Nick Bernthal, oncologist and Jon's brother - REAL ONES with Jon Bernthal

even when i come to the hospital and i see you in your [ __ ] nerdy ass lab coat and [ __ ] i always make sure people understand that you're a great athlete because i feel like i you know got you there i beat your ass every day of your life i made you a man i toughened you up all american football all city dc basketball played d1 sports uh well anyways you were good in baseball which also was frustrating as [ __ ] [Music] today is a very special guest one that i've known for his entire life it's my little brother nick bernthal nick was an all-american athlete played division one sports set up hospitals all over the world has now become one of the most revered cancer surgeons in the country for as well as i love and respect and know my little brother today i feel like i got to know him a little bit better look nick you got [ __ ] cameras on you dude that make you nervous huh you know and and having this conversation there's always a a need for me to explain and i have to explain to everybody in the room that uh that that nick my little brother here is actually like an elite athlete right and i i say that you don't look like that you definitely definitely don't look like it and the thing is is is because i i [ __ ] it's be and and i do take that as my response i beat your ass every day of your life i made you a man i toughened you up but like what you uh all-american football all-city dc basketball played d1 sports and good at like really all [ __ ] games it's frustrating you play baseball what like what like your junior and you were were you all league in baseball uh don't act like you don't [ __ ] know dude were you all league in baseball well anyways you were good in baseball which also was frustrating as [ __ ] like even when i come to the hospital and i see you in your [ __ ] nerdy ass lab coat and [ __ ] i always make sure people understand that you're a great athlete because i feel like i you know got you there and i guess you know to start man i wanted to know like from athletics like what is what is some [ __ ] that you you you have taken from from sports you know i think i think for me sports kind of started out just being something about um when you're the youngest brother sports are a way that you can engage with your older brothers and and for us as you know i mean growing up in a house with with guys and sports all around everywhere it was for me a way of kind of being included that i felt like if i could kind of be good enough to play in that get that that that was it like that's the goal that's the goal is being good enough that you're not kind of the weakest link in a sport but you know then from that i think you know there's all the cliche [ __ ] the relationships and the growing up in dc and the kind of the the links it made across but i think deeper um you know the deeper friendships when you start talking about things that actually put people on an equal playing field i've always just really kind of i've loved the idea of sports it's one of the few areas where everybody puts on a uniform and um it doesn't matter who you are where you're from what your parents look like what you look like i mean none of this stuff matters and so it always felt like it was this place where it's a true meritocracy you create your identity and you earn your identity and nothing's given to anybody and and so um for me that was a big part of it i mean dc is a multi-racial city it's a multi-background city and and um there just aren't that many places they equal opportunity it's just like you you're judged by that's how hard you work and how much you get you get each other and growing up sort of like how we did and where we did and when we did um i i i think was just so like just unbelievably unique and i think everybody has their own sort of relationship with their upbringing i'm constantly going back to how we grew up and um i'm just like so enormously grateful for it and um and first i just want to talk about like just like the environment of that and and you know i was thinking about you today and you know and like in the course of your life like growing up as like a high school student you know you drive your little shitty ass car to the [ __ ] white house you know what i mean like your [ __ ] broken down car with no air conditioner no radio and like amazing and like pull up at the white house and like watch football bill clinton and then you also had you know dear friends that you know who parents were you know first-generation immigrants you had friends whose parents you know your best friend's dad was a cop you know you you had friends whose parents were incarcerated you know we knew kids that you know had had been incarcerated been shot and killed you know there's there's just such exposure i think in in in a city like dc at the time we grew up where you have this like unbelievable power center but it's also just this um city with his own you know super vibrant culture and there it was a violent city and a live city and an artistic city i'm just wondering like how do you feel that like how would you characterize the way that we grew up in the environment we grew up in and like how has it served you i think as far as like the the dynamic of dc and and how it's i think one of the really cool things um is that there is a sort of genuine uh peace and comfort level in almost any group that comes out of growing up that way where you can really give people a shot where you can really sit and not worry about what you look like to them or what they look like to you on kind of first pass if you grow up an environment like that i mean part of it is that the valued resource in dc was never wealth which gets passed down it just never was really about wealth it was never about fame which in you know these famous families in california these wealthy families in new york yeah dc was never really about that i mean things change so fast there's elections this guy is the most important guy this month and then the next guy but but you know in dc as a city um it really felt like um the things that were valued were much more uh kind of what you had to say what your thought process was um and it integrity integrity i'm afraid you were yeah i mean those things really seem to just um be there you know obviously like you know better than anyone else like nobody needs to sit around listen to [ __ ] my ass like pontificate about politics or culture or any of that [ __ ] i you know i i've just been you know really just like disturbed and and um disappointed at like the just the the state of discourse right now in in in the country and i think it's just like we're listening to the wrong [ __ ] people and it's like loudest voice in the room wins and i think that that's against like everything that i believe in my heart my soul and how we were raised and um i think we're so [ __ ] divided right now that you know strength and sort of patriotism um it's just it's just all about bravado it's all about bluster it's like how how hard can i [ __ ] cheer for my team over here how stringently and stridently can i hang on to my [ __ ] point of view and that's mistaken with again with with strength and masculinity and and um fierceness and and um so i guess like what i'm really trying to do is is expose people and like bring in like interesting people that i think embody wisdom and and and strength and education and discipline and integrity and and and kindness and empathy and i think i i wanna i wanna just like give examples of that and like honestly man like you know even though i do take a lot of responsibility for you know all of your success i you know i think you are a perfect example of that and when i think about people who i would want in my corner i can't think of anybody more than you and but i also think about just like the way that we were raised in our house and my mom and dad and when you think about it you know look our our parents eventually were foster parents and literally brought kids in our house raising themselves but like for 40 years man like mom had a [ __ ] open door policy like it didn't matter how [ __ ] up you were how much trouble you were you could be running from the police you had a hot meal and a bed in our house like you were you were you were part of our family pops like always had an open door like no matter what you [ __ ] did you could go to him even