Speaker 1: Hi, I'm Aaron Welsh and this is this Podcast Will
Speaker 1: Kill You. Welcome to another episode in the tp w
Speaker 1: k Y book Club series, where I get to interview
Speaker 1: authors of popular science and medicine books about their latest work.
Speaker 1: We have covered some fascinating topics so far this season,
Speaker 1: from the history of the pelvic exam to the origin
Speaker 1: of language, the world of regenerative medicine, and how everything
Speaker 1: truly is tuberculosis. If you'd like to see the full
Speaker 1: list of books we've covered in this season and past seasons,
Speaker 1: head over to our website This Podcast Will Kill You
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Speaker 1: has lots of TPWKY booklists, including one for the book Club.
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Speaker 1: so you never miss a new episode. Drop How does
Speaker 1: our heart pump blood? How does our gut digest food?
Speaker 1: How do our lungs draw in oxygen and exhale carbon dioxide?
Speaker 1: Medical training focuses on the how and the why of
Speaker 1: our bodies, the anatomy and physiology of all the parts
Speaker 1: that keep us alive and healthy, what happens if they fail,
Speaker 1: and how to fix it. There are diagrams and charts
Speaker 1: and atlases that help instill specialize knowledge in medical trainees
Speaker 1: that they can use to heal, to relieve, and to repair. Sometimes,
Speaker 1: over the course of a career, a doctor might find
Speaker 1: themselves forgetting that a kidney is not just a kidney,
Speaker 1: it's this person's kidney. A heart in need of star
Speaker 1: surgery is more than Tuesday's operation. It's the beating muscle
Speaker 1: that has faithfully kept this mother, son, friend, spouse alive
Speaker 1: for the past fifteen thirty sixty ninety years. And it's
Speaker 1: not just medical professionals that may benefit from a moment
Speaker 1: of reflection on what it means to live in our bodies.
Speaker 1: When is the last time you thought about your skeleton,
Speaker 1: the bones inside you, and how it supports us? When
Speaker 1: have you last looked over your skin, examined the scars
Speaker 1: and freckles and wrinkles, and appreciated how it protects us
Speaker 1: and holds us together. In Alive, our bodies and the
Speaker 1: richness and brevity of existence, Award winning writer and surgeon,
Speaker 1: Doctor Gabriel Weston transcends the usual boundary between doctor and
Speaker 1: patient to instill a sense of humanity in our bodies.
Speaker 1: Throughout each chapter, she explores a different part of the body,
Speaker 1: examining not just how it works, but what it has
Speaker 1: meant throughout history and how it has shaped the story
Speaker 1: of her life. The liver with its incredible capacity for
Speaker 1: regeneration and transplantation. The brain unfathomably complex and yet so vulnerable,
Speaker 1: as doctor Weston discovers with her son, the womb that
Speaker 1: nurtures and provides, and that has been used to control
Speaker 1: women for millennia. A profound blend of memoir, science and meditation.
Speaker 1: Alive is a beautiful, absorbing book that honors what it
Speaker 1: means to be human with our incredible yet not infallible bodies.
Speaker 1: I really loved chatting with doctor Weston, so we'll just
Speaker 1: take a quick break here before getting into the interview.
Speaker 1: Doctor Weston, thank you so much for joining me today.
Speaker 2: Thank you so much for having me. I'm absolutely thrilled
Speaker 2: to be part of this podcast. Oh, thank you.
Speaker 1: It means the world well. In your latest fantastic book, Alive,
Speaker 1: you take readers on this really thoughtful and captivating tour
Speaker 1: through the human body. You weave together your personal experiences
Speaker 1: and reflections with the history and the science of the
Speaker 1: body parts that you explore. So tell me how did
Speaker 1: this book take shape?
Speaker 2: I mean, I think, first and foremost, it just came
Speaker 2: from this place of and this is why I called
Speaker 2: it Alive, this sort of sense that as doctors and
Speaker 2: medical students that the anatomy that I was taught at
Speaker 2: medical school and as the basis for my surgical training
Speaker 2: had this kind of dead call to it. So, you know,
Speaker 2: physiology always felt like it was a kind of experimental
Speaker 2: sort of specialty, and pathology, of course, had all the fantastic,
Speaker 2: wonderful illnesses that are so exciting. But there was something
Speaker 2: about anatomy, which I had expected that I would love,
Speaker 2: that just seemed really kind of inanimate, and almost like
Speaker 2: the way it was taught was inanimate as well. And
Speaker 2: basically I got to this point sort of twenty five
Speaker 2: years into my surgical experience, where I started realizing that
Speaker 2: actually the facts of anatomy are not as inert as
Speaker 2: we were led to believe, and also that many of
Speaker 2: those facts don't really apply to women or people of color.
Speaker 2: But then, I think even more than that, I had
Speaker 2: this feeling, as a doctor who was herself getting older
Speaker 2: and going through lots of life's experiences, that actually the
Speaker 2: way that we live in our bodies is so ever
Speaker 2: changing and so kind of like not just a progress.
Speaker 2: You know, you have times in your life where you
Speaker 2: feel like you're going backwards and where everything has collapsed
Speaker 2: in on itself, And I just sort of thought it
Speaker 2: would be really interesting to try and write a book
Speaker 2: that was almost like an alternative anatomy that would allow
Speaker 2: me to explore some of these kind of spaces that
Speaker 2: I didn't feel I saw anything of when I was
Speaker 2: learning myself.
