Rebuild Your Life Around Friendship (Before It's Too Late): Vivek Murthy's Life Lessons

0:15Vivek Murthy.

0:30giant ideas to share the three photographs that would define their lives and the wisdom that they've accrued along the way so what would your three photographs be let's see i think the first one is actually a photograph that's hanging on the wall of my parents home which was taken when i was about six years old it's a picture of my mom dad and my sister and me shortly after we came to the United States. And it's a beautiful photo that reminds me not only of the incredible bonds that we built and still have with each other, that reminds me of how my sister has always been like a best friend and confidant, but also how my parents have supported me through thick and thin over a lot of hardships.

1:13But it also, to me, reminds me that we had then actually what we needed most in life, which was love and love that comes from beautiful, meaningful relationships. The second picture that's in my mind is one of my wife and my two children and I hiking in Marin County in California a few years ago. And that picture is striking to me because there's just a look of joy on our faces, joy of being in nature, joy of being together. And it reminds me just how powerful nature can be in our lives as a source of healing. But for me especially, I've realized as I've spent more and more time in cities and offices, etc., that I've lost some of my connection with nature, and it's what I want to rebuild.

1:59And the last picture is a picture of my family, my mother, my father, my sister, and my wife. This is before my kids were born, standing next to me as I took the oath of office when I first served as Surgeon General. And that was an extraordinary moment for me and for our whole family. but it was not an easy one. I had a very challenging process, you know, ultimately from being nominated by the president to being confirmed to serve in that role by the legislature, by the Senate. And that made that, you know, being able to serve all the more meaningful. But having them around me and just that moment was a powerful reminder to me that we don't always know where life is going to take us.

2:42I never thought I would be working in government or have any role in policy or an office like the Office of the Surgeon General. But life can take us in unexpected directions. And I realized at one point in my life that I needed to stop making five and 10-year plans. One, because I wasn't very good at them and often didn't stick to them. But two, because I realized that the most important thing to do for me was to be open to what life would bring and then to ask myself the honest question, like what would feel deeply meaningful to try next? It doesn't mean that I'm sure it's going to succeed. It doesn't mean I'm going to do it forever.

3:17But what would feel meaningful to do next? And then to take a step in that direction with courage and with faith. And that picture reminds me of that new unexpected step on that journey that I didn't just take alone, but that my family took together with me. What's that great quote from John Lennon? I think life is what happens when you're making plans, something like that. It's always resonated with me. it seems only fitting on a podcast talking about loneliness that we ask you when have you been most lonely in your life and why you know I've I've struggled with loneliness at different points in my life a lot as a kid who was pretty shy and introverted and it was tough to make friends at school I wanted to and once I did things were were good but it took a long time to get there and often didn't want to go to school as a result I faked having a stomach ache often And so my mom would let me out of going to school.

4:10I still haven't told her that. I fake those stomach aches, but she might learn it if she listens to this podcast. But as an adult also, I have had periods where I struggled with loneliness. I think one of the toughest ones for me was after I finished my first stint as Surgeon General, when my time in office ended, suddenly I was left without the community that I had worked with for a number of years. And I had made a critical mistake along the way, which is that I had neglected to really stay in touch with close family and friends during those years I was serving. And it was a mistake on my part, for sure.

4:46But I told myself this story that may feel or sound familiar to folks who are listening, which is I said, you know, I only have a limited amount of time to do this job. Let me just put all my time into this, and then I'll catch up with everyone else after it's over. And, you know, I would say that after one deadline, after another project, and things would roll on by, and two and a half years will go by, and I didn't. I lost touch with a lot of people. So I come out of office feeling like I have no community at home, no work community. And thankfully I had the support of my wife and my parents and sister.

