Narrative in Medicine and Fiction with Dr. David Weill

My guest this week is Dr. David Weill, the former director of the Center for Advanced Lung Disease and Lung and Heart-Lung Transplant Program at Stanford University Medical Center. He’s currently the principal of the Weill Consulting Group, which focuses on improving the delivery of pulmonary, ICU, and transplant care. He’s also the author of the new novel, All That Really Matters, which follows his memoir, Exhale: Hope, Healing, and a Life in Transplant. David talks with me about how he made the shift from surgery into writing, how healthcare workers have historically been encouraged to deny the emotional reality of their work as a defense mechanism, and how that is finally shifting; the harsh and sometimes cruel realities of the transplant world; how fiction allows greater latitude in telling the truth about those realities; why transplant patients often like to go sky diving after their surgeries; and more.

Episode breakdown:

00:00 Introduction

01:31 Transplant professional documented experiences, produced two books.

05:19 Hid emotions in career, later embraced vulnerability.

06:53 Health care work strains minds, career change needed.

12:14 Interesting emotional arc, unwise career decision impacts surgeon.

16:51 Medicine’s learning curve: years of motivating terror.

18:01 Mentor’s patient admiration influenced his demeanor.

22:32 Some should leave jobs earlier, unlike most.

26:47 Healthcare struggles balancing patient care and profitability.

29:34 Moral injury from value misalignment in healthcare.

31:57 Left clinical role; now consulting for solutions.

36:49 Saving young lives is my most memorable work.

40:27 Enjoyed writing fiction; eager to continue exploring.

42:31 Organ allocation ethics and financial incentives examined.

45:40 Talented, flawed protagonist falls and redeems self.

50:55 Next book explores questions of identity.

Dr. David Weill Show Links

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Transcript

Please note: This is an unedited transcript, provided as a courtesy, and reflects the actual conversation as closely as possible. Please forgive any typographical or grammatical errors.

Nancy Norbeck [00:00:06]:
Welcome to Follow Your Curiosity. Ordinary people, extraordinary creativity. Here’s how to get unstuck. I’m your host, creativity coach, Nancy Norbeck. Let’s go. My guest this week is Dr. David Weill, the former director of the Center For Advanced Lung Disease and Lung and Heart Lung Transplant Program at Stanford University Medical Center. He’s currently the principal of the Weil Consulting Group, which focuses on improving the delivery of pulmonary ICU and transplant care. He’s also the author of the new novel, All That Really Matters, which follows his memoir, Exhale, Hope, Healing, and a Life in Transplant.

Nancy Norbeck [00:00:47]:
David talks with me about how he made the shift from surgery into writing, how health care workers have historically been encouraged to deny the emotional reality of their work as a defense mechanism and how that’s finally shifting, the harsh and sometimes cruel realities of the transplant world, how fiction allows greater latitude in telling the truth about those realities, why transplant patients often like to go skydiving after their surgeries, and more. Here’s my conversation with doctor David Weill. David, welcome to Follow Your Curiosity.

David Weill [00:01:21]:
Thank you, Nancy. Thanks for having me.

Nancy Norbeck [00:01:23]:
So I start everybody off with the same question. Were you a creative kid or did you discover your creative side later on?

David Weill [00:01:31]:
I think later on. I don’t

Nancy Norbeck [00:01:32]:
I I wasn’t particularly creative as a child. I, I was into sports and I did a lot of those kind of activities.

David Weill [00:01:40]:
Found academics pretty late in life, actually. So I don’t think, the creative side came out in me until much later.

Nancy Norbeck [00:01:48]:
Alright. So would you say that that it came out when you started writing or did it start before then?

David Weill [00:01:55]:
I think it actually came out as I was seeing things in my professional and personal lives that sparked the curiosity in me and sparked that creative part. I think I was drawn to writing, as many people are because they saw a lot of things experienced a lot of things and had a lot on my mind that I wanted to put down on paper. And so I think it was a matter then of how best to express it either through nonfiction or fiction. And, for me, it’s both nonfiction and fiction. And I think that that’s where the creativity probably came from.

Nancy Norbeck [00:02:33]:
So let’s get into that a little bit because obviously you’ve spent a lot of time in medicine. So how how give us a little overview of of how that came about for you and then how you got into the writing side.

David Weill [00:02:47]:
Yeah. I was I I was in the transplant field my entire professional life. And I think in that field, there’s so much there. There’s morality, there’s ethics, there’s life and death situation, there’s courage, there’s humility, There’s high highs and low lows. And I think that in seeing all of that every day, I was walking around the hospital essentially looking over my shoulder to see if anybody else was catching all this. And I decided about 10 years into my career that I was gonna start journaling. And so I kept fairly extensive notes about what I was seeing. And and many of those notes made its way into my first book and then some more into my second book.

Nancy Norbeck [00:03:29]:
Do you have a a note on your website about a mother a mother of 2 kids and having to go and and tell her husband and the kids that she wasn’t gonna make it and, you know, wandering off afterwards and crying. And even just the little little blurb is heartbreaking. And I think, you know, most people see shows like ER and don’t, you know, and just kinda think that that’s reality, but we don’t really think about what it must be like to be the actual person in a situation like that.

David Weill [00:04:10]:
Yeah. I wrote I wrote that story in my first book, exhale. And I remember that really distinctly, not only because it was just profoundly sad, you know, a young mother losing her life and leaving behind 2 young children that I got down on one knee and talk to and tried to explain to them what was happening as best I could. But I think it was even more profound than that for me because it was the first time I’d ever cried inside of a hospital. And I, had been in a hospital setting since I was in high school. I started working in hospitals when I was 15 years old. And although I saw a lot of sad things happen in hospitals, I think all of us do. I never really got emotional the way I did in that in that particular scene and actually wanted to sorta hide that from the rest of my team.

