A Terminal Diagnosis Confirmed the Beauty of Life He'd Already Built | Dr. Bryant Lin

0:00Jonathan Fields: So two years ago, a chest x-ray showed fourth generation Stanford physician and med school professor Bryant Lin something abnormal. By the time additional scans were done, doctors had identified stage four lung cancer and then counted a further 50 lesions in his brain. His condition was terminal. And yet, as he told me, he considers himself the luckiest man on the planet. Bryant talks about it almost matter of factly and then explains why almost nothing about his daily life after that. actually changed. In our conversation, you'll discover why he refuses to look at his own survival statistics and what a friend actually told him instead that really helped.

0:39Jonathan Fields: You'll hear how he decided what to tell his teenage sons and why he chose complete transparency over protecting them from the news. You'll learn what made teaching a class about his own cancer, literally narrating his chemo in real time, feel less like a burden and more like an act of kindness, both towards himself and his students. And you'll hear his answer to what it actually means to live a good life, drawn straight from his own parents and apply to the time he has now. In addition to being a physician, Brian also is the author of Sunshine, a book about what happens when you focus on what really matters.

1:16Jonathan Fields: So excited to share this moving conversation with you. I'm Jonathan Fields, and this is Good Life Project. And we'll jump right in after this short break.

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4:29Jonathan Fields: When I see that, especially I'm so fascinated by the phenomenon of fourth generation physician, what was your journey into medicine? Was it just like, this is what was tracked from birth or did you kind of rebel and then come back? It's funny, you know, I like to joke around that my mother has some kind of brainwashing power, you know, so that all the physicians are on my mother's side. She's not a physician, but half of her brothers and sisters are and their spouses. And then I found out later, actually, after I was already a physician that my great grandfather went to the first medical school in Taiwan, Western Medical School in Taiwan.

5:09So, you know, Yeah, I've got this illustrious history, but I never grew up thinking I was going to be a doctor. Never. I was like, I like figuring out machines. I like computers. I want to be an engineer. I hated it. It was a soul-depriving experience for one year. It was unpleasant. And then I decided to go into medicine. So that's kind of definitely a roundabout route. Well, that was not me at all. I mean, what I loved about medicine was the people, working with people. So, you know, can't get closer to people than primary care. But yeah, no, and I've been in medical devices for 20 years as well.

5:50So I still, I've been lucky. I've been fortunate. I'm grateful. I've been able to kind of scratch all those itches, you know, work, do develop devices, create inventions, work on companies, but, you know, see patients and do everything I love. I've been lucky. I look back at my life all the time and I think about how lucky I've been.

6:10Jonathan Fields: It does seem like you were wearing multiple hats for so long. You have your primary care practice. And there's also this really strong, it seems like entrepreneurial impulse in you that says, okay, there's a problem. And I can also switch on my engineering hat and my problem solution hat in a different context. And maybe we can build something around that and scale the impact of what we're doing beyond the primary practice. Absolutely. I'm always looking to say, hey, how do I identify the problem? What's the need? What's the unmet need? Let's try to figure it out. Let's try to solve it. Of course, you know, you try something, maybe one time out of 10, you're lucky and you can figure out how to.

6:50But, you know, to me, the attempt is worth it. Right. I mean, you can help people. I mean, that's obviously there's this, you know, with entrepreneurship, you think about making money and definitely I thought about making money. It was not, you know, especially when I started young, you know, kids were coming, started to have kids and got to feed the kids. But, you know, as time went on, it really, you know, became more about the meaning of the role. You know, how do I have how do I help people in many different ways directly in clinical practice? But, you know, through inventions, through technology.

7:23And, you know, I'm happy that somehow I'm wired that way, I guess, to kind of think about, you know, if there's a problem, and how do we solve it?

7:31Jonathan Fields: Yeah. At some point you start teaching also Stanford Med School. What's the impulse behind that? I never thought of myself as a teacher. If you'd asked me 20 years ago, even maybe 10 years ago, and said, hey, Brian, you're going to spend a lot of your time starting new classes and teaching not just med students but undergraduates at Stanford, I would have said, eh, no way. Clinical teaching, yes. You know, we all doctors do that, right? You go through training, right? You teach med students and you get, you know, you learn from great mentors and and senior faculty. And I was the beneficiary of that.

8:10But, you know, I'd never thought I would be a classroom teacher. That was farthest from my mind. And yet somehow I got into it. You know, I think it was roughly about 10 years ago. I started my first class at Stanford and, you know, haven't looked back since I've started, God, maybe eight plus classes since then. And it's really been enjoyable to be able to take that different view of education and educating people. We do that with patients all the time. We're trying to relay what we know about medicine and teach them something. And we do that in the clinical setting with residents and students.

8:49But the classroom, I have to say, has been very satisfying to be in the classroom.

8:54Jonathan Fields: So you're building this life. And along the way also, you get married, you become a dad, you have kids. And practicing, researching, teaching, getting involved in consulting, it sounds like an incredibly full and rich life. 2018 was an interesting year also. Tell me if I have the timing right. I believe that's the year that you co-found the Stanford Care program. Take me into this. yeah it's it's interesting you know at the time i i had the same exactly what you said i felt like i've gotten to be able to accomplish so many things do many great things and i felt like it's time for me to give back you know i don't have many regrets in my life but i think looking back now maybe one regret i have is i should have focused on giving back sooner rather than waiting until 2018 or, you know, in a larger way.

