Interview: Grief is complicated — but drawing cartoons can help with Dr. Nathan Gray

0:01This is Ted Health, a podcast from Ted and I'm your host Dr. Shoshana Ungerleider. Grief is messy. It rarely follows a straight line. But sometimes healing begins when we pause long enough to trace one. For cartoonist Naveed Madhavyan, that metaphor is literal. When he learned a loved one was close to dying, he sought refuge in art. Not as a cure, but as a kind of companion. A way to make sense of what feels too big, too raw, too complex to carry alone. In this talk, Navid shows us how creativity, through drawing and through presence, can help metabolize emotion and reconnect us to empathy, memory, and even our own bodies.

0:44Because when it comes to loss, sometimes the most powerful form of care isn't found in a treatment plan, but in the stories that we allow ourselves to tell. Then stick around after the talk for a conversation with Dr. Nathan Gray. Nathan specializes in internal medicine and palliative care, and he's also an amazing cartoonist who uses comics to foster empathy and capture the human side of medicine. Together, we'll talk about how art and storytelling can change the way we understand suffering, healing, and what it means to truly care. But before we dive in, a quick break to hear from our sponsors.

1:26And now, Naveed Maravyan takes the TED stage. When I found out my grandmother, my last living grandparent, was dying. My first thought was, I need to draw her hands. I'm a visual artist, a cartoonist for The New Yorker, and comics writer, so drawing is how I understand much of the world. For a long time, my cartoons had been impersonal. Commentary on the world around me, sure, but not really about me. The closest my personal life got to influencing my cartoons were cartoons I lifted from things my friends and family had said around me. It was only after my daughter, Elika, was born that my personal life began to creep into my cartoons more.

2:06Every artist will tell you that their medium is the highest art form. But they're wrong, because cartooning is in fact the highest art form. Cartoons can say so much with so little. With just a few lines, you can express happiness, smugness, and sadness. This is called face pareidolia. It's the phenomenon where we see faces in inanimate objects. We see ourselves in these cartoonish faces. They're blank canvases onto which we project ourselves. We see faces everywhere, ourselves and everything. It's evolutionary, a survival technique. But how do we convey complex emotions using just lines? Emotions like grief.

2:56This became really important to me when I found out that my grandmother was dying. I got to know my grandmother, Homa, in a way I didn't get to know any of my other grandparents, because they all lived and died in Iran, a country I've only ever been to twice, and not since I was 10. But Homa lived with my parents for the last 10 years of her life, and in that time, she danced the funky chicken at my wedding, she got to hold my newborn daughter, and she told me stories about Iran before the revolution over morning tea, which was usually around noon because she liked to sleep in. One of my earliest memories is of her hands.

3:34Not the way that they looked, but the way that they felt. I can still, even today, recall the physical sensation of them, like the smoothness of her nails and even their smell, but not the way they looked, which is why when I found out that she was dying, my first instinct was to try to preserve that memory, my memory of her, by drawing her hands. Not surprisingly, when I finally made it there to see her, I didn't have a whole lot of time to sit around drawing because I was busy with other things, things like comforting my mom, comforting my grandmother by doing magic, and helping my mom and my sister plan for what would come next.

4:14It's that classic Proustian experience. Life doesn't mean anything while you're moving through it. It's only when you stop to reflect on it that you can make any sense of it. Sense memory, what Proust calls involuntary memory, contains the essence of the past. And so if I wanted to tell the story of my grandma, Homa, I would have to begin with a sensation of her hands. When I set out to write this comic, which was published in the L.A. Times, I wanted to take something complicated and big and make it small. Grief is complicated. I needed to reach a point where I could process my loss to distill the experience of losing my last living grandparent into its essential parts and make it clear enough that I could actually grieve.

5:01My family doesn't tend to deal well with grief, which isn't great because we have so much experience with it. When we're trying to dodge grief, we caricature those we've lost. We focus on and exaggerate their most obvious features, which is why sometimes we'll hear somebody say something like, he was a saint. He probably wasn't. When we do that, we're not actually grieving. We're not confronting the person we've lost as a complex individual, flaws and all. cartooning has allowed me to go narrow to find the details that are emblematic which opens up into a whole rich complex person into my complicated relationship with them it avoids flattening them and leaves them their richness so i can grieve all of them and so i focused on my grandmother's hands the quivering lines of her arthritic fingers the contours of her veins now pronounced by the thinning of the skin that she spent so much time caring for.

