Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. 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: This is The Nocturnists Conversations. I'm Emily Silverman. Today, I'm joined by Dr. Jessica Zitter, and Chaplain Betty Clark, two healers whose friendship became the heart of a remarkable new documentary film, The Chaplain and The Doctor. Jessica is a critical care and palliative care physician and the author of the book, Extreme Measures: Finding a Better Path to the End of Life. She's also a filmmaker whose work examines how we live and die in the modern hospital. Betty Clark is a hospital chaplain, community leader, and lifelong caregiver whose warmth, candor, and spiritual insight have guided patients and families through some of their most difficult moments.

Together, Jessica and Betty explore what it means to care, not only for patients, but for each other. Their collaboration began in the hallways of Oakland's Highland Hospital and grew into a deep friendship that bridges race, faith, and professional hierarchy. In my conversation with Jessica and Betty, we talk about how a physician and a chaplain builds trust and friendship in a safety net hospital, the craft of chaplaincy and what it means to look with your ears and listen with your eyes, recognizing bias and racism in medicine and learning to meet them with honesty and humility, the idea of the wounded healer and how our personal stories shape the way that we show up for others, and how to find connection, grace, and hope in increasingly divided times. It's a rich and intimate conversation about friendship, power, and presence, and I hope you enjoy it as much as I did.

Before we dive in, take a listen to the trailer for the documentary film, The Chaplain and The Doctor.

[The Chaplain and The Doctor trailer]

Betty Clark: I don't interact with all doctors because all doctors don't interact with me.

Jessica Zitter: When I was raised up as a doctor, we didn't even know what chaplaincy was. It's touchy-feely. Yes, it's a nice-to-have, but it's not medicine. That's not why people are coming to the hospital.

Betty Clark: Then one day, I said, "You want to join us in prayer? You want to join us [unintelligible 00:05:19]?" She did, "Do you want to hold hands?"

Jessica Zitter: I was watching Betty, and I was seeing this impact that she was having on the patient, and I realized that it was something that I was not offering to my patients at all.

Betty Clark: After that, we started going to visit patients together.

Jessica Zitter: As we got closer, she opened up to me about her incredible pain and frustration about how her people were treated in the hospital.

Patient 1: [unintelligible 00:05:49] you know that I'm really sick, I would think that you know, unless you just don't care.

Patient 2: They tried to say [crosstalk] [unintelligible 00:05:55] that I'm seeking drugs.

Jessica Zitter: What I was hearing was really disturbing. The system that I was a part of was causing so much harm due to bias. We are two people working in one public hospital in Oakland, California, and we're trying to leverage our connection and our work together, but what can we do?

Betty Clark: I think and I hope that we can make a difference, change something. You and I, we're in this together.

Jessica Zitter: Yes, we are.

[end of trailer]

Emily Silverman: I am sitting here with Dr. Jessica Zitter and Chaplain Betty Clark. Jessica and Betty, thank you so much for being here today.

Betty Clark: Thank you for having us.

Jessica Zitter: So great to be here.

Emily Silverman: The two of you have made a beautiful film. I've had the pleasure of seeing a couple different versions of the film. I think I saw an early version, and then I saw the final version, and it's filmed in this really immediate, vérité style, bringing us into the hospital. We get to see you, Jessica. We get to see you, Betty. We get to see you working together. We come into patient rooms. It's just such a visceral experience to watch it and to learn about how palliative care and chaplaincy can work together to take care of patients.

It's also a film about friendship, and in some ways, it's a film about friendship before anything else. It's a film about two people getting to know each other, and there's almost like a buddy element to it. Maybe you can start by just telling us about coming together as friends and as colleagues, and how your partnership came together professionally.

Betty Clark: Well, I can start. We started in the old hospital, because Highland now has a new hospital, Alameda Health System, and the old hospital was very interesting. It was very friendly, a little bit more friendly, I think, than the new hospital because of the way it was set up. We didn't have fancy offices. I met Jessica. We were in a very tight, small office, and I liked her energy right from the beginning. Jessica has this kind of energy that she'll sit anywhere; it might be on the floor, on the table. [chuckles] I just really liked her energy.