9:52So it's interesting. I had a patient, he actually had a bad outcome from something I did. I gave him a drug, common drug called allopurinol for gout. So gout's a common problem. It's inflammation of usually one joint at a time, usually it's the big toe. And it's very painful, basically crystals deposited in the joint. And, you know, you can have these episodes, these flares, and if you get them too many times, we give you a medicine to try to prevent the gout. And I gave him this drug called allopurinol, a common drug, costs, you know, pennies, you know, very cheap, cheap, inexpensive drug. And I didn't know at the time that people of Chinese descent can have a severe reaction to this drug.

10:38And most American doctors don't know this. this patient of mine lovely gentleman you know and he's told me to share this story widely he had a severe reaction he ended up in the hospital he had to be put on high dose steroids so he was significantly ill he was in the hospital several days he didn't blame me he didn't say hey dr lin you you messed up right he didn't say that and he said hey i know doctors in the u.s don't know about this he's from taiwan He's like, I want you to spread the word. I want you to, you know, raise awareness that, you know, this can happen. And then I reflected and I said, well, there are a lot of things that happen to Asian, our Asian population that are unique or different to Asian Americans and Asians.

11:26And I said, hey, this would be a great time to start a center. So centers have a special place at Stanford. And usually they're started with, you know, a big grant or a big donation. We had none of those. We had a lot of spirit and hopes and a lot of support from everybody, from all the faculty, from the administrations. But looking back also just at my personal life, I realized later, I didn't think about it at the time, my grandmother died from a disease that disproportionately affects Asians, hepatitis B. So she had hepatitis B and liver cancer from the hepatitis B, and she died from that. And I never thought until maybe a couple of years after the founding, I was like, wait, there's something else in my background that led me to help start this center.

12:13So, yeah, it's been an amazing experience to start the center and help grow it. And the staff have been incredible. And, you know, it's part of my way of giving back, giving back to my community that's supported me. And that has been, you know, under-resourced, honestly, from a healthcare funding and research point of view. We always quote this source, Asians are, you know, 30 % of the Bay Area, 60 % of the world. But NIH funding is around 0.17 % of research. So hopefully we're moving the needle on that part at least.

12:50Jonathan Fields: Yeah. I mean, it is interesting. I think if you probably talk to the average lay person, the average person on the street, and you say, hey, think about any of the big scary diseases or conditions. And do you think they would affect any one population differently? Most people would probably say, probably not. I don't know. Isn't everyone just sort of equally at risk? So it's fascinating to hear that that's completely untrue, that, you know, like that, in fact, there are very different risks for different populations. Yeah, absolutely. I mean, you know, your background, your family history, obviously, we all know family history is important.

13:31But, you know, the genetics come from the group of people you're from. Right. So, you know, we have shared genes across those racial ethnic groups. And, you know, there's all sorts of issues that can disproportionately affect Asians and other groups. So we know that in other groups like African-Americans with prostate cancer. So, you know, it's not just Asians. It's many different groups.

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16:37Jonathan Fields: This is what your life is looking like. You've got so much going on. It seems like there's so much purpose, so many beautiful relationships in your life and a very full, abundant life. We come into May of 2024 and everything starts to change for you. Take me there. Yeah, I remember this distinctly because my son was a junior. It was the spring of his junior in high school, and we were going to do college touring, right? Like every family does. So we said, you know, he really wanted to stay in California. So we said, hey, let's drive down to Southern California and visit a bunch of colleges. And I had a cough at the time.

17:18And then, you know, I remember walking on the college tours and being like, God, it's kind of like not easy to get around. I'm coughing and maybe a little bit, you know, uncomfortable. and uh you know we drive back and uh get it doesn't go away you know and kind of get tired and luckily i'm in primary care my primary care doc is like two doors down from me in the office so i have the ultimate access his name is dr paul ford he's been at sandford for 30 plus years and you know i say hey paul you know this i've been coughing i've tried you know flonase zyrtec Claritin. So we tried some inhalers, you know, maybe it's asthma from allergies, didn't work.

18:02Tried albuterol, tried a steroid inhaler, didn't work. And finally, he gave me some antibiotics, you know, after several weeks of this, didn't work. And then it was a Tuesday late May, you know, went to get a chest x-ray. And of course, at this point, I'm like, it's going to be something bad. It's going to be something bad, right? So get the test x-ray and it's abnormal. I've got this kind of white area, maybe lymph nodes enlarged.

18:30Jonathan Fields: As a physician, when you just see that, our bell is going off already. Oh, yeah. Yeah. So you think it's a weird infection or it's cancer. Those are the two things you think about first, especially in a guy. I was 49. I'm 52 now. I was 49 at the time, I'm, you know, otherwise healthy, not on any medicine, nothing like that. So I'm like, oh, geez. So, you know, I order a CT scan. It's a Tuesday chest x-ray, Wednesday CT scan. I get it, and there's a big white patch. It's like 8 centimeters by 5 centimeters. Huge, huge white patch. And, again, lymph nodes. And, again, the radiologist says, geez, it could be some weird infection or cancer.

19:13and you know by then I'm like uh geez I hope it's some weird infection I'm like praying for the weird infection and then I get a bronchoscopy so that was a Wednesday the Friday again I'm very privileged I've worked at Stanford for 20 plus years and you know I can call people I know they get me in on a Friday I get a bronchoscopy to get a biopsy so it's they go through it's like a you know fiber optic scope sort of like the colonoscopy but it's for the lungs and they do a biopsy and then slowly over the weekend, you know, the results come back. All the infectious tests are negative, negative, negative.

19:49On the Monday, I get the result and, and it's, it's, they did like six biopsies, you know, six needle passes and, and each one said, you know, metastatic, you know, non-small adenos, non-small cell adenocarcinoma of the lung. So, So, yeah, it was just, I was hoping for something else. I was hoping even for a different cancer. I thought, oh, lymphoma is a better prognosis than lung cancer. Yeah, and I mean, of course, I was crushed. It wasn't an immediate, because I kind of knew it was going to happen, right, over the week. It was in the back of my mind. And obviously, I knew about lung cancer in Asians, something my center's been, you know, supporting for eight years at that point.

