's so funny because you keep saying, "You know, I'm not that good at infectious disease yet. I'm not that good at rock climbing. I'm not that good at mountaineering." But I've seen the pictures. For the audience, this is some intense stuff that she's doing. I think she's underestimating how good she is at it, but that's just my own opinion.
Natasha Spottiswoode
Well, I think the cool thing about doing these things is that you're always surrounded by people who are much better than you at them. And so it's incredibly humbling, because I'm probably a good rock climber compared to you—I'll take that liberty. But I'm—
Emily Silverman
Definitely.
Natasha Spottiswoode
—compared to the people I know, I'm really not that good. And I'm so honored to know so many doctors who are so good at what they do, in and out of infectious disease, that I could never characterize myself as particularly good at it, because I've got such wonderful examples around me.
Emily Silverman
Yeah, and I love how you say that with a smile on your face. And with a positive and optimistic outlook, because I think, sometimes, when we come into medicine, and we find ourselves surrounded by extraordinary peers and extraordinary mentors, it can be a fuel for feeling shame, or feeling inadequate or feeling imposter syndrome, or "I don't belong here," or any number of thoughts like that. But I just love hearing you talk about this and hearing—the audience can't see your face—but you're, like, glowing as you talk about this. And how you really see these examples as sources of inspiration and how that humility comes through in a positive way.
Natasha Spottiswoode
Yeah, I don't think that that's universal. And I think that there are plenty of places where you're made to feel small, if you don't know as much or don't fit into everyone's idea of what a doctor is, or should be, or should look like, in any dimension. But I think if you're in a place, which validates being new and learning, then it is genuinely joyful to say, "Well, there are these fabulous people around, and I have so much to learn." And that part of the learning curve is so fun to me.
Emily Silverman
And in a way, that's what your story was about. In the end, it was...that's why there's two of us in the cockpit. Like, you're not alone. We're here as a team. Do you think medicine has that collaborative environment, that is pro-learning? Or do you feel like we have some work to do around normalizing not knowing failure? Where do you think we are with that as a medical culture?
Natasha Spottiswoode
Oh, there are so many ways to answer this wrong. I think more work is needed. Still a long way to go in a lot of parts of medicine. I don't want to sound ridiculously optimistic or pollyannaish. I think medicine has a history of being terrifically discriminatory and stigmatizing to people who were newer or younger, or any other way that we didn't perceive the role of doctor. And I certainly don't want to make light of that.But I'm really hopeful that we're getting better. And I really love the team that I work with now. And I am really hopeful about the future of medicine, and perhaps the way that I live within it.
Emily Silverman
As we wrap up, my last question is around your path as an infectious disease doctor. What is next for you? What do you spend your time thinking about? You mentioned that you're a scientist...what are you interested in learning about, researching? What are the big questions that you're turning around in your mind these days?
Natasha Spottiswoode
I think the big scientific questions are...what's going on with how we get so sick, from a respiratory perspective, both COVID and non-COVID? Why does that happen? And what can we do about it? Those are obviously huge questions. And I think I need to find ways to find bits of them that are amenable to me sort of chipping in my tiny little way at them, and taking what I learned clinically and building that in. And then there are the other big questions like how do you pick backcountry skis? And how does one start learning that? And that's another big question that I'm also dealing with.
Emily Silverman
Well, it's been so much fun to chat with you today, Natasha, about your story and about all of the exciting things that you're doing, both inside and outside the hospital. Is there anything else that you'd like to share with our audience before we end?
Natasha Spottiswoode
I think we lose the habit of being okay with being bad at things as we get older. Especially, a lot of work cultures are not forgiving of newness and failure. But I think continuing to try new things and to be willing to be bad at them is the closest I have seen to a gift. It's a gift to keep getting to do things to be bad at them to learn. And it just brings me so much joy. I would encourage listeners to keep doing that.
Emily Silverman
The joy of failure. Yeah, this is a phrase that I've been thinking about a lot as well—as somebody who can definitely tip into the perfectionism category—is the joy of failure. How do we tap into that? And so I think that's a great place to leave off. Thank you so much, Natasha, for coming in today and for sharing your story on The Nocturnists stage.
Natasha Spottiswoode
Thank you so much.
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
Learning medicine is tough. It requires a lot of reading, understanding, memorizing, but there are other parts of medicine that we learned differently: more body-based learning, which is grounded in feel, in instinct, in spidey-senses. How do we think about that type of learning?You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman.Today I speak with Natasha Spottiswoode, an infectious disease physician-scientist with a love of outdoor adventure. She grew up in California, studied malaria and iron metabolism in the UK, and moved to New York for medical school before coming back to UCSF for residency and now infectious disease fellowship. Outside of work, she loves to rock climb, backpack, cook new recipes, and explore new places with her partner and friends. Before I speak with Natasha, we're gonna hear the story that she told live at The Nocturnists in January 2020:
Natasha Spottiswoode
It was a dark and stormy night.I actually don't mean that literally. This is San Francisco. It's beautiful weather usually. But that night, it was clinically dark and stormy. I was brand new to being a senior resident, my intern was new to being an intern, and I think even my third year medical student was also new to being a third year medical student. And we were in the middle of the busiest call day that we had ever had. We'd taken so many patients, and they were all so sick. And I was super worried about being a senior resident, and doing my job well, and keeping the patient safe, but also giving everyone on the team the independence that they needed to grow. And I didn't know them very well. I knew my intern, George, well enough to know that I could trust him to take a thorough and sensitive history and to see patients as people, and not just collections of illnesses. But I didn't know how good his clinical acumen was. And I worried that in our newness, we might miss the forest for the trees.So that night, we got a call from the emergency room that they had an admit for us, who was a gentleman with alcohol use disorder, who had been found down, and then we hear that he has a low hemoglobin, which is bad. And then we hear that he has a fast heart rate, which is much worse. And in that context, suggested that he was bleeding somewhere. So as we're walking to the ER to get this patient, I said to George, "What's the first thing we're going to look at when we go into the room?" And he says, "Well, this man has drunk a lot of alcohol over many years. I'm worried about his brain and his memory. We should know if he knows where we are and what year it is". And I said, "Yes, George. That's right, we will do that. But I'm really worried he's bleeding. So the first thing we're going to look at is how many IVs he has in case we have to give him blood."So we get to the room, and the patient does indeed look quite sick. And I said, "Actually, I'll take this patient, you'll take the next one." So I got to work, and my pager was going off. And the next thing I know we have a second patient. And the second patient has metastatic cancer and is coming in confused. And I remember hearing that and thinking, "This