Jay Shah, MD, took a deep breath as he stood on the Berg Hall stage and looked out across the crowd. It was made up of 150 of his Stanford Medicine peers, some of them longtime mentors and collaborators.
Though he is accustomed to speaking before much larger crowds, this time was different. The surgeon and urologist was about to share something profoundly personal with a group of physicians, a human subset often preconditioned to wear the same steely veneer he had long worn. Those reflexive instincts, the ones that make a person hold their true feelings in tight, were doing a number on his stomach.
"I haven't been this nervous since medical school," the veteran bladder cancer specialist said as he took the stage. Shah recently became Stanford Health Care's chief of the medical staff, meaning he is the elected leader of some 3,200-plus physicians. Now, he was about to let them into his world.
"Even after I'd been here at Stanford for years, I didn't feel truly connected to any of my colleagues," he told them. "I just kept showing up with my war paint on, ice in my veins. After a lot of therapy, I finally learned how to identify my emotions and how to express them. And thank God I did because I don't know where I'd be right now if I hadn't."
Shah had been chosen to lead off the latest rendition of Story Rounds, the WellMD & WellPhD and the Medical Humanities and Arts Program (MedMuse) co-sponsored live storytelling program -- a safe place for MDs, clinical students and residents to share with their colleagues.
Nerves are a natural byproduct of real talk. As Shah told his colleagues, opening up to others with his true self, showing vulnerability, certainly hadn't been part of his surgical training. But he was up there to demonstrate his transformation and tell this group that it may have saved his life.
Shah's tale was an impassioned 13-minute story of metamorphosis: Of going from a doctor determined to trudge forward without self-reflection, watching it destroy his marriage and spiral his mental health, to one who recognized the harm in not processing the difficult situations and emotions that come with the job -- such as the pain, guilt and loneliness of losing a patient and feeling like it was all his fault.
His was the first of five stories that evening, delivered in a personal storytelling format inspired by Public Radio Exchange's podcast The Moth. It encapsulated a growing movement toward doctors talking openly about burnout, stress and mental health -- and trying to support one another, whether they're a wide-eyed first-year resident or a veteran health care leader like Shah.
As he looked out into the crowd, he exuded appreciation for his new lease on life and the opportunity to share this truth with others like himself.
"This experience has taught me that being vulnerable is not a weakness," Shah said. "If anything, it's the superpower that allows us to continue doing the incredible heroic things we're asked to do every day as physicians."
This experience has taught me that being vulnerable is not a weakness. If anything, it's the superpower that allows us to continue doing the incredible heroic things we're asked to do every day as physicians.
Jay Shah
They are human
Story Rounds sprouted into existence just before the pandemic and has always been an outlet for cerebral, problem-solving doctors to tap into and express their emotional intelligence and connect with peers about the inherent challenges of their profession.
But the Medical Humanities and Arts Program's executive director Jacqueline Genovese, who helps the speakers hone their stories, said this particular collection of stories, the sixth Story Rounds, appropriately themed "I Am Human," hit at the heart of a burgeoning physician wellness movement that has sprouted as a result of concerns over burnout and attrition. (According to an American Medical Association survey last year, 40% of doctors said they planned to depart their position within two years.)
"I Am Human" is a mantra inspired by former Story Rounds speaker Shireen Heidari, MD, a family care physician who specializes in palliative care and is part of a growing number of Stanford Medicine physicians and researchers committed to creating a more open culture among colleagues. Heidari used the expression in a heartfelt perspective piece she wrote for the New England Journal of Medicine about the difficulties of being a palliative care doctor during the pandemic.
The theme dovetails with Stanford Medicine's commitment to clinician and researcher wellness, a cause that Tait Shanafelt, MD, the institution's inaugural chief wellness officer, has dubbed Physician Wellness 2.0. (It also inspired a recent five-minute video produced by WellMD & WellPhD portraying the difficult real-life juggling act physicians undertake each day -- part of a larger movement centered on the "I Am Human theme.)