without going to us first like you could go to him and he would [ __ ] help you out and like do whatever he could to like make you okay and and and you could bring anything to him and we grew up i think with this like tribe of people i mean huge [ __ ] group of kids and like you know really like a competent you know powerful group of people now from all [ __ ] walks of life all races all religions all socio-economic levels like i'm so grateful for growing up that way and i'm so grateful like like like that support and that base that that that we have it it's it's it is the reason you know that i feel like i can like go out and and do what i do and i'm sure you feel that way too surgery we talk about things being strong like palm trees rather than strong like like oak trees was that like an oak and like a you know an oak if you have a really rigid tree it it's looks really sturdy you hit on it it doesn't go anywhere but in a storm it falls right in a storm it's rigid is brittle and so it's very stuck and and you can't conceptually kind of fix things you can't put bones together when they're broken and make it rigid they actually won't heal you actually need to make them like a palm tree so they have some give in the system so that they can respond to stress because it lets the body actually heal and mend and grow stronger so when you heal a broken bone it the goal is to create a palm tree you create something with a little give in it and and i think you know to me that's that that's the metaphor that is kind of the building the solid foundation it's got to be planted it's got to be rooted but like the concern is does the kind of current climate go so far that you have the overprotective side of things in growing up that you control everything and you build it rigid on its way up and it has no ability to tolerate a storm it has no ability to to sort of respond to stressors and so you know i think that's the goal i mean all of us is young parents trying to raise kids like that that's the environment you're trying to create and i think a household that says the doors open whatever you do i got your back but i'm going to tell you when you make a a bad decision i'm going to try and teach you from it we're going to bring in everybody from all walks of life because you don't know what stress or what's going to make you stronger what's going to make you weaker and and so i think that that model certainly holds you know i think obviously like right now we're like sitting here in the middle of this [ __ ] pandemic and um there was like two things you know that i found like really hit home for me i mean i think number one like losing adam you know like losing our cousin spent every christmas with him uh you know unbelievably you know probably the most talented person you know i've ever it's like he was the em emblem he like he meant talent to me he was like first thing i had first sort of an example like he he could just you could throw it in front of him and he could do it blow your [ __ ] mind dude and and music and and and like you know man it's like you know this covet thing hit and you know you were sort of you know you were the one that like everybody obviously was going to and talking to him being like what's it like anytime anybody has like in the tentacles of our of our family which is you know probably in the thousands like people are hitting you up and you're always there for them and you know you were on the phones with the doctors and you were you were you know i'm like look man like you you had to break the news to your aunt and uncle that you know that there they'd never see their their boy again and you know you two young girls a young man perfect health and you had to break that news and i thought about you so much in that and that like what that [ __ ] must have been like to call you know bobby and steve and like and then like i realize you do that kind of thing sort of all the time and just like i know how much empathy you have and i know how much heart you have you're not like an aloof cold person it's like how do you [ __ ] deal with that and i guess you know what was it like to sort of be faced because it was the first time i sort of could go to you on something and you were like dude i like i don't know we don't know you don't [ __ ] know and and what was it like to sort of be faced with that and and have no frame of reference for it and like how how common is that yeah incredibly rare for us as a field i mean it's the first time i can remember and i think the guys who are a little bit older than me talk about it with the hiv epidemic at the very beginning in san francisco that that that was the feeling that you just didn't know what was hitting you but you knew something bad right um but you know i i think the deal with the beginning of covid that made it just uniquely difficult to help patients and people and friends through this is that um you know i live in the cancer world primarily and in cancer man something bad goes on and everybody coalesces it's amazing you watch what families do when somebody is suffering and somebody is struggling with cancer and it it can be the hardest thing in the world but more often than not man it brings out the best in everybody around and infectious disease stuff in covid it is the most isolating thing i mean you go through an icu and you saw especially at the beginning they were letting nobody anywhere near these you couldn't see your family you weren't you couldn't say i mean that was bobby and sit there adam adam said you know they held a phone through two windows to say goodbye to his daughter like his daughter said goodbye to him through a phone across two windows and um that was something none of us could come to grips with and you start seeing um the isolation of it i mean and this was it was adam's story but it was so many people's story of like i think i'm okay i'm a little feeling a little crappy there's this new pandemic i'm gonna go to the hospital to just get it checked out right and then you're gone you never see and you disappear and you never see anybody again that is a horrifying kind and you know as a doctor of your level i mean we've failed like america has like failed compared to the rest of yeah i i just don't there's no objective metric you can use that doesn't say we've failed miserably our our system is really good at certain things um this has exposed some of our biggest problems uh and we didn't what we've always kind of held on to is once we unleash our system at something that we had so much upside that we could always deal with it right that's the way our health system works is but this exposed just it's exposed it exposed some really big flaws in that system what does kovid reveal about the american health system so for me if it was about not having any central organization in our system makes it very hard to identify best practices and respond to them so from a system standpoint it's you know you you go to to the uk and you know the 90 of the patients are in the nhs or in the national health system and so you can see one hospital is doing better than another immediately that's recognized how does that best practice get conveyed to everybody else in our system everybody was kind of doing their own thing and trying to communicate as best we could but it's info it's emails it's hey this is what we're doing does that work for you and it's just because you have a friend in seattle who happened to do it that way you're doing it this way in la and and that's just not that's not the way to handle it then kind of after the initial process then it just became a thing about who can get resources i mean then it became a resource grab and so suddenly states are competing with states hospitals are competing with hospitals and like the reality is is like there's a finite number of everything right right you are like definition taking away from somewhere else and like that that's our system right right you know and so once this thing got into a phase of past the first month at that point the big rich hospitals were able to get stuff the less resourced hospitals were not and everybody started fighting over the same research that's why more poor people and and people of color are dying from this thing well so so i i there's a combination i mean these are things are all multi-factorial but you know for sure that there is better there is care that we can provide at our