Adam Stern, COMMITTED
“The more that I achieve, the more I realize that achievements have nothing to do with the value of who you are as a person.” Psychiatrist, professor, and writer Adam Stern joins Zibby to talk about his debut memoir, Committed, which combines his medical experience with the story of his cancer diagnosis. The two discuss when Adam realized he had a story that has yet to be told, how psychiatrists approach mental illnesses in their personal lives, and what he’s learned from living with 50/50 survival odds.
Transcript:
Zibby Owens: Welcome, Adam. Thank you so much for coming on “Moms Don’t Have Time to Read Books” to discuss Committed: Dispatches from a Psychiatrist in Training.
Adam Stern: It’s so great to connect with you. Thank you for having me.
Zibby: This is such a pleasure. I eagerly dove into this book. I’m so interested in psychology, psychiatry. I actually worked on an inpatient unit once myself, the psychiatric unit in Westchester. I came into it with super excitement and interest and was just devouring it. Thank you for this fantastic read and insight into not only you, but what it’s like to be in a residency program and all of that. I really enjoyed it. Why don’t you tell listeners a little bit about why you decided to write this book and the time period it covered and all of that?
Adam: Sure thing. I’ve always wanted to be a writer. I’ve always written. I suppose it’s a little bit hard to know what defines a writer versus someone who writes and nobody reads their stuff or very few read their stuff. I’ve been writing my whole life. It wasn’t until a few years ago, some circumstances changed, I was actually diagnosed with cancer like many millions of Americans out there, so for the first time in my life, I actually was writing from the perspective of not just a physician, as I am, but also a patient and the intersection of those things. I found that self-disclosure in this radical kind of way was really powerful. For whatever reason, my pieces were finding homes in really well-read outlets. One of those pieces got the attention of a literary agent who offered me the opportunity to make a proposal.
When we sat down to really think about, what kind of book could I write that’s never been written or that really would captivate readers? the thing that jumped out at me was this ability or this opportunity to be able to talk about, how does someone go from a really eager, wide-eyed medical student, medical school graduate to what we all think of as this sort of strange, cerebral psychiatrist kind of thing? There’s got to be a journey there. When I thought back to my own journey in residency, it wasn’t something very mysterious or deep or anything. It was really filled with self-doubt, things that everybody can connect to, self-doubt, learning, connecting with your peers, relying on each other. I just so happened to meet my wife in training. We had friends that have become now future lifelong friends. I thought, I can tell this story in a way that I don’t think has ever been told. Hopefully, I can make it interesting for the reader by especially — even people who aren’t necessarily interested in medical memoirs, they might be interested in the stories behind the people in the book and the interpersonal drama that I hope comes through.
Zibby: I don’t feel like it was overly medicalese in any way at all. I think it was very approachable. A lot of it was about you, which was great because you really got us into your life and your head. Even until the very end, you were still doubting if you had been matched by mistake to the Harvard program. I was like, no, it’s okay.
Adam: I think the more that I achieve, the more I realize that the achievements have nothing to do with the value of who you are as a person. It’s a sad thing that it’s taken as many years as it has for me as an individual to come that realization, but it’s something that I feel more and more strongly every year.
Zibby: You mentioned as part of your self-doubt, if you will, that you didn’t have the skills for memorization that so many of your peers did and how you felt like that sort of shifted you even into a certain course of psychiatry where you didn’t have to use that rote memorization as well. I’ve always wondered, how do doctors keep everything in their heads, every single thing that could go wrong with a person? I don’t know. How did the other people do it? What did they say? They just naturally were able to memorize?
Adam: Certain people in my medical school class just have this gift to be able to take in huge amounts of information and then be able to represent it on the exam. What I would say, though, that I think is important is that, for any young listeners out there or people interested in medicine or any kind of field where you’re going to be studying a lot and trying to memorize and learn material, if you picture yourself ten years from now, you’re very likely not going to be needing the details of everything that you’ve memorized for the exam. Really, the education is all about learning how to learn and then how to apply those lessons. If you think of any of my peers that went into anesthesiology or radiology or any form of internal medicine, they remember the language of psychiatry. They remember the language of another field and how to fits in the context of medicine, but they don’t necessarily remember all the details that they memorized for those exams.
Zibby: Another part I found really interesting was how your own depression sort of ebbed and flowed with the tides of the training and how you weren’t alone in that, of course, with all of the triggers, essentially, that were presented all of the time, and particularly during the loss of one of your patients, which really, obviously, hit home, which I understood. I’m sorry, I can’t get a sentence out today. How did you cope with that? How has it followed you now? I guess my question really is, how do you manage your own emotions, which of course ebb and flow sometimes at higher and lower peaks and valleys, when your job is to take care of other people’s mental health?