David Weill [00:05:03]:
And so I went into a storage closet, in the hospital supply closet and, cried my eyes out. Incredibly sad scene.

Nancy Norbeck [00:05:14]:
Did you ever talk to anybody else who admitted they’d done the same thing?

David Weill [00:05:19]:
Later, I did. You know, at that time of my career, and I would say my own emotional development, I I I was more trying to hide the emotion that I was experiencing in the hospital. And as we do, a lot of health care workers do this. We don’t really share that with one another because it seems weak, overly vulnerable. And, you know, a lot of our mantra, a lot of what we’re taught in medical school is just go on to the next patient and, you know, don’t wear your own emotions on your sleeve. So you walk around with this armor around you that I had most of my career and then started to shed much later in my career. And, you know, it it it it really hit me that that was what was happening to me, you know, because I I wasn’t really someone that looked at myself as very emotional in terms of my own patients, but I I became that way certainly.

Nancy Norbeck [00:06:18]:
That’s really fascinating to me because it seems to me that in a medical setting, you are by definition in a place where you really can’t avoid emotional situations. So to try to live that way is is massive denial of what’s going on around you. And I I can see where on the one hand, it’s survival to try to just say move on to the next patient. But on the other hand, it’s gotta take a toll on you.

David Weill [00:06:53]:
I I I think it does, and it did with me. And I think it it you know, in working with a lot of health care teams now in the role that I have now, I see that it’s taken a toll on a lot of us and that this was well before COVID, but certainly exacerbated during COVID. And it’s a defense mechanism, and it’s something we really are taught early on to use to kinda shield ourselves from the emotional ups and downs of doing this kind of work. But I but there’s to your to your point, I don’t think there’s any denying what’s happening and, you know, the body does know and the mind does know what’s happening. And as I’ve sort of reached the end of my run-in the clinical arena, in the hospital arena, I I realized that it was time for me to to change gears and do something else.

Nancy Norbeck [00:07:46]:
Yeah. Do you think that that that needs to change, or do you think that that defense mechanism is necessary?

David Weill [00:07:53]:
I think it needs to change, and I think it actually is changing. I think COVID brought to light the emotional duress that our healthcare workforce is undergoing. And I think there’s a lot of healthcare institutions that have taken measures to address that. And I think there’s also much more openness now for people that are working in health care to share their stories and their emotions with one another, which I think is a positive trend. And I think that that’s gonna be very good, especially for the younger generations coming up. I think that’s gonna be very important. And I, and I see it changing. Is it, is it changing fast enough? Probably not.

David Weill [00:08:32]:
But I do, I do see it changing.

Nancy Norbeck [00:08:35]:
Yeah. It was coming to mind as I I talked to a woman named Carrie Maluesta a couple months ago who actually started a writing program for health care workers during the pandemic and got a lot of response very quickly. So I think there’s a lot of self identified need there at the very least. So

David Weill [00:08:55]:
I think you’re right. And I see a lot of healthcare workers doing just Weill you talked about. You know, they’re starting to write There’s a whole area of medicine now called narrative medicine, which is storytelling around the hospital experience either from the patient side or the health care worker side. I get invited to talk at, medical institutions and they have these humanities lectures. They didn’t have any of that when I was, working on the front lines. And I I see that only as a positive trend.

Nancy Norbeck [00:09:25]:
Yeah. Could be very interesting to see if there’s a whole new genre of medical writing coming up.

David Weill [00:09:32]:
I think so.

Nancy Norbeck [00:09:34]:
So how did writing end up becoming more important to you as you moved through your career and and transitioned into what you’re doing now?

David Weill [00:09:44]:
I think both inform the other. In other words, I, I see things that I’m passionate about and wanna write about them a lot. I write a lot of op eds and essays for various publications in addition to the long form, which are the books that are, you know, different animals. But I also think that in thinking about these issues and expressing them, I can actually help the health care teams that I work with more because I’ve really thought deeply about what they’re experiencing, and I can try to give them the best advice I can about number 1, how to do their jobs better, but also how to stay healthy from an emotional and physical standpoint. Things that I didn’t necessarily have when I was working on the front lines. It it was, you know, I had to keep my own counsel as they say and

Nancy Norbeck [00:10:39]:
Yeah. So the first book that you wrote is a memoir. Right. And this one is a novel.

David Weill [00:10:47]:
Yep.

Nancy Norbeck [00:10:48]:
I haven’t read the memoir, but reading the novel, I get the sense that there is a lot of you in it. So I’m curious to know what it was like writing both of them actually. Like, how are they similar and how are they different? Yeah. I think when I wrote

David Weill [00:11:02]:
the memoir, it was obviously me, as memoirs are. They’re all about the author.

Nancy Norbeck [00:11:07]:
Right.

David Weill [00:11:07]:
Self indulgent in that way. And, I I think that with the novel, there are parallels between me and the main character. The main character was in transplant. I was in transplant. He liked to ride his bike. I like to ride mine. He spent some time in New Orleans. I grew up there.

David Weill [00:11:27]:
I think the similarities pretty much stopped there though. You know, the this the characters in the book and the setting was all informed about from what I saw. I mean, I didn’t make all of this up out of thin air. I I I ran up against a lot of interesting people while I was doing this kind of work, and so it made coming up with characters pretty simple. But I wouldn’t say that Joe Bosco, the character, and David Weill are are the same kinds of people. I like to think I’m a better guy than he is. That’s in the eye of the beholder, I suppose.