hospital because of the resources we have that are not being provided at other hospitals now whether people are dying because of that or in addition there are medical problems i mean now we know obesity leads to big prob there's obesity in underserved communities is a huge problem we're also like living in a country right now where there's like so much conspiracy theories and there's so much like that just like ripe with just like [ __ ] i mean like how do you feel about conspiracy theories like are they dangerous and like like the whole thing is i mean now it's it's spiraled into madness and it's gotten to a point now where um you know i i try and think about this if you break it down to a microcosm of a patient walks in who's got a cancer right i'm about to go through this treatment what i think is going to be the best shot they've got if we don't establish the ground rules of they've got a cancer if they don't buy that they've got a cancer if they don't buy that the cancer will kill them if we don't go down this road if we don't buy the facts kind of going into the system my discussion about how to treat them is totally a waste of time right right and and they can't get there and so now we're just unfortunately like culturally we're in a phase of of no underlining facts or trust to start this thing and and you know not to get overly political with it but it's like it's it's just we're in a an undermined culture right now and with covid that's what we missed is that nobody from the beginning said here's where we are here's what the under this is the facts as we know them they are going to change this is a disease we don't know that much about but here's what we do know and you know the unwillingness to have the hard conversation up front this desire to like just make things into the facts we want them to be yeah i think is one of those things that like any cancer patient will tell you that's just not how the world works right like that's that's not you get the set of facts you get right and then you've got to make decisions with them and if you can't accept that starting point is that how it worked in other countries i mean that's how we're of course yeah i mean that's that's other countries countries that were successful countries that were successful say this conversation sucks i'm an elected political leader i got to lock it down yeah you're gonna businesses are gonna close bad things are you're gonna [ __ ] like me my [ __ ] haters and you know what yeah i say this to every patient walks into my office when they come in with a new tumor that we haven't biopsied i say look i i have to shoot straight with you i look at thousands of these images this looks like cancer this is probably going to be something bad i hope that the next 20 minutes when i talk about what's gonna happen if this is cancer i hope that two days from now when we get the biopsy results back i'm wrong and i hope that you're a little pissed at me and you say look man why did you put me through the last 48 hours of worrying about this but like i'm a grown-ass man i'm a teacher i'm an adult you're an adult or a kid yeah and amazingly the kids are even better at it yeah but you say like i have to tell you if i'm sitting here saying damn in my head this is a cancer yeah and i'm telling you well i hope this is just a little infection that antibiotics will take care of like that undermines everything going forward because then when i break the bad news to you two days later right you're sitting there saying was he holding back he did keep looking at the screen and when the fellow came in he kind of gave him that worried look like do i have to read into everything this guy said and that's what we missed here yeah if you don't start from having the conversation that's just transparent yeah that says these are the facts as best as i can give them to you i'm not perfect you're not perfect but this is what we got as a starting working place i would rather have you informed and then saying damn that guy had me worried about something he didn't need to be yeah i went on that traveling fellowship uh a few years back and and that traveling fellowship started out where five surgeons would represent the united states and canada and north america and go to europe and travel around and teach them what we're doing as best practices and they would teach us best practices and then the next year they would send five surgeons back here and that's the way information used to be passed that all came from world war ii a bunch of surgeons went over in world war ii american surgeons went over and volunteered to help the british and they were like oh you guys are doing things differently than us how can we learn from each other so after the war they were like we have to make this an actual exchange that was medicine in 1940s and 50s and 60s now you know that the day i come up with something new i mean my lab works on stuff all the time it it's two months from when we discover it to when it's published it's out in the literature it's searchable all over the world i get an email a month you know a week after it's published from someone in abu dhabi saying i'm working on this hey what did you guys do to get to this step you get some so the idea of going it alone is so absurd it's not going to happen it's just totally totally the doctors are all talking the scientists are talking the doctors are talking the only thing it can do is create i mean the go it alone concept it is a financial concept it's who's who has ownership of this stuff where is the intellectual property who's going to benefit from that's not about driving the science forward it science is past that right right right i guess like first of all like what may like i don't even know if i've noticed but like what made you want to be a doc i was kind of doing my own thing you know i'm saying yeah yeah um so i guess you know the big kind of transition point for me was living in south africa so when i went down there and i was kind of working on um i was a politics major as you know in college and i was working i actually didn't know that i didn't give a [ __ ] about what you're doing i'm sure i'm sure yeah but i mean you know i went down there uh at a time that i i was i kind of thought boy how much has changed since then but i mean at a time when you know i felt like mom and dad always talked about the 60s as being like the time when history was being written in the united states and that was the exciting time and we kind of we grew up in the 80s and 90s and like there wasn't it was an amazing time to grow up amazing place but i didn't feel like we were writing america's history and at that time i thought the most interesting place in the world was south africa like mandela had just you know taken over was transitioning to taboo and becky as the next president like it's a it's um apartheid it ended uh within the last six years um big big changes and they were writing their history and so i went down there and i thought you know i'm gonna get into politics i'm gonna work on politics i this is where the most interesting issue of our time is and you know i got down there and partly was the timing of it like everything else in life you know but i i got down there and um the big pressing issue was health policy and at that point hiv in south africa more than a third of the population had hiv and um they were trying to figure out what to do and it was one of those super interesting times so i i spent my time kind of comparing and contrasting uganda to south africa and uganda was this country with a military dictator it had the worst hiv epidemic in the world it wasn't like you sli you have to rape your emergency crazy crazy crazy stories about what you need to do how you but they had a dictator who in the early 90s said this is going to wipe out our country if we don't respond to it and so he said i'm going to take i'm taking action he started putting up signs about safe sex abstinence condoms whatever it took he saw that it was going to ruin his country so you have uganda this horrible quote-unquote military dictatorship that went from the highest rate in the world of hiv down to a very i mean single digits in in a period when south africa this new democracy the rainbow nation nelson mandela getting all the world's accolades their rate went up in the same time up to more than a third of the population and so i was down there trying