How Stoicism Can Help Make Health Care Better

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2:29Welcome to the weekend edition of the Daily Stoic Podcast. On Sundays, we take a deeper dive into these ancient topics with excerpts from the Stoic texts, audiobooks that we like here or recommend here at Daily Stoic, and other long-form wisdom that you can chew on on this relaxing weekend. We hope this helps shape your understanding of this philosophy, and most importantly, that you're able to apply it to your actual life. Thank you for listening.

3:12Hey, it's Ryan. Welcome to a weekend episode of The Daily Stoic Podcast. One of my favorite things to do. Well, I wouldn't say favorite, but I always get excited when I'm talking to a group of people whose line of work lines up with the Stoics, but maybe they don't think it lines up with the Stoics and I get to take ancient philosophy and connect it to what they do. Like if I'm talking to a bunch of athletes or coaches, I want to show how, you know, when we think of philosopher, we don't think athlete, but actually in the ancient world, philosophy and athletics were much more connected than we might think.

3:50Or if I'm talking to the military, right? What are the connections? How can we learn from some of the Stoic warriors of the past? What can they teach us or teach them about their line of work? And you might not think Stoics and medicine would have much of a connection, but of course they do and did. Marcus Aurelius's Dr. Galen, one of the sort of great medical minds of antiquity, is a fellow Stoic. And there's a bunch of medical metaphors in Stoicism. Actually, Epictetus says, the philosopher's classroom is like a hospital. He says, you weren't well when you entered here. and so when you exit, you're still gonna feel a bit sore but hopefully he's patched you up and made you better.

4:46So I did a talk, I guess this was back in February to a group of doctors, mostly surgeons who have obviously been through the ringer the last couple of years with COVID and burnout and all these things. I mean, these are, you know, sort of real heroes having been through the sort of crucible, come out of the other side, sort of so selflessly put themselves on the line, helped so many people and, you know, had to spend so much time away from their family, especially early days in the pandemic. So this was a lecture series. They had me come out and I passed on some Stoic lessons about obstacles and overcoming adversity and, you know, just best practices for leaders that the Stoics can teach us.

5:37And so that's what I'm bringing you. I gave this remotely over Zoom from my office here in Texas. I was sad not to be able to see everyone there in person, but I think hopefully some lessons came through and now I also get to share them with all of you.

6:05it's an honor to be with you guys i was thinking as i was uh getting up in the dark to come talk to you um that actually the perfect place to start would be one of my favorite meditations from marcus aurelius who although he lived a long time ago and although he clearly had some wonderful virtues and strengths that seem almost superhuman to us, was in fact very much a human being. And when you pull up meditation, so meditations is the work of Marcus Aurelius' life. It's this journal he's keeping as the most powerful man in the world, never intending it to be published, never intending it to be published, but writing it for his own edification, his own benefit.

6:50And I think we see this very clearly in what opens book five. We don't know what order he was writing them in, but it comes to us at the opening of book five. And I think it pertains to what we all probably went through this very morning as we woke up. He says, at dawn, when you have trouble getting out of bed, tell yourself, I have to go to work as a human being. What do I have to complain of if I was going to do what I was born to do? The things I was brought into this world to do? And then he says, or is this what I was created for, to huddle under the blankets and stay warm? And then he's sort of talking to himself.

7:29He says, but it's nicer here, which is what I was thinking this morning. It's a little cold here in Texas. And he says, so you were born to feel nice instead of doing things and experiencing them? Don't you see the plants and the birds and the ants and the spiders and the bees going about their individual tasks, putting the world in order as best they can, and you're not willing to do your job as a human being, why aren't you running to do what your nature demands? And then he goes on and he talks about how people who love what they do wear themselves down doing it. And they do it without asking for what he calls the third thing, which is gratitude or recognition, or in some cases, even compensation.