Speaker 1: Yes, and I think that is what is one of
Speaker 1: the things that makes this book so valuable is being
Speaker 1: able to see the body parts and read about these
Speaker 1: body parts, not just in the way that you are
Speaker 1: exposed to it in a medical class or even in
Speaker 1: a history class, but it's this bigger picture, that complete,
Speaker 1: more beautiful picture. And each chapter kind of goes into
Speaker 1: a different body part. You've got gut, lungs, kidneyed, genital's heart,
Speaker 1: and so on many more. And I'm curious how you
Speaker 1: decided on this organization, especially the order of the chapters.
Speaker 2: I mean, I was very keen that the book should
Speaker 2: start with a post mortem, because I thought, in a way,
Speaker 2: like the dead body, and the first chapter of the
Speaker 2: book is called dead, that in a way is my
Speaker 2: start points as a surgeon, as a kind of medical
Speaker 2: student that once was, as I was saying before, this
Speaker 2: kind of sense that the anatomy I was taught was dead.
Speaker 2: And I thought, if I can begin the book not
Speaker 2: just with a dead body, but actually with a kind
Speaker 2: of language that feels very cold and clinical, then that
Speaker 2: will be a kind of start point from which the
Speaker 2: rest of the book should be almost a coming alive
Speaker 2: of not just the body itself, but my way of
Speaker 2: kind of integrating my understanding of the body when it
Speaker 2: came to the actual like organs and which ones to
Speaker 2: go first and stuff. I mean, in a very sort
Speaker 2: of light way. I had all of the piles of
Speaker 2: organs on the floor at one point, and I remember
Speaker 2: kind of noticing that a lot of the organs have
Speaker 2: got memories of my own body in them, and I
Speaker 2: sort of thought, I wonder if I could just very
Speaker 2: lightly arrange them in order of my age. So, for example,
Speaker 2: you know, I think I remember a nasal fracture from
Speaker 2: when I'm a child in bone, which is the first organ,
Speaker 2: and then obviously womb is an organ I wanted to
Speaker 2: put later so that I could examine childbirth, manopause, all
Speaker 2: that kind of stuff in there. So there is some
Speaker 2: sense in which these organs are kind of telling the
Speaker 2: story of my body, but you know, it's not super visible,
Speaker 2: so it was more like a kind of scaffolding for
Speaker 2: my sake rather than the readers.
Speaker 1: Throughout your book, you share many personal stories with the readers.
Speaker 1: You give them it's really intimate glimpse into some of
Speaker 1: the most challenging times of your life. And I was
Speaker 1: wondering whether that was difficult to be vulnerable in that way,
Speaker 1: or to put so much of yourself out there.
Speaker 2: I mean, it's such a great question. And what I
Speaker 2: find really difficult actually is not vulnerability, and it's not
Speaker 2: telling the truth of my experience of the body. I
Speaker 2: think my difficulty is I think in medical literature, I
Speaker 2: don't mean like textbooks, but more kind of popular medical literature,
Speaker 2: there is a lot of sentimentality that attaches to the
Speaker 2: way that people write about the body. You know, it's
Speaker 2: I mean, it's a hard thing to describe without sounding
Speaker 2: slightly psychopathic, but I slightly feel, particularly as women, that
Speaker 2: there's this sort of expectation that if we're writing, for example,
Speaker 2: about childbirth or motherhood, that there should be a kind
Speaker 2: of softness to the way that we do that, when
Speaker 2: in fact, many of my experiences of certainly of motherhood
Speaker 2: have not been soft, fuzzy, nurturing ones. They've been ones
Speaker 2: that have been kind of full of confusion and sometimes
Speaker 2: rage and exasperation and even regret at times. And so
Speaker 2: I think what I wrangled with was not the sense
Speaker 2: that there was anything that I didn't want the reader
Speaker 2: to get to see about me, but that I wasn't
Speaker 2: wanting to write in a set mental way or in
Speaker 2: a way that I felt for me would not be true,
Speaker 2: and so it did mean kind of departing from a
Speaker 2: lot of the sort of medical writing that I have read,
Speaker 2: particularly written by women, where I feel sometimes there's this
Speaker 2: expectation of, you know, what these feelings ought to be
Speaker 2: around death and birth and reproduction and love and all
Speaker 2: this stuff. So I think always kind of as a
Speaker 2: feminist writer, I'm very keen to have myself be an
Speaker 2: example maybe of a slightly like monstrous female who doesn't
Speaker 2: always feel all of these nurturing feelings that I think
Speaker 2: were Still there's still such a great expectation that we
Speaker 2: should have.
Speaker 1: Let's take a quick break, and when we get back,
Speaker 1: there's still so much to discuss. Welcome back everyone. I've
Speaker 1: been chatting with doctor Gabriel Weston about her book Alive
Speaker 1: Our Bodies and the richness and brevity of existence. Let's
Speaker 1: get back into things. I'm sure that that also filters
Speaker 1: into not just your role as a writer, but also
Speaker 1: your role as a surgeon and how you are expected
Speaker 1: to be or think or feel about your patience or
Speaker 1: about your own self.
Speaker 2: I think so, and I think I mean in a way.
Speaker 2: One of the things that I find most beautiful about
Speaker 2: the body as a writer, as a doctor, but also
Speaker 2: just as a human walking around as a woman, is
Speaker 2: you know, if you have a thought, it is very
Speaker 2: likely that most other people are having that thought to you. Like,
Speaker 2: you're going to have thoughts and you're going to think
Speaker 2: you're the only person in the world that is having
Speaker 2: those thoughts or desires, or you're going to think that
Speaker 2: you've just thought something that is the most shocking thing
Speaker 2: that you could even ever imagine someone thinking. It is
Speaker 2: highly unlikely to be that shocking. And the body as well.
