Jonathan Reisman: The Human Body - From Sex & Sperm to Hands & Heart | Lex Fridman Podcast #297

we have two tubes that are right next to each other in the throat one is for food drink saliva mucus snot whatever you're gonna swallow all of that stuff must go down the esophagus the food tube and end up in the stomach and right next to the esophagus millimeters away is the windpipe or the trachea which goes down to the lungs throat heart feces genitals every organ from moment to moment keeps us alive and ensures our survival the genitals are in a way the opposite how would you improve the penis and the vagina the following is a conversation with jonathan weissman a physician and writer of the unseen body a doctor's journey through the hidden wonders of human anatomy he has practiced medicine in some of the world's most remote places including the alaskan and russian arctic antarctica and the himalayan mountains of nepal this is alex friedman podcast to support it please check out our sponsors in the description and now to your friends here's jonathan reisman you wrote a book called unseen body all about the human body the messy the weird the beautiful and the fascinating details so from an evolutionary perspective are most parts of the human body a feature or a bug is it like the optimal solution or just a duct tape solution great question i think that most of the time the way the body works is the best solution i haven't seen many alternatives so it's hard to compare but i think you know there's some parts of the body that make more sense than others you know the way our hands work for instance um you know the muscles are up in the forearm and then the tendons kind of come down like strings on a puppet and just the dexterity it gives our hands is just really amazing and it's hard to imagine a better a better tool than the human hand to do everything from you know hold things to play piano and do a million other daily activities that we do one thing i talk about in the book there's some other body parts that seem to be lacking that kind of brilliant design such as the throat you know where the food drink are swallowed and air is inhaled and they kind of those two paths come within millimeters of each other and you slip up once you laugh while eating or you speak while trying to swallow and you die from choking so it seems less than optimal though i'm not sure it could be better from the way we're kind of formed in the womb as a beginning as this tiny little tube i don't think it could have been done any better or there's any other way to do it but it is an unfortunate thing that you know does lead to some problems so the hand if i could just linger on that for a second you talk about the wisdom of a design in the book what are the important things about the hand it seems like very useful for many things and it seems to be quite effective a lot of people think the thumb is foundational to um to the human civilization um is there any truth to that i think that is true actually one of the ways in which the importance of individual fingers comes to attention is when people have severe injuries to their fingers for instance um i have a story in the book about a guy whose thumb is nearly ripped off by his dog's leash and you know when we when plastic surgeons who are often the ones to repair that sometimes it's orthopedic surgeons they will debate you know how important is it to save this finger or how important is it to save you know let's say the kind of tip uh the one-third the tip one-third of one of your fingers you know it depends on the length that you'll lose it depends on which finger and so the thumb really is the most crucial um just you know for your occupation in most cases to just daily life um and your ability to get around take care of yourself and others so you know they'll be more they're willing to go further do more surgeries more aggressive therapy to save a thumb let's say than you know the tip of your pinky finger so in that way i do think the thumb you know does seem like the most important in many ways it's nice that there's backups i wonder if that's part of the feature or is it just the symmetry that nature produces you think you think that two hands is like is it about the symmetry or is it about backup we'd be much less formidable hunters gatherers survivors in any way if we only had one hand so i think that is important to have two so we can you know even everything from kind of spearing an animal to firing a bow and arrow to butchering an animal you really need two hands to do it very effectively but can you do a better job with three great question and we'll never know perhaps um you tweeted now i'm gonna analyze your tweets like it's shakespeare sometimes you tweeted that quote millions of years of sex and death designed the human body it's like poetry are those two basic activities uh basically summarize everything that that resulted in humans on earth so like uh is it is that a good summary of the evolutionary process that led to this conscious intelligent being is death and sex in a way yeah and so sex is how more of us get made obviously and death is how we get weeded out or the gene pool gets weeded out and certain genes survive and others don't and you know the age at which we die whether it's before we've you know had sex and reproduced ourselves is a big factor and who survives who doesn't who passes on their genes and what the future of the body looks like you know who lived and who died before they were able to be at reproductive age a million years ago was pretty important in what we look like now um and perhaps how we have sex and die now will determine what we're shaped like unless technology has an even bigger role in that you know a million years from now do you think that's fundamental to like if there's alien civilizations out there that have uh the same order of magnitude of intelligence or greater do you think that we will see something like sex and something like death so the reproducing and this selection