8:11They do their duty, they do their job, because that's what we are put on this planet to do. And sometimes it's hard. We get the sense that he was a little bit of an insomniac, but that's what we do. And I love the idea that even 2 ,000 years ago, the most powerful person in the world who could have done whatever they wanted is having a little pep talk with themselves before they get out of bed to go do what his nature demands. So that's one connection between us and Marcus Aurelius. The second between Marcus and you guys that I thought was interesting, that's probably worth kicking around a little bit, is that Marcus Aurelius' doctor happens to be Galen.

8:49He's known then as the first physician. He's the great medical mind of the ancient world. also happens to be a fellow traveler in the practice of stoicism. But they intersect not just patient, doctor, friend, colleague, in the way that probably isn't too dissimilar to your world. But I also think what's interesting is Marcus Aurelius is writing this in so much of Meditations in what becomes known as the Antonine Plague. The Antonine Plague originating in the far edges of the Roman Empire. It comes back. It overwhelms Rome's institutions. It lasts for something like 15 years. It kills millions of people.

9:35It's probably some version of smallpox. But an ancient historian is writing about Marcus and he says something like, Marcus doesn't meet with the good fortune that he deserved. He had all these big plans as a leader, as a philosopher king. and he bumps right up into reality. The historian, again, this is writing not far from Marcus's time. He talks about, he says how Marcus, his whole reign is involved in a series of troubles, which is sort of putting it mildly because there's the plague, there's an invasion, there's a coup, there's flooding. It's like disaster after disaster. And he says, but actually I, for my part, admired Marcus all the more for this very reason.

10:20He says, because despite unusual and extraordinary circumstances, he survives himself and the empire, which to me is sort of a prescription of what Marcus's philosophy is trying to get him towards as a leader, which actually brings me to another sort of medical connection. So in 5.8, the same book in Meditations, Marcus says to himself, just as you overhear people saying that the doctor prescribed such and such for him, like riding or cold baths or walking barefoot. Again, they didn't have the, Galen may have been the first physician, but his understanding of medicine is pretty rudimentary if he's prescribing riding a horse as a medicine.

11:11But he says, Just as the doctor prescribed such and such for him, say this, nature prescribed illness for him or blindness or a loss of limb or whatever. There prescribed means something like ordered so as to further his recovery. And so to hear what happens to each of us is ordered. It furthers our destiny. And what Marcus realizes is that he didn't choose this moment in time that he happens to be born. He didn't want any of it, but rejecting it, objecting to it, fighting against it doesn't get him anywhere. The idea inherent in Stoicism is first that we accept it and then we begin to get to work on it, right?

11:55We get to work on using it, on being who we are capable of being inside it. And this ultimately, if we're successful, is why people come to admire us more than if we'd been born or been blessed with the circumstances that we'd asked for or wanted. And this is where I think the most famous passage in meditation comes in. This is what I built the obstacles the way in. Same book. This is also in book 20. He says, in some sense, people are our proper occupation. Our job is to do good to them and put up with them. And he says, but when we face obstructions, like it becomes irrelevant. He says, our actions may be impeded by these obstacles, but there can be no impeding our intentions or our dispositions because we can accommodate and adapt.

12:48The mind adapts and converts to its own purposes, the obstacle to our acting. And then this is, I think, the epigram worth always remembering. He says, the impediment to action advances action. What stands in the way becomes the way. So this is the essence then of Stoic philosophy of Marcus Aurelius' leadership philosophy, which is life hands us things. We don't control that. We control how we respond to that. We control what we do with that. And so for the Stoics, this conception of amor fati, a love of fate, embracing the difficult moment. It is, however, frustrating, not our fault, undesirable, unprecedented, unusual, whatever the characteristics of the circumstances happen to be.

13:39They nevertheless always are, the Stoics believed, an opportunity for virtue or erite, which means excellence. So the last few years, again, horrendous, heinous, in some ways unnecessary, in some ways, in many ways and always tragic. All the things you want to describe COVID as, all the things you want to describe our political situation, our market situation, all the things you want to look at, they are what they are. But they also happen to be, the Stoics believed, an opportunity to stand up and be what we are capable of being to practice one or all of the four virtues, which for the Stoics are pretty simple.