Adam: That’s a great question. One of the skills that you have to cultivate over the course of any kind of medical training is the ability to compartmentalize. I have to do that on both sides of the fence. You have to be able to focus on your kids and your family and the things that you care about in your life when you’re at home and not be spending as much of that mental energy worrying about what’s happening back at the hospital. At the same time, when you’re at the hospital, you need to have faith that your kids are doing okay and everything’s going okay in the rest of your life and focus just on the patient. Doing those things, it doesn’t come naturally because our minds are naturally inclined to be a mishmash of all kinds of thoughts and worries and concerns. It all adds up to a certain degree of anxiety. It came with practice. Then as I wrote about in the book, being able to see someone objectively that can tell you, this is — in medicine, there’s a phrase called negative outcomes. Every field has negative outcomes. Surgery, medicine, psychiatry has negative outcomes. If you’re a family medicine doctor and you treat someone from the time they’re born all the way until they may pass away, eventually, all of your patients will pass away. That will be a negative outcome. That kind of idea is sort of foreign to someone in psychiatry. In psychiatry, we have negative outcomes. People die by suicide in psychiatry. People end up in the hospital with very serious illness. At the same time, it’s never something that we want or expect. You have to be able to live in that world and not have it devour the rest of your world. That ability to compartmentalize came with experience and also a little bit of training.
Zibby: One of the lines that stayed with me was when you first encountered this dramatic scene with a schizophrenic patient. They had to tie the patient down. You were really traumatized right at the beginning. The nurse said, “Don’t worry, doctor. You’ll get used to it.” You were like, “I don’t want to get used to it. This should always be horrible.” I think that’s so important. It’s such a valuable lens. These are people and people’s feelings.
Adam: You’re a hundred percent right. Even beyond feelings, it’s people’s lives. We can become numb. In any field, we can become numb to the humanity behind whatever it is that we’re trying to do. In psychiatry, there’s a lot of misery and pain and suffering. While on the one hand you’re compartmentalizing to protect yourself and your family and the rest of your world, you have to work to remain vulnerable with your patients because if you’re not empathic with them, you’re not going to be doing as good of a job with them in trying to care for them. It’s a challenge.
Zibby: I feel like you charted the evolution of your ability to do that so well by the time you got to the anorexic patient at the end of the book. You had a chance to kind of redo and start from scratch with a new patient. The moment when you were smiling and she’s like, “Why are smiling?” and you’re like, “Am I? I’m just ready to get to work,” that was so great. It was very inspiring the way you made it through all of this and all the work and everything. I just have to ask, what’s up with your brother these days? I feel like I got very interested in him in the book.
Adam: First of all, I’m going to tell him that the biggest bookfluencer in the world is asking about him. He’ll be so excited about that.
Zibby:
Adam: He’ll be super excited. My brother’s doing great. He’s a cardiologist. He actually ended up working in the very same office in the same system down on Long Island that my father works in. They have this wonderful thing going where they get to work together and even cover each other’s patients. They have that. It’s something that I love for them. My brother’s my best friend and always has been. I’m just so happy for him and his family. They’re doing great.
Zibby: Awesome. So neat that you ended up in med school at the same time.
Adam: That was a really funny, strange — going through it in parallel, it opened up this degree of sibling rivalry that I never in a million years would’ve imagined.
Zibby: I hope my kids don’t end up in med school starting at the same time. I don’t think any of my kids will end up in med school, so it won’t be an issue.
Adam: If you want them to go, then tell them not to go. If you don’t want them to go, then maybe tell them it’s a great idea. That’s how it worked out in our household anyway.
Zibby: Interesting. I’m open to any parenting tips you want to share on any front. Suicide also played a role in the book, and not just in your patients, but one of your cohort members you referenced at the end. I’m so sorry for your loss. That’s terrible. I’ve lost a really close friend to suicide as well. Many have at this point. I’m forty-five. I don’t know how old you are. At some point, it touches so many people. When you’re going through both your clinical life and personal life, how do you make sense of that and carry on the knowledge that, especially with patients, that’s a negative outcome to be avoided? How do you deal with it in your personal life too? How do you reconcile those two?