20:36So, yeah, it was it was it was immediately went to the stages of grief. You know, in med school, we learn about the stages of grief. But, you know, until you experience them to this degree, you don't appreciate how rapidly they can cycle and turn and go in different orders. And, you know, it's incredible. You know, probably not so much. Some depression, you know, bargaining, not so much bargaining, anger, some anger, you know, denial, definitely some denial. And, you know, definitely acceptance. Luckily, it came quickly, took a couple of weeks, during which I finally came to acceptance of my diagnosis.

21:21And part of that's because I later got, you know, more data, more information spread to my brain, 50 spots on my brain. Poor radiologists. I kind of always joke around. Never seen the radiologists count 50 of anything. Poor radiologists. I kind of felt bad. 50 spots of cancer in my brain. And, you know, spread to my bone, to my liver, my adrenal glands. It was all over. I was just lousy. I even had little lumps under my skin that I could feel that actually had the pathologist needle biopsy and aspirate. And they were cancer. They weren't lymph nodes. They were like pure cancer. They were just lumps of cancer under my skin.

22:06So I got my molecular testing back, which showed I had the classic Asian mutation. So Asians get this mutation called EGFR 50 % of the time if you're not a smoker. whereas other groups get it maybe 20 % or less of the time. That was a good thing because we have a treatment for that. So once I kind of got that news, I think that helped me because I knew there was a plan, there's a treatment that works at least temporarily. So that helped me, I think, arrive at acceptance through all those stages of grief.

22:39Jonathan Fields: You know, as you're describing this, there's a book that I've reread so many different times, When Breath Becomes Air by Paul Kalanithi. I had the chance to actually sit down and have a conversation with his wife, Lucy, a couple of years back. And I remember in the book, you know, when he got a diagnosis, and for those who haven't read it, you know, there's this sort of like brilliant rising neurosurgeon who gets a cancer diagnosis also. And he kept saying to his oncologist, he kept demanding on seeing sort of like what I can't remember the name of the chart, but like, what is the chart for life expectancy for me?

23:12Jonathan Fields: And his oncologist kept refusing to show him and saying like, that is not what we need to focus on. And I'm wondering where your mind went with that. Absolutely. Every doctor will go, these are like the survival curves, right? These are like the, you know, like on the Y-axis is like, you start at 100 % of people, they're alive, right? And the X-axis is time. And so, you know, of course it goes like this. And so you're like, how many people, you know, common thing in studies is like, how many people are still like, when are half the people still alive? So what's the average life expectancy? And for, and actually it turns out, yeah, I have the exact same kind of cancer that Paul Kalanithi had.

23:53That's the same type of lung cancer. I know his widow, Lucy, fantastic person. And yeah, it's kind of, again, ironic, same type of cancer, like specifically the same type of cancer. And no, absolutely. It's funny though. And I looked at them without a doubt. And, you know, you looked at the published data across all lung cancer. It's about a 12 % survival rate at five years, 12%. So, you know, one out of 10 people are still alive at five years with advanced lung cancer. So if you catch it early, survival rates are much higher. I looked at those, of course. I knew those. I didn't even have to look, honestly.

24:34I mean, I still look. I knew the data. But it's interesting. I talked to a friend of mine from med school. he's a pulmonologist lung doctor he said hey why don't you talk to a buddy of mine he's also a pulmonologist but he had stage three lung cancer and i talked to him he was very nice and i talked to him he said don't look at the survival curves don't look at it it's not going to help you right because that's the average person you're not the average person right you could live longer you could live shorter you know for a in medicine we've got all this data in technology, but I can't predict things on a single person basis.

25:13So that helped me. I was like, yeah, you're right. It doesn't help me at all. It doesn't help my mentality. It doesn't help my spirit to kind of focus excessively on that number, which it may or may not apply to me, right? If there are a hundred of me, sure, you know, that'll be, that'll be the average, but doesn't say anything about me as an individual, what's going to happen. So, so that helped a lot talking to him and thinking about those survival curves, um, yeah, it really helped a lot to not, not do that and not obsess about it.

25:41Jonathan Fields: Yeah. But I could see the, you know, your brain wanting to say like, let me immediately get an understanding of what this looks like. Oh yeah, absolutely. And then the counter is, which it sounds like was so compelling to you, like that, you know, that's a cross section of a wide number of people. You are one person here, you know your unique individual outcome is going to be as varied as you are um so let's like just focus on you and on that so in in the weeks after that as you're processing this and sort of saying okay so this is what's going on as you described me like there is this identified treatment for it um so you start to you know like explore what are the treatment for um you make some really interesting decisions also, both about what you want to keep doing and not doing.

26:29It's, I would say funny. I don't know why I use that term all the time. It's not haha funny, but it's interesting. You know, I, I've always tried to live my life where I'm doing, you know, what I want to do. Right. And kind of nothing was more affirming that I was actually doing what I want to do than getting a cancer diagnosis, advanced cancer diagnosis, a terminal cancer diagnosis, theoretically, because stage four lung cancer is not considered curable. And fortunately, most of life didn't change, you know, because I was doing things that I wanted to do. I really did examine my life and said, hey, what can I cut out?