person is sick. And I don't quite know why. And that's scary." But I couldn't leave the first patient. So I said, "George, can you go take a history, find out what's happening. And if they look bad, or their vital signs change, just call me and I'll be there." So he goes off, and I go back to work on my first patient. And I was trying to keep track of everything that was happening that day. And I was thinking about someone's insulin level and an anion gap and a heart rate, and things were just stacking, and my pager kept going off. And somewhere in the emergency room, somebody was just screaming this long, unconnected string of expletives. And it didn't help. And at some point, I was talking to the emergency room doctors, and I was kind of worked up and gesticulating, and I knocked my coffee over, and it went all over my medical student.So then I had to stop for like, at least two minutes, and apologize, because I was now the resident who had thrown coffee on a medical student, no matter how accidental and eventually, I got that cleaned up. And I got my patient sorted out, and I sent him to the ICU. And I could think, and I could breathe.And as soon as I could, I went to go and see George, my intern. And so I get to the room where he is and the patient with metastatic cancer and confusion. And from the door, I saw two things.Firstly, I saw George taking a meticulous and comprehensive and thoughtful history, asking the patient who they are and where they lived outside the hospital and how many children and I also saw that his pager was going off as mine had been, and that he was triaging: that he looked down, see what it said, look at the patient, look down, look at the patient.And then also, from my bird's eye view in the doorway, I saw the numbers on the screen: I saw the blood pressure lowering, and the heart rate going higher. And I just remember taking that moment and breaking it and saying, "Stop everything. This is unstable." And then I just—I took control. And I did all the things that you do to stabilize someone who's in septic shock—the fluids and the blood cultures, and the lactate, and the antibiotics. And I called the ICU again.And then when the urgency was done, I looked at George, who looked horrified, because he knew what he'd missed...that this person was decompensating. And in the busyness, he hadn't seen it.And I felt terrible, because I was so worried that in our collective busyness and the chaos of that night, and our collective inexperience that perhaps we had not been fast enough. And also, I had done exactly what I shouldn't have done and just taken control of the situation instead of talking through it. And I was kind of thinking about what to say, and trying to put a name to what it is that a new intern didn't yet have, but was going to learn.And the word I kept coming up with was "airmanship," which is a very old concept from a very different part of my life.Before I was a doctor here in San Francisco, I used to be an amateur pilot in England. I didn't know I wanted to be a doctor when I was a kid. I actually thought I wanted to be a pilot, or an astronaut, or Amelia Earhart except less dead.And then I got the chance to go to graduate school at the University of Oxford. And I found out that they had a flying team. So, of course, I joined. And I called up my parents and I said, "I'm at Oxford, I have a robe, and I wear it to dinner, and I'm learning how to fly. I think I'm actually at Hogwarts. It's pretty great." And the things I was learning how to fly are called gliders and their little planes without motors. And, as you can imagine, they're actually kind of harder than planes with motors, which are sort of 3D cars.For example, for a glider to go up, you have to find a thermal column of rising air and circle for height. If you've ever seen like a hawk, or a big bird of prey doing that—same thing. And I really quickly found that I was actually bad at it.I could do the book learning, I could learn the principles, but I had no innate sense for how a plane should move. And I couldn't plan ahead. And I couldn't anticipate dangers. And I really, really couldn't do landings..like could not stick landings, just couldn't get it right.And I—I watched all these people who had started with me, like go on and get their solo licenses and, like, take part in competitions. And I was just stuck. And the pilots didn't make this super easy on me. We learn to fly on old planes. And the pilots who taught us were as old and as cantankerous as the planes themselves.And the one I flew with most—his name is Fred, and he was among the oldest and most cantankerous of the bunch. His thing was to hang out at the clubhouse between flights and eat these filthy sandwiches...like fried bread, butter, bacon, eggs, butter, and fried bread. He looked as though at any moment, he might have a heart attack. And he sometimes made jokes about women on the airfield that didn't quite land.But I knew that every time he got into the plane with me, he was quite literally putting his life in my really inexperienced hands. The thing about gliders is that they're dual control. But there is no override. So if the junior pilot—that's me—screws up, you both crash.And so for that reason, they teach us a command before we ever leave the ground that we must always obey. And the command is, "I have control." And what it means is that I as a junior pilot should take my hands off the stick and my feet off the rudders, and do nothing until the senior pilot sorts it out.And so I'd be practicing a landing and going in, and I hear, "Spottiswoode, I have control," or going for a stall, "Too slow, so I have control."I hated it.And there came a day that I was flying with Fred, and he was really putting me through my paces: we'd done stalls, and we'd done spins, and we'd done a loop. And finally, we were going in for the end, which was a landing, and this time I was going to get it right. And I remember, I was thinking about so many things. The wind was kind of gusty, and I was compensating for it. And I was keeping the nose down, and I was keeping the speed on. And I was adjusting the trim. And I was going in, and it was gonna work.And then I heard, "Spottiswoode, I have control." And I thought, "What?!" But I—I took my hands off the stick and my feet off the rudders as I'd been taught.And I watched in dawning horror, as Fred steered us out of the way of a tree.I had been about to hit a tree.And we landed, and I was sitting there. And I remember thinking, "I'm going to be yelled at." And then I thought, "I deserve to be yelled at." And then I thought, "What am I doing? I just put two people at risk. I'm bad at this. I've never been good. I have no business here."And we got out of the plane, and he lights up one of his filthy cigarettes. And then instead of yelling, he said, "What do you think happened?" And I said, "I don't know. I just did not see it." And he said, "I know. That's why there are two of us in this cockpit. Take half an hour, and we'll try again."So then there I am in the hospital, looking at my intern, who in his newness has missed something which is, in its way, as deadly as a tree.And I said, "What do you think happened?" And he said, "I don't know. I didn't realize how sick they were." And I said, "I know. It's gonna be okay. They're gonna be okay. We'll take this. We'll learn from it. And we'll do better next time."In case you're wondering, I did eventually get my license. I did eventually learn to fly. And on one of my first solo flights, I found one of those thermals I told you about, and I was flying in it circling for height. And I happen to look out the window. And I saw a hawk...a big hawk. And it was just circling right along with me.And the two of us were just sharing the air.
Emily Silverman
So I am sitting here with Natasha Spottiswoode. Thanks for coming into the studio today.
Natasha Spottiswoode
Oh, thanks so much for having me.
Emily Silverman
You told this story in January 2020, which is now a couple years ago. How does it feel to reflect back on that night on that performance—pre-COVID, pre-chaos?
Natasha Spottiswoode
It's funny that you say that because my first thought listening again to my performance was, "Wow, that was a long time ago. A lot has gone down."
Emily Silverman
That's what everybody says, and you became an infectious disease fellow during a pandemic. So tell us about that.
