Vivek Murthy: Everyone Gets Lonely; Here's How to Counter It

; Abraham Verghese, MD, MFA; Vivek H. Murthy, MD

Disclosures

October 30, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

Abraham Verghese, MD: Hi, everyone. Welcome to this episode of Medicine and the Machine with my co-host, Eric Topol. It's such a treat for us today because I get to welcome Vivek Murthy, someone I've gotten to know and really admire. He has had a very distinguished career. He began at Harvard College and went on to Yale for medical school and his MBA. His residency was at the Brigham and Women's Hospital, where he then was a hospitalist before being tapped by President Obama to become the 19th Surgeon General. He has been such a wonderful, calming voice of reason in a very unreasonable time.

Vivek, I want to share one anecdote, if I may, of the first time we met. I remember seeing you in your wonderful Vice Admiral's uniform. I knew who you were, of course, and came over and introduced myself. You said, "Dr Verghese, I remember seeing you when I was a medical student." I never felt older than that moment when the Surgeon General remembered my talking to his medical school class. It's a real treat to have you with us. How is life going?

Life During the Pandemic

Vivek H. Murthy, MD

Vivek H. Murthy, MD: First, let me just say how excited I am to have this conversation with you and Eric. Conversations with friends are something that I appreciate now more than ever, given how this pandemic has separated us from people we care about and has made it harder to see folks. And I should just say, Abraham, not to embarrass you, but that event I remember in medical school was when you gave grand rounds at the Yale Department of Medicine. You captivated that audience in such an amazing way with your eloquence, humor, and insights. All those years later it's stuck with me. It's a testament to you.

But to answer your question, I'm doing okay. I'm doing well. Like everyone else, it's been a tumultuous time dealing with COVID-19. There are some hardships in the sense that I worry about my family. In Miami where there is a lot of virus, my dad and sister are still seeing patients as primary care doctors and I worry about their exposure. I also worry about my kids; they are 4 and 2 years old. They haven't been able to see friends. My older one is starting pre-K, but he's shy and it's harder for him to make friends online with kids he's never met before.

But the good news is that we have a roof over our heads, we have food, we're healthy. I'm grateful that for the past 7 months I've been quarantining with my extended family: my sister, my parents, my grandmother, and my wife and our two kids in Miami. It's made me grateful for the time with family.

COVID-19: A Time of Intersecting Threads

Verghese: That's wonderful. When you were in college, you founded a nonprofit organization that supported HIV patients. And later when you were a resident or on the faculty, you began Doctors for America, which evolved into a large organization focused on healthcare reform. I imagine that your ideas are now being very much sought out by one or both candidates as people try to formulate what's next. How much can you tell us about that?

Murthy: I certainly have been privileged. I have had the opportunity to work on public health from a number of different angles since I was in college. It was a journey I began with my sister, which made it particularly special. But in this time where we are dealing with COVID-19, it's interesting to me because it has brought together so many threads of work from the past two decades. We're working on outbreaks, which is something that I worked on when I was Surgeon General. We were dealing with Ebola and Zika when I was in office. But there are deeper challenges around our public health infrastructure and how to come to grips with the fact that we've been struggling for a long time, long before this pandemic, when it comes to having adequate public health systems, infrastructure, workforce, and funding for public health. That also intersected deeply, in a profound way, with issues around mental health and emotional well-being, which have been areas that have captivated me over the past several years.

When I was Surgeon General, I was coming to see that beneath so many of the stories I was hearing — whether it was about the opioid epidemic or violence in communities or people's struggles with depression and anxiety and chronic disease — were these threads of emotional struggle and pain. It became clear to me very quickly that that deeper pain that so many people are experiencing is very much connected to not just their overall satisfaction about being, but to the physical illness that we see.