Speaker 2: I feel like the way that we experience kind of
Speaker 2: life's big changes and events through our bodies. It's like
Speaker 2: if the body is kind of telling you I feel discussed,
Speaker 2: or I feel desire, or I feel fear, or I
Speaker 2: feel longing, it's okay. And sometimes we might have those
Speaker 2: feelings in odd circumstances, and I like putting that on
Speaker 2: the page, but I absolutely have I just have an
Speaker 2: aversion to doctoring and writing that is about telling people
Speaker 2: what they're experiencing in that moment. So yeah, that's a
Speaker 2: big thing for me.
Speaker 1: Your background is not necessarily you didn't start out your career,
Speaker 1: your adulthood with designs on becoming a doctor. Can you
Speaker 1: tell me a little bit about your atypical journey.
Speaker 2: Yeah, yeah, So, I mean in the UK, we have
Speaker 2: this crazy system where when you're about sixteen you have
Speaker 2: to choose three subjects that become the only three subjects
Speaker 2: you're going to study at school, and then usually you
Speaker 2: choose one of them to go on and do it university.
Speaker 2: And I gave science up when I was thirteen as
Speaker 2: soon as I possibly could, so I had to keep
Speaker 2: one science for what we call GCSE, which is a
Speaker 2: kind of fifteen sixteen year old style exam. And then
Speaker 2: after that science disappeared from my life. That was a
Speaker 2: great relief to me, and I had a year out.
Speaker 2: Then I went off to do English and philosophy. You know,
Speaker 2: English was always the thing that I was good at,
Speaker 2: so it seemed like the obvious choice of thing to
Speaker 2: read at university. And then when I was at Uni,
Speaker 2: I just started kind of discovering that whenever someone was
Speaker 2: sick or someone like fell off a ladder or broken
Speaker 2: arm or it was around the time that Er was
Speaker 2: on TV for the first time. That's how old I
Speaker 2: am now that It came on around that time that
Speaker 2: I was doing my English degree, and I noticed that
Speaker 2: I was much more than usually interested in all of
Speaker 2: this stuff, and not from the point of view of
Speaker 2: I did not have an overarching desire to help people.
Speaker 2: That was not the impulse. The impulse was just pure,
Speaker 2: untrammeled fascination, like kind of not okay style fascination. And
Speaker 2: then completely by happenstance, one of my friends, who was
Speaker 2: a maths student, his dad came to visit us up
Speaker 2: in Edinburgh, and his dad was a surgeon, and this
Speaker 2: was back in the day where you know, there were
Speaker 2: no mobile phones or anything like that, and he had
Speaker 2: these old school photo albums in his car filled with
Speaker 2: photographs that he or his scrub nurse had taken when
Speaker 2: he was operating. And I remember everyone else went out
Speaker 2: clubbing and drinking. He and I stayed in alone, and
Speaker 2: at the end of that evening he said, next time
Speaker 2: you're in London, give me a call. You can come
Speaker 2: to my operating theater. So I did that. I was
Speaker 2: about twenty one, back in the day where you could
Speaker 2: just rock up to someone's operating theater with no credentials,
Speaker 2: and I just literally walked into this room and it
Speaker 2: was like I was having some kind of religious conversion.
Speaker 2: I mean, I was just beside myself with excitement. And
Speaker 2: I went a couple more times after that, and then
Speaker 2: I kind of thought, I don't really see how I'm
Speaker 2: going to make be able to make surgery a hobby.
Speaker 2: I don't think that's going to be a kind of
Speaker 2: socially acceptable thing for me to be doing in my
Speaker 2: spare time. So after a little kind of while of
Speaker 2: arming and ring, I just thought, I think I'm going
Speaker 2: to have to go and be a doctor. So I
Speaker 2: had to go back because I had English, French and
Speaker 2: Latin A levels and I had to basically do all
Speaker 2: the science A levels that would get me a place
Speaker 2: at medical school. And then into medical school I went.
Speaker 2: And the crazy thing was that, apart from that early
Speaker 2: year where I had to do all the science and
Speaker 2: it was so difficult for me, really the rest of
Speaker 2: it was kind of fine. It's like I loved it
Speaker 2: and I had this amazing feeling that most of the
Speaker 2: other medical students didn't have, of like a kind of
Speaker 2: glorious sense of the glamour of being a medical student
Speaker 2: who had come from a background where it didn't seem
Speaker 2: like that would ever be possible. And so I never
Speaker 2: quite lost my sense of the kind of in loveness
Speaker 2: with the persona of this new person that I was,
Speaker 2: And in a way, I think I still have that now.
Speaker 2: It's like when I go into the operating theater now
Speaker 2: to do you know, very small surgery with you know,
Speaker 2: very low risk and kind of nothing to write home about.
Speaker 2: When I put my scrubs on, I just still feel
Speaker 2: that's very cool, you know, I've never lost that sense,
Speaker 2: and so I think there's a lot to be said
Speaker 2: for that, you know, for kind of whatever it is
Speaker 2: that makes you keep loving it. And I really, I mean,
Speaker 2: even despite our NHS being in the most kind of
Speaker 2: powerless state, the actual business of being a doctor who
Speaker 2: gets to handle people's bodies it's just a joy, isn't it.
Speaker 2: It's just it's like intimacy of the most extraordinary, beautiful
Speaker 2: kind that life has on offer.
Speaker 1: You write about the human body with such care and
Speaker 1: with such lyricism. It shines through along with your endless
Speaker 1: curiosity about the human body and about your own ability
Speaker 1: to express your stories. And I wanted to kind of
Speaker 1: get into a few specific parts of the body that
Speaker 1: you covered in your book, starting with bone. So in
Speaker 1: your chapter on bone, you talk about the common misconception
Speaker 1: that bones are these static, unchanging things, when really they
Speaker 1: are very dynamic. Can you talk about how our use
Speaker 1: of the skeleton as the symbol of death really contradicts
Speaker 1: the true vitality of bones.