Natasha Spottiswoode
I did. I was a internal medicine doctor during I'd say most of COVID. And then in July of 2021, transition to being an infectious disease fellow, which is my current job. In terms of how that fed into my life decisions and path, I think I'd always had this worry that academic medicine was very far away from the lived experiences of patients and physicians and healthcare workers. And then suddenly, it was so viscerally front and center in all of our lives. And it reinforced the idea that this was something which really, really could matter.
Emily Silverman
So listening back to the story, other than reflecting on how much time has passed, did you see the story differently at all? Did it change? Or did it feel like it rang true just as much as it did the night of?
Natasha Spottiswoode
I guess one thing that came up was—I think a lot of the story is about the idea of not being good at things and being new and being scared. And I think that the year of the pandemic was a time where we were all kind of new and scared and didn't really have a playbook for it. And so it felt very familiar to me, not just because, of course, I lived that story, but also because I feel like I kept experiencing it. And I was reflecting that maybe, in some ways, it was helpful to have had a lot of experience at being bad, and persevering at hard—sometimes scary—things. And maybe, in a way, that was good practice for me.
Emily Silverman
In the story, you use this word "airmanship," which I love. And you go into it a bit in the story—what is airmanship, how does it work. But I was wondering if you could expand on that a bit. How do you think about airmanship? And I'm curious, after what you just said around COVID, how did airmanship play into the pandemic, if at all, for you and your colleagues?
Natasha Spottiswoode
Well, I think the idea of airmanship, as used in the piece, is the gut feel—a sense of a situation and what is going on and what should be going on. And I'd call that the part of medicine that you don't learn from memorizing books, which is super important too. So in terms of the last year in the pandemic, I'd say that it was an experience for me of no one having that at first, because none of us had done that. It was all new. And I think the closest I got to someone having really had that was a lot of the older docs who had worked during the 80s and experienced a really different pandemic...but one that was also marked by fear, and stigma, and lack of understanding, and inequity.
Emily Silverman
I'm just wondering about this concept of airmanship. Do you have any sense of how that happens? Like for example, with flying...is it the case that one day you can't fly...and then the next day, you can't fly, and then the next day, you can't fly, and you don't know what you're doing, and then you don't know what you're doing—and then you just like wake up one day and something clicks, and then you can? Like a sigmoidal shape? Or do you feel like it's more gradual where the gut instinct develops incrementally over time? I'm just interested in almost like the kinetics of how people develop airmanship?
Natasha Spottiswoode
Well, I think it is both nonlinear and highly variable between people. Like one of the hardest things for me was that I was really bad at it. And, like, genuinely, I was watching a lot of people do what looked like sigmoidal curves, and I felt as though mine was linear—if linear. But I don't think it's easy to quantify like that. But I'd say that it's highly variable, and different parts may come at different times. I don't think I was particularly fast at learning medicine either, actually, as a med student, or even as an intern. There were certainly long periods where I thought, "Oh, God, it's linear, and it's almost flat."
Emily Silverman
And I was thinking, too, about how sometimes we toggle in and out of that state of airmanship or gut feeling or flow. And it reminded me of this scene from Star Wars. I don't know if you watch the Star Wars movies. But it might even be the first movie, where Luke Skywalker is flying in his machine. And he's trying to fly it through that hallway into the target, which is like the mouth of the Death Star or something. And he's flying the plane, and he's aligning all of the technical equipment and the target and pressing all the buttons and you can see that he's like so in his head and he's just trying so hard to keep the course straight and to hit his target. And you can see that he's kind of flustered and overwhelmed, and then you hear this voice—and I think it might be Obi Wan Kenobi. It's like, "Luke, use the Force." And then he like—I don't know if he turns off the equipment or if he just looks away from it—and it's this moment of just letting go and slipping into his intuition. And then he's able to use that to guide himself right into his target. And then he's successful and things like that.And so...I've noticed this with me—maybe less in medicine, but more in other types of tasks, like creative tasks, like writing—sometimes you sit down to write and you're just like in your head, and it's not flowing. And then there are other times where you get into a flow state, and it almost feels like you're just channeling, like, it's not even coming from you? Does any of this ring true around this idea of airmanship?
Natasha Spottiswoode
I think it brings up a couple things to me, and one of them is that I get really worried and a little suspicious, when doctors say that they're gonna make a decision, because, quote, you know, "It feels right to them." Because to me, the idea of airmanship is you get to the conclusion in a way that you may not understand at the time, like recognizing a syndrome or becoming worried about a developing clinical situation. But then, to me, in order to make sense of that, you should be able to go back and say, "Actually, these are why these things are coming up to me." It shouldn't be that you make decisions purely based on the Force. But I do think... (laughing) It's a protip: don't use the Force to do medicine.
Emily Silverman
Yeah, that makes a lot of sense. You mentioned rock climbing. And so we know that you are a pilot. Now we know that you are a rock climber. And then when you arrived at the studio, I was joking with you about the pictures I saw of you summiting a mountain, and...gosh, that mountain was so tall, it looked like you were in space! So I was wondering if you could tell us a little bit about your penchant for adventure. Where did it come from? Why do you love doing all of these exhilarating activities?
Natasha Spottiswoode
Well, I'll start by saying that I'm really not good at any of them. I don't fly anymore, because it is something that's really not affordable in the States. It's much cheaper in England, for sort of complex, historical reasons. But I do love rock climbing. And I do love mountaineering. Actually, I was never athletic as a kid. And then, when I was living in England, my neighbor found me climbing a tree, and asked if anyone had ever taught me to do it properly.So that's how I ended up rock climbing. And the mountaineering kind of came out of that. And I think what it is, is that it's just a wonderful sense of freedom. And it is a wonderful way to understand other people and to get to know people really well. Because after you've climbed a mountain of someone, you really, really, really know them.I think a good medicine metaphor is like spending a 28-hour shift with someone: you're not going to see them at their best. You're going to see how they make decisions under pressure. You're going to see what they do when they're afraid. You're going to see them without any sort of artifice, because there is nothing you can maintain, whether it's makeup or a coherent speech necessarily over 20 hours. And if you still like and respect each other after that, then you really, really love them.
Emily Silverman
Because a lot of these mountain climbs—you have to forgive me for not knowing the jargon, like the mountain climbs—they're dangerous, right? Talk to us about the reality of what could go wrong. And I imagine that's also similar to medicine, like really thinking ahead, and troubleshooting and managing risk, and things like that.