When we come to think about COVID-19, you find all of these threads intersecting. It's taking a toll on our physical and mental health. It's exposed the holes in our public health system and in our healthcare system as well. We have an opportunity now to think about how we fill those holes — not just how we address COVID 19, but how we strengthen our infrastructure, our healthcare system, our public health apparatus, as well as our willingness to come together and to address these types of challenges. This is a moment for rebuilding and for unification. If we approach it the right way, my hope is that we can come out stronger than before the pandemic began.

Public Trust Is a Key Asset

Eric J. Topol, MD: Vivek, this situation must be unrecognizable from the experiences you had with Zika and Ebola when you were Surgeon General. We've dug such a deep hole which makes it all the more formidable to get out of. To have an exit. You know what it would take to navigate through this, hopefully with the new leadership that we'll have. What do you think will be the most important components of digging out?

Murthy: It's a great question, Eric. The COVID-19 response has been really unusual, to put it lightly. Unusual in the sense that in prior experiences when we had a major outbreak or a pandemic, whether we were in Republican or Democratic administrations, we usually saw people line up behind the scientists and use science to guide their policy- and decision-making, as well as their messaging and communication. The way in which we've seen COVID-19 approached from the federal level has been a stark contrast to Republican and Democratic administrations in the past.

One of the greatest costs I worry about, certainly, is the loss of life — the suffering that so many families and individuals have endured. But I also worry about the erosion — "erosion" is probably too light a word — the destruction of public trust that has taken place during these past 7 or 8 months in particular. I really believe that when you're responding to a pandemic, public trust is one of your most important assets. You need to do everything possible to cultivate that trust and to be deserving of that trust. Because if you lose the public's trust, even when you were trying to get them to do things that could be helpful for themselves and the community, they may not do them. They may not trust, for example, that the vaccine you have is truly safe and effective. They may not believe you when you say that masks are an important tool to help reduce spread or that the judgment of the public health community is that we need to reduce crowd sizes. They may worry [about your being] accurate in your recommendations. You need to cultivate that trust.

Whether Vice President Biden serves as president or whether President Trump has the opportunity to serve again, any effective public health response to COVID-19 will require us to rebuild that trust.

We do that by communicating openly, clearly, and honestly with the public. Also, it has to include setting clear goals and timetables and deliverables and then actually achieving those goals. It's delivering results. We've also got to show that we are going to prioritize science and scientists. That involves not just saying that we're going to do it, but actually putting scientists forward to communicate directly with the public, allowing agencies like the FDA and CDC to be independent in the guidance they issue and in their decision-making. I think that will be the most important step that whoever serves as president will take. Because without that trust, you may have the best science, the best recommendations, and the most effective therapeutics and vaccines, but the people aren't going to follow that guidance or take those treatments or vaccines.

Red Lines and the Role of the Surgeon General

Verghese: This is timely because Eric and I just published an essay in Science Translational Medicine calling on the leadership of the CDC and the FDA to speak out, because one gets the sense that they're being reticent. It leads me to ask you, as a Surgeon General, one is shackled by the office in terms of what one can say, whom one answers to. The shackles have come off for you now and I was glad to see you talk about the superspreader event at the White House. How would it have been right now if you were Surgeon General? I imagine that this would have been a very challenging time for you.

Murthy: It would have been very challenging. I think every government official, especially those who are in a publicly visible position, before you agree to serve, you have to know what your red lines are: What are you not willing to do? What lines are you not willing to cross as you seek to serve in your role? One of the reasons I was interested in the position of Surgeon General when they called me about it was that the Surgeon General historically has an independent role. The job of the Surgeon General is not to execute the political agenda of the president who appoints him or her, but it's actually to have the highest fidelity to science in the public interest. And if that involves disagreeing with your president, then that is actually what you're supposed to do — that is the job. Frankly, I'm not sure how long I would have lasted in the current administration, because I know that it has been challenging for many of the public health officials there to speak openly and to speak their minds. But it's important to do so.