Jessica Zitter: Wow. As you see in the film, not to my credit, or something I'm proud of, I was less attuned to Betty than I think she was to me. I can only explain it by the fact that I really believe that there is a weird hierarchy in hospitals, maybe a little bit less so on the palliative care team, but I think most doctors do not feel that chaplains have a lot to teach them. Again, I learned, as you can see in the film, how totally, as they say, bass-ackward that is. I think for me, this film is really about showing the development of a friendship, a really close friendship, one that was unexpected to me and one that's unlikely in most hospitals in America.

Betty Clark: Jessica probably doesn't remember this, but one of the things that impressed me was when I wrote a note-- In the old hospital, we had to write in a chart. I wrote a note about the story of a patient that she had been seeing, and she called me. I had never had a doctor that I worked with to call and ask questions. She called me and said, "How did you do that?" I said, "Do what?" She said, "How did you get the story?" I said, "I just ask." I think that was the beginning. That was really the beginning. There were bumps and ups and downs along the way, but that was the beginning of her being willing to ask a chaplain about what I did for the very first time.

Jessica Zitter: Let's not forget that that came after a really tense moment between us, where you felt that not just me, but that the team was, I think you said being racist. You said you are making a judgment about this patient – who I then later called you about and said, how did you get that story – that we were making a judgment about a patient that we had never met, we hadn't laid eyes on. It was just some kind of little random fact that was being thrown around the table, and we decided we knew who this guy was. You basically said, "No. No, that's racist."

Betty Clark: Yes, and unfortunately, that still happens. I was going in with a doctor, and he said, "He's a druggie." I said, "Well, it says here he's got cancer." They tend to identify some patients by their lifestyle rather than by their condition.

Emily Silverman: I think what you just said, Betty, about the importance of getting to the story and even possibly putting some of that story in the chart, or bringing that story, the life story, to the forefront is something that we don't see as much in traditional medicine, and that is foregrounded a little bit more in the chaplaincy tradition. I was wondering if you could talk a bit more about your approach to chaplaincy. How do you get called about a patient?

Betty Clark: Well, I'm on the palliative care team, so whatever patient the palliative care gets consulted on, I'm also a part of that. I tell the doctors, "Don't go in and say, we have a chaplain who can visit," because soon as you say that, patients start thinking, "Well, the doctor says, I need a chaplain. I must be dying." Then they will say, "No, we don't want to see a chaplain." Then I get shut out.

When I was trained, I was trained by a little lady. She was 80 years old. She was my age now. She told the social workers, said, "When you introduce me, tell them the nice little lady is going to come and visit." [laughter] I like to go in, and I introduce myself because if they say, "Oh, we're not ready for that," then I can say, "I'm not here because you're dying. I'm here because you're living, and I'm here to support you in living." People began to say, "Oh, okay."

Chaplains should do a lot of listening, more listening and looking than they do talking. It seems like I take a back seat to the doctors, but I know that the doctors have to find out if they're in pain. They don't want to hear me if they're in pain. They don't want to hear me if their pain is not being

addressed. I let the doctors do those things first, but all the time, I am observing how the patient is looking, how they're answering the questions, what pops out at me, and then I know how to support.

Emily Silverman: What are some things you look for, Betty? I think I remember when I was in medical school, once we did an exercise, an observation exercise, where we were meant to go into a room, and instead of coming with our agenda, we were supposed to notice- look at their tray. Did they eat? Has anyone been there to visit? I'm wondering, are there specific things that you look for to notice, or is it more you just take it in and whatever it is, it is?

Betty Clark: I look for flowers, stuffed animals. Sometimes religious figures; doesn't always mean that that's what they are. They may not even belong to them. I had a patient one time, and they had some rosaries hanging across the bed. Then I said, "Oh, I see rosaries here." I said, "Are you a Catholic? He said, "No, some nurse put those there." [laughter] You can't assume.

I supervise and train volunteer chaplains, and I tell them to look with your ears and to listen with your eyes. You're looking for things that may or may not mean what you see. You're listening because you see something, but you're listening to what the patient is saying to the doctor or the nurse or the social worker. Then you realize, "Oh, okay, that doesn't mean what I see. That's not it." A lot of observation goes on.

Emily Silverman: Jessica, you noticed that Betty has this preternatural ability to get to the patient's story and get to what matters, and so you call her. You say, "How did you do that? How did you get the story?" Then what happened? Did you make a decision to specifically start working together in a different way, or was it more casual, or what happened from that point forward?