process plus the weeding out of the old to make room for the new is that kind of foundational to life i would think so i mean it sure seems to be on earth you know perhaps in some distant future when medicine is nearing you know perfection and people can live a really long time uh maybe we won't even need to reproduce as much or something like that you know it's hard to even know what what life will be like in the distant future but i would guess that any alien civilization will have the same dependence on who who has sex and who dies well that's the problem with immortality how are we going to clear out the old to make room for the new which is as kind of um it's like a framework of adaptability to changing environments so as long as the environment is changing and it seems to always be because this the entirety of the earth system is a complex system it seems like you have to adapt and to adapt you have to kill off the stubborn old ideas and uh unless there's a way to like not become stubborn and old but it feels like the nature of wisdom is stubborn and old like that's that's what wisdom is it's like the lessons of life solid the lessons of experience solidified and the solidification is the thing that actually prevents you from reinventing yourself to adapt to the new um changing conditions but then again why not have that both of those modes like i have two minds and one person one immortal person that like in the morning they act like a teenager in the evening they act like a old wise man that's possible so you can imagine within one mind both modes but those are required you have to have you have to have the ability to completely reinvent yourself which is what death does in an ugly way or a beautiful way depending on your perspective depending whether you take the human perspective of the human uh the nature's perspective and then you have to have the selection so competition so sexual selection it's an interesting interesting little planet we got what's the weirdest part function concept idea about the human body to you we'll talk about fascinating details but what's you i should say for people that should uh read your book they will come face to face with the fact that you do not shy away from the weird and the wonderful of the human body it's like it's fun but it's honest uh so given that sorry to make you pick one of your children but uh what's the weirdest one would you say the weirdest body part um or concept or function so the chapters you divide it up kind of into parts but there could be a thread that connects all of them the weirdness maybe or maybe the the texture of the substance could be the liquids the solids i don't know definitely every body part and bodily fluid has their own um kind of both gross and fascinating aspects that's probably why i'm a generalist as a doctor and couldn't just as you said pick one of my children become a specialist because i like them all um i feel like one of the strangest concepts about the human body is that kind of the aspects of it that are the most universal that we all do are the most taboo socially um i wouldn't have expected that if i had you know just looked from the outside like what we do in the bathroom what we do in the bedroom what we do to our own genitals what we do to our uh you know quote-unquote private parts they're private even though it's sort of the thing that we have all have in common um is the most we try to hide from other people and don't talk about polite company i mean it makes sense as a human living in the society but from the outside it sort of might be surprising how do you make sense of that if you put on your sigmund freud hat the thing we all do why do we make that a taboo thing is it because we like taboos maybe we get off or maybe our our our our kinks as humans is to have taboos and it's kind of efficient to have taboos about the things that everybody does like you can make walking taboo or something i don't know but just uh maybe that's what we love that's what's exciting to us is the is the forbidden i think yes society loves rules for sure they loves some societies more than others you know they love controlling how you think and what you do in public versus private you know there's a lot of societies where for instance parents have sex in front of children um not you know for instance like in in a traditional inupiat eskimo societies that was sort of normal i mean but what are you gonna do go outside in the middle of the winter in the arctic and do it out there of course not so um you know there's different uh different taboos in different societies some taboos make perfect sense some taboos are even public health measures you know like as i talk in the book about in in india where they uh you know the hands are symmetric as you said but in indian culture and the left hand is taboo and the right hand is what you use for shaking hands for eating for other things and the left hand is the dirty hand that you use for wiping your own bottom you know that's the toilet paper as your left hand so um while the body is anatomically symmetric the taboo creates this pretty intense asymmetry uh but for a good reason you know you probably shouldn't be shaking hands with other people with the same hand that you use to kind of clean your bottom so in that sense it makes sense yeah maybe the roots of it make sense but the way it propagates especially as the times change might not because you can wash your hands but the the taboo remains right society is very slow to change what is the most fascinating part function or concept in the human body so you know something that fills you with awe i guess the most obvious one is the brain partly because it's so you know sort of poorly understood that we understood understand more than we ever have in the past there's still so much that we don't understand about how the lump of matter and our skulls kind of creates this subjective experience that we all kind of understand quite viscerally that's an easy one i would say the kidneys