6:03They were beautiful hands, soft from years of moisturizing. They were also the hands of someone who was really, really vain, emblematic of the gender norms of an Iranian woman of her period, and as a consequence, incapable of dealing with the process of aging well. For example, I can remember this one time she called me into her room, and when I walked in, she was standing there, arms stretched out to her side and topless, and she said, Look what I've become.

6:36They were also the hands that she used as she got older and was less capable of caring for herself to hit those around her, the people she loved the most. Because I didn't actually get to draw her hands when I last saw her and I don't have any photos of them, I had to use my own hands to draw her hands. So I drew my hands old and spotted, my knuckles gnarled, and I imagined what it would be like for my hands to no longer be able to perform basic everyday functions, to no longer be able to draw. I regularly use myself as a reference for my comics, and through this, I've become my grandmother, I've become my friends, and I've even become my five-year-old daughter.

7:16It's a process that's allowed me to experience these stories more deeply in a physical way, allowing me to inhabit them, to come to a fuller, richer understanding of them in context. If a loved one's death makes us confront our own mortality, then the process of physically transforming myself into my grandmother or my father, who is slowly dying of kidney failure, has made me confronted in a uniquely deep way. It's a process that's also allowed me to reach a place of deeper empathy and of forgiveness. For me, art is about communication. It's about expressing what's most important to us and knowing that other people feel the same way, that we're not alone, which is particularly important when we're grieving.

8:08It's that distillation of something complex into its simplest terms. For you to see your grandmother or a parent in the curved lines of my grandmother's beautiful hands and to communicate without words, because words were never the point anyway. Thank you. Thank you.

8:47That was Navid Madhavyan at TED Next in 2024. Now, I'm really excited to bring you my conversation with Dr. Nathan Gray. He's a physician specializing in palliative care and an assistant professor of medicine at Johns Hopkins University and a well-regarded cartoonist. Nathan uses comics and other artwork to educate and promote empathy and sometimes explore the ironies of the medical world. His illustrations have appeared everywhere from major medical journals to national newspapers, and they offer a window into medicine that's equal parts poignant, humorous, and deeply human. In our conversation, we talk about how drawing can be a tool for reflection, for connection, and even reshaping how we think about care itself.

9:31Nathan, thank you so much for joining me today. Yeah, thanks for having me. I'm excited to be here. So many people might think of comics as being light or playful, but in medicine, much of our work day-to-day is serious. What makes drawing uniquely suited to capturing the world of medicine, would you say? Visual art and drawing really have such a wonderful way of tapping into some nonverbal aspects of communication. All of us start out in drawing long before we write, doodling, and many of us continue to doodle subconsciously at times. So there are parts of our mind and our way of looking at the world that sometimes can be accessed when we are not thinking so hard about where am I going to put that comma or which word will I pick here, but instead putting pencil or pen or crayon to the paper and allowing ourselves to be a little bit more uninhibited and put our emotion down on the page.

10:26Medicine is full of stories, full of patient stories, clinician stories, fun at times, serious at times. And I've found that drawing for me is such a wonderful way to bring some of the things I see in the hospital or in the clinic to life. Take me into a moment where art showed you something about medicine that you might have missed otherwise. Yeah, I was a kid who drew all through growing up, loved cartoons, loved Disney movies, loved drawing Ninja Turtles, pirate ships, everything. If there was a class project, I always chose the draw option. But then during medical school and residency, I really felt like I was facing this fork in the road where you had to migrate towards science and research and studies and books, textbooks.

11:14And I didn't think there was space for art in that. Over the course of my medical training, I did get a little burned out with that art piece missing. And so I started doodling again late in residency in my seventh year of formal medical training. And I found that it gave me an outlet that I had been missing to unpack some of the things I saw. And one of the first pieces that I put together was for a medical journal. And I told the story of a patient that I had cared for back in residency earlier in my time who was undocumented and some of the ways that our health system disadvantaged him in receiving even what we would consider very basic standard care.

11:54And I felt complicit at times in that substandard delivery of medical care. And I told the story of what it was like to watch this patient go through illness. And I found that when I finished the story, seeing it from start to finish allowed me to externalize a lot of things that I had kind of stuffed away. So medicine teaches us to be cool, composed, to move from one patient to the next, and at times, I think, compartmentalize, which can be important and necessary at times, but also can leave us as doctors, as humans, without the space we need to really unpack some of that raw emotion or injustice or advocacy that can get lost in the grind of modern medicine.

12:43How have you used your art to spark conversations about difficult topics, given that your work is in palliative care? I have found loads of space to bring topics that might be a little uncomfortable or surprising or not things you would think about as being a comic type subject into talking with other doctors, using comics to highlight aspects of my own specialty in palliative care, whether it's aspects of how to communicate with people about serious illness, or whether it's advocacy, whether it's talking about some of the ways that our health system struggles to meet the needs of people who are at the crossroads with serious illness, where people are in a stage where perhaps they can't be cured and still have a desire to keep receiving medical care to be either cared for at home or in the hospital, and at times how our health system has undervalued that over the years.