Jessica Zitter: It was very internal. I think in my life, there have been moments where I have had a sudden, sort of thunderbolt realization that I have been thinking about something wrong. I think honestly, in that moment on that phone call, I just realized that we build up these incredible suits of armor around us, especially as doctors. We're so scared a lot of the time. It's scary to be a doctor, and you're given this cloak of greatness. When you see it, and when you understand it, it's easy to put it aside, but it's just so easy to get sucked up into that world, and sucked up into being defensive and having to stand tall.

I think when you can-- It's like good therapy. A good therapist helps you see something about yourself, and once you've seen it, it's hard to unsee it. I think that's what happened, and that's when I just opened up to Betty, and opened up to her amazingness, and to wanting to be her friend and to wanting to learn from her. That's really the beginning. It was a long time ago. It was probably 12 years ago, Betty, right?

Betty Clark: Yes, at least. More like 14, 15, years ago. I learned from Jessica too, because as a chaplain, you are taught and part of your calling is to be humble and to be submissive. Working with Jessica, I've learned to speak my truth and speak up to doctors and share with them things that I wouldn't have without having this relationship with Jessica. For instance, I've told the doctors there's certain language that you don't use with African Americans. I said, you can go into white patients and Asian patients and whatever, and say those things, and they're comfortable with it, but African Americans aren't comfortable with what I call baby talk.

Emily Silverman: What's baby talk?

Betty Clark: When you say to a patient, "We're going to wean you off of this medication," it sounds like baby talk because we wean babies. We don't wean adults. They don't use the word like, "We're going to lower your pain medicine as your pain level goes down so you don't get addicted." That's just plain English language. When they say, "We want to wean you off of this medicine," African Americans start building up anger because now they feel like they're being talked down to. Or when they use the word like poop, [chuckles] and they use it all the time, all the time. I said just don't say that to African-- That's what we'd say to babies, "Have you pooped?" There are other words that are more adult.

Emily Silverman: Jessica, what was it like to learn from Betty about racism and bias, and all of these problems that we see in medicine, historically, but even ongoing today?

Jessica Zitter: Oh my gosh, completely ongoing today because I participate in it myself. It's not a thing of the past, unfortunately. I realized-- In the film, you see there's a patient who's actually from my culture. She's a Holocaust survivor, and some things happen where there's bias against her. It's very different. It's not the same tropes. It's a different kind of trope, the rich Jew. Well, this woman was living on food stamps.

There was a moment, and you see it in the film, where I realized this trope against this woman, and it was actually a moment where-- I cognitively have always understood. I know what racism is. I know about racial inequities. I know how prevalent and how devastating they are and harmful, but this was a moment where something visceral happened for me because it was against my people. I said to Betty, "I finally understand on a visceral level what it must feel like for you every single day to be the only Black person--" Now that's different now. We have more African Americans on our team, but on a team of white people, which is what it was for many years, and how you feel like you're the person who has to stand up against tropes.

I see them everywhere. I certainly see them against African Americans, and working with Betty has really made this clearer and clearer to me, but I also see it against everybody. When somebody has power, when someone has a hospital badge on, when someone has a stethoscope around their neck, when someone's wearing a chaplaincy collar, when someone's sitting behind the desk at registration, they're in a position of power over the person who's coming for service and support. I think when you mix power and prejudice, it's a deadly combination, and I think it's something we should all be afraid of.

Betty Clark: I think sometimes it's power and unawareness of the consequences of what happens. We have security at the front door, and they make the men take their belts off – doesn't make sense to me – and older men have a hard time putting their belts back on. I said to one of the security guards, I said, "Why did you make this old man take his belt off?" He said, "Oh, I didn't make him take his belt off." Then I understood and noticed they make them all take their belts off, so yes, he did make him take his belt off.

That's without consideration of who. Someone's coming in, and they're crippled, and they're on a cane, and now they have to take off the belt, and somebody at home probably helped them get dressed. Now they got to figure out how to get this belt back on, and their pants are falling down. It's a lack of humanity, I think.

Emily Silverman: We see patient cases in the film. Maybe you can talk to us a bit about the decision to take your collaboration, your friendship, your teaching and learning from each other about medicine, spiritual care, different perspectives, different backgrounds, and your decision to make this into a film so that we could see examples of this play out on screen and learn from them directly.

Betty Clark: No, you.

Emily Silverman: They're pointing at each other.