27:09What should I cut out? I did cut out some things. I had a lot of extra meetings and a lot of coffees, which, you know, I enjoy, but I cut those out, those kind of extra things. But, you know, I really still was working with CARE, Asian Health Center, still seeing patients, you know, still teaching in the resident clinics, still teaching classes. I was doing all these things. I was still also the Director of Medical Humanities and the Arts and still doing all these wonderful activities because they're so much fun. Like I found they're fun. They have a lot of meaning to me. Um, but yeah, I did, I did stop doing things which I felt like didn't have an endpoint, meaning there's no indefinite, you know, I did a lot of projects before that are indefinite.

27:59So I tried to stay away from projects that have no clear ending, except I made the exception for anything to do with lung cancer. So, um, early on, I didn't, it wasn't a conscious decision, but you know i thought hey i'm in such a position i'm at stanford i'm i'm you know a direct to center co-direct to center you know i i really need to put my story to work um to bring awareness that lung cancer happens to so many people number one causal cancer death in the country and the world uh and 20 percent of people who have lung cancer have never smoked you know a lot of people assume It's I've never smoked.

28:38I've never puffed anything in my life. I've smoked a lot of brisket, but that's about it. Yeah. So 20 percent. I wanted to raise awareness and to really push the whole field of screening, prevention and treatment so that I was like that can be open ended because that I, you know, I probably won't see the end of in my lifetime or multiple lifetimes. But, you know, that I wanted to put my story to work, you know, to see if it'll help people.

29:07Jonathan Fields: I mean, it's such an interesting moment, right? Because when you get a diagnosis like this and you have the time to let it settle, and then I'm sure conversations with your wife, conversations with your kids at some point, I'm sure there's this process of reckoning. you know like if i know that you know we all know that we have a finite time on the earth but you have a stronger sense that yours may be significantly less than you thought like a couple of weeks earlier what what do i want and so many people i would imagine hit that moment and they say like there are big changes that i want to make there's a whole bunch of things that have been centered in my life that i'm gonna jettison and there are a whole bunch of things i've been putting off that I'm going to start saying yes to.

29:51Jonathan Fields: It seems like you did that analysis and the vast majority of things you held onto, because it looks like you were looking back at your life and looking at the present life you had and saying so much of what I do is exactly what I want to be doing, which is incredibly rare. I do think I've lived my life to try to do that always. You know, I always thought, am I, even when I decided to go to med school, you know, I had many choices, I could have gone to engineering, business, I could have gotten an MBA. But yeah, I made the decision. I'm like, hey, if I went to med school and something would happen, would it be a worthwhile experience for me?

30:31And I thought, hey, it would be. It's just such a unique thing to go into med school and to learn about people and to talk to people from all backgrounds and to try to help them. And I think I've tried to live my life that way. I didn't really know until this diagnosis came out that it turned out, hey, I really, really am living my life the way I wanted. One of my colleagues and good friends, she said, hey, are you going to quit and travel the world and get your travel bucket list out? And I'm not that kind of bucket list guy. I'm like, here are the top 10 places I want to go in the world. I'm part of that.

31:14I'm lucky. I've been able to travel a lot, but part of that's, you know, I, you know, I think there are many things here, you know, with my family and, and with my work that I love doing and I've been privileged that, yeah, I, I've been able to do them and continue to do them.

31:33Jonathan Fields: There's also something that you added into this, something new that you added into what you're doing on the teaching side of things. Yeah. That was crazy. Right. But I want to wrap my head around this. Like, you're starting treatment. You're in chemo. You're like, okay, so I need to take care of my body. And then you're like, I need to share this in real time. Yeah. I looked up my emails because I'm like, God, it's all a blur, right? You look back and it's all a blur and I was feeling lousy. And I'm like, God, why the heck did I decide to start a class about my own case at Stanford? This kind of, I saw that I have a tool, my story can be used as a tool to educate students, to educate the next generation.

32:20I thought this was a unique opportunity. And, you know, I joked around, it's like, you know, I kind of have this mindset of turning lemons into lemonade, right? And another friend of mine said, well, maybe a better way to say it is to turn crap into fertilizer. So yeah, maybe that's better. um yeah so i thought geez i need to share my story what i'm going through because students don't get a lot of continuity in med school right you see patients kind of sporadically and you know you may see a patient for a few days or you know randomly over the a few months uh but i thought hey this is a great experience i can share what i'm going through in real time and they can learn from experts in the field.

33:09So it wasn't just based on my story. So we created this class called From Diagnosis to Dialogue, a doctor's real-time battle with cancer. And, you know, I said, hey, every class, 10 lectures, 10 meetings, I'd start with what's going on with me. So talk, share my experience, what I was going through with chemo, talk about my diagnosis. And then we'd invite a guest speaker who's kind of an expert in the area. but what I really wanted to do is not talk so much about the medical science, the clinical science. I want to talk about the patient experience because, you know, even though I'm a doctor, right, I knew, but I didn't know.

33:50And I wanted to really rebalance that experience to show that, hey, this is what's important to patients. So not only do we talk about diagnosis, epidemiology, treatment, you know, we talked about difficult conversations, talked about nutrition, talked about spirituality, talked about access to care, talked about gratitude, you know, so it talked about mental health. So really wanted to reposition and rebalance the story, you know, not away from medicine, but toward what the patient is feeling and going through at the time. And again, luckily, I'd worked with several students in the past, and we had three awesome student volunteer to be my free TAs, arrange the class, and it just came together wonderfully.

34:38But yeah, looking back, I'm like, wow, what was I thinking to do that, you know, to start that? But I think part of that was me also thinking, hey, maybe I'm not going to be around in six months, you know, so I'll lose this opportunity. Maybe this fall is the only time that I can share my story and to have an impact on students and what they're doing. So again, lucky it came to fruition.