13:35So I've been able to write for lay press publications and talk about some of these disadvantages that we place because of our value system in modern medicine on the stuff that for many patients really matters if their time does run short. And so, Nathan, you look at medicine from two angles, or probably more than that. But as a doctor tending to patients and as an artist drawing some of your experiences, which one do you tend to gravitate towards the most? Or are there situations when you prefer one perspective over another? I would say all medical specialties kind of exist along a spectrum of the technical aspects versus the sort of more relational and human aspects.

14:16And I think there are fields that still contain a lot of humanity, but also contain a much heftier dose of technical prowess or technical training. So the advanced surgical specialties or interventional radiologists who spend a lot of their day with needles and tubes and figuring out how to access various parts of the body in technical ways, palliative care does skew slightly toward the meaning and the story behind people's medical care. And so I think I had some bias toward that. But at the same time, I've still got to look at the technical aspect and pick the right dosage, looking at their kidney function or their liver function and understanding the lab tests and dosing appropriately or looking at what side effects they might be at risk for.

15:00But at the same time, I think being a doctor, being a storyteller, all of us as physicians have to be able to sit and listen and capture what is this patient's story? What do they need out of their medical care? And so for me, art really allows me to, I would say, be a better doctor because I am in more tune with the stories around me. Even if it's not a story I would ever retell for a patient, it's their story, being aware of the narrative behind the illness experience. So if a patient is coming to me for pain medication management, it's not simply about the right dosages. It's also about what is the significance?

15:38Like when this pain flares up, what is that making this patient worry about? Is that person concerned that this means their cancer has grown? Are they worried that being on pain medications is a sign of weakness? So those sort of personal and meaning-focused issues that often underlie many aspects of care, say, why isn't a patient actually taking the pain medications I'm prescribing? If I understand the narrative that they worry that that's weakness or that they had a loved one who struggled with pain medication dependence, that really influences their care and that's part of their story. Nathan, medical training often emphasizes objectivity and a real clinical distance.

16:17How do you balance that professional boundary with the personal empathy that clearly drives your artistic work? You know, I talk a lot about how if you swim long enough in this water of suffering, and all of us as doctors, nurses, physical therapists, medical aides, all of us face suffering on a day-to-day basis. And when you swim long enough in that suffering water, you can't help but get wet. And so trying to dry off a little bit, trying to like step out of the waters periodically and dry off is really important. I find for me, art sometimes is one way to dry off. Sometimes just time away from work is so vital because I think if we completely insulate ourselves from the waters of suffering that we're swimming in, then it really puts a barrier up between us and empathizing with our patient.

17:07That said, if you lived all the time, completely soaked and saturated with the weight of that suffering, I think you would struggle too, to be a good doctor. You'd be overwhelmed, burdened, unable to move on to the next patient who needs you in that clinic day or that hospital day. Yeah. I think that's such a beautiful framing. And I think certainly a lot of the burnout that we see in medicine and nursing in the other allied professional fields is people having a really hard time for a lot of reasons, swimming in that suffering. And so I really like how you you named it in that way. I have a comic on that one.

17:43There's a dog shaking the water off himself. I think the world now seems to come to life in comics. So whenever there's a metaphor, you could probably find that one on my Instagram with the dog shaking to dry off. I love it. I love it. And so I want to come back to definition here that I think is really important. I talk about it a lot on this show, but you work in palliative care, which is often misunderstood. How do you explain to patients and families what palliative care is and what it isn't? I love that you asked that question because I work both in the hospital setting and in the clinic setting.

18:18And many times when patients come to see me, they may be carrying with them some anxieties or some myths about what we do in palliative care. I think hospice provides incredible and wonderful care to patients. But that said, the way hospice is structured in our country, it's really preserved for a specific chapter in a patient's illness story. The Medicare hospice benefit is for six months or less, and typically oriented toward folks who have decided not to pursue further disease modifying therapy. So if they have at that point elected not to continue with chemotherapy, you know, with the rare exception, most of the time people have shifted their focus of care on hospice entirely to quality of life.

18:56Palliative care in an ideal world should be available to folks upstream while they are hopefully still actively pursuing disease modifying treatments. So treatments to help with their COPD, their cancer, their lung transplant, their heart transplant, whatever that late stage condition is, palliative care should be there to support them in that serious illness. So when I meet a patient for the first time, I'll usually tell them kind of what I know from reviewing their medical chart about what they've been through and a quick summary. And I'll say, you know, I'm interested to hear what you've heard about palliative care.