to figure out what we could learn from uganda how we could apply it to the south african experience how we could and and i mean sadly because i mean you know i'm pretty optimistic person like what what i um what i figured out down there was that uh there were political obstacles that were not going to that that my impact was never going to be meaningful at the end of the day and this is one of those things that's just so sad to say but like you know the south african government um was so politicized at that time so so you know it's five years after apartheid tombow and becky is a new president coming after a legend nelson mandela you know mandela hands in power and he says you know look i've gotten us through apartheid i've gotten it so the economy didn't totally collapse i've convinced people there's a future i've aligned everybody but now the country's yours you got to do the next steps and then becky uh got swallowed up man he just unfortunately got in this position where he said hiv despite how bad it is i i can't solve it there's no cure there's no drug what am i supposed to do so the only thing i can do is basically push it under the rug because we need political successes we're a young black government in africa that many people are trying to prove we can't govern many people are out there their biases are to show what a failure we are and so i can't take on an issue that doesn't have a path to success and hiv is a is an issue that i don't know the path to success right and he recognized that for better or for worse and it turned out very much for worse and he basically said the only thing i can do is kind of sweep it under the rug sure and what they did i mean they used the first year i was down there they used their entire hiv budget on making a play a play a play like a theater play that one of him becky's family members was running was the producer of but they made a play to like literally it was so crazy they they started with condoms and then they stapled the instructions to all the condoms so all the condoms had two holes in them oh [ __ ] millions of condoms so you had these things where it's an issue they didn't want to address they then had a couple of political missteps at the beginning of it and then they just said we gotta get away from this thing like hiv just ain't it we can't deal with it and so what happened for me is that i got there and i was like that was almost it um what happened what happened for me is i was like you know i can work kind of dedicate my health my my work and my life to trying to help policy positions for this government yeah but i don't believe this government has the political will to make changes they don't want to touch this issue and the doctors were out there fighting it the doctors were going out so every friday i got in the i got in this mobile medical clinic from uct you know this groud skir hospital these doctors would get out there with no drugs no nothing they'd get in a mobile medical clinic they'd go out to the townships and you know i'd spend my week being told never go into that area right that area is a no-go zone right then you drive in with the doctors man people are coming in hugging them they're trying to get with the best they had they were like look we can help their nutrition we can help their general health we can treat their tuberculosis which is flair so um so the doctors were [ __ ] taking the they were into it in the past they were christians were just talking about that [ __ ] not even i mean even worse than not even i mean literally running from it because they they viewed it as a losing battle and that's kind of sim and that's where we are yeah that's where we are that's where we are holy [ __ ] i mean i mean i i think i know the answer to this but like why aren't you the lakers team doctor like why aren't you like a [ __ ] guy who does sports injuries i mean i think i know the answer obviously but like going into oncology into cancer um you know i mean that's uh i mean it's certainly not for the money so like what yeah so so i i mean i think at the end of the day like everybody else's path you sort of you you tend to ping pong a little bit and you kind of find your way and you bounce off walls you know you kind of go somewhere and then you find something that's getting too far one way and then you try and adjust and so for me um you know that's medicine was getting in through seeing the doctors in south africa i was 100 committed to being an infectious disease doctor i mean that was the natural thing hiv that was where my background in the policy side was and then uh and then i remember in medical school i went in and met with the head of infectious disease and and i said you know i'm thinking about this as a career can we talk about it and he said to me um look if you want to go raise your family in a developing country and not have a home base here in the united states infectious disease is the way to go but if you don't think about going down a surgical path because if you want to go in and have an impact on people but not commit your entire life to living somewhere away uh that you can't do it with infectious disease and so for me um it goes back to the roots of our family man like i just i i more power to those who do it but for me i wanted to have a home base here i knew that i didn't want to raise kids bouncing country to country and dealing with epidemic that just wasn't the life that i wanted for the family side so then i found the surgical stuff and and got in with some uh orthopedic surgeons who did um international work where they'd go in and and really make an impact and i saw the impact they were making and i loved the kind of sports mechanical part of it um the nice thing in orthopedics is that patients really want to get better it's one of these interesting things in medicine that i think people who aren't in medicine sometimes lose track of but um you know it goes back to alignment and there's no one more motivated than orthopedic patients it's mechanical it's all about like getting doing this surgery rehabbing so i get my physical life back and so patients are super motivated we generally aren't taking care of um the very old elderly trying to prolong end of life that's just not and so you're aligned you're totally and so that got me all uh got me kind of jazzed for orthopedics i went into the field and uh then when i was in my training like i got there and i did a sports medicine rotation and then right after an orthopedic oncology rotation and for me it was a way to kind of ping pong back a little bit to i realized that that um i don't have as much empathy as i thought i did it's hard to have empathy like i you know somebody telling me that their rotator cuff hurt like in their tennis serve wasn't as hard as it used to need your help that i like i couldn't fake it i mean i couldn't i couldn't even get behind it to be like i you know i and it's no knock-on yeah it just like that didn't pull me into a kid with cancer but you walk in and and i mean you know how much uh dr eckhart's like experience i mean my mentor you'd walk into his clinic every patient he took care of man followed them for life he saw them they'd come in for their annual visits 20 30 years after their surgery bring their kids and grandkids and they'd introduce them and say this is the guy that saved my life he took my cancer out when i was 13. and like you can't be in that office and then be in kind of a a kind of a non-life or death situation like that and and feel for me it just was that was it and and when you're in med school because i lived with you i mean like we me you and aaron when she was my girlfriend we lived together in you and i feel like i didn't really see you but i really do i mean i remember like our cat was always in like in heat but i don't really i mean i was just so [ __ ] you know self-centered like i was like a struggling broke failing [ __ ] actor who could not get a break and i was totally self-centered you know the careers people choose and their training and what they go through to get there is all about what tolerance for what type of hardship like what what what challenge does your personality allow itself to what are you willing to take on and so you know if you want to be an actor like you deal with a lot of uncertainty and you're willing to take on the hard work and then not knowing that if you do a it will lead to b that's an