35:06Jonathan Fields: Yeah. So it sounds like there's a real sense of urgency then because you really, things were so uncertain about your future. You sharing also your lived experience being on the patient side after so many years of being on the other side in the context of students who are trained to become doctors, hopefully most of them at least, right? I would imagine that was incredibly powerful, compelling for them. Have you had conversations with some of those students about how it affected them? Absolutely. I mean, they're, again, I'm privileged as a teacher to connect with them and to hear their stories.

35:45I was, maybe I shouldn't have been surprised. I was surprised by how many also came with their own personal experience of cancer, either in themselves or their family. And some of them, it was so powerful, that's what brought them into medicine.

35:59Jonathan Fields: Wow. You know, so, you know, I was very, you know, it just blew me away to think about these students who were, you know, vulnerable to me and sharing what was going through, what they were going through. And taking the class seemed to help some of them also deal with their own experiences. And that was unexpected. I didn't think that would be the case. And yeah, it was incredible. There was one student who shared with me his treatment as a teenager for blood cancer. And it left him with neuropathy, so numbness, chronic numbness of his fingers. And he was not able to play the instrument he loved so much.

36:44uh i mean he could play it but not to the level at which he was you know he very high standards he's kind of sounded like a very almost concert level uh performer um but you know he still enjoyed it he still found meaning in playing and even though those goals were not accessible to him anymore right for him to become a concert level musician you know he still enjoyed doing he still put in hours a day of practice. So yeah, I was, I was lucky to be able to hear those stories and, and how, you know, their sharing with me impacted me. Honestly, like I said, I feel like the students teach me more than, than I learned from the students.

37:23So yeah, it was a powerful experience. I think all around, everybody asked me, Hey, you taught it and it was recorded and it's on the classes on YouTube for, you know, through our continuing medical education office. And people people ask me, hey, are you going to teach it again? And yeah, it was very emotionally draining. I wouldn't teach it again. I think it was difficult to do. But now it's recorded. It's out there for posterity. I'm happy it's available.

37:50Jonathan Fields: Yeah. You know, because in moments like that, often the advice or the impulse is to go inward and say, I need to conserve everything. I need to do everything that I can to give my system everything that it's capable of harnessing to heal. I've heard you describe your decision to do this also as you were trying to be kind. And I remember hearing you say, it's easy to forget to be kind when you're sick. But equally, I feel like it's also easy to forget to be kind to yourself when you're sick. Yeah, in a way, it's interesting. So some students were like, are you creating this class? Is this cathartic for you?

38:31Is this part of how you're dealing with the cancer and creating this class? And I don't think so. I think, though, because it had so much meaning for me, to me, that was a kindness for myself. Like, I do find, yes, absolutely, I'm probably not the best at being kind to myself. But I do feel like it was so meaningful, so deeply, deeply meaningful, even though it was difficult, that it was a kindness for myself to be able to share my story and, you know, impact people broadly. So, yeah, I didn't view it as a task, you know, even though it was difficult, it was challenging. You know, I viewed it as something that I found, even if, you know, one person benefited or maybe zero, I found, hey, at least the experience was very deeply meaningful to me.

39:25Jonathan Fields: Yeah. And we'll be right back after a word from our sponsors. Your Life Project is sponsored by Vindid. So here's a question that I have been sitting with. how many things in your closet were bought for, let's say, a version of you who never quite showed up. Maybe it's the tailored jacket for the dinners you were going to go to or someday pieces with the tag still on them. They're lovely clothes. They're just not yours anymore. That's where Vinted comes in. So Vinted is a secondhand marketplace app where everyday people sell the clothes that they're not wearing to people who actually will. Listing on Vinted is quick and simple.

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41:15Jonathan Fields: Subject to credit approval, Apple Card is issued by Goldman Sachs Bank USA, Salt Lake City Branch. Terms and more at AppleCard.com. Good Life Project is sponsored by Bumbus. So my wife, Stephanie, has been one of the great gift givers in our family. And her secret is that the best gifts often aren't the flashy ones. So the ones that people reach for in any given day without even thinking about it. That's why so much of my list ends up at Bumbus. Fuzzy Sunday slippers for the friend who lives in sweatpants from November to March. Merino wool and cashmere blend socks for anyone who runs cold. That would be me, by the way.

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42:30Jonathan Fields: I know as we head into 2025 and then further into 2025, the cancer progresses to a certain point where you make the decision to close your practice, which had to have been hard. I really do miss it. I developed relationships, some for, you know, 15 plus almost. I mean, I probably have had some patients almost the full 20 years of my practice who stuck with me, you know, honestly. Right. It's a two way street. Your patient's got to stick with you and you've got to stick with them. Right. I was really grateful that so many people reached out and, you know, dropped off thank you notes and gifts and so forth, you know, for that that relationship that we developed over the years.

43:15I think that was incredible. And I was sad to lose that. You know, I still do see patients just with the residents. So they're not my patients. They're the residents patients. But once in a while, one of my old patients will sneak in to see me with the resident. And yeah, I miss it. I do miss it almost every day, you know, to be able to talk to people that I've known. And, you know, I've hopefully helped a little bit through thick and thin, you know, and, you know, medicine is a privileged profession. I think medicine to me is like medical profession and then maybe clergy. There's probably a few others where, you know, you're with people, you're trying to help people at the best and worst times of their life.

44:01Right. And people from all backgrounds. In one day, especially in the Bay Area, I can see somebody who doesn't have any housing in the morning and in the afternoon, somebody who's worth billions of dollars, and they could have the same problems. So that was an amazing thing to experience and to be part of. So, yeah, I definitely miss it. It was difficult to do that. But I felt it was a fairness to the patients because if I'm sick and not sick, sick and not sick, it's difficult for patients to get in, to be seen, to have continuity. So I thought it was much more fair to the patients to be able to, you know, have a new doctor.