There's always a calculus that public officials make: Should I stay in and try to do as much good as I can behind the scenes and prevent even more damage from being done? Or should I speak up, knowing that that may make a difference now, but I will likely get terminated or shoved into a closet and may not be able to make much of an impact later? That's a difficult decision. It's easy, on the one hand, to say that everybody should just say their piece and get fired on day 1. But you do need good people in there continuing to run the operation. Where the calculus shifts, though, is if you find yourself on big issues and on too many small issues allowing mistruths and other sorts of statements to continue to go by unchallenged or unaddressed; then you start to erode confidence in your institution itself.

Having worked with many people in the CDC, I have great respect for the institution and for the people who work there. They have tremendous expertise. There's a reason that the CDC has been the envy of the world for many, many years. It is not because they're perfect; it's because they're really, really good at what they do. I know that institution has the ability to put together really good guidance and to help us figure out how to think about reopening schools and workplaces. The fact that they weren't allowed to do so, that there was pressure from the White House to shift their guidance, to soften it — and in some cases to eliminate it entirely — is deeply disturbing. And if you allow that to continue to happen, then you erode people's faith in the institution itself and it becomes bigger than you as a leader. I always told my team when I served as Surgeon General that we were custodians of an office, an office that was there long before us and an office that would be there long after us. Our job was to leave it stronger and leave it a better platform for the Surgeon General who came after us. That meant investing in strengthening the integrity of that platform.

I do think that in cases like what we're facing right now, this CDC director, the FDA commissioner, and all of these leaders have to have their red lines. They need to know where they're willing to stand up and know what price is willing to be paid. I have no doubt that they recognize that. I'm sure they've thought about it many, many times. But I do worry that the credibility of these institutions, the FDA and the CDC in particular, has really been challenged in the minds of a lot of people in the public. Part of what we have to do, not just for COVID-19 but for the future, is rebuild that faith.

Verghese: That is very well said.

'I'm Deeply Worried'

Topol: This is interesting because now we're seeing a war develop between President Trump and Tony Fauci, who many of us deeply admire. Fauci received a major award from the National Academy of Medicine today, and at the same time, Trump is saying, "I should never have listened to him and the other idiots." This is an all-out assault on the science side of a pandemic. This has to be a unique situation in the history of the country, at least the history that I've ever been a witness to. You're very diplomatic in terms of describing it. But it seems like if we don't see a major change — and even now we're months away — we're looking at the third surge. It's substantial. With the weather getting colder, with more indoors and possibly coinfection with flu, where do you see the prospects?

Murthy: I'm worried about this surge too, Eric. I'm worried that the time where we need to be doubling down on precautions like mask-wearing and distancing, we're not seeing our leaders lead by example. And we're seeing controversy over things where there's actually very broad scientific agreement. So, yes, I'm deeply worried too. A lot of this starts with us recognizing what's going to guide us through this. It's going to be science. It's going to be the research that's being done. It's going to be the best practices that we've developed, from epidemic after epidemic, pandemic after pandemic, that we've worked on over the years. What we really need first and foremost is a leadership that recognizes that value of science and respects the scientists who are the conveyors of that science. What we can't have is a scenario where you have leadership — a president or other people or his staff — denigrating scientific authorities, because the message it sends to the public is that you shouldn't trust scientists. Even more than that, even if you trust scientists, it leaves people with little faith that their country can be able to pull through. I do think that we need different leadership.

Part of the reason that I'm advising Vice President Biden and that I have been briefing him on COVID-19 since he requested that at the beginning of this pandemic is because I really believe that he could be that leader. I've seen him in other responses with Ebola and Zika. I know, first and foremost, that he's somebody who deeply believes in science and scientists. I wish I could invite you into some of these briefings so you could recognize not just how deeply respectful he is of science, but also his deep curiosity about science. I remember several briefings where we were talking in great detail about the nature of RNA vaccines and details of adenovirus-like vectors. And to hear him then talk about that later publicly was just striking to me. This is not a man who takes these issues lightly. He puts a lot of time into these briefings. It's the respect he has for scientists and for science that is especially helpful.