Nancy Norbeck [00:12:08]:
Well, he does go on quite a journey.

David Weill [00:12:11]:
Yeah. He does. He does.

Nancy Norbeck [00:12:14]:
Yeah. I I thought it was very interesting to watch him, and I’ve I don’t wanna give away too much here, obviously, but he has he has an interesting an an interesting emotional arc because you do he kind of he makes one career decision that you kind of see you kind of watch him make this decision, and you’re kinda going, I don’t think you’re gonna be happy there, man. I don’t think you’re gonna be happy there. And and he kind of is on the one level, but it it ultimately just doesn’t work. It doesn’t work well for him. And you sort of you see it coming, but not in the way that it all falls apart for him. But but you kind of see that image that surgeons can have of kind of becoming god in their own mind, which is exacerbated by that decision that he makes. And one of the things that I found really fascinating that that you brought out intentionally or unintentionally as a as a writer.

Nancy Norbeck [00:13:29]:
I know sometimes your themes are not as intentional as you realize when you’re writing it, but the idea that he’s kind of addicted to his patient’s gratitude. You know? Like like, he he feeds off of it almost, and I I just found that so fascinating because I had never really never really thought about it before. I think when I’ve encountered that notion of that god complex, that it had always seemed to me more like a power thing and not something that came from that, oh, my patients are so grateful because I saved their lives kind of aspect. And I’m just curious about how that how that, you know, came about for you or where where that sort of fits into your own experience.

David Weill [00:14:32]:
Yeah. I mean, it’s a very perceptive point. I I think that my observations of other people working in my field, especially transplant is is different and unique. I I think that you saw all sorts of motivations for doing the work. I mean, yeah, we got paid well and so money could be, a motivating factor. Power can definitely be a motivating factor. I worked in academic medicine, my whole Weill, big institutions like Stanford. And, yeah, power was a big deal there, as it is most places.

David Weill [00:15:08]:
But I think there’s also a subset of people, and I might include myself in in this area where the most important interactions of the day were not when the check arrived in the mail or when I got a new title. It was when I was talking with a patient, and they said, wow. You saved my life. I owe you everything. And that happened pretty regularly. And I think that there’s very few people that would be not changed by that, not influenced by that if you hear that day after day, you’re up. Mhmm. So when you look in the mirror, just like my character David, and I have scenes of him looking in the mirror.

David Weill [00:15:56]:
The question is, what do you see? And I’ve thought a lot about identity, you know, while I was writing this book. My character looked in the mirror, and he saw somebody that in the course of an operation could change somebody’s life. They knew it. He knew it, and the people he worked with knew it. And I even write in the book that if you don’t think that that influences how you look at yourself in the mirror, then you’ve got another thing coming.

Nancy Norbeck [00:16:27]:
Oh, yeah. Yeah. And yet at the same time, the scene where he’s, like, first told, okay, you know, go go for it. It’s your turn to do do this operation. I was reading that thinking, oh my god. I’d be terrified.

David Weill [00:16:47]:
Well,

Nancy Norbeck [00:16:48]:
Absolutely terrified. Yeah.

David Weill [00:16:51]:
I’ve said this before that when you’re when you’re especially in the first, like, say, I don’t know, 10 or 15 years while you’re on the learning curve in medicine, it takes a long time to learn how to do this. There are moments of extreme terror, and I and don’t let anybody tell you differently. You know, you’re you’re you’re terrified. I mean, you’re you’re truly terrified. Now sometimes that terror can be motivating, get you to focus and work harder and study and do all sorts of things, but it’s terror nonetheless. That goes away. At least it did it did for me, where you feel comfortable that you know what you’re doing, but it takes 10 or 15 years to get to that. But I I remember very well those early patients when it was just me and the patient, and I tell you my heart rate was was clicking away.

Nancy Norbeck [00:17:46]:
I bet. Yeah. I kind of have this image in my head now of a graph where, like, the the terror line is slowly going down and the the gratitude effect line is slowly going up.

David Weill [00:18:01]:
Yeah. Yeah. No. I remember I mean, I remember when I was in training, an early mentor of mine, who I remain friends, you know, with to this day, I I was a trainee, and he would walk through the waiting room on the way to see patients when we were together. And the patients would all stand up and start clapping for him. And I was like, That’s why he is like he is. You know, if you get that if you get that attention every day, you know, it’s gonna go to your head.

Nancy Norbeck [00:18:34]:
Did you know anybody that had that kind of attention, but wasn’t affected that way by it? I think I did. Yeah. I think I did. I I I think,

David Weill [00:18:43]:
they at least weren’t outwardly affected by it. I think, you know, there’s certainly maladaptive behaviors in medical settings. You know, some people drink too much. Some people, have extramarital affairs. Some people become gratitude junkies and some people are wholly well adjusted and they do their job and they don’t have seemingly any kind of character flaws. So, yeah, I think it happens. I don’t think it happens as commonly as most of us wanna think it does, but, yeah, it happened.

Nancy Norbeck [00:19:13]:
Yeah. I was just kinda wondering, like, what grounds the people who are who are able to do that?

David Weill [00:19:19]:
Yeah. I I I thought I’ve thought a lot about that because, you know, in my own journey, I wanted to make sure that at least the best I as as I could, that I stayed grounded. And I think it comes down to family, friends, your faith, if that’s something that, you know, is important to you. And I think that the folks that adjusted the best to that had those 3 apps in place, pretty firmly.