14:26It's courage, which I think the medical community did in an incredible way in the last several years. So courage, self-discipline, right? Not getting upset by it, working harder than we thought we'd ever be capable of working, right? Keeping our, treating our body rigorously, as Seneca said, so it's not disobedient to the mind, right? Self-discipline as a virtue. Then justice, right? What we do for others, how we take care of others, the positive impact we make. And then finally, wisdom, the strength, the intellectual strength to understand, navigate, figure our way through these situations. So the Stoics believe that the obstacle, they're not denying the obstacle exists.

15:07They're not denying that it's – they're not saying it's not – it's going to be fun. But they are saying it is an opportunity for you as an individual, for you as a leader, for you as an organization to grow and change and be improved, to do things that you couldn't and wouldn't do under ordinary circumstances, right? That's what that historian is saying about Marcus. There's a famous line. I think it's from the CEO of Intel. He says, look, bad companies are destroyed by crisis. He says good companies sort of muddle through them. But great companies, great organizations, and I think great individuals, as we see in Marcus's case, are improved by them.

15:48They're transformed by them. They use what happens to their own benefit. That's what the Stoics believed. The metaphor for Marcus is that whatever you throw on top of a fire becomes fuel for the fire. And so if we can start to see the situations we don't control, the things that life deals us as fuel, we have the ability to transform and change them and grow because of them. Okay, so the next one I wanted to show you, this is now we're flashing forward to 815 in Meditations, which I think is also an interesting book. This is having to do specifically with people. You could argue that a good chunk of this entire book is about Marcus, who's perhaps an introvert and then perhaps lives with equally frustrating people as those who walk the earth today.

16:42Mark is trying to steal himself, trying to find a pathway towards getting through them. And actually, if I go backwards, just to prove this point that it's all about people, he opens what is effectively the second book or the opening of the book itself with a meditation. He says, when you wake up in the morning, tell yourself, The people I will deal with today will be meddling and ungrateful and arrogant and dishonest and jealous and surly. I'm sure none of your patients or colleagues are this way. He says they are like this because they can't tell good from evil. He says, but I have seen the beauty of good and the ugliness of evil and have recognized that the wrongdoer has a nature related to my own.

17:28And so none of them can hurt me and no one can implicate me in ugliness, nor can I feel angry at this relative or hate him because we were born to work together like feet and hands, like two rows of teeth, upper and lower. His point was not as sometimes people take that passage to mean, which is the world sucks. The world is awful. People suck. Just deal with it. It is true. And if you wake up and you say, everyone's going to be amazing. I'm going to get green lights the entire commute to work. Every patient is going to listen to me. Every colleague is going to do their job unquestioned, without question and with enthusiasm and hustle.

18:09Right. You're going to be disappointed. And the Stoics say that the unexpected blow lands heaviest. And so to set yourself up to be surprised or disappointed, that's partly on you. But I think the fuller reading of that passage, what makes it so important, why it's such a good strategy, is he's not saying, hey, write everyone off before you wake up. He's saying people are going to be this way and you can't let that drag you down. You can't make them, you can't make that make you not like them. You have to bring with you still an enthusiasm, a love, that sense of duty and obligation that allows you to work with those people, which is what he says more fully.

18:48Again, in 8.15 that I wanted to mention, he says, remember, you shouldn't be surprised that a fig tree produces figs, nor the world what it produces. He says, a good doctor isn't surprised when his patients have fevers or a helmsman when the wind blows against him. And so again, understanding what the day, what the environment, what the job itself is likely to bring you allows you to not be broken or discouraged or disoriented by what is inevitably a byproduct of life. And another place the Stoics say sort of the same thing, but the opposite phrasing. Marcus is saying, don't be surprised that a fig tree produces figs.