I've been struck by how he gravitates toward two themes that inform how he thinks about policy and governance: the personal and the practical. On a personal level, when we brief him, he's always wanting to know how this issue would affect a mom or dad who's worried about sending their kid to school. How does this issue affect a mom-and-pop shop that's trying to put in place safety precautions so their employees and customers can come back? He's always bringing it back to the individual because he's always taking calls from individuals. He gives his number out a lot, so a lot of people call him and he's constantly thinking in that context.

But in addition to the personal, there's the practical. He's not somebody who necessarily hangs his hat on titles and processes and such. What he wants instead is to deliver results. He wants whoever needs to be in the room to be in the room; it doesn't matter their rank or title or status. He's constantly thinking, Okay, how are we going to implement that? If we had the privilege of being able to serve on January 20th, what would we do and how would we ensure that we're taking those steps to make sure schools can open? How do we make sure that we close the gap on the testing and have the testing we need?

I do have faith that he would take us in the direction that we need to go in terms of addressing this virus. But like you said, Eric, it's going to be a few more months, even if he were to win the election.

Topol: I just want to echo your points that are so valid and important. The interactions I've had with Joe Biden were with the cancer Moonshot program. You could see how he was really committed. He understood, obviously, not just because of the loss of his son, but from interacting with the physicians and scientists. He even took on Judy Faulkner of EPIC regarding how important it was for people to have all their data. Very practical. I have seen him in action and I was very impressed with all of those things where it came to a medical-science interface.

Social Recession or Social Revival?

Topol: I wonder if we can go back to a topic that you touched on earlier. The last time we spoke at any length was when you were getting ready to roll out your phenomenal book, Together. The loss of togetherness and the mental health hit that we sustained and are continuing to sustain have turned out to be big themes in the pandemic. Can you give us a sense about how this book that you worked very hard to put together turned out to dovetail so well with the experience that we have been suffering through?

Murthy: Thanks for those kind words, Eric, and for the advice you gave me before I rolled out my book. I didn't think that I would write a book on the power of social connection and the consequences of loneliness. It was a book, though, informed by my experiences as Surgeon General, where I saw in so many of the stories of people I met that this was a deep, deep issue.

It was striking to me how broadly it was being experienced. When you talk about loneliness, people have a stereotype in their mind. They think about an older patient who's ill and living alone in a nursing home. They think about somebody who's older toward the end of their life, who may have lost friends and is living by themselves. These are the stereotypes we conjure. But I was hearing stories of loneliness from college students who were on campuses, surrounded by thousands of people. I was hearing from moms and dads who were active in their PTA and in their neighborhood, surrounded by people, but were still feeling isolated and alone. New parents who were feeling really alone, even though they felt guilty about saying that because they thought they should be grateful that they just had a child.

As you run down the list, I was hearing these stories of loneliness from doctors and nurses, from CEOs, from people who live in small towns and big cities, and even from members of Congress who would tell me behind closed doors that they, too, were struggling with loneliness. And that just made me realize that there was something much deeper happening here. While writing the book, I had no idea that COVID-19 would arrive on the scene. COVID-19 has been extraordinarily stressful because of an uncertain timeline and end date, but also because at times of great stress when we would typically reach out to people in our lives to help reduce that stress, we've been placed in a situation where many people feel like they can't go visit their friends or fly to see family because of the concerns around infection spreading. That has been a double-whammy, if you will.

But as challenging as that is, Eric, I think we have an opportunity with COVID-19 in terms of how we think about and address loneliness and disconnection. We can allow this physical separation that we're being asked to observe to develop into social separation and contribute to greater loneliness. But if we do that, then I worry that we will incur a social recession, if you will, marked by deepening loneliness, more distant ties, and one that will have profound consequences for our physical health, our mental health, and our productivity in the workplace and at school — a consequence, I think, that ultimately will rival the economic headwinds we're facing.

Another possibility, though, is that we take the path of "social revival" and use COVID-19 as an opportunity to step back and take stock of our lives, to ask ourselves: Where do people really fit in our hierarchy, in our priorities? And to ask ourselves how we can double down on our relationships with one another.