Nancy Norbeck [00:19:43]:
Yeah. So did you have a moment where you kind of, you know, looked at that person and said, oh, that’s why they’re that way, and I don’t wanna be like that?

David Weill [00:19:51]:
Oh, definitely. Yeah. Definitely. I mean, I I think especially early on, there were people that I encountered in the hospital setting that were leading a life and doing their job in a way that I did not. You know, I I did see all of it. I I saw the extramarital affairs in the hospital. I saw the too much drinking. I I saw the, you know, profound ego displays and all sorts of anger issues and, you know, you name it.

David Weill [00:20:21]:
And, you know, I tried to steer and I think I did steer away from all all of the really, really bad behaviors. But, you know, there was a times when I I probably wasn’t a day at the beach either. You know? I I think that, you know, you have to own that and just say, well, I’m gonna try harder, you know, and that’s that’s what I tried to do, you know?

Nancy Norbeck [00:20:44]:
Yeah. We are all human after all. Though I’m also wondering now if what we were talking about earlier with the whole, you know, denial go on to the next patient kind of feeds into that too. If you don’t have an outlet for everything that you’re seeing and experiencing, that probably tends to lead towards some of the behavior that you really don’t wanna exhibit, but it’s gotta go somewhere.

David Weill [00:21:11]:
Yeah. Definitely. And I and I think that, you know, the the dizzying part about transplant is you could have a great outcome and save somebody’s life in the morning. And then the afternoon, a patient you care about deeply dies, and then somebody else needs a transplant that comes and sees you the next hour and then knew the process and you have to start again. Or you’re in the ICU room and somebody passes away and they will another patient in the same ICU room and you have to, you know, so you’re constantly kind of having to reset yourself, which is exhausting times.

Nancy Norbeck [00:21:44]:
Right. And if in the morning, you’re a savior and in the evening, you’re suddenly a complete failure. That’s a lot to deal with in a single consciousness in a single day.

David Weill [00:21:58]:
Yeah. Weill, it was for me. I mean, you know, that’s why even when I started out on this, you know, field when I was 32 years, 31, 32 years old, when I was fully trained by that time, I kinda thought I had about a 20 year rip in the hospital, and then I was gonna do something else. And in fact, it worked out to be almost exactly 20 years. And, and, you know, I had gone to chapter 2 of my professional life.

Nancy Norbeck [00:22:27]:
Is that about average or does it vary widely?

David Weill [00:22:32]:
Mine was probably a little a little faster. I I think that there’s and I’ll be frank about this. I think there’s some people where they probably should leave, or earlier than they do. A lot of people don’t have either an option or the creativity or the wherewithal to think of another career path. They have real life concerns, and I and I get that. And I think that especially in transplant, I don’t think you see a ton of old transplant doctors walking around the hospital. I I walked out at least from the front lines, you know, from Stanford when I was 52 years old, and, it was time for me. Are there people that go a bit longer than that? Sure.

David Weill [00:23:22]:
But probably not a lot longer than that.

Nancy Norbeck [00:23:25]:
Wow. I mean, there’s a part of me thinking that’s kind of a shame because you need people with experience to train up the next set of people, but at the same time, I’d imagine that burnout comes pretty quickly just because you are on that emotional roller coaster.

David Weill [00:23:44]:
Yeah. I think it’s accelerated in our field. And not to say that other fields in medicine aren’t intense. They are. But I I think in our field, especially, it’s a 247, three 65 kind of endeavor. We we didn’t really have time off or say just because of the nature of transplant happens when it happens. You don’t have a whole lot of choice about when you when you do the operations. So I think it probably happens sooner in the transplant field.

Nancy Norbeck [00:24:12]:
Yeah. Yeah. So you get into a lot of detail in the book about the process behind the scenes, the meetings, and, you know, how it’s determined, who goes on a list, and and then you also get into the ethical considerations of of who goes on a list, which was certainly eye opening. And it I I think a lot of people would be surprised by, you know, just just how bureaucratic some of that is. Yeah. And I get the this sense that that was part of why you wrote the book and part of what you’re working on now. Has it changed much since you started working on the book?

David Weill [00:25:01]:
No. It hasn’t changed much at all. And, you know, yes. Part of why I wanted to move to fiction is is that I can have more latitude about telling things a little more closely to how they they were. You know, it’s difficult when you write a memoir. You know, you don’t sit down to write it to settle scores or to hurt people. That’s certainly not my intention. I think with fiction, it does give you latitude to tell a more complete story.

David Weill [00:25:31]:
And that’s what I tried to do in the book. I think I was all clearly making commentary about our health care system, you know, and the difficulty of the ecosystem right now, you know, to work in. I I don’t think it’s a real secret that, you know, health care has lost its humanity and it’s lost a lot of its soul because we do put profit over the purpose of it all. And I definitely wanted to make that point loud and clear in the novel.

Nancy Norbeck [00:26:04]:
Yeah. I mean, the the hospital that’s kind of at the center of the story is pretty clearly a for profit hospital, which is still an idea that kind of makes my head hurt, that such things exist even though am I surprised? No.

David Weill [00:26:23]:
I, you know, I I I think that, you know, hospitals are interesting places right now. You know, they have they have the public face that they show to patients. You know, we we’re here to help you. We believe in you. We’re all about you. We just want you to get better. Nothing else matters to us. That that’s just that is not true.