19:31Well, the Stoics also say, don't expect figs in winter, right? Don't expect things when they're not supposed to be there, when you know they're not there, right? And the idea of focusing on what life prescribes, how life is, allows you to say, okay, I'm going to steal myself for this. I'm going to prepare myself for this and I'm going to do what is my job, which is not just putting up with these people, but understanding and loving and coming to appreciate the value that they put in my life in the world. And again, it's easy to forget this stuff. And Marcus clearly did forget this stuff or he wouldn't have repeated himself with these same ideas in meditations.

20:15What we understand of the practice of journaling. This isn't a philosophy book in the sense that Marcus was writing down his understanding of the universe, his systemic philosophical approach. What he was doing in meditations is journaling, writing to himself reminders of what he needed to know when he needed to know it, which quite often was the same thing. So he says at the beginning of book two, hey, remember, this is what people are going to be. And then flash forward eight books later, there could have been a war in between these two passages. The plague could have broken out between these two passages.

20:53He could have buried one of his own children between these two passages. He could have fallen down and broken his arm between these two passages. He's trying to remind himself, oh yeah, this is what I believe. What I believe is that people are frustrating and annoying, but I love them. I want to do good for them. It's my duty. It's my job. I'm doing what my nature demands. And so when he slips up, he's writing that reminder. And he talks about this idea of rhythm in meditations, like that we are jarred by circumstances. We know who we want to be. We know what we want to be. And then we relapse.

21:30We fall short. We mess up. We get overcome by our emotions. He says, and then you catch yourself and you come back to that rhythm. It's always there. I sort of liken it to music. It's like if you're jamming with a group of musicians, you can mess up. You can have a problem with your guitar or your bass or whatever it is. And then you can get off the beat. And then all you have to do is come back to it. The song continues on, right? The rhythm of the universe of life continues on and you can come back to it. And when you come back to it, it's there and it's ready for you to be your best self.

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23:23So the other thing that I think is particularly interesting for Marcus is, I think, an underappreciated side of Stoicism, which is when we hear the word Stoic, we tend to think invulnerable without emotion. I don't think this is borne out by the facts for the Stoics. We have only a dozen or so examples or anecdotes about Marcus as a historical figure. And a full three of them involve him crying. He cries when he is promoted to be emperor. He's thinking of all the bad kings of history. He's thinking of the enormity of the power that's thrust upon him. I think he's having a little moment of imposter syndrome, which is familiar to all of us.

24:10Do I have what it takes to do this? I think this is actually great. Not just the being in touch with his emotions, but I tend to find that people who are best at their jobs are the people who occasionally doubt whether they can measure up to the job. It's the person who says, I'm amazing. I'm flawless. Of course, I can do this. It'll be easy. That's the person I don't want operating on me. Right. I want the person who's actually present and intent on doing a good job, who is conscious of the responsibility in front of them. That's who I want operating on me. So the next sort of moment of weeping for Marcus comes from, I think, another sort of ordinary moment in his life.

25:02He's grieving the loss of a tutor. This is a man who sort of shaped him as a philosopher and as a thinker. Marcus is in his 20s at this point, and he's crying. And one of his servants comes over and sort of admonishes him like, hey, people are watching, you know, get control of yourself. And Antoninus, who's Marcus's stepfather, says, hey, let the boy be human for once. He says, empire and philosophy don't take away natural feeling. And so, again, I don't want you to think of the Stoic as the invulnerable robot who never feels anything that's the exact opposite of who the Stoics were. I think if the Stoics were saying, hey, sometimes we're overcome by emotion and that's okay.

25:42They were saying it more specifically towards crying or being sad. They weren't saying, hey, you just got super upset and beat the crap out of someone. We're all human. That happens, right? It was the Stoics were talking about losing our emotions. They felt like temper was the emotion to be most aware of. The passions, particularly the destructive passions, were what Marcus is warning against. And then finally, the third example, which I think is interesting and again ties us to our times, comes towards the end of Marcus's life. He's sitting in court. They're discussing a court case. And the lawyer mentions all the people who have died in the plague.