Speaker 2: Yeah, I mean, skeleton's so interesting, isn't it, because it's
Speaker 2: like lay people. You don't have to be a doctor. Like,
Speaker 2: we all know what skeletons look like. Kids know what
Speaker 2: they look like. They wear Halloween costumes with skeletons on
Speaker 2: the front of them, and you can go for a
Speaker 2: walk in the woods and like see a bird skeleton.
Speaker 2: And most of us have touched bones, you know, whether
Speaker 2: we're eating a chicken wing or whatever. We have a
Speaker 2: very kind of established sense of what bones are. And
Speaker 2: yet when you see bones inside a body that is alive,
Speaker 2: they're not like that at all. So for this book,
Speaker 2: I went to there's an amazing orthopedic hospital just outside
Speaker 2: of London called the Royal National and I went there
Speaker 2: and saw an amazing surgery where a guy was basically
Speaker 2: removing a tumor from a woman's thigh bone and he
Speaker 2: had to kind of take an enormous length of her
Speaker 2: thigh out in order to take this tuma out. And
Speaker 2: when they were sawing through the femur, it's just so
Speaker 2: struck by the cross section of this biggest bone in
Speaker 2: the body that it was filled with marrow, and it
Speaker 2: was filled with blood vessels, and it had this kind
Speaker 2: of live, yellowy looking periostium, and it just I looked
Speaker 2: at it and I thought, it's just not at all
Speaker 2: the way you would think bones are. And then of
Speaker 2: course when you look at the physiology of bone, you
Speaker 2: realize that bone is kind of changing itself all the time.
Speaker 2: So the bone, you know, the bones that you have today,
Speaker 2: you wouldn't have had ten years ago. Every year, ten
Speaker 2: percent of our bones are being remodeled by a process
Speaker 2: of you know, osteoclasts removing old bits and osteoblasts putting
Speaker 2: in new bits. So I think even this kind of
Speaker 2: symbol of death, when you look closely at it inside
Speaker 2: the living body, which obviously most people don't get to do,
Speaker 2: you just see that it's alive in a way that's
Speaker 2: really counterintuitive and really beautiful.
Speaker 1: It's like, instead of ship of theseus, we have the
Speaker 1: skeleton of theseus. You know, the bones that we have
Speaker 1: now are not the bones that we started out with.
Speaker 1: They've just been continuously remodeled throughout our entire lives. And
Speaker 1: in your chapter on the womb, you take readers on
Speaker 1: journeys through the inner workings of this amazing organ. You know,
Speaker 1: the ways that it's been used to dismiss or harm women,
Speaker 1: as well as your own experiences in childbirth, both you know,
Speaker 1: as the one giving birth and as the one observing childbirth.
Speaker 1: Did any part of this chapter feel especially meaningful or
Speaker 1: challenging to write?
Speaker 2: Yeah, I mean, like you say, it's such an incredibly
Speaker 2: sort of dynamic organ, the womb when you think it
Speaker 2: sort of begins as something the size of a small pair,
Speaker 2: and then if you're pregnant, you know, it occupies your
Speaker 2: entire abdomens, so it kind of it presents itself as
Speaker 2: something to write about, almost like the most beautiful kind
Speaker 2: of metaphor for changeableness, and that really appealed to me.
Speaker 2: And then it kind of, you know, it kind of
Speaker 2: intersepted with really in a way. The main drive behind
Speaker 2: this book is this kind of philosophical desire that I
Speaker 2: have all the time with the body to somehow occupy
Speaker 2: that space between being in a body and observing a body,
Speaker 2: you know, like where that's the mystery, isn't It is
Speaker 2: like when you're a surgeon. You're standing at the operating cable.
Speaker 2: You have your hands inside someone's body, but your own
Speaker 2: heart is beating, your lungs are working, your hands are
Speaker 2: warm because of blood running through them. I'm so struck
Speaker 2: always by that kind of like a desire to be
Speaker 2: and know at the same time, which never feels possible.
Speaker 2: It's always like a hologram that you have to kind
Speaker 2: of flip from one side to another of And So
Speaker 2: when I had my so my first two children, I
Speaker 2: had vaginal the second two at the same time by
Speaker 2: sea section because they were twins, which was also kind
Speaker 2: of cool because I thought I get to kind of
Speaker 2: experience all the ways that the womb can give birth
Speaker 2: to children. And I just thought it would be really
Speaker 2: interesting to get in touch with the obstetrician who delivered
Speaker 2: my babies by sea section, which I did about six
Speaker 2: months after they were born. I mean, I think she
Speaker 2: probably thought I was crazy, but she was very accommodating,
Speaker 2: and I just sort of said to her, like I
Speaker 2: really I want to see what you did to me.
Speaker 2: I want to kind of be on the other side
Speaker 2: of the line, like having Laine on that table with
Speaker 2: my womb open and you pulling my twins out. I
Speaker 2: want to stand there next to you with my scrubs on,
Speaker 2: seeing you do that to someone else. And so in
Speaker 2: the womb chapter, I'm really exploring that kind of very
Speaker 2: female again. I think it's a very existentially deep part
Speaker 2: of being a female, this way that our bodies are
Speaker 2: the thing that life is enacted on, but it is
Speaker 2: also self. It's like, if we are to express agency,
Speaker 2: it's through our bodies. And yet the second you hit
Speaker 2: puberty as a girl, you're suddenly aware that the world
Speaker 2: is objectifying you. And so I felt like the womb
Speaker 2: was a really really exciting organ to look at some
Speaker 2: of those things through and then just as the icing
Speaker 2: on the cake. I also, for the BBC went to
Speaker 2: Sweden to see a womb transplant being performed. That was
Speaker 2: just kind of mind boggling in a wonderful way as well,
Speaker 2: to see like in adjoining operating theaters, you know, a
Speaker 2: mother's womb being carried down a corridor in a dish
Speaker 2: to be put inside the pelvis of the daughter who
Speaker 2: had been gestated in that womb herself. Just so cool,
Speaker 2: you know, just like those moments again where I'm kind
Speaker 2: of maybe thinking to myself, in this moment, I should
Speaker 2: be having a sentimental reaction, but actually I'm just blown
Speaker 2: away by how exciting it is and how kind of
Speaker 2: existentially deep it is. And you know, so that was
Speaker 2: really like a terrific experience as well.