David Weill [00:26:47]:
It’s it’s simply not true. I I don’t think I know I haven’t met a hospital administrator that didn’t want patients to get better. I’ve never met anybody like that. I don’t think they would be in health care, but they are running a huge business, that not only has to be responsive to Wall Street and shareholders and all sorts of people, but they’re they’re they’re trying to make money. And it’s pretty obvious when you work in health care that that’s an important goal of of the environment. And in the novel, I wanted to be sure that I showed that that not only impacts patient care, it impacts people that work there because they’re trying to, on the one hand, just save the patient in front of them and give them a good outcome. And on one hand, you’ve got all these people behind you that are counting the beans as it were, and that’s a tough environment. That’s what’s going on out there right now.

Nancy Norbeck [00:27:51]:
Is there this almost seems self evident, but is there a moment where new med school grads are suddenly hit with this reality? And and if so, I mean, I can’t imagine it goes well.

David Weill [00:28:07]:
No. It it doesn’t go well. And unfortunately, it’s gotten something a lot of medicine, especially young people who are more idealistic, and especially this younger generation who I think is interested in greater goods. And I think it happens gradually. At first, you see it while you’re in training and you think, well, yeah. I mean, we understand there’s money involved in this. And then you say, you see it more and more. And you’re saying, at some point, not only is money involved in this, it actually may be the most important thing in this.

David Weill [00:28:40]:
And you see then to especially if you get into a leadership role, you interact with people that are running the business more and more, and you hear from them and you see that they are trying to make money. And if they hope the patients do Weill, and I wouldn’t say otherwise, but they are clearly trying to make money. And sometimes care gets compromised because of that. I don’t think that’s any secret.

Nancy Norbeck [00:29:09]:
I imagine that there’s there’s a moment where there’s a clash with those people, but probably also an internal clash. There’s

David Weill [00:29:22]:
a doctor, doctor Wendy Dean, who I’ll give a shout out to who I think is mainly created this term. If not, she certainly has popularized it called moral injury.

Nancy Norbeck [00:29:33]:
Mhmm.

David Weill [00:29:34]:
Moral injury happens in the health care workforce because of a misalignment in values between those of us who provide the care and those that are running the business. I don’t think that they necessarily have to be in conflict with one another, but they often are. I I I think when things went the best when I was working in the hospital is when I partnered with the people that were running the hospital to give them what they wanted and to get what I wanted and to to work together. Now that doesn’t happen all the time. It may only happen some of the time, but that’s that’s the goal. So I do think it’s a moral injury of sorts.

Nancy Norbeck [00:30:16]:
Yeah. I mean, there are examples in in the novel that, I mean, it’s really one example, but obviously of, of a situation that that happens fairly regularly. That seems downright cruel of keeping someone alive to meet a 1 year anniversary because that means something larger for the institution when it’s just cruel.

David Weill [00:30:45]:
Yeah. And I’m afraid all of the things that I wrote about in the book, whether it’s that issue, keeping a patient alive for a year so that the survival statistics for the program look better. I didn’t make any of those. I mean, they were fictionalized about Right. But I didn’t create that out of thin air. It’s not science fiction.

Nancy Norbeck [00:31:07]:
Yeah. I didn’t think so.

David Weill [00:31:09]:
So I I think would patients be disappointed to to know that? Sure. I would be. But does it really happen? Absolutely.

Nancy Norbeck [00:31:23]:
Yeah. It it just seems like is it is it really medicine at that point, or is it just number crunching statistics?

David Weill [00:31:34]:
It’s the latter.

Nancy Norbeck [00:31:36]:
Yeah. Yeah. How do you how do you I mean, you mentioned partnering with those folks to as much as possible, make sure everybody gets what they want, but how how do you how do you reconcile that for yourself when it’s not possible to make sure that everybody gets what they want?

David Weill [00:31:57]:
It it it becomes difficult. And and and it’s one of the reasons, frankly, that I left the clinical front lines is, you know, I I just didn’t feel like it was happening enough to my satisfaction. Now there’s other people that may have a different opinion. But to my satisfaction, it wasn’t happening enough. But now I work with those people in my consulting role in a similar fashion, and I know what they want, and I know what the clinicians want. And I try to figure out a way to come up with solutions that everyone can get what they want. And, you know, and I like to think that I have an impact on that. But does it happen every time? It it doesn’t.

David Weill [00:32:35]:
You know, it doesn’t. But I think it’s something to strive towards, certainly.

Nancy Norbeck [00:32:39]:
Yeah. Absolutely. And and how long have you been doing that?

David Weill [00:32:44]:
I left Stanford in 2016, and then opened a consulting practice, and we go around and help transplant programs. And also ICU situations, we just help them improve. We help them improve from a clinical standpoint, team dynamics, financial, administrative, you name it. We just help them perform better. And, you know, I like to think as opposed to being the quarterback, I’m more of a coach at this point, and, it’s it’s a role that I accept. I think it’s I think it’s great. I’ve really enjoyed it. You know, it there’s nothing that replaces the 1 on one contact with the patient, but this is about as close as you can get.

Nancy Norbeck [00:33:31]:
So does that how does that leave time then to write? Because obviously, it does.

David Weill [00:33:37]:
Yeah. It does. I I split for David and hour. I I’m a morning writer, so I write up to lunchtime when I usually can’t take it anymore. It’s hard work. And I and I, get a bite to eat, and then I switch gears and do my consulting work usually in the afternoons.

Nancy Norbeck [00:33:56]:
Oh, that’s cool. That’s very cool. So the the title of your book, tell us about how how the title came about.

David Weill [00:34:07]:
Yeah. I struggle with titles. I’m terrible at it. My publisher titled my first book, the second book. I got tons of advice about how to title it. And finally, I just sat down with a big glass of wine and, you know, tried to figure out what is this guy really looking for? What is the main protagonist in the book? What does he want? Well, he’s trying to figure out all that really matters. And I said, why Weill not that? So, all that really matters is a reflection of what this guy is trying to figure out in life. And I think, frankly, I think all of us are trying to figure that out.