Natasha Spottiswoode
Yeah, so I would argue that the way that I do this is not particularly risky. I think climbing has had a lot of press recently, especially with Free Solo as a movie, where it looks like this sort of daredevil, free-spirited, slightly crazy feat. I don't do any of that. What I do is, I think, relatively fairly tame. I usually go climbing at well-established crags, or I go up mountains which are mostly hiking with a bit of ice involved—which is not to say that there is zero risk.And I think one thing that a lot of my climbing-medicine friends felt around the pandemic was that, for the first time, the perception of personal risk had come into our work lives. But it was something that we were used to navigating in this other part of our lives, which had suddenly, and unwantedly come in to work. But I would say that I really don't think I'm an adrenaline junkie. I'm sure my parents would disagree.
Emily Silverman
It's funny that you say that about "adrenaline junkie" because I almost was gonna ask why ID and why not...emergency medicine, or critical care medicine, or any of these specialties that we stereotypically associate with adrenaline junkies? How did you land in infectious disease?
Natasha Spottiswoode
I love both of those fields. I think ER is not longitudinal enough for me. I mean, it's super fun. I loved rotating in the emergency room, especially at the General. But that doesn't fit me. Critical care, I very much considered. I think that infectious disease is very central to trying to recognize the inequities in medicine, both in this country and globally.And also, the ways that medicine is changing as our world is changing are very tied up in infectious disease. I think the terrifying challenges of our time do include pandemics and do include things that affect them, like climate change, like biodiversity decreases. A lot of the ways that I think medicine is fundamentally going to change have to do with infectious disease.
Emily Silverman
You mentioned health, medicine, and climate. Obviously, these are intimately connected. And I'm wondering, as somebody who spends so much time in the outdoors and connecting to nature and connecting to the earth, if that has affected at all your understanding of how medicine and health interacts with the environment? I'm a city person. Obviously, I understand the concept of "we all share air, we all share water." But do you find yourself having any unique insights on that topic, having all of these hobbies in the outdoors?
Natasha Spottiswoode
I think it just makes it very visceral. So there's Mount Shasta in the north of California, which is a very special mountain to me, because it's connected to how I met my partner actually. We did it last year; we did it this year. And this year, there's no snow on it. So we did it in May. And we had to do it via a rock route...which is fine. That's fun, too. But there shouldn't be no snow on it in May? It's just very obvious.And then in 2020, I think the hardest part for me, just personally speaking, was when both the pandemic and the fires were really bad in California, because it just felt as though I couldn't be inside and I couldn't be outside, and there was just nowhere I could be. I found dealing with the fires, like just, quite psychologically hard.
Emily Silverman
You mentioned this story of how you weren't very athletic growing up. But then in England one day, your neighbor found you climbing a tree and asked you, "Do you know how to climb a tree properly?" So, can you tell us that story? What does it mean to climb a tree properly?
Natasha Spottiswoode
Oh, that was really funny. I mean, I'll start by saying my dad is reasonably outdoorsy and hikes. But my mom is from New York and grew up in Manhattan. So I grew up hiking, but I didn't know how to camp. I didn't know how to go to the bathroom without, like, a bathroom. Really basic stuff. And then I was living in Oxford, and literally just climbing a tree. And my neighbor, who was this fantastic Welsh scientist, was just like, "Hey, I climb. Have you ever learned how to do this for real?" And I was like, "No, what?" and I was 18 or 19.And so he started taking me to the climbing gym. And I was like, "This is wonderful. I'm so enjoying it." And then I started running to cross-train. And then gradually I got more and more into it. And then I moved back to the States and met some really lovely people who took me under their wing, and taught me to climb. And then in med school, my classmates happened to be good trad climbers, and so they told me how to trad climb.
Emily Silverman
What is “trad climb?”
Natasha Spottiswoode
Oh, it's a different style, which involves different gear. It's very cool.And then I started dating my partner, who's much more of a mountain person. So I started learning a bit of mountaineering. But the fun thing is, there's so much to learn. My new thing is that I really, really want to get anywhere decent at skiing, because I really don't know how to ski. And so my big project for the next couple years is to try to learn how to ski because I'd really love to backcountry ski more.
Emily Silverman
You mentioned how flying in the United States is difficult for a variety of reasons, including cost. But I'm wondering if you hopped on a plane to England tomorrow, could you get in an airplane and fly? Is it like riding a bike? Or would you have to start from the beginning of the curve? Or what would that be like?
Natasha Spottiswoode
You know, it's funny, because every time I go back to England—which hasn't been recently because of the pandemic, obviously—I do try to go flying because I have a few very good friends in England. And all of them fly. And one of them had her wedding when I was an intern. And, at the wedding, they actually had a flying display, which was ridiculously cool. But no, I would say that you certainly are not starting from the beginning. You know how it should feel, even if you can't make it happen. But I wouldn't necessarily trust me to manage a flight takeoff to landing because it has been a hot minute.
Emily Silverman
It's so funny because you keep saying, "You know, I'm not that good at infectious disease yet. I'm not that good at rock climbing. I'm not that good at mountaineering." But I've seen the pictures. For the audience, this is some intense stuff that she's doing. I think she's underestimating how good she is at it, but that's just my own opinion.
Natasha Spottiswoode
Well, I think the cool thing about doing these things is that you're always surrounded by people who are much better than you at them. And so it's incredibly humbling, because I'm probably a good rock climber compared to you—I'll take that liberty. But I'm—
Emily Silverman
Definitely.
Natasha Spottiswoode
—compared to the people I know, I'm really not that good. And I'm so honored to know so many doctors who are so good at what they do, in and out of infectious disease, that I could never characterize myself as particularly good at it, because I've got such wonderful examples around me.
Emily Silverman
Yeah, and I love how you say that with a smile on your face. And with a positive and optimistic outlook, because I think, sometimes, when we come into medicine, and we find ourselves surrounded by extraordinary peers and extraordinary mentors, it can be a fuel for feeling shame, or feeling inadequate or feeling imposter syndrome, or "I don't belong here," or any number of thoughts like that. But I just love hearing you talk about this and hearing—the audience can't see your face—but you're, like, glowing as you talk about this. And how you really see these examples as sources of inspiration and how that humility comes through in a positive way.
Natasha Spottiswoode
Yeah, I don't think that that's universal. And I think that there are plenty of places where you're made to feel small, if you don't know as much or don't fit into everyone's idea of what a doctor is, or should be, or should look like, in any dimension. But I think if you're in a place, which validates being new and learning, then it is genuinely joyful to say, "Well, there are these fabulous people around, and I have so much to learn." And that part of the learning curve is so fun to me.
Emily Silverman
And in a way, that's what your story was about. In the end, it was...that's why there's two of us in the cockpit. Like, you're not alone. We're here as a team. Do you think medicine has that collaborative environment, that is pro-learning? Or do you feel like we have some work to do around normalizing not knowing failure? Where do you think we are with that as a medical culture?