Speaker 1: I don't have the words. It is the coolest thing.
Speaker 1: And it is also you know, earlier you mentioned and
Speaker 1: I wanted to circle back to this. Earlier you talked
Speaker 1: about how it wasn't like you went into medicine because
Speaker 1: you wanted to help people or because you had this
Speaker 1: like altruistic this is what I was put on this
Speaker 1: earth for. You love the huge and I feel like
Speaker 1: that is the expectation to feel that way, to feel
Speaker 1: like I went into medicine because I want to save
Speaker 1: the world and make the world a better place, and
Speaker 1: I feel like it is it is challenging then, or
Speaker 1: is maybe viewed as sometimes not acceptable to say I
Speaker 1: really just thought this was fascinating and I wanted to
Speaker 1: do this.
Speaker 2: I mean, I definitely feel sometimes when I was a
Speaker 2: jenior surgeon that I would be so excited in an operation,
Speaker 2: I'd kind of think, I'm glad I've got a mask on,
Speaker 2: because then they you know, they're not going to see
Speaker 2: how excited I am. I mean, obviously there is a
Speaker 2: limit to how much a patient wants to see that
Speaker 2: on a person's face. But we would prefer all of us,
Speaker 2: I think, to have our doctors really into what they do.
Speaker 2: And I definitely think for writing about the body, like
Speaker 2: there are lots and lots of places to get facts
Speaker 2: about the body, and I think it's I still feel
Speaker 2: that it's very political writing the truth about the experience
Speaker 2: of being inside one. I still feel that that is something.
Speaker 2: Women can keep writing truthfully about their experiences of being
Speaker 2: inside their bodies till the cows come home, and it
Speaker 2: will not be enough, you know, the deficit.
Speaker 1: Let's take a quick break here, We'll be back before
Speaker 1: you know it. Welcome back, everyone, I'm here chatting with
Speaker 1: the wonderful Gabriel Weston about her book Alive. Let's get
Speaker 1: into some more questions. So Skin is an incredible organ.
Speaker 1: I mean again, like they all are. I say this
Speaker 1: about all the organs, but I really appreciated how your
Speaker 1: chapter encouraged readers to see skin not just as the
Speaker 1: thing that holds us together, not as a barrier to
Speaker 1: the outside world. And you talked about some of the
Speaker 1: things that skin can show, what it can reveal, as
Speaker 1: well as what it can hide, and I was hoping
Speaker 1: you could just elaborate a little bit more on that.
Speaker 2: Yeah, I just so, I think, again, like with all
Speaker 2: of these organs, I'm always sort of after something literal.
Speaker 2: You know, what does the skin do? What is its
Speaker 2: function as our biggest organ? And I guess its main
Speaker 2: function is letting sunlight in and heat out in the
Speaker 2: most basic way, but it's kind of it is a
Speaker 2: barrier and a protective barrier, but it's also like a
Speaker 2: filter because your skin doesn't work well and if it's
Speaker 2: completely impermeable, it wouldn't be doing the things that has
Speaker 2: to do. But also I got, of course thinking about
Speaker 2: skin more symbolically as the thing that marks out where
Speaker 2: I end and the world begins, which is again kind
Speaker 2: of going back to the more philosophical sense of like
Speaker 2: what is a self? Where are we inside ourselves? And
Speaker 2: where do we touch the outside world? And we do
Speaker 2: that through our skin. So it was a chapter that
Speaker 2: I felt was kind of a really interesting chapter to
Speaker 2: examine themes of time through. So one of the things
Speaker 2: I did in this chapter was kind of take a
Speaker 2: bit of a like a spread of members of my
Speaker 2: family from at the time my twins were like toddlers
Speaker 2: right up to my parents in their eighties, and have
Speaker 2: these kind of moments where I'm stopping my usual physiological
Speaker 2: inquiry into the skin to just look at the skin
Speaker 2: of these loved ones, you know, of my little kids
Speaker 2: and my teenage kids, and my middle aged husband and
Speaker 2: my elderly parents. And then I also had this amazing
Speaker 2: opportunity to visit one of the immigration removal centers near
Speaker 2: one of our airports in London. So these are kind
Speaker 2: of like hidden places with no signposts, and basically it's
Speaker 2: where tens of thousands of people who don't have their
Speaker 2: asylum papers are left, often for years while those papers
Speaker 2: are processed. And I managed to get access with a
Speaker 2: GP who goes in there to kind of assess some
Speaker 2: of these asylum seekers claims for asylum. I managed to
Speaker 2: go in with her and had this fascinating day where
Speaker 2: I realized that this particular young man who we were
Speaker 2: seeing that his job and the job of the GP
Speaker 2: who'd come to visit him, was to document all of
Speaker 2: the scars on his skin, which were his evidence that
Speaker 2: he had come from a place where he had been
Speaker 2: traumatized and tortured. And so since really fascinating, like turning
Speaker 2: on its head of how we usually want our skin
Speaker 2: to be, particularly again women aging, we want skin to
Speaker 2: be sort of perfect, like the perfect flawless canvas. And
Speaker 2: yet here was this young man at pains to show
Speaker 2: all these kind of traumatic blemishes because he knew that
Speaker 2: if we could document enough of them, and if he
Speaker 2: could get them to match the story that he was
Speaker 2: telling us, that that might be the ticket for him
Speaker 2: to be able to stay in the UK. So that
Speaker 2: was the kind of way of acknowledging the complexity of
Speaker 2: skin as a political organ without treading on ground that
Speaker 2: didn't feel like my ground to tread on.