5:19But I felt a real lack of purpose as well. I didn't know what to do. I didn't have a sense of identity at that point. And I felt embarrassed about that. I felt like who am I to complain about this? I've had so many privileges in life, And I also felt embarrassed to have lost touch with close friends. And I didn't feel like I just all of a sudden picked up the phone and called them and asked for help when I hadn't exactly been there for them for a few years. So that was a period of really intense, intense loneliness. And there were two things that helped break it for me. One was I had a friend who I ran into one day up in Boston who said to me in her very characteristically direct way, which I love about her.

5:59She said, Vivek, your problem is not that you don't have friends. your problem is you're not experiencing friendship. She's like, if they're, if you reached out to some of the friends in your life, they would want to be there for you. You know, if you said, Hey, I'm sorry, I wasn't there for you. They would understand. Um, but you need to reach out because you have friends and you can experience friendship, but only if you choose to. And the second thing that happened that was very powerful is thanks in part to her suggestion. I did reach out to a couple of friends and two of them I ended up seeing at a retreat that I was at.

6:32And we actually blew off a few of the sessions and just took this walk around this lake that was at the retreat center. And we realized that all three of us were struggling with loneliness and were feeling a bit lost in life. And we made this decision in that moment that we were going to form a Moai. This is an old Okinawan tradition where young people are brought together early in life and they're told, okay, going forward, you're going to be a Moai, a group where everyone has each other's backs. Whatever comes up, health issues, financial issues, other issues, you've got to be there for each other.

7:03And so we decided we are going to form a Moai, and that meant taking our friendship, which was really implicit in a lot of ways, and making it explicit. So we committed to once a month video calling each other for two hours once a month and making sure that we were not distracted by anything else during that time. We also committed to talking about what really mattered during those calls, including the stuff maybe we were embarrassed about, whether it was our fears, our health concerns, our failures, our family, whatever it was. And then finally we said, okay, in between those calls, if something comes up, a moment of joy we want to share, or we're really worried or anxious about something and we're not sure what to do, that we would just reach out to each other via text and then maybe get on the phone if it was something urgent.

7:46and that Moai, I'll tell you, changed my life over the next few years. And there was one moment in particular where I was thinking about taking a job that had been offered to me. It was a very prestigious job. And for somebody who didn't have a sense of direction or identity at that time, and who was struggling with my own sense of self and self-esteem, having a prestigious job offered to me, I was like, oh my gosh, yeah, I should just take this. And I called my two Moai brothers, and I said, who are Sonny and Dave, and I said, hey, amazing news. I just got this great opportunity. I think I'm going to take it.

8:19Let me just tell you about it. And I told them and they listened. And at the end, they said, you're saying all the right things, but it feels like you're trying to convince us something's missing here. And I was really kind of annoyed at them at that point, because I was like, oh, if they just said yes, you can sign off on it. We could have just moved forward. I would have had the certainty I needed. But what I realized after talking it through with them is that they were right, that this was a job that would have been great to get, but not great to do. And I would have been unhappy years later.

8:47And so I ultimately said no. And because I said no, all of these other things opened up in my life. I was able to write a book about a subject I deeply cared about, loneliness. I was able to spend the first year of the pandemic actually working out of Miami, where my parents and sister lived, where we could all be together as a family. I was able to say yes when then Vice President Biden reached out and asked for help with this emerging pandemic, COVID, before he took office. So all of that happened because I said no, but it wouldn't have happened without my MOI. Very striking there, your ability to talk about being lowly.

9:22And I think that's interesting, because I think one of the problems is it's still, there's a lot of stigma around admitting that you're lonely. And that was something you were able to get around. But I want to ask you about, you're quite unusual, because you did the big job, the same big job, twice you had a second bite at the cherry and you talked a little bit there about the ways that you didn't do it right the first time at least in terms of your own mental health and loneliness and spending too much time at work and not enough time on on friendship and family perhaps how did you try and fix a second time around were you successful and then i'd also love to ask about your second abrupt exit and how that impacted yourself and basically were you able to protect yourself mentally in the way that you struggled to the first time that's such a good question and And this is actually the question that my wife had for me when the president asked me to come back a second time.