To create a safe, private space conducive to real-life sharing, Story Rounds is open only to physicians. The rare glimpse provided by Shah came only because he chose to share his story more broadly, believing his greatest achievement as chief of staff is to help doctors take as good care of themselves and their colleagues as they do of their patients.
"We do hard things by the very nature of our profession," Shah said in the days leading up to Story Rounds. "Yet we don't talk about the impact of those things on us. It's not bred into us. We don't see that behavior modeled. Because we don't see others doing it, we also may never feel comfortable doing it."
We do hard things by the very nature of our profession. Yet we don't talk about the impact of those things on us. It's not bred into us.
Jay Shah
Heidari, who was in the crowd the night Shah spoke, believes that seeing health care leaders like Shah demonstrate vulnerability is a critical step in ensuring doctors, nurses and technicians that they, too, can be human.
"Medical students and undergrads in the audience heard somebody in a leadership position say, 'Hey, I messed up. I will mess up again. I was devastated when this happened. And not dealing with it ultimately had consequences years later,'" she said. "I think hearing that when you are in your formative stages of your medical career can change your trajectory."
Processing the pain
Shah's story began with a tragic loss he experienced as a young surgical intern: An elderly patient coming out of a bladder cancer operation died while under his care. "I distinctly remember feeling like I had killed this kind man," he said.
He recalls a conversation with a more senior colleague about ways that patient's treatment regimen might have been altered. But there was no formal procedure for processing the situation -- or how he was handling it.
"I never talked to anyone about the impact of that experience on me. In my head, I had killed the patient, and talking about it would just make it known to more people," Shah said. "I showed up to work the next night as if nothing happened, and I soldiered on. I bottled up my shame and my sadness, and I pushed them way down, out of sight from the rest of the world ... and myself."
I showed up to work the next night as if nothing happened, and I soldiered on. I bottled up my shame and my sadness, and I pushed them way down, out of sight from the rest of the world ... and myself.
Jay Shah
After all, he figured, he was tough, he was resilient, he wasn't about to let the ice in his veins thaw. And for the better part of 15 years, bottling up that emotional pain served him well.
But that approach eventually caught up to Shah and led him down a dark path. "The loneliness I refused to acknowledge finally punched me in the face," he said. It took the dissolution of his marriage, to another doctor, and a feeling of despondency to get him into therapy where he began processing emotions and learning how to communicate.
After Shah began feeling more like himself, like the person he was before icy-ness had taken over his circulatory system, he faced a test of his foundational change. An elderly patient recovering from surgery, on Shah's watch as the attending surgeon, died in eerily similar fashion as the patient he treated as an intern. Shah found the nearest stairwell, broke down and bawled his eyes out.
"A kind elderly man had trusted me with his life, and I felt again like I had killed him," he said. "All the shame, guilt, sadness and pain that I had bottled up 20 years ago rose up from the depths of my soul."
All the shame, guilt, sadness and pain that I had bottled up 20 years ago rose up from the depths of my soul.
Jay Shah
As he returned from the stairwell, several of his concerned residents greeted him. Instead of trying to hide the anguish on his face and pretend everything was fine, he looked each of the residents in the eyes and told them he was sorry.
"Rather than judge or ridicule me, which is what I guess I'd always feared, they each came up to me and gave me a genuine hug -- and it felt so good," he said. "Contrary to what my younger self would've thought, what got me through the day was not the ice in my veins but rather the warmth in the hearts of those around me. And that happened only because I acknowledged my own pain and didn't hide it."
Shah hopes that his openness will allow others to give themselves grace. And embrace their role as humans as well as physicians.
"I want people to say, 'If the chief of staff can go up there and talk about these things," he said, "then maybe I'm not so unusual, maybe I'm not so bad. I guess I can feel OK owning my imperfections too.'"
The seventh edition of Story Rounds has been scheduled for Oct. 10 at Stanford Hospital's Assembly Hall at 5:30 p.m. It is only open to Stanford Medicine faculty members, residents, fellows, medical students and physicians at Stanford-affiliated clinics (UHA, PCHA). Go here for registration. If you are interested in sharing your story at a future Story Rounds event, please contact Jacqueline Genovese at jmgeno@stanford.edu