uncertainty that like that i can't deal with that yeah i i went through my whole life knowing if i do a i get b if i do b i get c you know you get that grade you get into that place you get in that place you get that degree you and so i never had a day where i thought man what if what if i do all this and it doesn't work out right that's that's not a skill set you need in medicine right um there's a really big difference in my mind and about like what makes good and great doctors and and how you tease that apart and this is something that um you know i remember one of one of the guys at my program where i trained used to always say never never let your patients see you eating never let your patients see you eating why your patients do not want to see you as a human being yeah they want to see you as their doctor like go eat somewhere else go hide in a corner doesn't matter but your patients don't want to know your troubles they don't want to know your home life they don't want to know and it was just this thing he would put on his mask his cape whatever it is every day when he got to work and he was like i am supposed to be this to be a doctor i think that you can be a really good doctor that way i do think it's hard to be a great doctor that way i think i think you have a level of um engagement with your patients that helps you get over uh that that allows you to be connected to them in a way that that um really helps what you do and um trying to find that line between engagement and and enough disengagement that you can stay sort of cognitively on the right track and you can stay objective-ish in your decision making um but at the end of the day if you can't take on some of the emotional tie to being connected to them you can make a scientifically correct decision that is not a medically correct decision and to some degree i mean everybody's got to draw their line where they draw their line you know like i i've kids who die from their cancers and um i can't let that no matter how much it eats at me i can't let that not allow me to go in and do the best job or to change decision makes so i got to learn from anything that's happened in my past but i can't there are times that you do everything right and cancer you can do the best surgery in the world and take out the cancer kids doing great three months later the cancer shows up in their lungs and that kid dies you sit there and rethink all of the decisions you made along the path was it worth it to do that surgery did i put that kid through more pain than he needed was he gonna die without that surgery could i have avoided that what and but the next kid who walks in you have an obligation to to sit there and and try to go through it with them and make the best decision and not let you know not say man my last kid died after i did this surgery that's just not a choice you have right right so you divorce yourself from that but um i don't know man i mean it goes back to the bigger picture like i i just um i'm much more optimistic about how strong people are than i think a lot of our global narrative is right now and unfortunately we live in a world that like is all about um trying to convince us that we're weak and everybody everybody is weak everybody needs stuff everybody over there everybody is yeah and like the truth is is i spend my life with people who are getting real tough news yeah and um people are extremely strong and families are strong kids are strong and resilient and and when you can frame that we are aligned in this i'm going to give you everything i have but we're aligned in this and i can't promise you i'm not going to tell every kid walks in and says first question am i going to die from this and i have to say i can't tell you no but i think we're going to beat this okay and if i tell them you are not going to die from this we're broken you have to yeah like we're we're we're done i mean most of what i do is um is curative so most of it i truly believe we're gonna take this cancer out and you are going to have a very good chance of coming in that day to the operating room with cancer and walking out without it and having your life back and so that for me i mean that's the that's the fuel that's the that is what you feel um keeps you through it sounds like most of the time what you are confronted with in those situations is like unbelievable strength and resilience and it is crazy you cannot it's just like saying you can't watch the news and not be depressed like you cannot deal with pediatric cancers and not be inspired no nobody is around those kids and doesn't come out and say like it it i mean dude very recently um i took care of a girl who you know young teenage girl who um had literally a 50 pound tumor in her arm arm completely non-functional get no nerve function at all the arm's just dangling literally like uh like a lead weight off of her and the arm is you know that big around and she and her family had um really bounced around to some of the best places in the country trying to find somebody who would do a limb salvage operation and so limb salvage means we can take the tumor out but keep the arm and an amputation is the opposite so 95 of what i do is limb salvage surgery and i think there's a lot of surgeons and a lot of us like our predilection is to see limb salvage is a success and an amputation is a sort of a surgical failure and i talked to her about it and i said look you know that this is you do not have any tumor anywhere else in your body like this you got to give this arm up you really we got to get there because if we do a limb salvage we're going to leave tumor cells behind and it's going to come back and take your life and you're a teenager and i know you don't want to give up your arm but it's non-functional it's not doing anything for you it's never going to work again i can't make it work and she she said no i've heard this from other surgeons and i said look just make a deal with me like come let's let's meet a couple of times let's talk through it meet my colleague meet my partner dr fetterman who's just amazing with kids who does the medical oncology side just let's go through the process and try i promise you we will make a decision you're comfortable with after a couple of visits she said to me um she would she would go for it she said i get it um and her parents were pissed off at me he said we came here because we heard you were the guy who could do limb salvage and you were the guy who you know and they traveled here changed their insurance did all this stuff um people pick up their whole families and uproot for this i mean if your kid you can save your kid's arm man you'd move anywhere yep and um you know i i was really having a hard time because it looked like the parents um saw this as a massive failure and um she decided reluctantly but she decided after these conversations to go for it um she woke up and i mean young teenager dude think about what you and i were doing as a teenager yeah you know she's 15 years old she wakes up from the surgery with her arm off and i walk in to check on her and just say you know how you holding up in the recovery room she's 20 minutes out from this and she says two things to me she says can i give you a hug so i lean in she gives me a hug with her one arm and then she says you know this must have been really hard for you wow and it's like dude yeah you know you like you don't go through that you walk out of that room and like you tear up a little bit on your own and you get away from it and um and then you come back and you just realize that like man people are strong yeah people bounce back man and and she's gonna go and kick ass you've hit on this a little bit but like who who are the strongest when facing like horrible news like do you find you know religious people people with great families people with great friendships people with love in their life like who people who are really deeply religious have an advantage in these really tough situations i mean that's not nothing yeah and um you know there are i mean one of the most interesting things for me was operating in ethiopia like you go down to ethiopia and um we pray with the patient before the surgery starts like you hold the patient's hand they don't get general anesthesia so they're awake during the operation so they're like prepped and draped and they're sitting there and you have a drape and they hold the drape down and the patient