are an underappreciated organ uh they the the way they tinker with the bloodstream raise levels of this lower levels of that kind of our entire lives from uh inside the womb until we die is just really incredible and when you look at how much energy different organs consume the brain and the kidneys are two of the biggest ones because the brain obviously in us is always active and controlling parts of the body but the kidneys are just consuming a ton of energy to do what they do they're kind of the unsung hero of the body relegated to the back of the abdomen like some forgotten organ but they're they are great i did consider being a nephrologist which is a kidney specialist because i was so taken with the kidneys but you know decided i like all the organs so couldn't pick just one so your book is ordered in a particular way it's throat heart feces genitals liver pineal gland brain skin urine fat lungs eyes mucus fingers and toes and blood alright first of all great great uh chapter titles uh is there a reason for this ordering or is it all madness there's a few different reasons that went into it um i did want to start with the throat for the reason that it kind of presents uh the topic of death which is sort of obviously very important in the training of a physician in the career physician it's a big part of what i deal with you know on the first day of medical school we started the dissection of a cadaver in the class called anatomy lab and so in a way we were kind of thrown right in there in the beginning like this is the end of the human story you know understand this and then we sort of backed up to the beginning with embryology and reproduction and stuff so it's kind of like we got and i got thrown into that right right away right in the beginning kind of like here's a dead body now start cutting it apart and learn the name and function of absolutely every bit of flesh how did that change you that first experience with the cold honesty of human biology all right that's exactly what it was it's cold honesty about the kind of the story of of each individual human body it has an end and that's it um i think that well actually before the end of that first day so what we did on that first day was study the superficial muscles of the back like the lats or latissimus dorsi and some other muscles you know we cut through the skin of the back my cadaver was laying face down on this metal gurney we pulled back the kind of plastic sheets that would keep him moist for the next four months as we dissected him cut through the skin on his back and then started dissecting through the superficial muscles of the back and that was really all we saw that first day we didn't get any deeper didn't enter the abdominal or chest cavity to see internal organs but i was so fascinated with this sort of behind the scenes look at how things work in the body how you move your arms how you arch your back you know these are the muscles that do it that i decided i wanted to donate my own body for the same purpose um so i made that decision literally before the end of that first day of class and i i'm still sticking to it so someday there will be a medical student that can watch and listen to this podcast and while dissecting your body it could happen they might not know that that person they're listening to on the podcast will be the carcass in front of them but uh like we don't we never learn the universe will know the universe and they will acknowledge the irony or the humor the absurdity of that the universe will chuckle but the medical student won't know because they never as i did not learn any uh you know personal information about the person only what i could glean from looking inside him which actually tells you quite a bit i knew he was a smoker i knew he had coronary artery disease you know you get a a window into i knew he was overweight you get a window into people's lives just by looking in there in their bodies after death other other um cadavers in the lab not my own or i shared one with three other students but other cadavers some had you know metal joints like a knee replacement some had a kidney missing so they probably and we could tell it was surgically removed not that he was born with one uh and we could tell that he probably had a kidney tumor or cancer that was removed so you you do get an insight into people's lives from you know picking them apart after they're dead uh but you don't know their name or what podcast they've been on so the as the book title says unseen body so it it tells some kind of story of your life so it does capture the decisions you've made in your life the things you've done that might be kind of secret to that person and maybe to a few others that knew him or her well it's so fascinating so what kind of things can reveal like what kind of choices in terms of the injuries the the the catastrophic events the lifestyle choices of smoking and diet and all those kinds of things what what what what can you see what kind of history can you see about the human before you so all those things you mentioned are things you can see you can you know take the skin for example right most things that happen to us leave a mark uh you know as i say a kind of a story written in the language of scar where it tells you injuries you've had and same thing with animals you know i've i've seen deer hides that have marks that look like they're made by maybe a barbed wire fence something like that you can tell you know you sometimes it's conjecture but you can sort of imagine what might have happened to cause that perhaps you know two bucks were fighting and one got injured with an antler um and the same with humans you know i have scars on my body and when i notice them i remember what happened you know i got a big cut of my hand when i was 13 and it's still there and i remember what happened uh you know every time i look at it and so in that way only i might know that story but other people you know when they dissect me and notice the same scars they can