[laughter]

Jessica Zitter: I thought Betty was going to want it. Betty has answered this question before, but we'll both answer it the same way, which is that in, I'm going to say, 2012-- When did you start working at Highland?

Betty Clark: 2011.

Jessica Zitter: 2011. Probably, in 2012, I started listening to Betty, even though I didn't have that epiphany moment yet. Maybe it was after the epiphany moment, so maybe it was 2014, something like that. I would listen to Betty, and I felt like every conversation had some nugget that I wanted to inhale and ingest. We'd be sitting in rounds, and I would hear her say something, and I would then whip out my phone, and I'd say, "Whoa, wait a minute. Can you please say that again?" Just because I wanted to have it. I am a writer, and so I was writing a lot at the time. I just felt like, "Oh, this is a beautiful thing for a piece."

Then in 2018, Betty-- and sometimes I would do iPhone video. Again, in those days, iPhones weren't so great, so it wasn't great stuff. Then in 2018, Betty came to work. It was probably a Friday. She said, "Oh, yes, this weekend--" we were talking about what we were doing on the weekend. Betty said, "Oh, well, after church on Sunday, my family is coming over, and I'm going to do my advance care plan with them." I was like, "Hold the phone. Can I come in and film it?" Betty said, "Yes, sure. Why not?"

I don't know how I did it, but I found some filmmaker, some poor filmmaker, who had no idea what this was, to just come and document it. We had a camera person and an audio person, and we moved around the room listening to Betty, which is- you can see in the film, do her advance care planning with her family. It was the first real official shoot that we did, and from there on, it just was clear that we needed to make a film.

Betty Clark: The story behind that-- and yes, Jessica would pull out her camera and say, "Can you say that again? Can you say that again? And stop the meeting. The story behind my planning to do that was that I had had an episode at home and was taken to the hospital. They thought I'd had a stroke, but I didn't. Then they found that I had an aneurysm, and that was in an inoperable place. I said to the doctor, after being on palliative care, "Okay, what's the prognosis?" They told me what would happen if it burst. Then they said, "Well, you need to talk to your family." I got a second opinion. They told me the same thing.

Then I decided I know what I want and what I don't want. I told Jessica, I said, "I do not want to be intubated," and Jessica said, "But, Betty, if I can bridge you from where you are to where you were--" and I said, "Can you guarantee?" She said, "Well, no." I said, "Then I don't want it." [chuckles] I knew that I had to tell my family so that they would understand what I want, what I don't want.

Jessica Zitter: To this day, I still-- it's my ICU genes, but I still feel like, "Well, what if it's urosepsis? We can get you through it," and Betty just absolutely refuses.

Emily Silverman: What if it's urosepsis? That's so funny. That's such a doctor question. I remember that scene in the film, and I didn't know that that was the first scene that you had filmed that was the foothold for what became, ultimately a beautiful film. I remember, Betty, you were sitting there. You look very regal. You look like a queen, and you're sitting there in the chair-

Betty Clark: I'd just come from church.

[laughter]

Emily Silverman: -and your family is sitting all in front of you on the couch, and you're telling them, "This is what I want. This is what I don't want." Which you're part of a palliative care team, so I imagine for you, that conversation was probably pretty standard and routine and comfortable, since you have those conversations with patients all the time. I don't know. Your family actually seemed pretty game in the scene. What was it like filming that scene?

Betty Clark: Well, for my part, we came home from church, and Jessica was there, and the cameras. They had lights coming in through the window from outside. [laughs] It was interesting. I think my family was very serious because they were very concerned, and they didn't know what I was going to say. My daughter, Crystal, she can be very bossy. [laughter] When I said that I was going to put my form on the door, oh, she just wasn't having that. It is in the drawer by the door, my physician orders.

Emily Silverman: Yes, I think you said, I'll write down my wishes, and I'll tape them to the refrigerator or something. Then Crystal says, no, no [crosstalk]--

Jessica Zitter: No, she says, "And I'm going to tape them to my door." It's a very good moment in the film. Let's not ruin it for people, but it's a very funny moment, I think.

Betty Clark: It was my door. It was my place, not hers. [laughs]

Emily Silverman: That was the first scene. Okay, so then after you filmed that, did you have the sense, both of you, like, okay, this could really be the beginning of a documentary that shows-- Did you even know what this story was going to be at that point?