Adam: I think my instinct and most people’s instinct, especially in the field, is almost always to try to dissect it and figure out, where did it go wrong? What did I miss? How could I have steered things in a different direction? Those instincts are usually not adaptive. They’re not helpful because, A, they’re just second-guessing things that have changed. Ideally, you probably made the right choices when they happened. B, very often, people who die by suicide are the last people that you would necessarily have guessed would. Psychiatrists are charged with this terrible, enormous responsibility of trying to predict suicide. If someone comes through the emergency department, we do a risk assessment and try to figure out — I’ll give you a very concrete example in the modern age. A kid at college posts online somewhere something vaguely suicidal, something very vague but clearly hinting at suicide. That person comes into the ER. They end up seeing a psychiatrist. That psychiatrist has to somehow figure out, is this person a risk or not? The answer is obviously, there’s a degree of risk and there’s a degree of unknown. We’re not very good at predicting these things. We have certain modifiable risk factors that we can do, so things like removing lethal means. If someone’s a gun owner, you can try to help reduce the risk by protecting them from their own access to that kind of thing. Things like substance use are increased risk factors. Then there are certain things that are totally non-modifiable. Someone’s male gender over age sixty-five, past suicide attempts, family history of suicide attempts, these are all things that either they happened or they didn’t happen. They play into this overall decision that you’re trying to make. I don’t even remember the original question, but I feel like I’ve been talking about suicide for long enough. I’ll just pause.
Zibby: Okay, all right.
Adam: Absolutely. I’ve been dealing with this, on January 19th, it’ll be four years. I feel incredibly fortunate. I was very unlucky to get this — it was kidney cancer. It was a pretty large thing. As many kidney cancers go, they’re sort of quiet. They don’t cause a lot of symptoms until they get to be problematic. As it works, I happen to have access to some of the best care in the entire world. I worked pretty hard to put myself in a position to then, thankfully, be very lucky. Next week, actually, I’m going to have my sixth surgery since this diagnosis happened. I’ve had three different systemic therapies, one of which was in an almost ICU kind of setting. It hasn’t been easy. In that span of four years, I have had a second child. I have written this book. I’ve written essays that ended up in The New York Times and The New England Journal of Medicine. I have taken all these opportunities. I’ve gotten to see my, at the time, one-year-old now grow up into a five-year-old and learn who he is. I can’t wait to see who he is at six and hopefully at sixteen. It’s been an incredible journey of unknowns but trying to become okay with the unknowns, trying to live your life despite the unknowns. I’m just so thankful that I’ve had that opportunity. A lot of the people who were diagnosed right around the same time as me haven’t been so lucky. It’s been eye-opening. I wouldn’t wish it upon anyone, but there are certain aspects of it that I think have been insightful for me.
Zibby: Are you glad in this case that you have all your medical training, or would it be easier not to know?
Adam: It’s a double-edged sword. On the one hand, I can read the literature. I follow when there’s the largest cancer conferences and all the researchers get together and new data is released. I follow it just the same way that I think a lot of oncologists do. I can understand it. At the exact same time, I can read those survival curves as well as anyone. I know exactly what the data says and what the limitations are. At this moment, my disease is not curable for more than ninety percent of patients who have it. I like to be a realist about these things, a realist that holds onto hope. Those are the two principles that I carry with me all the time. So far, it’s served me really well.
Zibby: Wow. I will share my hope and all the good wishes. That’s a lot to do on top of being ill, all these things. It’s hard enough for people to write a book when their life is going great. Do you feel like it really helped you? Do you feel like all the writing has been therapeutic for you?
Adam: Yeah, that’s actually why I write to begin with. I started off by talking about, am I a writer? Am I not a writer? That kind of thing. I think that I’ve always written because I’m generally an introverted person. I sometimes can feel overwhelmed with the world around me. Since I was a little boy, writing has been a way for me to just process the world. When you get hit with the asteroid landing on your front door of cancer, suddenly, there’s a lot to process. I started writing these essays. The very first one was about this idea of — at that moment, my five-year survival rate was fifty/fifty, essentially. That was before we knew various things about how it had spread. I wrote this essay about the cruelty of a fifty/fifty survival rate. It’s not ninety percent. It’s not ten percent. It’s a coin flip. You may as well flip a coin, that kind of idea. By writing that essay, I was able to take these emotions that I was having and articulate them. Then once it was out into the world and actually was put out on Boston’s NPR radio — I got to go to the studio and record it. My voice was out to the world. What I love is it’s almost like a kind of sonar. If you write and people actually do read what you’ve written, it can sort of bounce back. You realize that you’re connecting with people you’ve never even met with. The ability to connect, I should say, is just really something that I hold onto very tightly.
Zibby: I love that, writing as sonar. I haven’t heard that before. I love that. That’s amazing. What next? Now you’re doing publicity for this book. You’re a psychiatrist. Your kids, whatever. What are your hopes and dreams for the next little stretch? More writing? More essays? What are you up to?