Speaker 1: It's sort of runs parallel in some ways to some
Speaker 1: of the challenges that people face and the range of
Speaker 1: challenges that people face when seeking healthcare in general, and
Speaker 1: one of those being communication and being able to adequately
Speaker 1: receive care and attention and explanations from their physician and
Speaker 1: This is something that you touch on in your chapter
Speaker 1: on the kidneys, some of the ways that doctors just
Speaker 1: aren't always the best communicators. Why do you think communication
Speaker 1: still poses such a challenge and there's still so much
Speaker 1: room for improvement.
Speaker 2: So I think in the UK, the primary difficulty is
Speaker 2: one of the resource of time. So in our NHS,
Speaker 2: which is free at the point of access and kind
Speaker 2: of on its knees now as a system which is
Speaker 2: just totally overrun with need and insufficient resources to meet
Speaker 2: those needs. I genuinely think that if hospitals and medical
Speaker 2: schools could take whatever paltry funding they have that they're
Speaker 2: diverting into communication skills courses and just somehow enable that
Speaker 2: to manifest itself as a couple more minutes per consultation
Speaker 2: for each doctor, a lot of the communication problems would disappear.
Speaker 2: So I think, you know, if you can imagine, like
Speaker 2: if you were trying to talk to your partner about
Speaker 2: being unhappy in the relationship, or you know, talk to
Speaker 2: one of your kids about their drug problem or whatever,
Speaker 2: if someone said you've got ten minutes to do that,
Speaker 2: it would be absolutely impossible. And yet that's what doctors
Speaker 2: and nurses are expected to do with highly complex patients
Speaker 2: who they've never met before. It's just totally extraordinary. So
Speaker 2: I think time is one thing. I think the other
Speaker 2: thing is we have such an embedded kind of distance
Speaker 2: in the way that we're taught as doctors, the kind
Speaker 2: of ancient ways of treating patients from on the other
Speaker 2: side of a desk, from above. You know, if you've
Speaker 2: got through medical school, you're someone who's really good at
Speaker 2: learning facts. You're probably someone who's come from a pretty
Speaker 2: advantage background with all the assumptions that go with that.
Speaker 2: And I just think there's still such a distance between
Speaker 2: doctor and patient so much of the time, and you know,
Speaker 2: that's a really complex thing to fix. But I think,
Speaker 2: certainly in my own experience, I think having become a patient,
Speaker 2: and perhaps more importantly, the mother of a patient, I
Speaker 2: have just really experienced now how awful it feels to
Speaker 2: be in a doctor's room or in a hospital where
Speaker 2: you're terrified, you feel like no one is listening to
Speaker 2: the thing that you need them to know, and this
Speaker 2: kind of awful sense that you somehow have to kind
Speaker 2: of behave yourself in order not to irritate the people
Speaker 2: who you need to look after you, and I think
Speaker 2: a lot of those problems are probably quite British problems
Speaker 2: and quite entrenched in the fact that our healthcare system
Speaker 2: doesn't involve any exchange of money in the way that
Speaker 2: it does in other places. So it's almost as if
Speaker 2: any motivation for a doctor to be nice to a
Speaker 2: patient that might have anything to do with patronage or
Speaker 2: reputation that doesn't exist here. And so in a way,
Speaker 2: all you're left with is these very overworked, exhausted healthcare
Speaker 2: providers who are just going to get paid what they're
Speaker 2: going to get paid regardless. And yeah, I just I
Speaker 2: think the dual problem of this kind of culture of
Speaker 2: superiority combined with real time deprivation is the problem of
Speaker 2: communication between doctors and patients.
Speaker 1: Now, I think it's also not helped by some of
Speaker 1: the as you kind of touched on, this entrenched way
Speaker 1: that physicians see patients, where we've incorporated more quantitative tools
Speaker 1: to assess a patient's condition, or you know, we have
Speaker 1: these scans, we have blood tests, we have all of
Speaker 1: these these ways to look at the individual parts of
Speaker 1: a patient that can sometimes then make a doctor lose
Speaker 1: sight of the person as a whole, not just as
Speaker 1: a patient or as a patient's body part. What role
Speaker 1: do you think that plays, and how can we maybe
Speaker 1: strike a better balance between using these quantitative tools not
Speaker 1: just as something that's shaping the entire narrative.
Speaker 2: Yeah, it's really tricky, isn't it. I mean in an
Speaker 2: area like, for example, psychiatry versus neurology. I mean, that's
Speaker 2: quite interesting. Those two specialties were the same specialty until
Speaker 2: the late nineteenth century, early twentieth century, and then as
Speaker 2: neurology became I guess a more sort of objectifiable form
Speaker 2: of medicine, it kind of split off. I mean interestingly,
Speaker 2: Freud I think, was a neurologist to begin with, and
Speaker 2: then became a psychiatrist. And once he started, you know,
Speaker 2: developing ideas of a kind of psychological and psychiatric self,
Speaker 2: those two things split. And now we're in a situation
Speaker 2: where as you say, the quantitative tools that have gone
Speaker 2: so far with neurology have given people with neurological conditions
Speaker 2: a kind of status in a way that is very,
Speaker 2: very different from the continuing stigmatized low status of psychiatric patients.