Jessica Zitter: Well, I will say that the story was supposed to be about Betty alone. It was really-- I was behind the camera. For several years after 2018, I was always behind the camera, or I was directing a hired camera crew to do it. It was called The Chaplain of Oakland, and that was the film, The Chaplain of Oakland. It became pretty clear to me, probably three years ago, two and a half to three years ago, that I could not make this film without being in it. First of all, because the film was-- Originally, it was just about racism. It was about chaplaincy, obviously, because this is a chaplain who's teaching me this, and it's about showing and showcasing chaplaincy work, but it was really about racial inequities.

There were several reasons I didn't want to make it without being in it. One was, how do you show that when you don't have any person on the other side willing to talk about it, any white doctor? You can't ask somebody. I can't stand behind a camera and say, "Can you tell me about your implicit bias?" That doesn't work, and so that was one thing. I was willing, although it was very uncomfortable, and it still is, although I've gotten more comfortable talking about some of these things; I was willing to go and be vulnerable, and I felt that that was the only way to make this film.

Second of all, it's hard to make a film about racism when you're a white doctor. It's not my personal story to tell. I'm an observer of it, I'm a participant in it as part of the healthcare system, but it just felt like, from an authorship perspective, it wasn't really mine alone to tell. I decided at that point that this was really about a relationship. It's about both of us. It's about our relationship, our friendship, our mutual support and learning. That became The Chaplain and The Doctor.

Betty, you can tell about the day that I told you we were changing it and changing the focus and changing the title.

Betty Clark: I was not comfortable with that because they had filmed so much about me and my family. I was talking to a friend, and I said, "If they're going to change the name, then they've got to add her life and her family, and it's got to be equal." Then I said, "And it's about the Chapel of Oakland, and so if they're going to take the Chapel of Oakland out, they got to put something about Oakland in there," because I didn't like leaving Oakland out, and they did it. When I saw it, and I saw what they did, I was just like, "Yes, this is what I was talking about."

I think it's a good balance because it's really about- not just about inequities in the African American community. It's inequities and biases in all people, and how we treat, how we judge one another.

Jessica Zitter: Yes, and I would say, there are systemic and very well-documented inequities for African Americans. There's entire journal series in JAMA, for example, dedicated to talking about and looking at the data around racial inequities. It is a very well-documented and heinous reality of our healthcare system. There's also many, many articles about other groups where there are true inequities: LGBTQ, transgender, women, misogyny, ageism, et cetera. There's documentation of those types of inequities.

I would say, just to emphasize what Betty just said, this film became more than just inequities. It became about bias. It really became about the concept of bringing your own beliefs, preferences, and opinions about other people and other groups, based on very little information, to the bedside, and how that can be harmful. It did morph a little bit.

Betty Clark: Yes, I think it's also about humanizing people. Instead of just judging or looking at them as who you think they are, but humanizing them, and they're funny, and they're loving, and they're hurting, and they're sad, and all of those things that makes us human. The thing of it is, is that I believe there's one race. That racism was a term that was setup to separate, but there's one race, and that's the human race. When we can look at other people as human, just like we are, then there's a coming together rather than a separating.

[music]

Emily Silverman: Can you tell me a little bit about some of your favorite characters or favorite scenes or favorite moments in the film? Some of them are challenging; some of them are more humorous. We've been talking a lot about this problem of people bringing their bias to the table when they're in a position of power, and how that can be an opportunity for cultural humility and connection and humanizing each other, but if that goes wrong, it can lead to ruptures of trust and harm. It's such a messy terrain, and we really see that in the film. On some level, people are trying to do their best, but it's a flawed system, and we're flawed.

Are there any particular scenes or characters that stood out for you and that you would like to tease our audience around?

Betty Clark: I can start. [chuckles] My very favorite scene is when Jessica and I are tired, and it seems like I'm telling Jessica, "You need to go out and you need to relax," and then find myself lying on the bench, the two of us lying on the bench. That's one of my favorite. I told them, I said, "Don't take that scene out. Leave that scene in." My other favorite scene is with the man and the banana, and I walked away with the banana. [chuckles]

Emily Silverman: Tell us what that was.