44:42And so they can make sure they get in to see as opposed to waiting to see me, which, you know, if I'm not doing well, then it may take some time to get in. So I did it for me, but also for the patients so that they would have better care.

44:56Jonathan Fields: Yeah. It seems again, like there's this default to thinking of others in nearly every decision that you make at a time where there's also a lot of import to thinking about yourself. I mean, as we have this, so we're sitting here having this conversation, you know, as we wrap the summer in 2026 years, two plus years into the diagnosis. And as we're chatting, somebody might join us. They might listen to us. They might see you. He's radiant. He's energetic. He's funny. He's enjoying life. He's fully alive. And the brain is probably saying, how can he also have stage four metastatic cancer? Yeah, I mean, I love the name of your podcast.

45:42I mean, to me, that resonates with me. you know i feel like you know i say a bunch of things i'm like 99.999 percent of my life has been awesome i've lived a great not just a good life a great life right and this has been 0.0001 percent of that you know and you know i'm i'm i'm grateful that i've been able to live this life really not everybody was is able to but i do think part of it is you know perspective and attitude. But to me, you know, part of that's under your control. You know, if you have circumstances, if you're, of course, able to put food on the table and have a roof over your head.

46:25You know, I've been lucky that I have all these things and I've been able to live a great life. And every day I examine, I'm like, I look at my, I did it this morning. I'm like, oh, great. I have this podcast. It'll be fun. It'll be fun to do. Talk to Jonathan today. And, you know, but I look And sometimes I'm like, eh, I don't, that's not something that's going to, it's not going to be fun. I'm going to cut that out. You know, I try not to do it the last minute, but I do look at life more immediately. I think in the past, probably I would cut things out in the long term. But today, day to day, I'm like, geez, what should I do this morning?

47:03You know, I was like, oh, I woke up and was feeling good. And unfortunately, I recently had actually progression again. so I had to go through a month of chemo of radiation that chemotherapy radiation and I was feeling pretty lousy this past weekend I just finished my radiation on Friday and I have esophagitis because the radiation was in the chest and it can so I can't eat things but last night we went to we had a dinner set up for the residents so we have a little small group groups of residents that are assigned to us and I'm like I'm not going to miss that that's so much fun I enjoy that every time.

47:40We try to eat dinner with them like two or three times a year. It's so much fun. So we went to this nice restaurant. I really couldn't eat much because it felt like food gets stuck. And I was tired. Honestly, I was running a little low, but I enjoyed it. I didn't cancel. I didn't bail out. So I think about what's worthwhile. I think about that. But also, I look for the joy in life. I think, you know, too often it is easy to forget to look for that happiness. It's easy to wait for that happiness. Right. But, you know, I try to look for happiness in everything I do. Yeah. I don't want to wait for it.

48:20Jonathan Fields: Yeah. I mean, I'm inclined to say, you know, like, I wonder if what you've been through has changed that for you. But what the bigger story that I'm hearing you saying is it seems like this has been a part of your wiring for your entire life. but maybe it's just, there's an, there's an urgency behind it now that wasn't as strong before. Yeah, I think so. I think urgency is, is, is the right word for it. Yeah. I think the urgency to, to, you know, to really experience every minute, to, to live in the moment, you know, all these kind of hackneyed things you hear about all the time. It's true, but I love sitting in the backyard put my feet in the grass, read a book, you know, just reflect on life, to listen to the birds, to listen to the hummingbirds, the bumblebees.

49:05You know, so it doesn't necessarily mean I have to do something, right? Sometimes doing nothing is also just, you know, where I find my happiness. So I've been trying to do that. And luckily, I haven't had to cut out too many negative things. I guess my life has not had too much negativity so far.

49:23Jonathan Fields: Which is a powerful reflection of the choices that you had made before this moment in time. I'm curious, clearly you have two sons. And when you think about them, I'm sure when you're talking with your wife and you're trying to figure out how do we have this conversation with them? What do we share? What do we not share? How transparent or not transparent are we? Are you open to sharing some of how you've processed that? Yeah, absolutely. I think with my kids, I guess, number one, they're now 14 and 18. So they were 12 and 16 at the time of my diagnosis, roughly. And so they're not super young.

50:11So that's one thing. I was lucky in a way they're not super young. I think if they were very young, you know, it would be a different story. I think as teenagers and, you know, we were completely transparent with them through this whole process. Hey, daddy's not doing well. He's had a cough. He's going to get an x-ray. He's going to get a CT scan. So we kept them filled in all the time. I think it's been very good for them. We, you know, it wasn't like a conscious decision. I think we thought it would be just something very difficult to hide from them. but also we wanted them to know what was going on.

50:45We wanted them to know and, you know, to understand and, you know, it's part of life. People in your family get sick, you know, they can get ill, they can die. You know, that's part of life. Of course, if they're five years old, it's different again than if they're 14 years old or 18 years old. I think also it helped us kind of, you know, be conscious about spending time together. I think we, you know, we all get busy and, and they've got to live their lives. You know, I, I don't want them to spend 100 % of their time with me, you know, like during the day, my, you know, my, my oldest is in college.

51:20He's starting his sophomore year. So, you know, we won't see him probably till the, maybe Thanksgiving. Um, and, uh, you know, my youngest, you know, he goes to high school and he comes back and luckily he walking distance and, you know, he does what he does, plays with computers and, you know, I still got to yell at him every day to do his homework. But enjoying those moments, I think, has been a good thing to point out, to say, hey, we got to enjoy this time together. Not so explicitly, but really making this extra effort to spend time together. And not necessarily quality time. I always find that an interesting term.