Speaker 2: And I think it is really interesting that, you know,
Speaker 2: if you think the brain is the site where schizophrenia,
Speaker 2: bipolar depression, you know, all that stuff is coming from there,
Speaker 2: and the brain tumors and all the neurological stuff. And
Speaker 2: yet I know from my own experience one of my
Speaker 2: son had a brain tumor. You know, it was an
Speaker 2: awful time. But you couldn't imagine a situation where people
Speaker 2: would be nicer than a children's hospital with a brain tumor.
Speaker 2: But by comparison, I have a very close family member
Speaker 2: who's been very acutely psychiatrically well for a long time,
Speaker 2: and I've walked through that path with that family member,
Speaker 2: and all there is is stigma and low status. You know.
Speaker 2: It's and that is because I think because there isn't
Speaker 2: a scan that shows what the problem is in a
Speaker 2: way that kind of makes it easy to delineate. And
Speaker 2: also I think when we can't find it's the same
Speaker 2: with all these conditions where there's a little controversy over
Speaker 2: whether the condition is a so called functional condition or
Speaker 2: an organic condition. There's something that kind of brings out
Speaker 2: the kind of nasty playground thing in us that is
Speaker 2: to do with kind of this idea of a person
Speaker 2: faking something or like why are they saying they have
Speaker 2: these symptoms when there's nothing to correlate them with. And
Speaker 2: so I think there is that problem in psychiatry that
Speaker 2: because it's all in someone's head, so to speak, we
Speaker 2: can't kind of corroborate it in the ways that we
Speaker 2: seem to need to.
Speaker 1: You mentioned this really terrifying medical ordeal with your son,
Speaker 1: and you begin that chapter on the brain by asking,
Speaker 1: you know, did I think being a doctor would protect me?
Speaker 1: And you discuss some of your roles as mother, as surgeon,
Speaker 1: as patient yourself. How did those roles intersect during that time.
Speaker 2: Yeah, I mean it's so interesting. I try very hard.
Speaker 2: Because a friend of mine who first came to see
Speaker 2: us in the emergency department when we first realized that
Speaker 2: my son he'd had headaches, and then they did a
Speaker 2: scan and they discovered he had a map quite a
Speaker 2: large mass in his brain. So, in that awful early
Speaker 2: stage of realizing something was wrong, a friend of mine,
Speaker 2: who was an edy doctor, said to me, just be
Speaker 2: a mother here, Like, that's my one piece of advice
Speaker 2: to you is don't try and be a doctor, just
Speaker 2: be a mother. And I kind of tried to do that,
Speaker 2: but I also feel in all honesty that there were
Speaker 2: certain moments in that journey where the fact that I
Speaker 2: was a surgeon helped me advocate for him in a
Speaker 2: way that I think actually did make a difference. I mean,
Speaker 2: I'll never be able to say whether it was a
Speaker 2: life or death difference, but there were definitely a couple
Speaker 2: of junctures where I was able to say to a
Speaker 2: system that was not acknowledging how serious something was. You
Speaker 2: know that I'm saying as to you as a mother,
Speaker 2: as a surgeon, and with this other surgeon friend of
Speaker 2: mine who's my kind of backup plan guy. So there
Speaker 2: was a weird braiding of mother with surgeon in that time.
Speaker 2: And I think if the healthcare system had been perfect,
Speaker 2: I would not have needed to be a surgeon at all.
Speaker 2: And I certainly I was astonished by my lack of curiosity,
Speaker 2: like about the actual surgery my son had and about
Speaker 2: the particular he ended up when they finally found out
Speaker 2: what it was, because they thought he had something called
Speaker 2: a medulla blastoma to begin with, but he actually had
Speaker 2: a cavanoma, which is an abnormal cluster of blood vessels
Speaker 2: in his brain. Once we knew what it was and
Speaker 2: that he was going to have surgery. I amazed myself
Speaker 2: with how like I did no research. I didn't go
Speaker 2: on Google, I didn't look anything up. I said to
Speaker 2: my family and friends, I don't want anyone telling me
Speaker 2: anything outside of what the surgeon looking after him tells me,
Speaker 2: Like he is my source of information and that's all
Speaker 2: I want. So I really did the opposite of what
Speaker 2: I do as a writer and a doctor in other circumstances,
Speaker 2: which is to cast my net as wide as I can,
Speaker 2: you know. But it was a very I mean, we
Speaker 2: were very lucky because he came out of that surgery,
Speaker 2: he's recovered, he's fine. It's given me a lasting feeling
Speaker 2: for any patient who is in a situation where they
Speaker 2: are completely terrified. And I don't think i'd realized before
Speaker 2: that happened to me. You're not in your right mind
Speaker 2: when you know, I mean, never mind that you're not sleeping,
Speaker 2: you're like you're in an altered state. And the way
Speaker 2: that I am with patients now when they're in the
Speaker 2: early stages of discovering something very shocking, is completely different
Speaker 2: than it was before in view of that. So, you know,
Speaker 2: I'm grateful to have learned that, and I sometimes feel
Speaker 2: I feel a little bit ashamed of the young doctor
Speaker 2: I was. I don't think I was harsh, but I
Speaker 2: think I was very disconnected, almost as if by being
Speaker 2: a doctor. I don't know, I had some kind of
Speaker 2: I mean, I can't ever have actually been that stupid
Speaker 2: is to think that that was going to protect me,
Speaker 2: But in a weird way, I think I did think
Speaker 2: it was protecting me.
Speaker 1: Throughout your book, you also discuss you interspersed correspondence with
Speaker 1: some of your physicians and recollections about your own heart condition,
Speaker 1: and you end the book with a chapter on the heart.