Betty Clark: This was a patient that I had been seeing, and we just had a really good relationship, and he would say, "Yes, come on in." He happened to have his brother there on that day, and Jessica was with me, and he was eating, we were talking, and I was saying something about this, "My boyfriend." He had a banana, and I said something about the banana, and he said, "Take it. I said, "No, it's yours--" "No, take it. Take it," so I had to leave out with the banana. [laughs]

Jessica Zitter: When you first listen to the audio for that scene, you don't hear them saying it. We pulled out that track and lifted it up so you could hear, "No, take this banana." "No, you take the banana." "You take the banana," and it's a very funny moment. That was a scene-- First of all, Betty, I don't even know if you know this, but the day before, I had gone in to see him, and he kicked me out of the room. He didn't even want me in the room. He didn't talk to me. When I came in with you-- and this happens so frequently. When I came in with you, it was like, "Come on in." The trust issue. That scene is really about trust, and it's about lack of trust in the healthcare system. So frequently, when I go in with Betty, it's like she's building a bridge to the patient that I can cross over, and that bridge just doesn't exist a lot of the time because of lack of trust.

Betty Clark: A lot of times it's about the fact that patients will tell chaplains what they won't tell the doctors. He was having a problem with his trach, and it was too small. He would go to talk, and the thing would just- blood would shoot out across the room. It just didn't seem like anybody was listening to him. I was able to talk to the doctors and say, "This trach is not--" and they fitted him up with a different trach. That builds trust when they feel like this person can help me or will help me. I think a lot of times, doctors just-- Some of the things that patients say to the doctor, if they say it at all, is minimal for the doctor, rather than major. It's not about a surgery or a pain medicine or something like that. With a chaplain, I can bridge that gap.

Jessica Zitter: Well, and there's one-- Again, really, we're giving away the whole film here, but there's one important scene in the film where Betty and I are at a funeral that she's officiating of one of our patients. The patient's sister comes up to us, and she has sickle cell disease, and she starts asking me- she's asking me about, where should she go? What should she do? She's having trouble getting her sickle cell managed. Betty, who is a sickle cell organizer and a sickle cell advisor in Oakland, starts getting involved and giving her all sorts of suggestions. Then this woman says to Betty, "When I go into the hospital, and I'm having pain and I ask for medications, they treat me like I'm a drug addict."

There was something about that moment. Again, you can actually see it in the film. You can see me look down, sort of this realization, I've been that doctor. I've been that doctor at 3:00 in the morning, "Oh, that patient in Bed 5 with the sickle cell, asking for more Dilaudid," and going and doing it, but having that feeling in my head of, "Ah, it's a sickle cell patient." I think we have to-- Maybe not every doctor listening to this podcast has had an experience like that, but I think a lot have. I think we need to check that and think about it and raise our awareness when it happens, not beat

ourselves up, but just understand that that's the way the human brain- that's the way the tired human brain, the stressed human brain works. It was that moment when she said that, that I was like, "Oh my gosh, she wouldn't have told me that."

Betty Clark: Yes, I brought some material in for our doctors and our team at that time – it's different doctors now – to get more information about sickle cell. Because when a person is sickling, they need high, high pain medicine and doses that doctors don't normally give. If they don't know, then they treat the patient like they're seeking drugs, and it is demoralizing.

Emily Silverman: Betty, there's a scene in the film where you are at church giving a talk, giving a speech, and you're talking about your life, and you're talking about your journey. I was wondering if you could tell us a little bit about your background and how that informs how you think about suffering and healing.

Betty Clark: My great-grandparents on my father's side were slaves in Kentucky. My great-grandmother died at 103 when I was 16, so I knew her more than I knew my great-grandfather, but I know their story, I knew their story. After slavery, they became sharecroppers. My grandparents sharecropped, on my father's side. My father and mother sharecropped. I got married at 17. My husband and I sharecropped.

On my mother's side, my grandfather died at 39 in the tobacco field and left my grandmother with 11 children. There was no welfare, there was no social services, there was no Medicaid or anything like that, and so the only way she could feed her children was work. She worked in a house, but she couldn't get a house because you couldn't sharecrop-- the only way you could get a house after slavery is to be a sharecropper, and she couldn't sharecrop because she had children and not a husband.

The children, my mother told me how hungry they were, and so she decided to indenture them, because Kentucky enacted the indentured slavery law right after slavery ended. She indentured them to white farms, and she dropped them off at different farms, walking and dropping off her children. My mother was dropped off at a farm where they were very mean to her. My grandmother never got to raise her children. She never got to see most of her grandchildren. That's part of my background.