Natasha Spottiswoode
Oh, there are so many ways to answer this wrong. I think more work is needed. Still a long way to go in a lot of parts of medicine. I don't want to sound ridiculously optimistic or pollyannaish. I think medicine has a history of being terrifically discriminatory and stigmatizing to people who were newer or younger, or any other way that we didn't perceive the role of doctor. And I certainly don't want to make light of that.But I'm really hopeful that we're getting better. And I really love the team that I work with now. And I am really hopeful about the future of medicine, and perhaps the way that I live within it.
Emily Silverman
As we wrap up, my last question is around your path as an infectious disease doctor. What is next for you? What do you spend your time thinking about? You mentioned that you're a scientist...what are you interested in learning about, researching? What are the big questions that you're turning around in your mind these days?
Natasha Spottiswoode
I think the big scientific questions are...what's going on with how we get so sick, from a respiratory perspective, both COVID and non-COVID? Why does that happen? And what can we do about it? Those are obviously huge questions. And I think I need to find ways to find bits of them that are amenable to me sort of chipping in my tiny little way at them, and taking what I learned clinically and building that in. And then there are the other big questions like how do you pick backcountry skis? And how does one start learning that? And that's another big question that I'm also dealing with.
Emily Silverman
Well, it's been so much fun to chat with you today, Natasha, about your story and about all of the exciting things that you're doing, both inside and outside the hospital. Is there anything else that you'd like to share with our audience before we end?
Natasha Spottiswoode
I think we lose the habit of being okay with being bad at things as we get older. Especially, a lot of work cultures are not forgiving of newness and failure. But I think continuing to try new things and to be willing to be bad at them is the closest I have seen to a gift. It's a gift to keep getting to do things to be bad at them to learn. And it just brings me so much joy. I would encourage listeners to keep doing that.
Emily Silverman
The joy of failure. Yeah, this is a phrase that I've been thinking about a lot as well—as somebody who can definitely tip into the perfectionism category—is the joy of failure. How do we tap into that? And so I think that's a great place to leave off. Thank you so much, Natasha, for coming in today and for sharing your story on The Nocturnists stage.
Natasha Spottiswoode
Thank you so much.
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.
Emily Silverman
Learning medicine is tough. It requires a lot of reading, understanding, memorizing, but there are other parts of medicine that we learned differently: more body-based learning, which is grounded in feel, in instinct, in spidey-senses. How do we think about that type of learning?You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman.Today I speak with Natasha Spottiswoode, an infectious disease physician-scientist with a love of outdoor adventure. She grew up in California, studied malaria and iron metabolism in the UK, and moved to New York for medical school before coming back to UCSF for residency and now infectious disease fellowship. Outside of work, she loves to rock climb, backpack, cook new recipes, and explore new places with her partner and friends. Before I speak with Natasha, we're gonna hear the story that she told live at The Nocturnists in January 2020:
Natasha Spottiswoode
It was a dark and stormy night.I actually don't mean that literally. This is San Francisco. It's beautiful weather usually. But that night, it was clinically dark and stormy. I was brand new to being a senior resident, my intern was new to being an intern, and I think even my third year medical student was also new to being a third year medical student. And we were in the middle of the busiest call day that we had ever had. We'd taken so many patients, and they were all so sick. And I was super worried about being a senior resident, and doing my job well, and keeping the patient safe, but also giving everyone on the team the independence that they needed to grow. And I didn't know them very well. I knew my intern, George, well enough to know that I could trust him to take a thorough and sensitive history and to see patients as people, and not just collections of illnesses. But I didn't know how good his clinical acumen was. And I worried that in our newness, we might miss the forest for the trees.So that night, we got a call from the emergency room that they had an admit for us, who was a gentleman with alcohol use disorder, who had been found down, and then we hear that he has a low hemoglobin, which is bad. And then we hear that he has a fast heart rate, which is much worse. And in that context, suggested that he was bleeding somewhere. So as we're walking to the ER to get this patient, I said to George, "What's the first thing we're going to look at when we go into the room?" And he says, "Well, this man has drunk a lot of alcohol over many years. I'm worried about his brain and his memory. We should know if he knows where we are and what year it is". And I said, "Yes, George. That's right, we will do that. But I'm really worried he's bleeding. So the first thing we're going to look at is how many IVs he has in case we have to give him blood."So we get to the room, and the patient does indeed look quite sick. And I said, "Actually, I'll take this patient, you'll take the next one." So I got to work, and my pager was going off. And the next thing I know we have a second patient. And the second patient has metastatic cancer and is coming in confused. And I remember hearing that and thinking, "This person is sick. And I don't quite know why. And that's scary." But I couldn't leave the first patient. So I said, "George, can you go take a history, find out what's happening. And if they look bad, or their vital signs change, just call me and I'll be there." So he goes off, and I go back to work on my first patient. And I was trying to keep track of everything that was happening that day. And I was thinking about someone's insulin level and an anion gap and a heart rate, and things were just stacking, and my pager kept going off. And somewhere in the emergency room, somebody was just screaming this long, unconnected string of expletives. And it didn't help. And at some point, I was talking to the emergency room doctors, and I was kind of worked up and gesticulating, and I knocked my coffee over, and it went all over my medical student.So then I had to stop for like, at least two minutes, and apologize, because I was now the resident who had thrown coffee on a medical student, no matter how accidental and eventually, I got that cleaned up. And I got my patient sorted out, and I sent him to the ICU. And I could think, and I could breathe.And as soon as I could, I went to go and see George, my intern. And so I get to the room where he is and the patient with metastatic cancer and confusion. And from the door, I saw two things.Firstly, I saw George taking a meticulous and comprehensive and thoughtful history, asking the patient who they are and where they lived outside the hospital and how many children and I also saw that his pager was going off as mine had been, and that he was triaging: that he looked down, see what it said, look at the patient, look down, look at the patient.And then also, from my bird's eye view in the doorway, I saw the numbers on the screen: I saw the blood pressure lowering, and the heart rate going higher. And I just remember taking that moment and breaking it and saying, "Stop everything. This is unstable." And then I just—I took control. And I did all the things that you do to stabilize someone who's in septic shock—the fluids and the blood cultures, and the lactate, and the antibiotics. And I called the ICU again.And then when the urgency was done, I looked at George, who looked horrified, because he knew what he'd missed...that this person was decompensating. And in the busyness, he hadn't seen it.And I felt terrible, because I was so worried that in our collective busyness and the chaos of that night, and our collective inexperience that perhaps