26:24And Marcus, at this mentioned breaks out in tears, sort of grieving the enormity and the incomprehensibility of the loss that has befallen them, which I can only imagine is a feeling shared in your profession, you know, having been on the front lines of this for so long. It's just not a thing that human beings are equipped or should be expected to have to deal with. And yet here we are. And so when when marcus uh talks about losing his emotions or being overwhelmed by something i think he talks most interestingly about this in chapter seven of meditation so i'm going to go back we're going to go to seven seven uh he says let me find this here um he says uh i wrote it down well actually here oh just uh this he says when jarred unavoidably by circumstances revert at once to yourself.

27:22And he says, and don't lose the rhythm more than you can help. You'll have a better grasp of harmony if you can keep going back to it. And then this is the passage that I think is most interesting about being overwhelmed. He says, don't be ashamed to need help. Like a soldier storming a wall, you have a mission to accomplish. If you have been wounded and need a comrade to pull you up. So what? And I think when we think of leadership, we think of the leader who stands alone. When we think of the doctor, we think of looking up at the doctor as the patient or as the subordinate. We see them as somehow above us.

28:07We see them as somehow invulnerable or having surpassed normal human limitations. And this is wrong, right? We're all human beings. We all struggle. We can imagine Marcus Aurelius staggering under the weight of the burden that had been placed upon him, the depths of the tragedy and stress and strain of what he was going through. And I think he's writing to himself, hey, look, when other people ask us for help, be it a patient or a colleague or a spouse or a friend, we're so glad to help. We say, yeah, of course, what do you need? What can I do for you? And then for some reason, when we are in positions of leadership ourselves, or when we are under strain or stress or are struggling, we feel reluctant to ask other people for help as though they're going to see that as a burden, as though they're going to resent us or dislike us for that.

29:04And that's not how it works, right? we're all in this together. The Stoics believe we are made to work together, as Marcus really said, like two rows of teeth. We help each other. And so I love this idea that for the Stoics, the Stoic is not afraid to ask for help. And in fact, the Stoic sees it as imperative to ask for help. There's another book that I came to read to my kids during the pandemic. It's a beautiful little book called The Boy, the Fox, the Horse, and the Mole. And there's a little section in it where he says, the boy says, asking for help is not giving up. He says, asking for help is refusing to give up, which I think encapsulates the stoic idea that, you know, vulnerability, sorry, courage is not simply charging out in the battlefield.

29:53Courage is not simply not being daunted or scared by things. Courage is also the ability to be vulnerable, the ability to work with other people, the ability to ask questions. Epictetus, who is the philosopher that most influenced Marcus Aurelius, he has this great line that I think captures the idea of why we have to be able to ask for help, why we have to be able to admit that we are struggling with something. He says, it's impossible to learn that which you think you already know, right? And so ego and superhero complex or whatever you want to call it, it's not just silly, but it also stunts our growth.

30:34It prevents us from connecting with others. It prevents us from accessing parts of ourselves. And then it prevents us from growing and changing and availing ourselves of resources that, by the way, are there for precisely these kinds of scenarios. And the refusal, the inability to ask for help is a major impediment to growing as a leader, but also enduring and surviving and thus thriving as a human being. The last one that I wanted to talk about is, I think, one of the more interesting practices in Stoicism. It's this idea of memento mori or a meditation, very briefly on our mortality, which something like a pandemic or a plague in Marcus Aurelius's case would have made vividly clear.

31:25Obviously, something like COVID brings mortality into the modern world in a way that the average person was not familiar with. These days, most people die in hospitals, right? And so it's sort of taken away from the average person's life in a way that makes us think that we're done with that, doesn't exist anymore. In Marcus's time, they wouldn't have had freezer trucks where they're loading bodies. The morgues wouldn't have been overflowing in that sense. But their understanding of medicine was so rudimentary that they felt, for instance, that incense warded off the plague. So COVID is defined by masks.