As a sharecropper and as a child of sharecroppers, they sprayed the tobacco, up until the late '60s, with arsenic. The arsenic poison got into our well water, so we we drank from the well. On the last-- well, not the last. Next to the third to the last farm that I lived on, they are the ones that sprayed all the tobacco. They stored their arsenic in a hangar, and it ran into that well water, so I was poisoned with arsenic and because of that, had many, many health issues.

Emily Silverman: In the speech that you gave, you say that there was a period of time where you weren't walking, and then you started walking again. I think you said something like, I'm never going back, or I'll keep walking, or-- [chuckles]

Betty Clark: Yes. For a year, I couldn't walk; part of it because of the arsenic and what the arsenic had done to my body. Once I was able to walk, my legs would hurt really, really bad. I started doing all kinds of things, like I was a cheerleader for three years. I would come home and my legs would hurt so bad, they'd have to be rubbed down. I decided that I was going to keep going because if I stopped, I might not be able to walk again. It makes it really hard. Things happen to you as a child that affects you for the rest of your life, and it makes it hard for me to stop and rest.

Emily Silverman: Yes, and we see a scene where you're seeing patient after patient walking through the hospital, patient walking, patient walking, and someone says, I think, "Betty, maybe you should sit down," and you say, "No, no, no, I'm going to keep going," and you just have this fire, and you have work to do. How do you bring that life experience to the bedside? Do you ever share your story, or is it more just a perspective that you bring?

Betty Clark: I live my story, but I consider myself a wounded healer. My wounds, all the things that happened to me, I can see it in other people, and that gives me a sense of connection and connectedness. I think Jessica can speak to this as well. They see something in my eyes, and I really believe that it is that common thread of life, that I've been where you've been. If they are homeless, I've been there. If they are struggling with children and trying to figure out what to do, I've been there. If they're sick, I've been there. I think my eyes tell them that, "I know your story. I've been there," and that connects me.

I hope that there is a way to help other chaplains get in touch with their own story. It's important to know your own story and what affected you as a child, so that when you hear that common thread – it may not be identical, but it's a common thread – you can be there in a way that you could not be there if you didn't connect.

Emily Silverman: Jessica, you also have a story, a background. We learn a little bit about that in the film. We spend some time with your family in the film, and was wondering if you could share a bit about that and how that informed your perspective as a physician.

Jessica Zitter: Yes. I think what Betty says is true. I'm also a wounded healer. I also come from my own personal and ancestral trauma. In some ways, I think most people probably have some-- I'm not saying everyone's traumatized, but I do think that most people can reach for something in their lives to help them connect with other people and to feel the empathy for other people, to remember times when they themselves have felt scared and lost and alone.

Yes, my own personal history, I think, is very- it's affected my values in a certain way. I walked away from my own personal history with a certain set of values, and I think that Betty walked away from her personal history with a set of values that actually are very similar to mine, I think. I don't know, Betty. We've never talked about that before.

Betty Clark: No, but I agree. We both have that ancestral pain. We have, I think it's a search or need deep inside for connectedness. There's love there that has carried us through hard times. Yes, we're very much alike.

Jessica Zitter: I really think so, even though you wouldn't know it. I mean, everything about our relationship. Honestly, you said to me, you said, "I don't have white friends. I have white acquaintances and white colleagues, but I don't have white friends." I think that's a testament, that is an important thing for us to acknowledge. There's a lot of separation, disconnection between many of us for whatever the reasons are. I think we're not the kinds of people you would necessarily think would come together in a very deep, close friendship. By doing that, that was very- instructive is a clinical word, but that was very healing for me, especially in this world which is so divided and so painful right now.

Betty Clark: I grew up on a farm where across the road was this family. There was this girl. She was a few years older than me, and she had a motorcycle, but she also liked to make brownies. She was white, and she would like for me to come over and spend the night with her at her grandmother's house. Sometimes we'd get on the motorcycle and ride to town and get a Coke. Then they integrated school, and I ended up at her school in my senior year, and she never spoke to me. It was like she didn't know me.

I think that when you look back on your life, that influences how you connect with other cultures, and so I've never had a white friend that I come to their house for just casual meals, or be with their children, or go to their events and all of those things. You have acquaintances and it's friendly, "Hi, hi," but not like Jessica and I. I've known her children since they were young, and now they're out of college and they're grown. We have kept that connection, the children and I, and now even the dogs, which I don't particularly care for dogs, but they like me. The dogs like me, and I'm comfortable with them. [chuckles]

It's a difference, and it's a value in my life that I never had. I don't know what it adds to my life, as far as other cultures, but I think it heals something that happened in my childhood and in my young teenage life.