David Weill [00:34:49]:
And in one way or the other, we have we have time on our hands and how we spend it is largely up to us. And so I think we’re Weill striving every day to figure out all that really matters.

Nancy Norbeck [00:35:03]:
Yeah. Did you when when you were working with transplant patients, did you see people shift what they thought mattered as a result of that experience?

David Weill [00:35:15]:
Yeah. Definitely. Definitely. You know, it it’s an education. I mean, it’s the education of a lifetime. You know, to see patients will tell you what matters to them as they’re facing death. And I think that that is profound. But also, you know, in medicine, we pick our field when we’re pretty young.

David Weill [00:35:34]:
I mean, I was in my late 20s, when I decided to go into transplant, and, you know, we change as people during the course of that career. We don’t stay the same. I had my wife and I had a couple kids. That changes everybody, I think. My father passed away during all of this, you know, to whom I was very close. That changed me. And, you know, during the course of my career, I saw some patients live and some patients not live. That changed me.

David Weill [00:36:06]:
So I think it’s difficult to pick a career or pick a field of medicine when you’re so young and expect that to sustain you and be perfectly static for the rest of your life. That’s just not particularly realistic. I don’t think.

Nancy Norbeck [00:36:22]:
Yeah. I think that’s probably true for everybody, but but maybe even more for doctors.

David Weill [00:36:27]:
Oh, I

Nancy Norbeck [00:36:27]:
think it is. I mean, I’m I’m

David Weill [00:36:28]:
re I’ve read and I’m sure you’ve read that people have more than one career, sometimes several careers days. Whereas I think in our parents’ generation, it was probably, you know, you pick a job and you do it. You

Nancy Norbeck [00:36:40]:
know? Right. Right. Yeah. Do you have a favorite transplant story?

David Weill [00:36:49]:
I have a lot of them. I tell I tell my first and second books. And I I think I think the most important stories to me generally were the ones where we took young people and especially young people, and we took them from a certain death situation and save them at the last minute. I mean, I’m I’m prone to the drama just like everybody. And, you know, when you’re running out in the middle of the night and doing this kind of work, that’s what you live for, you know, when you’re able to do that, when you turn somebody around like that. And I think that that’s those are the things that I remember as I look back on this career. You know, the people that not only do you save them and that feels good, but then you get cards and letters and pictures from them as they live their life and they get married and they have kids and they climb Mount Rainier and they do this and they, you know, on and on. You know, that’s what that’s all that really matters.

David Weill [00:37:48]:
I mean, that’s what it’s really all about. So I I’ve been fortunate enough to stay in touch with some of the patients that I that I helped, and that’s quite important to me.

Nancy Norbeck [00:38:02]:
Yeah, do a lot of them really get into skydiving? Because you mentioned

David Weill [00:38:07]:
that. Yeah, for reasons that are absolutely unclear to me, there was a couple of things that patients would do, especially young patients. Skydiving seem to be one of them. I don’t know what it is about getting a transplant that makes you want to jump out of a plane. But we had that, we had a lot of patients get tattoos of various sorts, all kinds of different things that I wasn’t necessarily in favor of. I had no particularly against skydiving Weill the tattoos, but it’s not for me. And so, I think it was just a reflection on patients wanting to squeeze every bit out of life, and they just said, look, I got this second chance. I’m gonna do whatever I want.

David Weill [00:38:56]:
And I’m gonna, you know, climb a mountain, jump out of an airplane, and I was, you know, I was mostly for it. Sometimes I would say I wish you wouldn’t, but patients would generally do it anyway. So

Nancy Norbeck [00:39:16]:
I can kinda see where if you felt like you’d suddenly got a second chance, jumping out of a plane might feel like the most alive thing you could do.

David Weill [00:39:26]:
I think that’s right. I think that that’s right. My daughter actually went skydiving last year. She was she she’s 21. And I asked her why, and she said it just makes you feel so free and alive. And I said, okay. Alright. I’ll buy that.

David Weill [00:39:41]:
That sounds good.

Nancy Norbeck [00:39:42]:
Yeah. Yeah. I can see that. I’m pretty scared of heights, so I don’t think I’d ever do it. But but you never know.

David Weill [00:39:48]:
Why not for me?

Nancy Norbeck [00:39:52]:
Yeah. I can see where from your point of view, you might be kind of thinking, I just put a new set of lungs in you, and you’re gonna risk them jumping out of a plane.

David Weill [00:40:03]:
That thought did go through my mind.

Nancy Norbeck [00:40:05]:
Yeah. Yeah. I can totally see that. Totally see that. So how was it for you to take your experiences and put them into this fictional character based somewhat on yourself and somewhat on other people and somewhat, I’m sure, totally on stuff you completely made up?

David Weill [00:40:27]:
To be honest with you, I I know this isn’t a popular thing for authors to say because I think authors tend to say, well, god, it’s hard work, and and it is. I had a blast, Diane. I’d like to do it again one day. My 3rd book, I already signed a contract to write. It’s gonna be nonfiction, but I may return to fiction because I really had Weill a good time doing it, just imagining things. I don’t know that I’m gonna write about that a medical setting anymore, but I I I have I have a good time imagining, you know, what could happen. You know, if my if my life, for instance, had gone right instead of left, what would have happened? And I think that’s the fun part of it all. So I enjoyed it.