Strategies to Strengthen Interpersonal Connections

Murthy: During the time of COVID-19, even though we can't go see people as easily, there are things we can do to strengthen our connection with one another. For example, we can take 15 minutes a day to reach out to people we care about, whether it's calling them on the phone or videoconferencing with them or writing someone a note saying, "Hey, I'm thinking of you and I wanted to know how you're doing." That done consistently can be a very powerful lifeline. And the reason the 15 minutes is so powerful is that as human beings, we are hardwired to connect with one another; and when given the opportunity to do so in a meaningful, authentic way, we gain a lot of satisfaction and fulfillment from that.

But the second thing we can do is improve the quality of time we have with one another by eliminating distraction when we're talking to others.

Like many others, I have this phone sitting next to me. Over the years as I've been catching up with friends, I will somehow find my hand reaching into my pocket, and all of a sudden, I'll be scrolling through my inbox or looking at something on my phone and convincing myself that I can multitask and listen at the same time. But we know from the best of science that that's not true. We actually can't multitask. We just task-switch very rapidly.

What's really striking, though, is if I can eliminate distraction when I'm talking to other people, I can actually create a very powerful interaction. Just think back to the last conversation you had when somebody was fully present, when they were listening deeply to you; were you able to share openly with them? Think about how that felt and how fulfilling and renewing it was. That is the power of what conversation can be. Five minutes of pure, focused conversation can be more powerful than 30 minutes of distracted conversation.

Service is one of the greatest antidotes to loneliness that we have.

The third strategy that can help us connect during these times is to search for ways to serve one another. One of the things I realized in the writing of this book was that service is one of the greatest antidotes to loneliness that we have. And even though we can't go to a soup kitchen or volunteer at an organization, at a time when so many people are struggling with the transitions from COVID-19 and the tumultuous nature of how it's affected our lives, you can be sure that people are hurting and many people are in need of help and support. That means simply checking on a neighbor to see if they're doing okay, delivering food to a friend who might have been struggling even before the pandemic arrived, offering to virtually babysit for 5 or 10 minutes for a friend who is a parent to young children and is struggling to telework and home-school at the same time. These are small but powerful acts of service.

Service is so powerful because when we experience loneliness, for evolutionary reasons, we enter into a state of stress and threat. Our attention focuses inward. We also become hypervigilant and perceive more threat around us. But we also experience an erosion in self-esteem over time as we come to believe that the reason we're lonely is that we're not likable or something is broken about us. But when we serve other people, we actually break that downward spiral of loneliness because we shift the attention from ourselves to someone else. And we also reaffirm to ourselves that we have value to bring to the world. These are very simple strategies that we can do to bolster, strengthen, and deepen our connection with one another despite this terrible pandemic that we're in.

Vulnerability and Humanism: A Message for Young Practitioners

Verghese: For our listeners, the book is Together: The Healing Power of Human Connection in a Sometimes Lonely World. I agree with Eric that it was just prophetic that you should write something like this, almost as though anticipating COVID-19. One thing that really strikes me is that isolation, solitude, and the sense of loneliness are very much rampant in the medical community.

We worried about burnout well before COVID-19, but it's now really reached global proportions. One of the lines in your book that really struck me was how you talked about being vulnerable and that there was a profound lesson in vulnerability. You said, "To be real is to be vulnerable." I think that too many of our leaders in the highest offices are frightened to show vulnerability. And yet to be vulnerable is to be human, and to accept your vulnerability is perhaps the first stage to getting some insight.

Do you have some messages for our physicians on the front lines? I'm thinking especially of the young residents and young hospitalists and people in the emergency rooms, in terms of their own burnout and stress. Everything you said is absolutely relevant, but is there anything else you'd like to add to that with them as your listeners?