Emily Silverman: Yes. As we come to an end, I think one thing you said, Jessica, is we are living in a world right now that's really divided, and there's so much swirling emotion and hate. I think films like this that show people building bridges, building friendships, and acknowledging how our personal experience and our personal wounds that have happened to us, how they might show up when we're standing at the bedside, when we are in this position of power, and how it's just such a risky place. It can feel so small, but it's not small. It's a tremendously vulnerable space to be in.

I don't know. Just watching the two of you; often, you'll link arms, and you'll walk through the hospital together, and you're really trying to bring awareness to that just vulnerable space and all the risk that lives in that space. Just was wondering if you had any final thoughts or words for the listeners about, how do we deescalate and decompress that space, and try to bring into that space as much love and kindness and humility as possible?

Betty Clark: You want to start? Oh, me? Okay. Well, two things, I think, is important. First, we have to get in touch with the fact that we are one race, and that's human. That if we can love dogs of all colors and a bouquet of flowers and all of that, all the differences that we love, we have to bring that to human and see each other as part of a bouquet. Then we have to be willing to hear someone's story and think about ways that you identify with that story. It might not be the same story, but there is something in the story. Maybe it's the hurt, the pain, the child, but there's something in their story that you can identify with in your own, and that brings us together, brings us closer, and understanding makes a difference.

Jessica Zitter: Yes, and I would just say, I think probably most of the people listening on this podcast are feeling some level-- This is not in our imaginations. These are dark times. I think it's very easy in dark times to want to retrench and just not be exposed to anything that might be painful, and I think many people are shrinking back into their worlds, which exacerbates the problem. There's something, for me, about having a dear friend from a totally different world than mine, who I know that I trust and I love, and who trusts and loves me, that is remarkably healing right now. I wish for everybody that they had that in their lives if they don't.

Betty Clark: I always say to people when they ask me how I am, I say, "I'm blessed in the mess. I'm blessed in spite of the mess, and sometimes I'm blessed because of the mess, but however it goes, I'm blessed."

Emily Silverman: Well, I think that's a wonderful place to end. I really encourage people listening to check out the film. Where can we find the film? Is it available?

Jessica Zitter: Well, I'm so glad you asked. The film is just going through the festival circuit right now, and if people will come to our website, they'll be able to follow where we're showing it. We just were at Woods Hole Film Festival, which was very exciting. We've got a lot of other things lined up, film festivals. We're also doing speaking and screening tour, so if people are interested, they should come to our website and see if we can arrange a screening. Sometime in the next year, year and a half, we'll have it up on some kind of a streamer or platform where people can access it for a licensing fee, but right now, we're really focusing on getting ourselves out there and speaking with people.

Please go to thechaplainandthedoctor.com and sign up for our email list so that you can be informed of all of our activities. If you're interested in having us come to speak, we would be thrilled to join you.

Emily Silverman: Yes, and I will just vouch. I've seen the film, and it's absolutely stunning. Just the storytelling, the characters, the two of you, the friendship, but also just aesthetically, it's immersive and, yes, just really, really powerful. Thank you for creating and for bringing this beautiful film into the world, and for sharing your friendship with us, and for coming on the show to speak with me today, Dr. Jessica Zitter and Chaplain Betty Clark.

Jessica Zitter: Thank you, Emily. What a pleasure.

Betty Clark: Thank you. Always.

[music]

Emily Silverman: This episode of The Nocturnists was produced by me and producer and head of story development Molly Rose-Williams. Our executive producer is Ali Block, and Ashley Pettit is our program director. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot Sessions.

The Nocturnists is made possible by the California Medical Association, a physician-led organization that works to ensure the doctor-patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org.

This episode of The Nocturnists Conversations is sponsored by The Physicians Foundation, which supports physician well-being, practice sustainability, and leadership in delivering high-quality, cost-efficient care. The Nocturnists is also made possible by donations from listeners like you. In fact, we recently moved over to Substack, which makes it easier than ever to support our work directly. By joining us with a donation of $2, $5, or $10 a month, you'll become an essential part of our creative community.

I'm your host, Emily Silverman. See you next week.