32:10The Antonine Plague is defined by the weird aroma of incense wafting through the streets of Rome. Marcus would have smelled it. It would have been a reminder of death. And he also would have smelled the burning of bodies. And so Rome would have had this strange fragrance combined with a putrid smell that would have reminded him constantly that death was ever present and couldn't be ignored and that it came for all of us. And as he writes in Meditations, this is 448, he says, Don't let yourself forget how many doctors have died after furrowing their brows over so many deathbeds. How many astrologers after pompous forecasts about others' ends?

32:55How many philosophers after endless disquisitions on death and immortality? How many warriors after inflicting thousands of casualties themselves? How many tyrants after abusing the power of life and death atrociously as if they were themselves immortal? How many whole cities have met their end, like Pompeii or Herculaneum and others? And all the ones you know yourself, one after another, laid out for burial and was buried themselves and the man who buried him, all in the same short space of time. His point was that life is short. Life is not in our control, that all of us who are born are born to die.

33:35And this meditation on mortality was not simply a necessary reality of their time, but it was also a reminder to be humble, to be present, and to be connected to those around you to do good while you still can. In another sort of more haunting passage in Marcus Aurelius, he says, quoting Epictetus, when you tuck your child in at night, say to themselves, they may not make it until the morning. And he wasn't saying this simply because infant mortality was atrocious in ancient Rome, that the most dangerous time to be alive was the first five or six years of a child's life, that you were in constant danger from the second you were born until you made it to your teenage years, basically.

34:24But what he was saying, I think, and what I take from that as I practice that exercise, and certainly it was brought vividly clear to me in the early days of COVID, I think he's saying, be present. Why are you rushing through bedtime? Why are you rushing through this drive to school with your children? Why are you rushing through even this unpleasant conversation with a colleague? Why are you rushing through doing the dishes? Why are you rushing through any of it? The future is uncertain, the Stokes would say. We have to learn how to live immediately. Mark Cirilius in meditations, he says, you could leave life right now.

35:01Let that determine what you do and say and think. To me, this helps us get up in the morning. It also helps us go to bed at night with the sense of gratitude. If we put the finishing touches on our lives each day, when we wake up the next day, right? It's bonus. We're playing with house money. We got a second chance. And this should inform our actions and give our actions a kind of lightness and grace as well as gratitude. And I think that ultimately is the place that we want to be as we go through the difficulties and the unpredictableness of life. That's the philosophy we want to bring to leadership.

35:44And I wanted to riff this morning on Marcus Aurelius, just some passages that I thought pertain to your world. Although I do think that all the passages in meditations are sort of shockingly relevant in today's time. But the great William Osler, the founder of John Hopkins Medical School, one of the sort of frontline workers during the influenza pandemic, ultimately dies of it. He would say that the first thing that he would recommend to young medical students is that they have a practice at the end of their day where they read a little Shakespeare or Montaigne or the Stoics. His point was that you had to have something to relax, but also to expand and grow your mind, something that was not directly related to the job, but allowed you to center yourself, allowed you to see yourself from a little bit of a distance, allowed you to understand human nature a little bit better, gave you perspective, gave you something to be inspired by.

36:52I think it also gives us a code of conduct and aspiration and ideal to try to hold ourselves to as human beings, as well as professionals. And to me, that's what this practice of stoic philosophy was for Galen 2 ,000 years ago. It's what they were doing in the Renaissance. It's what they were doing in the decline and fall of the Roman Empire. It's what I try to do every day as part of my practice. And hopefully this gives you something to chew on. But what I'm really looking forward to is the other part of philosophy, which is the discussion or the kicking around of ideas. And I'm excited to do that with all of you now.

37:43Thanks for listening to the Daily Stoic podcast. Just a reminder, we've got signed copies of all my books in the Daily Stoic store. You can get them personalized. You can get them sent to a friend. The obstacle is the way you go is the enemy. Stillness is the key. The leather-bound edition of the Daily Stoic. We have them all in the Daily Stoic store, which you can check out at store.dailystoic.com.

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