kind of can fire their imagination as my cadaver you know did for me they know that there is a story there that's such an interesting way that the skin does tell a story uh both tattoos and scars some of the damage you've done right and even when i when i evaluate a patient i can use scars to help me make medical decisions so for instance someone that comes in with abdominal pain into the emergency room you can see scars on their abdomen that tell you about you know the past kind of activities of a surgeon perhaps i know i recognize the scars that are left when someone has their gallbladder removed the scars when someone has their appendix removed when maybe when someone's had a hysterectomy and that can tell you what it might be or what it isn't you know if someone doesn't have an appendix their abdominal pain is not appendicitis end of story so in that way i'm sort of looking at these the the tracks or the footprints of past surgeries to tell me what what might and might not be the cause of this patient's abdominal pain which is kind of my main job in the er is figuring out what's causing it and to help them is there ways to get more data about the human body as we look into the future of medicine biology that would be helpful to fill in some of the gaps of the story so you know you have you have companies you have research that looks at you know uh collection of blood over long periods of time to see sort of you know paint the picture of what's happening in your body mostly to help with lifestyle decisions but but also just you know to anticipate things that can go wrong and all that kind of stuff is there can you just speak to um a greater digital world that we're stepping in how that can help tell a richer story i certainly think that we have more data than we know what to do with right now especially with kind of direct-to-consumer medical devices you know smart watches etc that are just collecting these reams of data i have not seen them put to i think the eventual use that they will um i think that the potential is is sort of just um you know unimaginable and i hope we're heading into a new age where you know you can determine for instance is a person going to have more of the dangerous side effects to a drug based on their genetics or are they going to tolerate one drug better than the other you know based on on their genetics and we are slowly moving into that age and especially the age of kind of completely synthesizing drugs in a lab um you know much like for instance some of the covid vaccines actually like moderna never had a vir the virus in their lab they made that vaccine completely without ever having the virus themselves just by having the genome which is sort of astounding and there's a lot of potential going forward you know based on that technology and some others well i didn't know that so they basically it's all in the computer it's computational right you have the genetic code you have tremendous power even if you don't have the organism itself what do you make of elizabeth holmes and efforts like that first of all i am a curious i'm drawn to the darkness in human nature because that somehow reveals um the full spectrum of what humans could be so there's a lot of controversial thoughts about who she is and her efforts and so on i think you may have even tweeted about it but i've read a lot of your tweets so i'm not forgetting um but what do you make of her and those that both those efforts and the charlatans that sort of snake oil salesmen that's promised those efforts to do more than they currently can i think that her you know that goal that she had that she created theranos to try to achieve to use less blood in tests is a very worthy goal and a huge frontier that we have not achieved and that i hope we will achieve so i understand why you know what someone describes what a huge step forward that would be and it would be indeed i understand why people put a ton of money behind it can you describe what was the promise what what are we even talking about what's their nose what just uh for people who don't know so theranose is a company that was basically started to revolutionize the way medical blood tests are done both to use a whole lot less blood in doing it you know if anyone's ever been to the doctor and had five to ten tubes of blood removed from them it can be uh quite surprising how much they take out uh and and it's you know that's the limitation of our technology that we need those volumes of blood to run all the tests that we want to and so the promise of theranos was that perhaps with a single drop of blood we would be able to know as much about the person's the condition of their their body um without drawing all that blood and and thereby you know there would be these devices she was going to create that would sort of do it you put a drop of blood in it spits out everything you ever wanted to know about what's in your bloodstream and in a way that would make it so much easier you know it could be you could have one in your home theoretically and you i don't know why you'd wonder what your potassium level is on any given day but you could check if you wanted to um and so that that goal is very worthy you know i i put that goal up there with uh the the frontier of making painkillers that are as good as opioids without the addictive quality you know that would be such a huge revolution if we did have that in medicine but and particularly for me because i trained in both pediatrics and internal medicine so i learned to care for both children and adults in children we do draw much less blood they have a much lower blood volume and we use these tiny little tubes to draw their blood and we seemingly get equivalent information out of the larger tubes we draw from adults and i'm still unclear to be honest why we can't draw that little amount of blood from adults it seems technically possible i don't know what the barriers are i'm sure there are or else we'd be doing it but i do think that that is a very important goal and