Adam: I would love for someone with a really great skill set and an interest to turn this book into a movie or a TV show. I’d love to be a consultant on that. That would be my dream, where I just get to show up and talk about what it’s really like and then other people do the hard work of making it good. That would be awesome. After the book came out, I spent a number of months working on something just specifically for my two boys that I had bound privately.
Zibby: Aw, that’s nice.
Adam: I’ve been working on it for a long time. I wanted to finally put a bow on it. Then I can get started on volume two. It doesn’t mean that the story’s over, but I wanted them to have this thing that I had written just for them. There’s that. I’m also thinking of — I have an outline of what I think is a really cool idea for a novel. It’s only an outline, so I’ll just give you the very, very, very broadest idea of it, if I may.
Zibby: Please.
Adam: I’m not that creative, so I’ll just make the protagonist a psychiatrist like me, but from that perspective, dealing with the aftermath of what happens in a small town if everyone’s internet browser history was published suddenly online available for everyone to see, almost like everyone’s secrets being suddenly revealed to each other, in a way. I think that that idea has so much potential as a work of fiction.
Zibby: Not to pull the wind out of your sails here or whatever, there is a book similar to that that I’ve covered.
Adam: Uh-oh.
Zibby: That’s okay. It’s not exactly the same. Every book is different. Sara Shepard’s book. I’m blanking on the name. It’s one word. It’s a long word, probably eight letters. I’ll look it up and send it to you. There’s a campus-wide issue with the servers, and everything becomes public. Not the browser history. It’s more the emails. As a comp, it would be a good comp for your book.
Adam: I’m going to have to read that.
Zibby: Yes, browser history would be — I’m always so worried about that. Everything I enter, I’m like, what if this ends up somewhere? What does this say about me?
Adam: We search the strangest things, and there’s no context. In our heads, there’s context. For everyone else, there’s no context.
Zibby: I love that. That’s a great idea.
Adam: I’ll have to read that and make sure I do something totally different.
Zibby: No, it’s totally different. It’s definitely more email-based now that I’m remembering. Reputation. It’s called Reputation.
Adam: All right, Reputation. Everyone, go out and buy Reputation. I’m going to read it too.
Zibby:
Adam: Thank you so much. I don’t have one, but one bit I’ll tell you is that one of my favorite parts of doing this book was the opportunity to go to a studio in Cambridge, Mass, which is a rock-and-roll studio, but that’s where I recorded the audiobook. I’ve never done anything like that. When someone tells you they listened to the book, I love it even more because I feel like I was just on a long car ride with them telling them about my journey over these four years in psychiatric residency. I appreciate that. Never had aspirations to do my own podcast.
Zibby: Do you have any advice for aspiring authors?
Adam: My advice is to write the thing that you want to write, and for you ideally. Writing for other people, usually not a good idea. If you write something and even if no one else reads it, you’re happy that you wrote it or you feel like it’s been a productive use of your energy and your headspace, then do it. I never in a million years imagined that this kind of book would happen and that I’d be able to do it. You just never know what can happen. If you’re somehow able to overcome the fear of trying something and it not living up to some idealized version of it that you have, then the sky’s the limit. You can achieve all kinds of things. That’s my advice. To anyone out there, take a shot. Do your best. If it’s something that you want to do, go for it. Be proud of it no matter what happens with it.
Zibby: Love it. If you ever want to brainstorm what podcast you should do, let me know. I feel like you should add that to your repertoire.
Adam: If I may be so bold, once I made it into the Zibby orbit and I became aware of all the things going on, I became aware of the viral sensation “SexTok with Zibby and Tracey.” Of all of your work, that’s the one that, on my commute to work, I can’t not listen to it.
Zibby:
Adam: One of the recent ones, you guys were talking about the variety of audience members that you have. I was like, yeah, add Harvard psychiatry to the list. We’re listening.
Zibby: That’s amazing. Oh, my gosh, I’m going to tell Tracey. That’s great.
Adam: Please do.
Zibby: That’s the problem with podcasting. Not the problem, but you just never know who’s listening. You never know who hears. Every so often, people email or DM or say something. It’s mostly, I just sit here at my desk and wonder. I see the numbers, so I know people are listening. You just never know. Thanks for telling me. We have so much fun doing it. It’s such a blast. I laugh so hard. Awesome. Thank you so much, Adam, for coming on. Feel free to stay in touch. Best of luck with everything. I’ll be rooting for you.
Adam: Thank you so much.
Zibby: Take care. Buh-bye.
Adam: Bye.