we had not been fast enough. And also, I had done exactly what I shouldn't have done and just taken control of the situation instead of talking through it. And I was kind of thinking about what to say, and trying to put a name to what it is that a new intern didn't yet have, but was going to learn.And the word I kept coming up with was "airmanship," which is a very old concept from a very different part of my life.Before I was a doctor here in San Francisco, I used to be an amateur pilot in England. I didn't know I wanted to be a doctor when I was a kid. I actually thought I wanted to be a pilot, or an astronaut, or Amelia Earhart except less dead.And then I got the chance to go to graduate school at the University of Oxford. And I found out that they had a flying team. So, of course, I joined. And I called up my parents and I said, "I'm at Oxford, I have a robe, and I wear it to dinner, and I'm learning how to fly. I think I'm actually at Hogwarts. It's pretty great." And the things I was learning how to fly are called gliders and their little planes without motors. And, as you can imagine, they're actually kind of harder than planes with motors, which are sort of 3D cars.For example, for a glider to go up, you have to find a thermal column of rising air and circle for height. If you've ever seen like a hawk, or a big bird of prey doing that—same thing. And I really quickly found that I was actually bad at it.I could do the book learning, I could learn the principles, but I had no innate sense for how a plane should move. And I couldn't plan ahead. And I couldn't anticipate dangers. And I really, really couldn't do landings..like could not stick landings, just couldn't get it right.And I—I watched all these people who had started with me, like go on and get their solo licenses and, like, take part in competitions. And I was just stuck. And the pilots didn't make this super easy on me. We learn to fly on old planes. And the pilots who taught us were as old and as cantankerous as the planes themselves.And the one I flew with most—his name is Fred, and he was among the oldest and most cantankerous of the bunch. His thing was to hang out at the clubhouse between flights and eat these filthy sandwiches...like fried bread, butter, bacon, eggs, butter, and fried bread. He looked as though at any moment, he might have a heart attack. And he sometimes made jokes about women on the airfield that didn't quite land.But I knew that every time he got into the plane with me, he was quite literally putting his life in my really inexperienced hands. The thing about gliders is that they're dual control. But there is no override. So if the junior pilot—that's me—screws up, you both crash.And so for that reason, they teach us a command before we ever leave the ground that we must always obey. And the command is, "I have control." And what it means is that I as a junior pilot should take my hands off the stick and my feet off the rudders, and do nothing until the senior pilot sorts it out.And so I'd be practicing a landing and going in, and I hear, "Spottiswoode, I have control," or going for a stall, "Too slow, so I have control."I hated it.And there came a day that I was flying with Fred, and he was really putting me through my paces: we'd done stalls, and we'd done spins, and we'd done a loop. And finally, we were going in for the end, which was a landing, and this time I was going to get it right. And I remember, I was thinking about so many things. The wind was kind of gusty, and I was compensating for it. And I was keeping the nose down, and I was keeping the speed on. And I was adjusting the trim. And I was going in, and it was gonna work.And then I heard, "Spottiswoode, I have control." And I thought, "What?!" But I—I took my hands off the stick and my feet off the rudders as I'd been taught.And I watched in dawning horror, as Fred steered us out of the way of a tree.I had been about to hit a tree.And we landed, and I was sitting there. And I remember thinking, "I'm going to be yelled at." And then I thought, "I deserve to be yelled at." And then I thought, "What am I doing? I just put two people at risk. I'm bad at this. I've never been good. I have no business here."And we got out of the plane, and he lights up one of his filthy cigarettes. And then instead of yelling, he said, "What do you think happened?" And I said, "I don't know. I just did not see it." And he said, "I know. That's why there are two of us in this cockpit. Take half an hour, and we'll try again."So then there I am in the hospital, looking at my intern, who in his newness has missed something which is, in its way, as deadly as a tree.And I said, "What do you think happened?" And he said, "I don't know. I didn't realize how sick they were." And I said, "I know. It's gonna be okay. They're gonna be okay. We'll take this. We'll learn from it. And we'll do better next time."In case you're wondering, I did eventually get my license. I did eventually learn to fly. And on one of my first solo flights, I found one of those thermals I told you about, and I was flying in it circling for height. And I happen to look out the window. And I saw a hawk...a big hawk. And it was just circling right along with me.And the two of us were just sharing the air.
Emily Silverman
So I am sitting here with Natasha Spottiswoode. Thanks for coming into the studio today.
Natasha Spottiswoode
Oh, thanks so much for having me.
Emily Silverman
You told this story in January 2020, which is now a couple years ago. How does it feel to reflect back on that night on that performance—pre-COVID, pre-chaos?
Natasha Spottiswoode
It's funny that you say that because my first thought listening again to my performance was, "Wow, that was a long time ago. A lot has gone down."
Emily Silverman
That's what everybody says, and you became an infectious disease fellow during a pandemic. So tell us about that.
Natasha Spottiswoode
I did. I was a internal medicine doctor during I'd say most of COVID. And then in July of 2021, transition to being an infectious disease fellow, which is my current job. In terms of how that fed into my life decisions and path, I think I'd always had this worry that academic medicine was very far away from the lived experiences of patients and physicians and healthcare workers. And then suddenly, it was so viscerally front and center in all of our lives. And it reinforced the idea that this was something which really, really could matter.
Emily Silverman
So listening back to the story, other than reflecting on how much time has passed, did you see the story differently at all? Did it change? Or did it feel like it rang true just as much as it did the night of?
Natasha Spottiswoode
I guess one thing that came up was—I think a lot of the story is about the idea of not being good at things and being new and being scared. And I think that the year of the pandemic was a time where we were all kind of new and scared and didn't really have a playbook for it. And so it felt very familiar to me, not just because, of course, I lived that story, but also because I feel like I kept experiencing it. And I was reflecting that maybe, in some ways, it was helpful to have had a lot of experience at being bad, and persevering at hard—sometimes scary—things. And maybe, in a way, that was good practice for me.
Emily Silverman
In the story, you use this word "airmanship," which I love. And you go into it a bit in the story—what is airmanship, how does it work. But I was wondering if you could expand on that a bit. How do you think about airmanship? And I'm curious, after what you just said around COVID, how did airmanship play into the pandemic, if at all, for you and your colleagues?
Natasha Spottiswoode
Well, I think the idea of airmanship, as used in the piece, is the gut feel—a sense of a situation and what is going on and what should be going on. And I'd call that the part of medicine that you don't learn from memorizing books, which is super important too. So in terms of the last year in the pandemic, I'd say that it was an experience for me of no one having that at first, because none of us had done that. It was all new. And I think the closest I got to someone having really had that was a lot of the older docs who had worked during the 80s and experienced a really different pandemic...but one that was also marked by fear, and stigma, and lack of understanding, and inequity.