David Weill [00:41:12]:
It’s hard work. I mean, you know, it’s it’s what everybody says it is. It’s it’s difficult to get it right. I don’t know if I did or not. That’s for the reader to decide, but it’s it’s hard work.

Nancy Norbeck [00:41:24]:
Did you talk to a lot of colleagues to get their perspectives?

David Weill [00:41:28]:
Not really. I talked to a lot of writers to get their perspective. I, I didn’t really talk to a lot of my transplant colleagues. I felt like I knew the Weill, that world. And I felt like I could describe it well, and I didn’t really have them look at it. Some have been early readers of the finished product, and their reaction to it has been positive, which I think is good. I asked them if I got any of it wrong and they said, maybe they Yeah. That they I think you’ve been surprised at how much I’ve revealed about the world.

David Weill [00:42:08]:
But I don’t think you sit down in a book and sit down to write a book and say, well, I’m not gonna tell the whole story because I don’t want people, you know, to know that. I think you have to, you know, be fairly transparent about it and honest and I tried to be.

Nancy Norbeck [00:42:22]:
Yeah. Has has anybody done any kind of reporting on the more ethical issues like you kind of

David Weill [00:42:31]:
Yeah. There’s just there’s just the beginning of that now. You you see, let’s call it in the last couple years, a a certain focus on the transplant industry, if you will. And it’s more about not as much about what I wrote about, but how organs get allocated, throughout the country. It’s a long complicated process that we could spend the next podcast on. But there there there is some examination of the ethics, the financial incentive, all sorts of different things about how organs get allocated. Believe it or not, it may it may be no surprise. There’s a lot of money in that too.

David Weill [00:43:15]:
That’s a huge industry. And so, there has been some reporting by Washington Post say and others, and they’re talking about that now, just now, after, you know, how many decades of doing transplants. So it’s a relatively new topic of discussion.

Nancy Norbeck [00:43:37]:
Yeah. That was something that, again, you know, I, like, I suspect many other people who aren’t involved in all of that had never really thought about. You know, it seems so straightforwardly altruistic, you know, somebody donates organs, somebody who needs one gets one, everybody’s happy. And so that was really an eye opening thing to read about. And and it made me wonder, you know, just how much blowback there would be for someone who kind of blew the whistle on it.

David Weill [00:44:12]:
Yeah. Well, I’ll Weill find out. I did some of this in my first book, and and there really was not a lot of blowback just because they look, as long as it’s the truth, very hard, you know, to blow back too hard on it. I, you know, I I think that, you know, we have to reveal these things. I love transplant as a field. That doesn’t mean I can’t criticize it.

Nancy Norbeck [00:44:40]:
Right.

David Weill [00:44:40]:
I love my children. I sometimes criticize them. I I think that I I love the field so passionately. I think about it all the time that I wanted to improve. And if I can help in that way by exposing some of these things, then that’s my role. I’m not trying to tear the field apart. I’m not trying to knock the people to do it for a living. I just want it to be better, and I think it can be better.

David Weill [00:45:09]:
But I think we have to reorient ourselves toward what what really matters. Another shameless plug for the title. Weill we really have to we have to be clear eyed that it really is about the person in the bed, in the hospital bed. And whenever we lose that focus, we start to stray. And maybe with my writing, I I don’t wanna overstate my importance in the universe, but maybe I can shed some of some light on that.

Nancy Norbeck [00:45:40]:
Yeah. Yeah. I think if people are aware of the factors that go into it beyond the naively simplistic description that I just gave, that that would help a whole lot. And I also think, you know, as I’m kind of reviewing parts of the book in my head, you know, that I I think one of the things that is really helpful about the novel is just that it’s such a 3 d image of someone who is a really, really talented guy at what he does, but is also a fundamentally flawed human being who, you know, gets caught up in that that world with all of his ethical dilemmas and has a pretty significant fall from it, but still remains a good guy underneath it all. Yeah. And has to kind of crawl out, you know, and find himself again, but doesn’t lose himself in it.

David Weill [00:46:47]:
Yeah. I think that’s real world kind of stuff. I mean, nobody Yeah. That and my guy isn’t either. I do think he’s passionate about his work and sometimes the passion shows up in maladaptive ways. But but I but I think that’s true to life. I mean, you see that in society, with some of the most brilliant people, you know, also have trouble interacting with the rest of the world at times. And, you know, I I wanted to show that, you know, my protagonist could care about his patients deeply, but also could be a pain in the behind to work with.

David Weill [00:47:22]:
You know? And I think that that dichotomy is something that’s true to life, and it’s certainly things that I saw.

Nancy Norbeck [00:47:31]:
Yeah. Yeah. And and it’s you you also make it pretty clear where some of that comes from in his life that it started long before he ever went to med school.

David Weill [00:47:42]:
Long before. And I think it doesn’t people. I mean, you know, most people that do this kind of work, things have gone right for them a lot. And, you know, they’ve had people like my guy did that have had huge expectations put on him. And he has been successful at meeting those expectations, generally speaking, and it’s a it’s a burden to carry around. And I think that he, didn’t wear it well at times, and I I just want experience.

Nancy Norbeck [00:48:14]:
Yeah. The expectations came with a big cost

David Weill [00:48:17]:
Yep.

Nancy Norbeck [00:48:17]:
As they do with a lot of people.

David Weill [00:48:19]:
I think that’s right.

Nancy Norbeck [00:48:21]:
Yeah. Yeah. So I I also have to say that that I was I I giggled with, with being both impressed and amused that you got Terence Blanchard to blurb your book.