19:28And how can I be most helpful to you? sometimes the myths come out sometimes people say well yeah i didn't know if my my oncologist was trying to tell me something by referring me here is it are they saying something about my timeline perhaps the patient didn't know anything and said you know i i just showed up because the appointment was on my schedule and i have no idea why i'm here in this clinic and i'll say well you know i wear a couple of hats one of those hats is helping with things like pain nausea shortness of breath, trouble sleeping, anxiety, family distress, working our way through any of those issues that are impacting a patient's quality of life.

20:03And the other hat is just helping as people navigate the ups and downs of illness. So there are twists and turns with modern medicine and new treatments coming around the curve. There are often disappointments and then disappointments followed by good surprises. And so helping people as they make their way through that. It's humbling to be a tour guide for something you've never done before. So I think of myself a little bit as a tour guide and what I've learned from my medical training in palliative care as a subspecialty. And then also from 10 years of working with patients going through this, I have learned a lot, but I always have to step back a bit and say, you know, the patient in front of me, you are the only one who truly knows what this is like.

20:44You tell me how palliative care can help you best today. I have no agenda. What can I be most useful to you for? I'm not here with a checklist. Tell me what you need. Wow. I love how you explain that. And, you know, I obviously working in medicine as an internist, but then having the opportunity to care for my father who faced H4 pancreatic cancer, we know how that story typically goes. And palliative care just makes such a big difference for patients and their families and really wraps around all the elements of what it means to live as well as possible for as long as possible. And I suspect that you're an incredible tour guide.

21:25I try. I do my best. I'm not perfect. And I'm reminded of that at least once a week. I stick my foot in my mouth. It's sensitive space, but powerful work. And it does feel like a tremendous privilege to do it. Yeah. So for someone who has never been seriously ill or walked this journey with someone close to them, how might your art help them understand what patients and families are really going through? I love when I'm able to give a window into the illness experience. And I try to be really sensitive to patients' privacy. I, these days, almost never present a specific patient's story without their permission or without their involvement in it.

22:06You know, there are times where a patient will come to me and they have Googled me and found some of my comics. And I always make it clear that they won't find themselves in one of those comics without their involvement and consent. That said, you know, comics allow me to talk in generalities. I can use a silhouette. I can talk about, you know, speech bubbles that can be not necessarily associated with a specific patient or person. I can be abstract if I want to. I can be detailed if I want to, but I can open up this world and talk a little bit about what things I see, what things come up, what worries people have when they're facing a serious illness.

22:41Years back when I first kind of got into this, I put a piece out in a publication that got shared on social media. And a surgeon came up and tapped me in one of the doctor's work rooms and said, I saw that thing that you did online with art. What was that? And I was like, oh no, am I in trouble? Did I do something out of bounds? He said, is that a graphic novel or what was that? I said, wait, it wasn't a graphic novel. I mean, you could call it a comic or a graphic op-ed, but he's like, that was good. Like that was really good. And he admitted he had never read a comic or did not consider himself a comic reader.

23:18But when you get past the labels and just show someone, hey, this is a really cool way to communicate, it can be so powerful. It's in the same way that sometimes when people show up and they have fears of labels about palliative care, that when I just show them what palliative care is in real time, like, hey, like, let's talk about your nausea. Like, wow, I see you're on a lot of different medications. Are they helping? Is there something else we can try? People say, well, okay, I like this. This is good. And I think sometimes the same thing, comics can have a little bit of that stigma of, oh, they're for kids or they're only about superheroes.

23:52But comics are a medium for whatever kind of story you want to tell. Yeah. Well, Nathan, you did this amazing LA Times op comic back in 2024, what one doctor learned as a guinea pig for AI, where you explored how using an AI powered scribe changed what ended up in your clinical notes, how some of the nuance and some of the important human details of the patient encounter got lost in translation, as they say. Now that you've had another year of living and working with this technology, I'd imagine, how do you feel about it? Cautiously optimistic, guarded, I would say is the best way to think about it.

24:29So in that comic, I talk a little bit about the ways that having this AI scribe allowed me to put the keyboard to the side a little bit and put the computer monitor away from the center of the room where it tends to inhabit its space between doctor and patient and to really just listen and worry less about whether all the details were being captured and whether I was going to have to type my note at home that night. That said, I always go back and edit because sometimes I find that like, oh, it missed this really important detail. Say a patient shared with me that the thing that is driving them most right now is the birth of a grandchild here in three months.