Emily Silverman
I'm just wondering about this concept of airmanship. Do you have any sense of how that happens? Like for example, with flying...is it the case that one day you can't fly...and then the next day, you can't fly, and then the next day, you can't fly, and you don't know what you're doing, and then you don't know what you're doing—and then you just like wake up one day and something clicks, and then you can? Like a sigmoidal shape? Or do you feel like it's more gradual where the gut instinct develops incrementally over time? I'm just interested in almost like the kinetics of how people develop airmanship?
Natasha Spottiswoode
Well, I think it is both nonlinear and highly variable between people. Like one of the hardest things for me was that I was really bad at it. And, like, genuinely, I was watching a lot of people do what looked like sigmoidal curves, and I felt as though mine was linear—if linear. But I don't think it's easy to quantify like that. But I'd say that it's highly variable, and different parts may come at different times. I don't think I was particularly fast at learning medicine either, actually, as a med student, or even as an intern. There were certainly long periods where I thought, "Oh, God, it's linear, and it's almost flat."
Emily Silverman
And I was thinking, too, about how sometimes we toggle in and out of that state of airmanship or gut feeling or flow. And it reminded me of this scene from Star Wars. I don't know if you watch the Star Wars movies. But it might even be the first movie, where Luke Skywalker is flying in his machine. And he's trying to fly it through that hallway into the target, which is like the mouth of the Death Star or something. And he's flying the plane, and he's aligning all of the technical equipment and the target and pressing all the buttons and you can see that he's like so in his head and he's just trying so hard to keep the course straight and to hit his target. And you can see that he's kind of flustered and overwhelmed, and then you hear this voice—and I think it might be Obi Wan Kenobi. It's like, "Luke, use the Force." And then he like—I don't know if he turns off the equipment or if he just looks away from it—and it's this moment of just letting go and slipping into his intuition. And then he's able to use that to guide himself right into his target. And then he's successful and things like that.And so...I've noticed this with me—maybe less in medicine, but more in other types of tasks, like creative tasks, like writing—sometimes you sit down to write and you're just like in your head, and it's not flowing. And then there are other times where you get into a flow state, and it almost feels like you're just channeling, like, it's not even coming from you? Does any of this ring true around this idea of airmanship?
Natasha Spottiswoode
I think it brings up a couple things to me, and one of them is that I get really worried and a little suspicious, when doctors say that they're gonna make a decision, because, quote, you know, "It feels right to them." Because to me, the idea of airmanship is you get to the conclusion in a way that you may not understand at the time, like recognizing a syndrome or becoming worried about a developing clinical situation. But then, to me, in order to make sense of that, you should be able to go back and say, "Actually, these are why these things are coming up to me." It shouldn't be that you make decisions purely based on the Force. But I do think... (laughing) It's a protip: don't use the Force to do medicine.
Emily Silverman
Yeah, that makes a lot of sense. You mentioned rock climbing. And so we know that you are a pilot. Now we know that you are a rock climber. And then when you arrived at the studio, I was joking with you about the pictures I saw of you summiting a mountain, and...gosh, that mountain was so tall, it looked like you were in space! So I was wondering if you could tell us a little bit about your penchant for adventure. Where did it come from? Why do you love doing all of these exhilarating activities?
Natasha Spottiswoode
Well, I'll start by saying that I'm really not good at any of them. I don't fly anymore, because it is something that's really not affordable in the States. It's much cheaper in England, for sort of complex, historical reasons. But I do love rock climbing. And I do love mountaineering. Actually, I was never athletic as a kid. And then, when I was living in England, my neighbor found me climbing a tree, and asked if anyone had ever taught me to do it properly.So that's how I ended up rock climbing. And the mountaineering kind of came out of that. And I think what it is, is that it's just a wonderful sense of freedom. And it is a wonderful way to understand other people and to get to know people really well. Because after you've climbed a mountain of someone, you really, really, really know them.I think a good medicine metaphor is like spending a 28-hour shift with someone: you're not going to see them at their best. You're going to see how they make decisions under pressure. You're going to see what they do when they're afraid. You're going to see them without any sort of artifice, because there is nothing you can maintain, whether it's makeup or a coherent speech necessarily over 20 hours. And if you still like and respect each other after that, then you really, really love them.
Emily Silverman
Because a lot of these mountain climbs—you have to forgive me for not knowing the jargon, like the mountain climbs—they're dangerous, right? Talk to us about the reality of what could go wrong. And I imagine that's also similar to medicine, like really thinking ahead, and troubleshooting and managing risk, and things like that.
Natasha Spottiswoode
Yeah, so I would argue that the way that I do this is not particularly risky. I think climbing has had a lot of press recently, especially with Free Solo as a movie, where it looks like this sort of daredevil, free-spirited, slightly crazy feat. I don't do any of that. What I do is, I think, relatively fairly tame. I usually go climbing at well-established crags, or I go up mountains which are mostly hiking with a bit of ice involved—which is not to say that there is zero risk.And I think one thing that a lot of my climbing-medicine friends felt around the pandemic was that, for the first time, the perception of personal risk had come into our work lives. But it was something that we were used to navigating in this other part of our lives, which had suddenly, and unwantedly come in to work. But I would say that I really don't think I'm an adrenaline junkie. I'm sure my parents would disagree.
Emily Silverman
It's funny that you say that about "adrenaline junkie" because I almost was gonna ask why ID and why not...emergency medicine, or critical care medicine, or any of these specialties that we stereotypically associate with adrenaline junkies? How did you land in infectious disease?
Natasha Spottiswoode
I love both of those fields. I think ER is not longitudinal enough for me. I mean, it's super fun. I loved rotating in the emergency room, especially at the General. But that doesn't fit me. Critical care, I very much considered. I think that infectious disease is very central to trying to recognize the inequities in medicine, both in this country and globally.And also, the ways that medicine is changing as our world is changing are very tied up in infectious disease. I think the terrifying challenges of our time do include pandemics and do include things that affect them, like climate change, like biodiversity decreases. A lot of the ways that I think medicine is fundamentally going to change have to do with infectious disease.
Emily Silverman
You mentioned health, medicine, and climate. Obviously, these are intimately connected. And I'm wondering, as somebody who spends so much time in the outdoors and connecting to nature and connecting to the earth, if that has affected at all your understanding of how medicine and health interacts with the environment? I'm a city person. Obviously, I understand the concept of "we all share air, we all share water." But do you find yourself having any unique insights on that topic, having all of these hobbies in the outdoors?
Natasha Spottiswoode
I think it just makes it very visceral. So there's Mount Shasta in the north of California, which is a very special mountain to me, because it's connected to how I met my partner actually. We did it last year; we did it this year. And this year, there's no snow on it. So we did it in May. And we had to do it via a rock route...which is fine. That's fun, too. But there shouldn't be no snow on it in May? It's just very obvious.And then in 2020, I think the hardest part for me, just personally speaking, was when both the pandemic and the fires were really bad in California, because it just felt as though I couldn't be inside and I couldn't be outside, and there was just nowhere I could be. I found dealing with the fires, like just, quite psychologically hard.