leans forward and holds your hand and you do a prayer with them before they start and they're just good they are good with that like it was amazing like our their patients were just like they had not on anesthesia they have local so they have a block so they don't feel most of it is not amputation um but yeah i mean you do whatever surgery you need to and they're awake with a regional anesthetic just a block but prayer is so like fortifying uh culturally there um and again it not to group ever but it just was kind of eye-opening i also as you know i i operated quite a bit and spent time in utah where it's a much more religious state and you see how religion factors into these things and there was acceptance of bad outcomes and death as god's will um and so it was much less what happened why what went wrong you know all those questions um so i think religion is is certainly helpful um and then i think it it it goes back to resiliency goes back to being a palm tree you know to having in your life seen some storms and um knowing that you've weathered them and the people around you have weathered them um you know i think people who have not seen any hardship have a really hard time with even mild hardship and have a hard time sure kind of seeing through it yep so you know one of the big challenges we got into and part of the reason we're in the opioid crisis that you know that's sort of gotten pushed away as a second tier issue right now but one of the reasons we got there was because the bad players on the pharmaceutical side created intentionally a marketing effort of expectation that you should not be in pain after surgery right or in other places like you you're going to be terrible you're going to have pain like if i'm taking a tumor out and you're cancer-free and this thing hurts afterwards yeah there's a certain degree of that that you should be okay with yeah and not be numbed too yeah yeah yeah and i i you know people don't need to be tortured but but you know and so when you operate in other places that i think aren't don't live with the same expectation going in of comfort comfort of outcomes being guaranteed yeah you know here there's this creepy culture where something went wrong if it doesn't work out the way you do who's at fault right right and that's a challenging i mean fortunately cancer it's not a huge deal because we are pretty aligned with our patients but a lot of my colleagues like you know that that plays big part in what they do yeah medical legal words who's consumed like who's i'm sitting there trying to do the best i can and you know and so you go to other places and like people um who don't have access uh life is not expected necessarily to work out exactly the way you want and any deviation from that is not seen as a big problem right like life has a lot of uncertainty what do you change about health care in this country you know what what what is what is your idea going forward about the best advice that you can give so so this is where i i think i move a little bit away from the sort of my political views party line on this um so i look at what america's role in health as a global issue so if you instead you say you know if you just focus on our country probably the best the right answer to this is focusing on preventative health i mean that's the right answer if you just think like textbook we got a lot of people with problems that could be prevented with more access to health care that's definitely right there's no question i think if you take a slightly wider lens of it though and so i try and think about health as what's going to move humanity forward a little bit and how healthy we are and i think there are countries that can work on how best to improve access better than us and then we can learn from it and what we're really good at is innovation it's what our country is good at and so whether it's for all the wrong reasons whether it's capitalistic or whether it's because we've got so many incredible science i mean for decades our universities were able to recruit the best and brightest from all over the world and just like so many other things america was the place to come and do science and so i think at the top tier we have the capacity to innovate and part of that fragmented system that delivers sometimes not great centralized care means that you have more people doing different things and you can actually innovate better in that respect so i think it's really create a system that addresses access issues but does not take away the diversity at the top and the push to be the global leader and i think a lot of times we see those as competing we're either going to focus attention toward equality and equity in care or we're going to devote resources to exceptional care we're going to devote resources to finding new cures and if you say i've got one dollar and i got to put it in either bucket then you're right like you got to decide which bucket but i don't think it really is that way i think we can support some degree of innovation and fragmented i kind of understand what the [ __ ] you're talking about but yeah all right let me just [ __ ] like dumb it down a little bit man yeah all right i mean for [ __ ] sake dude so so the the bottom line yeah is that if you have a bunch of different hospitals doing it different ways it is not going to be an organized system so in britain where they have the national health system like everybody walks in and they go and the whole idea is get care to be so that the lowest level of care is pretty high right right right right right but to do that just like in any other thing in life to some degree you're going to bring the top performers down because you're going to focus all the resources on bringing the bottom up yep and so what we the problem is is that our system is so ill-suited for that and we lose out on what our country is really good at by doing that i mean if we shift to a completely nationalized system where everything is about equality what happens is innovation and tech and sort of development go away they go somewhere else where it allows the differential because if i think i'm the smartest guy in the world if i think that i'm going to discover the next cure for a big cancer i cannot be in a system that makes me behave exactly like the guy who just clocks in and wants to get out two hours later and it's just giving whatever the protocol says this drive to that okay and so you gotta be able to create a system that says here's our baseline we're obligated to treat basic health as a right but we are still going to [Music] kind of be the the magnet for the top we are still going to be the people who who push the envelope and how do you do that so you're saying bring the bottom up take it you got to take care of the baseline establish establish what are what is core health care and that needs to come up that needs to come up no matter what because right now it's just that that that disparity in health is just that that is not acceptable i mean we are worse in many ways our bottom are worse off than many very very poor developing countries and that just can't be it can't be yeah um but it can't be and this is one of the problems man like everything is so polarized right now these are seen as binary choices do you support the police how do you do both or do you or do you support racial equality right like why can't you why can't you do both yeah why can't we have a new forced approach right to science that says we want to invest in both innovation and excellence and reward that but also enhance the bottom end and that just takes reorganization i mean that that just takes investment reorganization political will and and and effort and a nuanced non-blustered [ __ ] conversation just like a a yeah for sure that something that supports equality at the bottom is going to hurt me at the top or something that supports me at the top is going to hurt the the the you know the guy here it doesn't you know it just doesn't need to be that right a capitalist culture is going to sell what sells and so we don't do a particularly good job of protecting our society from things that are addiction forming and addiction has this negative connotation we're all addicted and we're sitting here hugging our coffees like everybody is addicted to stuff and um there's no question that we can do better um that we have the science to show what is addictive and what should be