52:02Sometimes it's doing nothing, right? I mean, just living your life, right? Sitting around watching TV or, you know, you know, sitting around and, you know, not doing anything, honestly, just just bedging out. You know, that's important. So, yeah, we were lucky that they, you know, were old enough. They understood. And we were worried, you know, early. We even told my wife told my kids teachers, hey, if you see anything, if they're, you know, if they're behaving differently, let us know. And luckily, they've taken it in stride and been helpful too. My son would drive me when he's available and my wife wasn't available to drive me to chemotherapy and to drive me to my older son to radiation.

52:52So it's been just a blessing to have them around and available. And yeah, no, they've, I don't know. Also, I think there is one side though. So I don't know if they think daddy's indestructible. You know, I do think there's a little bit of that because, you know, I'm a doctor. I'm at Stanford. I, you know, I tend to solve a lot of problems. Right. So maybe, maybe in the back of their mind, daddy's going to figure it out. So I don't know if that's part of it as well, but no, they've, they've, they've adapted to this news and this, this reality very well, surprisingly, which is again, reassuring for us as parents.

53:30Jonathan Fields: Yeah. I mean, I understand also that you've been writing letters to them. I'm curious, are those more letters for now or are those more letters for when you feel you won't be there to say what's in the letters? yeah i think one there was one kind of big letter that i did with my friend frish grant and i sponsor her class she calls herself a letter midwife um and uh you know that's they could read it now i think one of them has read it um but you know it's really for later honestly um i was thinking about you know i've written small things but you know i was thinking about hey should I record videos, you know, people always like, oh, record videos for later.

54:10And I haven't done that actually given advice and things like that. I think it's so tough to do that. And because you don't know what's going on in the future. I think, I think to me, just living the living life with them moment to moment is more important than anything like that. But, but at least they'll have that letter that was, you know, uh, Frisch has this great ability to interview people and extract different things that, you know, you weren't really thinking about. And And, you know, she was fantastic at doing that. So, you know, I learned stuff about myself. I learned that serendipity was really something I wanted to share with my kids, like the importance of serendipity, of seeing something that's maybe random or lucky or unlucky and, you know, doing something with it, right?

54:57You know, so like my patient who had this severe reaction, right? That was kind of unlucky for him. But, you know, I did something with it. So serendipity has two parts. Something has to happen, and there's a somewhat of a randomness to it, but you have to recognize what happened and have some action that resulted from it. So I didn't realize that was so important to my life until we talked about it. So writing that letter was really important to coalesce that idea. And I included a chapter about it in my book. It was so important to me, yeah.

55:29Jonathan Fields: I'm curious, you know, the other thing that I just feel from you is this baseline of happiness that is extraordinarily high. But I would imagine also there are days where that's not there, especially when you're going through really tough treatment or thinking about like, okay, so maybe, you know, maybe I can try and be positive about like the nature of where I am right now. There are going to be moments or days where it's probably a lot harder to access that. How do you navigate that? Yeah, I have this distinct memory, especially early on. My wife was out of town on a business trip. I'd just gotten a CT scan.

56:15And the CT scan was good news, actually. And it showed that the cancer was still there, but it had shrunk. But, you know, in the back of my mind, you know, there was that dream, especially early on. Oh, it's going to disappear, right? You'll get a scan and it'll be gone. And I had a tough time because my wife wasn't there. You know, I didn't have somebody to talk to about it. And, you know, that was tough. I still remember that I was in the shower and kind of choked up just thinking about this. But I think to me, it's really that support system, those connections, the people around you. That's what buoys me when I'm not feeling well.

56:51Just like this past two weeks, I've been feeling pretty lousy. Today, I feel awesome. So thank you, Jonathan. Today, I feel great. It's great. I think it's talking to people.

57:01Jonathan Fields: I'm not taking any credit for that. No, talking to people helps, honestly. I mean, for the past two weeks, I've been dealing with radiation fatigue and esophagitis. And, you know, what's helped me is, you know, talking to my brother, talking to my wife, talking to my kids and, you know, explaining to them, yeah, you know, I kind of feel lousy and, you know, and not saying much, you know, just having their presence. You know, sometimes I'll FaceTime my brother and I'll not even say anything. But the fact that he's there and, you know, he's seeing me and, you know, he's recognizing that I don't feel well, you know, it's helpful.

57:40I mean, that to me, I could not, I don't think I could be as positive or be able to recover resilient or whatever you want to call it without that support of my family and friends. And that has been unbelievable, you know, and even strangers. I've, you know, having strangers reach out to me and thank me has been amazingly powerful. Having strangers reach out to me and pray for me and chant for me or support me from their religion, it's been amazing. So all of that adds up and really helps this kind of unquantifiable aspect of humanity.

58:20Jonathan Fields: Yeah, I'm guessing you see parts of humanity that so often on a day-to-day basis, that story isn't told. Like the story that's so often told publicly now is the story of me, me, me, of, you know, like of scarcity, of not recognizing or dehumanizing everybody but yourself. And for you to be in this position where you say like, no, there actually is still goodness. There's still strangers who I have never met and probably will never meet actually doing beautiful things that I never asked them to do on my behalf. Yeah, it's definitely reaffirmed my faith in humanity. I, you know, I don't know, you know, people heard about my story and I don't know their political backgrounds.

59:03I don't know their beliefs. But, you know, the fact that we all have this shared human experience and some of them have a different type of cancer. Some of them, it was their parents who had cancer a long time ago. Some of them have not even have cancer. They've got a different challenge in their life. I still remember getting a card and, you know, this wonderful woman, she didn't say anything about what was going on in her life. She just said, hey, thank you for, you know, encouraging me to live my life day to day and to really enjoy my life day to day. And that was incredible, you know, that she would take the time out of her day.