Speaker 1: Would you mind sharing a bit about sort of the journey,
Speaker 1: sort of how you decided to intersperse those, and then
Speaker 1: why you decided to end with the heart.
Speaker 2: Yes, so all the way, as you say, all the
Speaker 2: way in between the organs, I have these little fragments
Speaker 2: of clinical evidence in a way from my own heart condition.
Speaker 2: I've got mutual valve regurgitation, so one of my heart
Speaker 2: valves doesn't work properly and it's getting worse. At some
Speaker 2: point on need to have open heart surgery for that.
Speaker 2: So that was all kind of happening while I was
Speaker 2: writing this book, And really what I wanted to convey
Speaker 2: by interspersing these little kind of emails from doctors or
Speaker 2: little kind of moments of almost like clinical text is
Speaker 2: present to the reader, this very profound textual difference between
Speaker 2: what happens when we tell a story and everything is
Speaker 2: perfect and has jeopardy and it has a kind of
Speaker 2: narrative arc and it goes up to a crisis and
Speaker 2: then it kind of falls away and wraps itself up,
Speaker 2: And on the other hand, the totally unshapely, inconclusive, disorientating
Speaker 2: experience of being a patient in the middle of a
Speaker 2: clinical story whose end you cannot predict. So someone who
Speaker 2: reviewed my book said something like they felt that these
Speaker 2: fragments in between were kind of a bit of a
Speaker 2: letdown because they didn't rise to a sufficient conclusion. And
Speaker 2: I thought to myself, well, no, like that's they're not
Speaker 2: meant to.
Speaker 1: Like.
Speaker 2: What I'm trying to do, in a way is almost
Speaker 2: destabilize my own narrative by saying, Okay, I've just written
Speaker 2: this chapter on the breast or the skin or the liver,
Speaker 2: and when you get to the last sentence, you'll feel
Speaker 2: a sense of satisfaction that I have closed that chapter.
Speaker 2: But here's the reality of me being in this body
Speaker 2: where there's just these few facts and there's all this
Speaker 2: space and all these questions that are not answered, and
Speaker 2: it doesn't go anywhere. It's like it doesn't end with
Speaker 2: me telling you what happens, because here I am, I
Speaker 2: don't know what's going to happen, Like my valve is
Speaker 2: still flapping around there with blood going in the wrong direction,
Speaker 2: and I don't know. I don't know what the end
Speaker 2: of the story is. And that's my experience of being
Speaker 2: in a body, and that's the way that I chose
Speaker 2: to tell it. So of course, at the end, I
Speaker 2: then thought, I need a heart chapter as well, to
Speaker 2: talk about some of the issues around really interesting new staff,
Speaker 2: to do with how kind of stress and emotion actually
Speaker 2: manifests itself in the tissues of our body, or the
Speaker 2: really shocking statistics around women and heart health, and how
Speaker 2: badly served we are currently in terms of our cardiology.
Speaker 2: So I thought, at the end of the day, I'd
Speaker 2: better provide that chapter, because there is all this really
Speaker 2: interesting stuff and if I just leave these fragments, it's
Speaker 2: like too big an organ to ignore. So I guess
Speaker 2: at the end it was like starting with a dead
Speaker 2: body and hopefully ending with this kind of integrated sense
Speaker 2: of an organ that is a pump but also the
Speaker 2: feeling center of ourselves.
Speaker 1: It touches on again this theme of honesty of this
Speaker 1: is the reality, you know, sort of this how you
Speaker 1: said there is no narrative arc to this, to your story.
Speaker 1: There's no narrative arc to any of our stories. If
Speaker 1: there is one, we've constructed it artificially. And that's fine,
Speaker 1: but that's not necessarily the reality. And I'm curious how
Speaker 1: you feel this honesty is or is not being accurately
Speaker 1: portrayed or acknowledged in science communication these days, or how
Speaker 1: we can all do better about incorporating honesty into science communication.
Speaker 2: I mean, that's such a big question, isn't it. And
Speaker 2: I guess it just really depends on sort of what
Speaker 2: area we're talking about. I mean, I think the introduction
Speaker 2: of AI and machine learning has been really really interesting
Speaker 2: in this regard, because now that AI is doing such
Speaker 2: a good job of data gathering and kind of synthesizing
Speaker 2: data in a way that you know, we used to
Speaker 2: have to do for ourselves just a few years ago.
Speaker 2: I think the lovely thing about that is it kind
Speaker 2: of puts more of an onus, on each of us. Actually,
Speaker 2: when we are communicating about science, to be doing it
Speaker 2: in a way that is not a way a machine
Speaker 2: could do, you know, in an authentic way, in a
Speaker 2: disruptive way, in a way that doesn't feel nice or comfortable,
Speaker 2: because the machine can do that stuff. So I prefer
Speaker 2: the messy truth, and I prefer it in I prefer
Speaker 2: it in lectures, I prefer it in books. I prefer
Speaker 2: it in movies, I prefer it in people. I'm not
Speaker 2: interested in the airbrushed version, but I am not like
Speaker 2: I don't think I'm in the main stream there. I
Speaker 2: think most people do prefer the polished version. So I
Speaker 2: don't know what we do with that.
Speaker 1: Well, I'm excited to see what you do next. And
Speaker 1: doctor Western, I just want to thank you for taking
Speaker 1: the time to chat with me today. This was so fantastic.
Speaker 2: Honestly, it was an absolute thrill for me.
Speaker 3: Aaron, thank you.
Speaker 1: A big thank you again to doctor Gabriel Weston for
Speaker 1: taking the time to chat with me. If you enjoyed
Speaker 1: today's episode and would like to learn more, check out
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Speaker 1: I'll post a link to where you can find Alive
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