avoided unless you want to accept risks of addiction i think the one challenge is that you know we have this other side of our political spectrum that's about freedom of choice yep and that's about the the right to go get a candy bar if you want a candy bar and and so culture has gotten so toxic about any sort of um intervention any sort of restriction that takes away my freedoms and so you know at the end of the day you know in new york they had the the soda taxes and you know you have to have buy-in on these things culturally rather than regulation as the driver my tendency is um quite frankly to try and that we can educate people a lot better and not regulate people that we can i worry about um anything that comes off as a ban of behavior because i think it in practice turns something into a political issue which creates automatic friction and i just think unfortunately we have really crummy communicators we have people who have not been able to say look you know yes a candy bar is going to be available until a candy bar is not profitable that's just unless we change the little cookies oh you want your [ __ ] vegan [ __ ] you want your vegan you're a california yeah you're a this you're the eater so let's put some compelling people in front and just say this is that and say this is the deal you want your kid to be you know hooked on diabetic causing sugars and all this so like go it's available yep yeah like i we're not going to regulate it but let's like how do you compete i mean i guess what you're asking too is like how do you compete with the the the the power of capitalism i mean you see every kid in the world is just stuck to their [ __ ] devices and [ __ ] and like there are there are huge powers at play pushing them towards those things yeah but but i do think the one place we are now man i think the one there's so many scary things about all of the information age and how everything is going shooting around i do think the compelling messages can be heard like never before i think they're celebrating people and places that do it right listen i think you got to make fun i mean for me it's like with my kids i'm always like look at that [ __ ] nerd like look at those nerds on their phones like those people are sitting there with each other on like have you ever seen such that [ __ ] nerds playing video games oh wait like and like i look i don't want my kids to bully kids or anything else but like they'd be like dad that guy's a nerd right i'm like you bet your [ __ ] ass like go climb that mountain [ __ ] go wrestle each other like you know what i mean we have to be able to like point these things out and and it not be like offensive and and and and look there's so much inequality to it i mean it's like the the food that is available in places where people or you know the haves versus the have nots a lot of people are not informed in a meaningful way about what their what they are setting their families up for and i just believe in the intelligence of people i believe that people are like the coastal elite [ __ ] where like we know it and but the people in the middle of the country just aren't smart enough to figure it out like that shit's crazy yeah yeah but it's like but but that was the thing man that was the thing that was the argument when the hiv drugs came out with africa well i was going to say that it's the same [ __ ] it was like we all said like oh we can't the drugs are too complicated how could these uh uneducated africans take drugs that are scheduled every eight hours what if they don't have a watch right we don't like these are like [ __ ] insane arguments right for why people shouldn't have access to good information so what our country has to do what the government has to do is figure out some compelling ways to communicate figure out some compelling people to communicate and not polarizing and not not marketing and not trying to get your political agenda to look like there are facts out there there is information out there and so you know when we sit and talk about there are a lot of things that are up for debate say they're up for debate say we don't know how this impacts things but if you talk about giving a bunch of mcdonald's or candy bars to a kid every day like we know what that leads to that's a very clear line like let's be transparent about it and and you know it's just not that hard yep one of the most common things i see unfortunately is that um there's this whole group of cancer survivors called aya and it's called adolescent young adult and these aya patients are kids who had cancer and now they're late teenagers and what happens is the health system drops them because as a kid with cancer there's lots of resources in our health system there's lots of social work there's lots of support for the family everything else they get cured and and a bunch of them go on to great things but a bunch of them this is a really traumatic experience going through as an eight-year-old a year of chemotherapy being pulled out of school being the weird kid with no hair being the kid with a limp being the kid like and that [ __ ] does not catch up necessarily in some kids it does but in a lot of kids it doesn't so then they become the teenagers and they they hit the challenges of adolescence and and something hits and the thing that it combines in with drug use as a kid because they've been put on opioid i mean historically these kids were given oxies that's what they were given after every surgery after every chemo you hurt oxyoxyoxac so many of them have addiction biology in their brain they go through natural hardship and they're dropped the pediatric sarcoma cancer people aren't with them the adult people they're not really plugged in because who i mean how many doctors did you go see when you were 17 18 years old none right none of us like that that's that's the time you're healthy the way people uh deal with it and i think it goes back to our our conversation at the beginning of like you know of trying and that's why it just sticks in my head this like this palm tree idea like you you've got to give yourself sway you've got to give yourself room for feeling it when when something doesn't go the way you hoped the family doesn't get the kid dies i mean that [ __ ] happens and if you don't give yourself sway you will get blown down by a storm i i mean i think the thing that that from my end that's always been the the hardest part to understand about your world is uh is how you um how you deal with the the notion or the concept of how much fortune or luck plays into something and um you know i've lived with you for a lot of years over the course and i watched you you know i i watched what it was and i saw you know you the the work you put in and the work you still put in every day i mean for this like sit and interview your brother you like you know spent hours on on putting stuff together and um you know but i but i do think you know you talk about like to some degree what we all care about how we're perceived and and um you know i think that sort of uh that notion that acting um or entertainment in general that there's this just like you showed up at the right place at the right time notion that a lot of people outside this world have and especially now frankly as things have gotten polarized i think a lot of it is like oh another hollywood like think they have idea why do you get to sit and do this show like you're just a guy who happened to be you know maybe a pretty fait i don't know what the right but um but you know what i mean so listen man i i look man i mean i i think number one i think perspective is is is is everything and there's no time no no question you know again you know like living in new york at an extremely hard time for me with you doing what you're doing and really like aaron you know like you know completely [ __ ] self-made you know never got a [ __ ] penny from anyone put herself through college put herself through nursing school became an icu trauma nurse like worked in the the biggest trauma centers in the world and you know i would face rejection after rejection after rejection going into these auditions where people would literally be appalled that somebody with ears like mine and a nose like mine would walk in and audition for this [ __ ] sitcom or this wb show and like literally just like i could feel they're disgusting me and i'm like [ __ ] man i've studied all over like i