10:13And we knew that if I was going to do this again, that I needed to do it differently. So I made it a point during my second term to, number one, stay in better touch with friends. And one of the simple things that meant, guys, is that when friends called, I would pick up. As simple as that seems. Like a lot of times what I would do before is if I was busy or something, I would just silence it. I'll just call him back later when I have time, and that date would never come. But I decided it's better to just pick up the phone. And even if it's just to say, hey, it's so good to hear from you. I'm about to walk into a meeting or in the middle of something.

10:44Is it okay if I try you another time? Even that 10, 15 seconds of hearing each other's voices would make a difference and help us feel more connected. The second thing that I did is I tried to protect some key spaces with family. So my wife and I would drop off our kids together at school each morning that I was in town. And in some ways that almost like I think maybe to some of the other families, school felt like inefficient. Like, you know, usually you split these things up. One person does drop off. The other does pick up, et cetera. But it was a time for us all to be together. That was actually the great joy of it.

11:17And I built my life around that so that I could I would sometimes start calls really early. I'd wake up at four in the morning and I would work then, you know, before my kids got up and get them ready for school, take them to drop off, and then I would start my meetings after that. So I made it a point to prioritize that, dinner time and key events in the kid's life. Like the kid's head would have this mystery reader day, for example, where a parent was allowed to come in and tell stories to the classroom. And I made it a point to do that, for example, even if it meant rearranging things. So I think just being very intentional about protecting time with family, about protecting time with friends, about reaching out to friends.

11:53Because here's the other thing about friends. I would sometimes in the past feel bad about just calling a friend if I had five minutes when I was like walking to work because I feel like, oh, that seems like rude. I'm just like only have five minutes to talk to them. I should wait till I have more time. But what I realized is that for both of us, we felt better just talking for five minutes. So if I just called and said, hey, I'm just on the way to work. I just was thinking of you, wanted to check in. That felt so much better than waiting for months and months and having names on the list that grew longer and longer of people that I needed to call, but ultimately was never able to.

12:27And I should just tell you lastly that the result of all of this was that I actually think I was a better search in general for the country. I think I was better at my job because that important source of fulfillment that we all need in our lives, our connection with each other, I felt I had so much more of that the second time around than I did the first time. So yes, it had to be intentional about it. Yes, it required an investment of time and energy, but my god was it worth it both for my own fulfillment and then ultimately even for the quality of work i did well that's great to see you leading by example showing that success and connection can uh can go hand in hand you've been uh risen to the top of the field in in two distinct fields medicine and government both incredibly competitive what do you think it is about you that's allowed you to succeed in the way that you have and you're not allowed to be modest you're not allowed to be modest here we want full bombacity in the answers yeah let's see well i think one of the things that i had to let go of was this attachment to the path i had in my head that my life was going to take um you know i had a certain ideas of what i thought i was going to do and but i had to at some point it was you know during my residency training and the years after i sort of realized that it was causing more stress in my life to try to adhere and force myself down a certain path, then it was probably worth it.

13:56And so I had to let go of that. And number two, get comfortable with uncertainty, with not always being clear on where I was going, what my direction was, and being patient about exploring opportunities, talking to people even when I wasn't sure where it was going to lead. So that's sort of one thing I think that helped me. I think the second thing that helped me was is just understanding fundamentally that every field, whether it's government, medicine, business, at its deepest level is relational. Like when I came to learn about the world of Washington, D.C. and politics and policy, et cetera, ultimately people still rely on their relationships with each other to know could they trust certain information.

14:42If they took a certain vote that was hard, would others be there for them? That was all based on relationships. The same I was finding was true certainly in medicine. And so I tried to keep that front of mind. You know, there was a, I tried to invest in relationships, not purely for utilitarian reasons, but tried to genuinely try to see in the people I worked with that these are folks who are more than their job. They're human beings. I want to understand more about their families, about their paths. And I think those stronger relationships helped me ultimately to do more. But lastly, I think also that one of the challenges, I think, in these different fields is they each have their own currency.