Emily Silverman
You mentioned this story of how you weren't very athletic growing up. But then in England one day, your neighbor found you climbing a tree and asked you, "Do you know how to climb a tree properly?" So, can you tell us that story? What does it mean to climb a tree properly?
Natasha Spottiswoode
Oh, that was really funny. I mean, I'll start by saying my dad is reasonably outdoorsy and hikes. But my mom is from New York and grew up in Manhattan. So I grew up hiking, but I didn't know how to camp. I didn't know how to go to the bathroom without, like, a bathroom. Really basic stuff. And then I was living in Oxford, and literally just climbing a tree. And my neighbor, who was this fantastic Welsh scientist, was just like, "Hey, I climb. Have you ever learned how to do this for real?" And I was like, "No, what?" and I was 18 or 19.And so he started taking me to the climbing gym. And I was like, "This is wonderful. I'm so enjoying it." And then I started running to cross-train. And then gradually I got more and more into it. And then I moved back to the States and met some really lovely people who took me under their wing, and taught me to climb. And then in med school, my classmates happened to be good trad climbers, and so they told me how to trad climb.
Emily Silverman
What is “trad climb?”
Natasha Spottiswoode
Oh, it's a different style, which involves different gear. It's very cool.And then I started dating my partner, who's much more of a mountain person. So I started learning a bit of mountaineering. But the fun thing is, there's so much to learn. My new thing is that I really, really want to get anywhere decent at skiing, because I really don't know how to ski. And so my big project for the next couple years is to try to learn how to ski because I'd really love to backcountry ski more.
Emily Silverman
You mentioned how flying in the United States is difficult for a variety of reasons, including cost. But I'm wondering if you hopped on a plane to England tomorrow, could you get in an airplane and fly? Is it like riding a bike? Or would you have to start from the beginning of the curve? Or what would that be like?
Natasha Spottiswoode
You know, it's funny, because every time I go back to England—which hasn't been recently because of the pandemic, obviously—I do try to go flying because I have a few very good friends in England. And all of them fly. And one of them had her wedding when I was an intern. And, at the wedding, they actually had a flying display, which was ridiculously cool. But no, I would say that you certainly are not starting from the beginning. You know how it should feel, even if you can't make it happen. But I wouldn't necessarily trust me to manage a flight takeoff to landing because it has been a hot minute.
Emily Silverman
It's so funny because you keep saying, "You know, I'm not that good at infectious disease yet. I'm not that good at rock climbing. I'm not that good at mountaineering." But I've seen the pictures. For the audience, this is some intense stuff that she's doing. I think she's underestimating how good she is at it, but that's just my own opinion.
Natasha Spottiswoode
Well, I think the cool thing about doing these things is that you're always surrounded by people who are much better than you at them. And so it's incredibly humbling, because I'm probably a good rock climber compared to you—I'll take that liberty. But I'm—
Emily Silverman
Definitely.
Natasha Spottiswoode
—compared to the people I know, I'm really not that good. And I'm so honored to know so many doctors who are so good at what they do, in and out of infectious disease, that I could never characterize myself as particularly good at it, because I've got such wonderful examples around me.
Emily Silverman
Yeah, and I love how you say that with a smile on your face. And with a positive and optimistic outlook, because I think, sometimes, when we come into medicine, and we find ourselves surrounded by extraordinary peers and extraordinary mentors, it can be a fuel for feeling shame, or feeling inadequate or feeling imposter syndrome, or "I don't belong here," or any number of thoughts like that. But I just love hearing you talk about this and hearing—the audience can't see your face—but you're, like, glowing as you talk about this. And how you really see these examples as sources of inspiration and how that humility comes through in a positive way.
Natasha Spottiswoode
Yeah, I don't think that that's universal. And I think that there are plenty of places where you're made to feel small, if you don't know as much or don't fit into everyone's idea of what a doctor is, or should be, or should look like, in any dimension. But I think if you're in a place, which validates being new and learning, then it is genuinely joyful to say, "Well, there are these fabulous people around, and I have so much to learn." And that part of the learning curve is so fun to me.
Emily Silverman
And in a way, that's what your story was about. In the end, it was...that's why there's two of us in the cockpit. Like, you're not alone. We're here as a team. Do you think medicine has that collaborative environment, that is pro-learning? Or do you feel like we have some work to do around normalizing not knowing failure? Where do you think we are with that as a medical culture?
Natasha Spottiswoode
Oh, there are so many ways to answer this wrong. I think more work is needed. Still a long way to go in a lot of parts of medicine. I don't want to sound ridiculously optimistic or pollyannaish. I think medicine has a history of being terrifically discriminatory and stigmatizing to people who were newer or younger, or any other way that we didn't perceive the role of doctor. And I certainly don't want to make light of that.But I'm really hopeful that we're getting better. And I really love the team that I work with now. And I am really hopeful about the future of medicine, and perhaps the way that I live within it.
Emily Silverman
As we wrap up, my last question is around your path as an infectious disease doctor. What is next for you? What do you spend your time thinking about? You mentioned that you're a scientist...what are you interested in learning about, researching? What are the big questions that you're turning around in your mind these days?
Natasha Spottiswoode
I think the big scientific questions are...what's going on with how we get so sick, from a respiratory perspective, both COVID and non-COVID? Why does that happen? And what can we do about it? Those are obviously huge questions. And I think I need to find ways to find bits of them that are amenable to me sort of chipping in my tiny little way at them, and taking what I learned clinically and building that in. And then there are the other big questions like how do you pick backcountry skis? And how does one start learning that? And that's another big question that I'm also dealing with.
Emily Silverman
Well, it's been so much fun to chat with you today, Natasha, about your story and about all of the exciting things that you're doing, both inside and outside the hospital. Is there anything else that you'd like to share with our audience before we end?
Natasha Spottiswoode
I think we lose the habit of being okay with being bad at things as we get older. Especially, a lot of work cultures are not forgiving of newness and failure. But I think continuing to try new things and to be willing to be bad at them is the closest I have seen to a gift. It's a gift to keep getting to do things to be bad at them to learn. And it just brings me so much joy. I would encourage listeners to keep doing that.
Emily Silverman
The joy of failure. Yeah, this is a phrase that I've been thinking about a lot as well—as somebody who can definitely tip into the perfectionism category—is the joy of failure. How do we tap into that? And so I think that's a great place to leave off. Thank you so much, Natasha, for coming in today and for sharing your story on The Nocturnists stage.
Natasha Spottiswoode
Thank you so much.
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