David Weill [00:48:40]:
Well, I I’m glad that you know who he is. Everybody needs to know who he is. He’s a genius. He happens to be a friend of mine, and he’s a creative genius, in every way. And he is also somebody that inspires a lot of us to do creative things. And there’s not a moment that I’m writing where his music isn’t on. And I truly think that it inspires me to do better and dig deeper because I think his music is very deep in the soul. And, you know, Terrence is somebody that I look up to.

David Weill [00:49:20]:
You can look up to your friends, and he’s one friend that I really look up to.

Nancy Norbeck [00:49:24]:
That’s fantastic. Yeah. I noticed that he that he turned up in the in the book and it’s even better than he’s a friend. That’s great.

David Weill [00:49:31]:
That’s right. That’s right. Yep. Yep. I that that art form, you know, jazz to me is is life. You know? It it has everything in it, and Terrence is an embodiment of that, I think.

Nancy Norbeck [00:49:44]:
I mean, you live in New Orleans. You’re not allowed to live there if you don’t like jazz. Right?

David Weill [00:49:48]:
I grew up with a guy on the corner that had a saxophone that blew it every morning. So, yeah, we have music here for sure.

Nancy Norbeck [00:49:58]:
Yeah. That’s great. So you’re working on a 3rd book. What’s the 3rd book about?

David Weill [00:50:05]:
I am. It’s about identity, and it’s specifically about religious identity, but it’s gonna be identity more broadly. And it it kind of is a building block. My I I think my books are kinda build on one another a little bit, and my 3rd book is gonna be, I think they wanted to be out in late 2025. So, still working on it. Still have a lot of thought thinking to do around it, but that’s the general topic.

Nancy Norbeck [00:50:35]:
Cool. I’ll be curious to see how how that comes about. Has so the since the first book was a memoir and the second book built on your own experience, Obviously, there’s a connection there. Does the third one build on the first two, do you think?

David Weill [00:50:55]:
I think it does. Because I think that, I’ve always been interested and had a complicated religious background. And I think that it speaks to a larger issue is how do we identify? Like, when when we do look in the mirror in the morning, who or what do we see? And for me, a lot of times, that was I’m a transplant doctor. That’s what I saw. And that was my main source of identity, but it also is a husband, a father, a friend to, to folks. And I got really interested in people that see themselves as a Catholic or a Jew or a Muslim. And I got interested in in religion as a way to identify ourselves about who we are, what tribe we belong to, what team are we on. And that’s what I’m writing about in this 3rd book.

Nancy Norbeck [00:51:50]:
Well, I’ll be interested to see how that goes.

David Weill [00:51:53]:
Me too.

Nancy Norbeck [00:51:54]:
Especially since it can be such a fraught thing as we see in the world right now.

David Weill [00:51:59]:
Yeah. I’m tackling these easy subjects. Right?

Nancy Norbeck [00:52:02]:
Yeah. Yeah. Let me know when you tackle the hard stuff.

David Weill [00:52:06]:
Yeah. I’ll talk to that later at some point.

Nancy Norbeck [00:52:09]:
Yeah. Boy, you have a lot to draw on at the moment for sure, if you decide to. So before we go, is there anything that you’ve learned in the process of of writing either book, but especially of delving into fiction writing, that you would pass on to anybody who is considering taking a leap from something not related to to fiction writing or to anything that they’re, you know, that they’re currently doing, you know, a creative endeavor that seems unrelated to what they’re they’ve been doing with their lives.

David Weill [00:52:45]:
I I think follow your dreams and follow your heart. I think writing, it can be for for just for you. It can be for the public. It can be to figure things out. For me, it’s an incredibly important part of my life at this point. And I think it’s such a great outlet for me. I can’t, I can’t do what Terrence does, but I but I can try to do this. And I think it’s just like anything else.

David Weill [00:53:11]:
Just it’s a lot of work and the work pays off because, you know, these aren’t the best books that I’ve ever written. The next one’s gonna be a better one and the next one is gonna be better. And I wanna I wanna grow as a writer just the same way I grew as a transplant doctor. When I first started out, I wasn’t as good at it, I don’t think, as I was when I finished. And I I look at writing the same way.

Nancy Norbeck [00:53:41]:
Yep. That’s that’s the way it works. The more you do it, the better you get.

David Weill [00:53:45]:
That’s right.

Nancy Norbeck [00:53:46]:
Alright. Well, I’ll be curious to see where you go from here. Especially curious to see where this next book goes. So

David Weill [00:53:54]:
Thank you. I’m actually a little bit curious about that.

Nancy Norbeck [00:53:57]:
If you weren’t, I’d be worried. So, yeah, definitely keep us posted.

David Weill [00:54:03]:
Alright. Thanks for the conversation, Nancy. Enjoy.

Nancy Norbeck [00:54:07]:
That’s our show. Thanks so much to David Weil for joining me and to you for listening. Please leave a review for this episode. There’s a link in your podcast app, so it’s really easy, and it will only take a minute. If you enjoyed our conversation, I hope you’ll share it with a friend. Thank you so much. If this episode resonated with you or if you’re feeling a little bit less than confident in your creative process right now, join me at The Spark on Substack as we form a community that supports and celebrates each other’s creative courage. It’s free and it’s also where I’ll be adding programs for subscribers and listeners.

Nancy Norbeck [00:54:43]:
The link is in your podcast app, so sign up today. See you there and see you next week. Follow Your Curiosity is produced by me, Nancy Norbeck, with music by Joseph McDade. If you like Follow Your Curiosity, please subscribe, rate, and review on Apple Podcasts or wherever you get your podcasts. And don’t forget to tell your friends. It really helps me reach new listeners.