did my [ __ ] like i i've been in theater companies i've been in hundreds of plays where there was more of us on stage than in the audience and i went and studied in [ __ ] russia i got into [ __ ] graduate school like with nothing in like i studied and i worked i worked and i worked and they want nothing to [ __ ] do with me and the hopelessness of it you know i there were nights that you know i was like [ __ ] man this ain't gonna happen and and i cried myself to sleep and then like aaron would walk in at like six in the morning after working the night shift and you know talk about you know holding a guy's hand as he died or you know holding a a young girlfriend of a guy who i remember this guy got pushed down in a fight and he hit his head and he was gonna die and like aaron was like with her and with the family and and the perspective of that and the things that you guys go through and and it would always just put the what the [ __ ] am i upset about like put this [ __ ] in perspective and i think you know perspective is something i think also in our family i often go back to our grandfather man like you know like [ __ ] you know him and his brother like 11 and 13 years old like escaping [ __ ] nazi germany with nothing with nothing you know running out like sneaking in the storage of a boat like getting to america not knowing anyone like working in any job they [ __ ] could with nothing like just scraping by making money sending it back having their parents come that parents get turned around like [ __ ] you know the nazis got him like you know like you know when you think about like perspective and and then and then you think about like what is this life [ __ ] about man and like for me like you know man i was a [ __ ] you know and like thank god you know nobody gave up on me and and people stuck by me because you know man like it was like not looking good for a long time and i could not stay out of [ __ ] trouble and i could not you know like every bad path i was going down but i i found this thing that i [ __ ] loved and that i i i connected me with something bigger and i felt that i was put on this earth to do and i was like the one thing you know i i remember talking to pop about he's like just [ __ ] work your ass off on it just and like so for me it was like look man if you have that that is something nobody can take away from me like i don't need to get hired in a tv show i don't need to get hired on a [ __ ] film like i have my passion i have my art and like isla and i am in control of how hard i go after it to everything i do and and look i i think as far as like this thing here it's like i don't know what the [ __ ] we're doing i just know that like i'm sick of listening to [ __ ] celebrities man i'm sick of listening to [ __ ] experts on tv and pundits i'm sick of listening to people who haven't been through [ __ ] talk about things because they're experts on it and like so i i really and i understand that it is like antithetical to my success to come out like no one's gonna believe me as the [ __ ] punisher no one's gonna believe me as [ __ ] lee iacocca if i'm here [ __ ] telling you about the way with like our like my mystery and keeping keeping like some removal between me and my audience that is my [ __ ] currency so like i'm super conflicted i put clothes on my kids back and food on the table by this acting [ __ ] that's my love that's my passion it's my religion and i know this goes against it and the last thing i want to do is be another [ __ ] celebrity spouting off that being said you know i think family and a sense of purpose i remember like you know thinking about like you said about the 60s and like looking back and and and the people who stood on the sidelines and didn't do [ __ ] [ __ ] about it and like what was that like like i get there's like some self-interest there but like you know man we grew up with like pioneers of of a [ __ ] the civil rights movement and people like not [ __ ] who like dropped out and [ __ ] did acid and like we're like peace they were like [ __ ] who like you know we were taught by people we grew up with people all of our friends parents our parents people who like got arrested protested went down to [ __ ] the south you know when it was dangerous when people were getting hung and like stood up for what they [ __ ] believed in so look man i don't know what the [ __ ] this is but i think that just like bringing in people who you know walk the walk instead of talk that [ __ ] and like saying hey look this is like a strong fierce educated kind empathetic person like we can be that way and we can like talk to talk about things and we could talk to people who think differently than us you know might just change a little bit of discourse so i don't i mean that's that's my [ __ ] up answer but i mean yeah man i and and and i think i think like you it all goes back to the family and the base and like what we what we had and and that you know the certainty or uncertainty of what i do it's all it's all perspective just how you chan you say you change your mindset in terms of like you you remain hopeful you remain optimistic you're telling somebody hey you're not gonna make it your child is not gonna make it but we can do x y and z i think for me i look at every job and i'm like this might be my last job i've gone through times where like i don't know if i'm ever gonna work again right but you also can look at that and you can say woe is me and oh this is so hard or you can be like man somewhere [ __ ] out there that job is out there that thing that's gonna like make me explore find parts of myself i'm gonna get better it's out there man and it might it could be coming any [ __ ] second you just reverse the way you you you you look at it i think yeah i mean but i i mean i think in the end though it is um it it goes back to kind of having some aspirational component to it though i mean that's what you're it's like there is something about moving the needle changing the discourse having you like you sound like um you know looking at life like we can do something of value here and like keeping that positivity toward your existence for sure just seems like what what what's lost right now agree and like what what we are so fixated on these um on these differences on these you know tribalism on this what what winning losing words and saying this is what i have more in common with this guy than that guy and um i don't know i just how we got here is amazing it's just amazing it's like i definitely thought with obama like i thought there was this moment of like aspirational unification that we were just like [ __ ] man i don't know if it's gonna get better but it sure looks like we might work at it but i i but look i think the only thing to [ __ ] do now is is to stay aspirational is to stay like it's like in in you know when times get tough you know the tough better get [ __ ] going i don't know what that's [ __ ] saying but like you know i mean like you've got to keep that going and we got to raise our kids that way and we got to raise them to be strong and to stand up for injustice and to and and and to not not play into tribalism on either [ __ ] side there's this [ __ ] chunk of people in the middle in the middle here that are not all the way over here waving their flag they're not over and this this is the group of people that i think yeah he knows no voice right they got no [ __ ] voice we gotta give them a voice man that's it gotta talk to him and gotta not judge him gotta not be afraid you know what i mean and and i think that that's i think you know that's what the [ __ ] you know oh it's cool yeah man it's cool i really appreciate you doing this man i'm very proud of you dude thanks for thanks for doing it i'm proud of you yeah dude i love you man love you too buddy yeah man i can still beat your [ __ ] ass though all right let's go [Music] thanks for being here everybody i really appreciate it if you dug what you saw and you want to hear more subscribe like do all that stuff and mean a lot to us i hope you dig these episodes as much as we dig doing them you guys take care of yourself

Channel: REAL ONES with Jon Bernthal

Views: 585,578

Keywords: Jon Bernthal, Real Ones Podcast, Walking Dead, The Punisher, Doctor, Brother, Oncology, Nick Bernthal, healthcare, africa, hiv, covid, sports, cancer

Id: oihwVn267pk

Length: 69min 32sec (4172 seconds)

Published: Fri Feb 25 2022