59:40And it was a handwritten card. I think she even designed the card, the artwork. It was incredible to receive something like that because, you know, it's an effort to write the card. You're making it. You're going to mail it. You're going to find the right address. That's, you know, that's amazing that people will do this for each other. And, yeah, I mean, it's incredible. I have faith in humanity. I think, you know, we're 99 % the same. Maybe 1 % different is, you know, and actually, yeah, looking at our genetics, right? Our genes are mostly the same. And there's a little bit of separation between us.

1:00:16But, you know, I think this is something where that lived experience is something we all share. we all have challenges in life we're all going through crap um and yeah sometimes sometimes you got to figure out what to do with it and uh you know i i don't think uh i think yeah the the current tenor and reflection of what's going on doesn't necessarily adequately represent you know real people about what they're thinking and what they're feeling i think we're all thinking and feeling very similar things. To me, they're not so much different.

1:00:53Jonathan Fields: So given where you are right now, and the fact that in the middle of all of this, you've literally spent the time to write an entire book. That was another thing. I was like, are you great? I can't believe I did that. I mean, the parallel here also, you know, like you mentioned that, like you have the exact same diagnosis that Paul Kalanithi had when he had the same impulse to actually sit down and write a book to essentially tell the story. And he is by far a better writer than me. I mean, he is such a high-quality writer. He was also a literature guy for his entire life as well. But we're not going to go on the comparison route here.

1:01:30Jonathan Fields: What do you most want people to know right now? What do you want to tell them? I didn't, because of Paul's book, was so amazing. I was like, I don't need to write a book. He's written this amazing book about his experience. But I wrote the book, you know, Sunshine, because so many people said, hey, hearing your story helped me. So I realized there's still this huge hunger for sharing stories and that sharing stories will still help people. There's not enough stories out there. And there's so many different experiences. People want to hear from other people who are going through what they're going or something.

1:02:14some commonality of their experience. So that's what I wrote the book. I hope it helps people who are on their own cancer journeys. I hope it helps people who are, maybe they're not on the cancer journey, but their family member, their friends, their loved ones are on a cancer journey. But I hope it helps people who are struggling with life. A lot of the chapters, 10 chapters are based on material from the class expanded. But the other chapters are my reflections on living life with limited time. And as you mentioned earlier, we've all got limited time. I've got much more limited time than most.

1:02:56But I think we all struggle with that. What are we going to do with our lives? What are we doing? How do we live our lives? So I hate to give advice, even though I'm in the advice-giving profession. So instead of giving advice, I just share my perspective and what I'm going through and what I chose to do. And I hope that helps some people when they read it.

1:03:19Jonathan Fields: Feels like a great place for us to come full circle as well. So in this container of Good Life Project, if I offer up the phrase to live a good life, what comes up? You know, I think about, in a way, my parents. You know, they, to me, are kind of examples of living a good life. They're also happy people. And, you know, they were amazing parents. We had idyllic childhoods. And, you know, I grew up in Tennessee. So, you know, Asian American growing up in Tennessee, you wouldn't necessarily connect that with being a, you know, a smooth childhood, let's so be say. But, yeah, I think about living a good life.

1:04:00I think my parents set a great example for me on how to live a good life, how to really prioritize what's important, how to share your values, share what you're interested in with your kids. Because to me, it's really about friends and family, family foremost. So to me, living a good life is really living a life with family and friends around you and helping other people, helping not just the people you know, but people you don't know. So I think that those are things I learned from my parents.

1:04:34Jonathan Fields: Thank you. So let's talk about some of the big takeaways from this conversation. One thing I keep coming back to is how little Brian actually changed in his life. Most of us might assume that a diagnosis like his would end up with a lot of things being blown up in our lives. His mostly didn't. And that says more about the life he had already built and how truly aligned and nourishing it was than it does about the diagnosis. Three other things I don't want to lose from this conversation. First, when a friend told him not to look at his own survival curves because the, quote, average person on that chart isn't him, it gave him permission to stop treating himself like a statistic or a verdict, to look at his life as unique to him and not another plot on a graph.

1:05:24Jonathan Fields: And maybe we all need to give ourselves that permission, regardless of the circumstance of our lives. Second, his rule for what stays in his life now is just so simple. No open-ended commitments except the ones tied to lung cancer, because those are the ones worth however much time he has left. And third, when he closed his medical practice, I thought this was so interesting. It wasn't actually for himself. It wasn't about self-preservation. It was because he thought it was fair to the patients who needed continuity that he just couldn't guarantee anymore. It was an act of generosity and respect to those he has loved and served for decades.

1:06:02Jonathan Fields: I have been spinning that around in my head a lot. So maybe here's what I'd leave you with this week. Pick one thing on your plate right now that maybe has no clear ending. It's just been going on and on and on. No finish line. Nothing that would ever let you call it done. and ask yourself honestly whether it's earned that kind of open-ended space in your life or whether it's just been there so long you kind of stopped questioning it. Maybe there's something to do about that. And hey, before you leave, do me a quick favor. Share this conversation, Brian's beautiful insights and his story with one person who you know needs to hear what we talked about today and leave a review wherever you get your podcasts.

1:06:41Jonathan Fields: It helps us get discovered and brings more people into moving conversations like this. This episode of Good Life Project was produced by executive producers, Lindsay Fox and me, Jonathan Fields. Editing help by Troy Young and Alejandro Ramirez. Chris Carter crafted our theme music. And of course, if you haven't already, go ahead and follow us wherever you get your podcasts so you never miss a conversation. Until next time, I'm Jonathan Fields signing off for Good Life Project.

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