Murthy: I'm so glad you raised this, Abraham, because one thing that is paining me greatly about our profession of medicine is seeing that there are so many people who enter with high ideals — the desire to serve, to relieve suffering — but then they themselves end up suffering and struggling, and they feel ashamed because of that. That can be an extremely lonely experience. I think many people in training have gone through that but many people, even after training, experience that. We have a culture in medicine where it's not okay to talk about how you feel if you're struggling, where somehow any struggle you may have with loneliness, depression, anxiety, or stress is seen as evidence of weakness.

I remember on the wards, whenever somebody would run a successful code, whenever they would clinch the diagnosis in morning report, the words that would often be used were "strong work," "great job." Think about the term "strong work" for a minute. What you are conveying to them is that they are demonstrating strength through those experiences, right? Running a good code. Knowing the diagnosis. Being able to cite the literature. There is nothing wrong with that. But we rarely would use such terms to describe people's humanity shining through in the context of a patient interaction. I can't remember many celebratory emails that went out congratulating a professor who had just been promoted because of his or her humanitarian work or, just frankly, for being a good clinician. A good doctor.

If you're training, you're looking at that. What message are you getting? You are understanding that it's not the stated value system of medicine but the lived value system of medicine that says: Success is publication, success is knowledge, success is having a name and reputation in your field. None of those things are bad. We want those things of our doctors. Certainly many want it themselves.

But what we leave out is the other half of medicine, the humanistic element of medicine, the fact that medicine is both a matter and a work of the head and the heart. But when we only reward the work of the head, then not only the work of the heart but the pains that we experience in our heart get left behind.

For people in our profession who are experiencing loneliness, here are a few things I want you to know. Number one: If you are feeling lonely, you are not the only one. Many of us, including myself, have struggled deeply over the years with loneliness, during training, after training, and well before training. The second thing I want you to know is that just because you are lonely, you are not broken. You are not deficient in some way. You are experiencing what all of us experience at some point in our life, just like we experience hunger or thirst when our body is lacking something it needs. We experience loneliness when we are lacking something we need for our survival, which is authentic human connection.

Last, I want you to know that it doesn't have to be this way in medicine. Our culture does not have to be one that does not embrace the totality of who we are, including our flaws and our imperfections, including our heart and our head. That ability to shape that culture, to be more inclusive, to be more accepting, to be more vulnerable, depends on how all of us lead in our own way. It is not the case that just because you are in training you cannot influence culture. I've seen myself that some of the biggest changes we made in the hospital were because a medical student or resident saw something that was broken and needed to be fixed, and they brought it to our attention. But I do know that if people don't step up and share their stories, if they don't take those opportunities to be vulnerable — especially people in leadership positions — then the culture won't change and the costs of that will be tremendous. Not only for the patients we want to serve, but for our fellow clinicians and colleagues that we also need to be serving and serving well.

This is a time where we have the opportunity to remake a lot of things in our country and in the world through the lens of COVID-19. In medicine, I think our culture is one of them. I think about the extraordinary sacrifices that people have made throughout this COVID-19 pandemic in our hospitals and clinics, often putting their own health and well-being on the line, caring for patients without masks because they weren't available. This is not the work of weak people. This is not the work that broken people do. This is the work of heroes, of strong people, of people who know that our greatest moments are when our head and our heart fuse together, when our sense of mission is married to our knowledge, and we bring that to bear in the service of the patient in front of us. If we can recapture that spirit now in remaking our profession into the kind, compassionate, knowledgeable force that it can be, both for patients as well as for clinicians, then we can build a profession that is truly healing, in the full sense of the word. That's what I want for my friends, my family, and all of my colleagues.

From Humble Roots to Surgeon General

Verghese: That is beautifully said, Vivek. Thank you so much. You've done so many things in your life and you are so incredibly young. You've been a practicing internist. You've changed society with some of your early social policies and your nonprofit work. You've been Surgeon General. You are an author of an incredibly beautiful book and one that I think is so germane to our times. What is the next iteration of Vivek Murthy?