15:20Like in politics, that currency is power, right? And in medicine, especially in academic medicine, the currency is publications, promotions, and prizes. Like each field has sort of its own currency. but because in part I wasn't looking to build a whole life and career in one of those fields I felt less attached to those currencies so in DC for example when I was serving as Surgeon General like I wasn't serving there so I could get to the next rung so that I could then you know run for you know elected office or do it wasn't like part of some path I was happy doing that job I wanted to do the best to the best of my ability and then I would go and do something else and I didn't know what that was going to be.

16:04But I actually think that gave me a certain freedom to be able to take risks, to be bold. And I would always tell my team, you know, when we had a big issue that we were going to take on that I knew was going to mean that, you know, special interests and others were going to oppose us, including certain policymakers, I would often tell them, what is the worst that could happen? The worst that could happen is that I get fired. And if I get fired, it's okay, I go and I'll do something else. But I'm not looking to like, you know, to build a whole career, like in the world of policy and politics. So I think that that gave me a freedom to be able to take risks.

16:38And ultimately, it was in those areas that I took on that were, you know, higher stakes that I feel like I was able to make the most contribution. Love that. Great power in that. Vivek, one more question for you before we wrap it up. It's a medical trade-off, both at the society level and the individual level, I want to ask you on behalf for the listeners alcohol versus loneliness so it strikes me we were talking about male loneliness and you know the time-honored tradition of of the way that men down the centuries have avoided loneliness is you know go and drink together and have a few drinks in the pub in the uk or or wherever else around the world clearly alcohol consumption is falling through the floor and there are lots of very good uh reasons for that and it's clearly very good for your physical health Do you think it's bad for society's mental health that men in particular are not getting together and having a drink?

17:29I think it is bad for men's health that they are not getting together. I think whether or not that involves their drink or not is actually an open question. I think there are ways to get together that don't have to involve everyone having to drink. Let me caveat this by saying that I think if people have a drink of alcohol every now and then, And like, that's their choice. Their risk of that from a physical health standpoint of an occasional drink is relatively low. But I do think that having to rely on alcohol as a social lubricant, I don't think that that's a healthy dependence for society to have.

18:06Look, there are times, as you know, having taken care of many patients over the years who've used a range of substances, Patients would often tell me that smoking was often helpful for them. Within social situations, they would get together with buddies and smoke. Smoking was relaxing as well. It helped de-stress them. That didn't mean necessarily that smoking was a good justification for gathering, or it was sort of the price, if you will, of smoking was worth it to enable them to gather. So I think that what we have to do with alcohol is ask ourselves, Why is it that we, in some cases, feel that we are dependent, like on alcohol, together?

18:49Again, occasional use is, you know, risk is quite low. But I worry about the message we send, especially to young people, and when we tell them that they need to depend on an external substance in order to get comfortable enough to be themselves or to have a conversation. What we should be doing instead is figuring out how do we enable young people and all people, really, to build the social muscle and skills that they need to be comfortable. You know, I was just at a university recently, just a few weeks ago, in fact, and the students there told me about the sense of fear and, one will use the word terror, that they feel when they walk into the cafeteria on campus, because they're going to have to sit next to somebody they don't know and talk to them.

19:35And I asked, how do you deal with that? One said, well, I just really try to practice what I'm going to say, you know, to somebody who I sit next to, like, many times before I actually go in. Another said, well, I try to make sure my friends come with me so that I don't have to interact with a stranger. And the third student said, I just avoid going to the cafeteria altogether. I think the wrong answer, you know, or message to send to those students would be, for example, well, you need to take something to make you comfortable before you go to the cafeteria. I think the right thing for us to ask is how do we help them build those skills so they can walk into any scenario, whether it's a party, whether it's a job interview, whether it's a cafeteria on campus, and feel like they have the ability and the comfort to be able to say hello, to start a conversation, to share, and to ask people thoughtful questions that can lead to good conversation and often great friendship.