25:06And they are determined to press through this chemo struggle because they want to see that baby born or something like that. But I will say it's even gotten better as I've also given feedback at times to the developer to say, hey, can you go back and look at this transcription? Because it missed some stuff that I think was really important. And I find that they've even adapted in the past year or so since I wrote that. The other great thing about drawing yourself as a guinea pig is you get to put more hair on yourself. I'm losing my own and drawing myself as a guinea pig was a lot of fun. I love it.

25:40Nathan, I love how your comics sometimes show the ironies and frustrations of the healthcare system. And I imagine these must be reflections of your own feelings too. I think for healthcare workers listening who might be feeling burned out right now, what have you learned about staying connected to why you chose this work in particular? Yeah. As I spoke before about drying out, there's no substitute for drying out. And I think there are times where people may have to say, you know what, I'm actually just saturated. And being completely immersed for this long is something I need to take a break from briefly.

26:13And I think that's huge because our patients need us to be healthy. And so taking a break is huge. But also, I think finding ways to bring your creative spirit into the room in ways that are hopefully sensitive and appropriate. But I think when we regard ourselves solely as technicians, solely as a robot with a prescription pad or a robot with a scalpel, we miss out on our own humanity too. And we are people too with lives, with families, with hopes, with worries. And I fear at times that in our wonderful scientific advances, we do at times run the risk of treating doctors and nurses and physical therapists and aides and social workers as machines to serve a purpose when we're just as human as the patients we need to be serving.

27:01And so when we've lost sight of our own hopes, interest, dreams, or aren't able to manage those well, I don't think we're able to connect with those before us. Oh, so true. And now you're at Johns Hopkins, right? Training the next generation of doctors. How can medical students and trainees benefit from seeing medicine through an artist's eyes, especially when it comes to relating to patients? I already feel like we are doing a much better job of honoring creativity and humanity in our trainees than we did 20 years ago when I started medical school in 2005. I very much felt that fork in the road of I will have to choose art or science and I'm headed towards science and therefore arts packed away.

27:45I know now there are so many students being encouraged to pursue this. You know, they're even honoring humanities more when they select medical students for admission to medical schools. Even just earlier today, I was at a panel about narrative medicine, so a whole packed room full of students listening to docs talk about the ways that they had integrated narrative medicine stories, creativity into their own medical practice. So I think we're doing a little better on that front. I will say medical science continues to march forward as well. And so I think there will always be this push-pull. And you need both.

28:23I think that medicine without the science portion takes us back a couple hundred years to an age where we didn't have good science and we did some not so great things like bleeding and all those things that we did that really didn't have a good evidence based and may have caused some significant harm. So I don't ever want to be perceived as being anti-science, even though I skew toward the holistic and the human side of things. I think I'm so grateful that there are people in labs right now coming up with drugs and technologies that hopefully will change some of my patients' illness stories in the road to come.

28:57Yeah. Well, so many professionals beyond medicine, right, deal with difficult human situations, teachers, you mentioned social workers, first responders. What are some simple creative practices that might help them stay emotionally grounded if they're looking for a place to start? Yeah, I would say everybody approaches unpacking in different ways. And I think our society's tendency to tell us the best way to unpack is to sit ourselves in front of Netflix or Hulu and kind of let our brain rest. And there is a time and a place for that. Indeed, I do love a good Netflix binge every now and again.

29:33But I'll say there's also time to reflect and a need for reflection. And that can look different for different people. That could be a hike in the woods for one person. That could be a late night journaling, just sort of writing or getting the crayon out and just scribbling and making a huge mess over a big sheet of paper. There are so many different ways, but I think we have to give ourselves space and realize we're all doing difficult work. If you're in the healthcare profession, guaranteed there are hard days. And so I think that finding those outlets, finding ways to take that difficult experience and just write a few words down about it, how you were feeling, what bothered you.

30:09I have found that with the space of a little bit of time, I can come back to a heavy memory or a heavy interaction with a patient. I can process it, digest it on my own. And it allows me to hopefully face the next challenging interaction with more composure and more compassion. Oh, Dr. Nathan Gray, you've certainly given me a lot of things to think about in my own life. I just have to say, I followed your work for some time and you've certainly brought a depth and a different perspective to many conversations that I think otherwise people wouldn't be engaging with. So I'm grateful to you. Thank you so much for having this conversation.

30:46Yeah, it was a delight. Thank you for having me.

30:52And that's it for today's episode. Thank you so much for listening. TED Health is a podcast from TED, and I'd love to hear your thoughts about this episode. Send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah DeGrange, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Highlash.

31:32You