Murthy: Thank you for those kind words, Abraham. I've been blessed in a lot of ways with opportunities. I was telling a friend the other day that when I think about my immigrant parents who left India in the 1970s, I think about the delta in their lives, where they started off and where they ended up. They started off in a really difficult place. My father grew up in a small farming village. He was so poor that they didn't have money for shoes; the first time he wore any coverings on his feet was when he was 15 years old. They were also so poor that they had to keep diluting the dal that they boiled every night until there was enough to fill the bowls of each child around the table. But somehow he made it through school, went to college (which no one had ever done in the village before), went to medical school (which was unheard of), left India (even more unheard of), and built a home and a life for himself and his family here in the United States with my mother, who also made an extraordinary journey.

I think there is nothing I can do in my life that will ever achieve the delta that they achieved. It's such an extraordinary story and it's not a unique story. It's a story of so many immigrants and others who came here maybe generations ago, of parents who grew up in humble beginnings and in their own selfless way provided the foundation for those of us who came after them to step up and take advantage of opportunities. I say that because you mentioned my time serving as Surgeon General. It will always remain in my mind when I was sworn in and was looking at Vice President Biden and the crowd of friends and family who had assembled, and was saying to them that there are few countries in the world where the grandson of a poor farmer from India would be asked by the president to look out for the health of the entire nation. That is a beautifully and uniquely American story, and it's one I'm deeply grateful for.

I don't know what comes next. One of the things that I've realized and tried to do more of over the years is think less long-term and more short-term. The reason is I was never very good at coming up with 5- or 10-year plans. They never seemed to stick, for some reason. Maybe I wasn't disciplined enough.

But the other thing I realized is that I'm in a place in my life where I need to continually reassess what my priorities are, and I need to ground myself in the priorities that I know are right in the world. For example, I know that people and relationships are what are most important to me. I am somewhat embarrassed to say that I haven't always led a life that has been consistent with that. I've often put work far ahead of the relationships that are most important to me. But I now know that I've done that. I now know what I want to be my priority. And so the question is, how do I best serve those relationships in my life? How do I best serve society and help create a better world for my children, and all of our children, so that the world they inherit will be more compassionate and kind and welcoming than perhaps what it otherwise might be? How can I be of service in that way? If it turns out that part of that is doing something related to COVID-19, then maybe I'll do that. If it turns out that it's continuing to work on issues related to social connection and thinking about how to rebuild that most important foundation of society, which are our connections with one another, then that may be something I focus on as well. Likely it could be both of them. But whether that's inside or outside government, that's a story that I'm still writing.

The most important thing in life is not where we're going, but why.

Something I always try to share with trainees — in part to remind myself because I need reminding — is that the most important thing in life is not where we're going, but why. Why are we choosing to take the journey we're about to take? What priority in our life is served by it? Will we truly be better off? I think about those patients who I cared for at the end of their life. The patients who we treated with everything we had but it came to a point where there was nothing left to give in terms of medical treatment. I remember just sitting by their bedside and often holding their hand and listening to them in those final hours.

I think about what they talked about. I'll tell you what they didn't talk about. They didn't talk about the last position they held in the workplace. They didn't talk about how big their bank accounts were, how many followers they had on social media. What they did talk about were their relationships, the ones that had brought them great joy, the ones they wish they had spent more time with, the ones that had broken their hearts. Even those final moments, when all but the most important threads of life fall away, it's our relationships that rise to the top. I don't want to wait until the end of my life to live a life that's consistent with that recognition, with that realization.

That's what I want to guide me. I know it won't be perfect. I know I'll need friends and family to keep me on that path, because I do get distracted at times and veer off into focusing too much on work or on the three things that society has told us we need to be meaningful and valuable: wealth, power, and fame. The truth is, I know that those aren't what makes life meaningful. I know plenty of people who are wealthy, powerful, and famous who are profoundly unhappy and very alone.

That's going to be my guide in these coming months: to be of service to the people I care about, to be of service to society, and to try to create a better world for my kids and all of our children.