20:25I think that's much wiser advice than go and have a drink. And this has been an absolutely fascinating and eye-opening journey through a world which I think is pretty poorly understood, actually. And giving us and our listeners insight into this loneliness epidemic, I think, is super interesting. And maybe just to close, I'd love to ask you, you know, you were a surgeon general during the most significant health event of this century, most likely, during the pandemic. I certainly hope so. well let's hope so exactly and you know so you would have thought maybe your books would be about that topic and it's really striking to me that you could have written about and focused on so many different things in health but you did choose loneliness and that's been your big thing ultimately why did you make that decision why does this matter so much to you Tommy I think fundamentally I think what I've realized in the course of my own life and in the course of taking care of patients and being so privileged to meet so many people around the world in the course of my term as Surgeon General, is I've realized that if we really want people to be fulfilled at a deep level, if we want to address some of the deep polarization we're seeing in the world, if we want our kids to be able to lead a life where they can be happy and healthy, that that can't happen without having healthy relationships.

21:47And the more I came to see the, not just how common this was, but how consequential it was for our health and well-being, the more I realize that this is an issue that we need to be talking more about, that we can't just try to put Band-Aids on the downstream consequences of loneliness. We have to get to the root causes and recognize that as human beings, we were designed to connect with one another, that we need each other the way we need water or food. And when we don't have water or food, we feel thirsty and hungry. When you don't have social connection, we feel lonely. and all three are essential for our survival.

22:25And so I've always been interested in getting to the root cause, the deeper root cause of what ails us. And in our lack of connection with one another, I found one of those deeper root causes. But I'll tell you what makes me hopeful and optimistic is that this effort to build a deeper connection, to live a connected life, this is not some effort to transform us into something we're not. This is fundamentally about coming home. It's about returning to who we have been for thousands of years, people who have leaned on each other, who have trusted each other, who have looked to each other during times of crisis and times of joy.

23:03And that's what we're called to do right now, because we need to do it for ourselves, but we also need to do it for the next generation, for the kids today who are struggling with loneliness and other mental health concerns, who look about them and don't necessarily have a point of comparison, pre-digital, for example. They don't have a world that was more connected that they can look to and say, ah, things can be better. They're worried that this is perhaps the best that it can get. But I know that at a time of great despair, where people are looking around the world and they're seeing all kinds of challenges, and they're worried, do we have what it takes to get through these?

23:40One thing I know for sure is that when we're alone, even the most ordinary of challenges can feel overwhelming. But when we are together up against whatever difficulty may come, we have a fighting chance. In fact, I would say we have a good chance. And history has told us that, that in the face of insurmountable odds, and when people come together with common purpose and common hopes, that they can achieve extraordinary, if improbable, things. And that's what we're called to do now. So I want us to not, as we look for hope, to not necessarily feel like we have to look for hope in a specific policy that's passed or in a specific politician who's elected or a specific program that's enacted, we find our hope most reliably in each other.

24:28In the neighbors in our community who are stepping up to help other neighbors who lost their job or fell ill. In the kid on the playground who reaches out to help another child who fell down because they know that their instinct is to be empathic and to be kind. We find hope in other parents who step up each and every day all across our world to help kids who aren't their own. Because they know at the end of the day that one of the most sacred things that we can do is to take care of our kids and make sure that their future is bright. And so that is what gives me hope. You know, we may not see on the newspapers and the headlines and media, you know, stories like this.

25:09We hear mostly about the pain. But that, I think, obscures a deeper truth, which is that at our hearts, we are not mean-spirited and cruel by nature. We are kind, we are empathic, we are loving. And that is our source of strength. It's not a source of weakness. It is our greatest source of strength. And this is our time to wake up to that, to embrace that, to approach each other with that kindness, that compassion and love, to model that for our kids and to recognize that that is how we will build the bonds with each other that will allow us to overcome even the greatest of challenges that we face today.

25:48Beautifully put. Well, thank you for sharing your story and your wisdom with us today, Vivek. Well, thank you both for having me. I really enjoyed this conversation. Likewise.