Building a World More Grounded in Love

Verghese: Vivek, I can't think of a better sentiment on which to end. I think Eric and I are deeply admiring of what you had to say. The rhetoric that floats around us in the blogosphere, in the Twittersphere, in the news sphere is so devoid of some of these wonderful emotions that you're expressing, especially the vulnerability, the compassion. How refreshing it is to speak to you. We wish you all blessings on your journey. I'm sure there is much more to come, even though you can't quite clearly see it. I'm sure it'll be great because it'll be influenced by these wonderful values you have.

Murthy: It's kind of you, Abraham. I do understand your point about the airwaves and what we're hearing on the airwaves. You are right that when we read social media, when we read blogs, when we read the paper and listen to the news, we often find a lot that agitates us and that increases our stress. But what I feel we're missing in so much of this is that powerful force of love that we have talked about before. In the book, I wrote ostensibly about social connection and loneliness but it's really a book about love — about how to recapture it, how to build a life on it, and how to recognize that it's the foundation that makes a society strong and vibrant and resilient. The truth is, we know that when love shows up in our life, it shows up in different ways: as courage, compassion, kindness, generosity, warmth. When we feel that, when we receive it from others, and when we give it ourselves, we feel good. We feel renewed. We feel whole. That's true in medicine and it's true in all dimensions of life. But the opposite of love is not hate. The opposite of love is fear. And what we hear, unfortunately, in the news and on social media is a lot of fear — fear that's coming across as anger, jealousy, rage, insecurity, anxiety. And the fundamental truth is that all of us have elements of love and fear inside us.

But the question we have to think about — the question that I found myself thinking about with my wife, Alice, when we found out that we were pregnant with our first child — is how do we ensure that we live in a world that is grounded in love and not fear? As we think about that balance in life, how do we put our hands on the side of love and tip those scales away from fear? No one of us can do it alone. I remember the commitment that Alice and I made that day when we were sitting there and looking at that positive pregnancy test for our first child. We were so excited. The commitment we made was to do everything we could to tip those scales toward love, and to do that in how we treated people in the world, by how we chose the line of work that we engaged in, by standing up and speaking up in the public square on issues that really matter (not just for ourselves but, more importantly, for others), by seeking to be of service to those around us. That's how we build a world that's more grounded in love. I think that that is the work of our time. That is the most important work of our generation. The generation that's not defined by age but by spirit and by a recognition of what we need to do at this moment together to build a world that is as nurturing and as vibrant, as thriving, as what I know we can build.

This is not ultimately a journey to somehow become something we're not. The journey to live a more connected life that's grounded in love, compassion, and kindness is a journey to return to who we ultimately are, who we were born as. I see that in my children every day, that they are, by nature, loving and compassionate. All of our kids are. It does not mean that they don't fight and scratch each other and bite each other at times. That happens too — don't get me wrong. But their true nature is to be trusting, to be kind, to be loving. That gets beaten out of us over time. We get told that if we show too much kindness or generosity, we will be taken advantage of. We will be perceived as weak. But in our hearts we know that in our best moments, we are operating from a place of love, kindness, and compassion. I believe that's our most important mission, in particular for our colleagues in medicine. I feel so proud to be a part of our profession because this is a profession that's grounded in values. We may not be perfect. We may not always get it right. We have problems that we have to fix in our culture. But by and large, we've come together around the idea that relieving suffering matters, that serving other people is a commendable thing to do. And ultimately, we've come together around a profession that is centered around compassion, kindness, and love.

Topol: Thanks, Vivek. I just want to add to Abraham's points that you're a natural leader. You're young and you are an activist. You started that in a very early time in your life. You had to fight the whole gun thing and become a Surgeon General. I don't know how you weathered that storm. We will be looking to you for continued leadership for decades ahead. Thanks so much for what you've done.

Murthy: Thank you both so much. It's a privilege to be here with friends and two people I deeply admire as leaders in our profession. I'm grateful for our conversation.

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