if theranos had done it they would have really revolutionized the practice of medicine so to return to that cadaver that first day uh when you got to meet with the with the dead with a human body that's no longer living so how how quickly did it take for you to get used to sort of uh he said looking at the surface muscles of the back i mean that can be overwhelming as a thought and people listening to this that have never dissected anything might might be overwhelmed by that thought so like how quickly were you able to get used to the brutal honesty of the biology before you for me it did not take long at all i guess i've not never been a squeamish person so for me it was kind of riveting and fascinating right from the first moment but i do know some of my fellow classmates did have some trouble with it some of them i heard had nightmares in the first few weeks of anatomy lab and but then everyone as far as i know got used to it and that was also actually a big lesson for me that it's pretty amazing what people can get used to in their daily lives and i kind of extrapolated that to people living through war and through you know just terrible uh situations and living under um you know oppressive regimes and it it really is amazing what people can get used to almost anything but you know in war people often come back and they have nightmares they suffer through it there's ptsd there's uh there's a lot of complicated feelings with that are echoes of those same complicated feelings possible in the case of training to be and becoming a doctor that's a good point yeah i think you know sometimes just as you know a barbed wire fence can leave a scar on your skin you know emotional uh psychological experiences can leave a mark on your brain or your memory and i think that that definitely could be um could be a problem in medical training you do see a lot of things that are very shocking very repulsive things that you'd never forget i know one of those students that had nightmares initially went on to be a surgeon so i imagine she's not having the ptsd of kind of seeing inside her first dead body because she sees inside them all day every day now but i'm sure it it could you know we we go on to see so many um kind of grosser or more shocking things in medical training through medical school and then by working with actual living patients not just dead and embalmed bodies so i do think that things can leave a mark but i don't think that initial cadaver would be the most traumatic yeah but maybe some of that trauma the demons make you a better surgeon just like some of your own psychological trauma might make you a better psychiatrist returning to the ordering is that order is a chaos to the ordering of the chapters from throat and heart and feces and genitals all the way to fingers and toes and blood so i i did mention that you know throat was the first one because i kind of wanted to throw the reader right into the the brutal honesty of death and i followed it up with feces as the third chapter and in a way partly to also throw them right into the deep end of how i like discussing parts of the body and revealing their gross and fascinating aspects so i didn't want to hide anything you know when you train to be a doctor everything is on the table literally in the cadaver lab but also just you know you deal with blood and piss and vomit and feces and that's kind of the medium of your craft and yes medium or the craft that's right right like if you're a painter this is the paint exactly and then you have to create a masterpiece with it uh like almost like a dance because there's multiple painters one of the painters is the biology so let's return to throat you mentioned it's a weird one so first of all a friend of mine said i i just see humans as a like a bunch of holes that just walk a walk around it's not untrue it's a funny way to look at humans so we have ears we have nose uh we have mouth we have um the sexual holes vagina penis and then uh you know what's the uh medical term for your yes anus thank you uh this is this is a very technical discussion the rectum's further in don't confuse the two oh that's very important what what is there a difference between throat and mouth by the way so when you say throat are we talking about when that hole actually became becomes tubular so the throat i would count as just sort of the very back of the of the you know the back of the mouth where the nose also comes down and meets it where the tonsils are and the uvula but you're right that you know we are a bunch of holes but more accurately we're a tube right we start in the womb as kind of this microscopic little disc almost like a uh you know a flat bread and then we're we roll in almost like a burrito into this tube and we're a simple microscopic tube and from there we grow into this bigger and bigger tube and we become more complicated and each end of the tube does split into various holes so all the holes you mentioned at the front end of the tube the front end of her body right it splits into the nose the mouth the ears the sinuses the the tube to the lungs which is the windpipe the tube down to the stomach which is the esophagus and then the other end of the tube splits as well uh you know men end up with two holes and women end up with three holes um you know the urethra the vagina and the anus and men just you know the urethra and kind of the reproductive system they share a hole so i'm learning a lot today it really is incredible that you start from sperm and egg and you have some dna information and from that the building project begins and then what that leads to is like a like a like pizza dough and then you roll it into a tube and that tube then eventually sort of becomes more and more complicated and gets eyes and a brain and then uh can create a twitter account so for so from it's it's really incredible that we're just a fancy tube right we are and we sprout eyes and a brain and a sense of smell and taste pretty much to regulate what comes in the front of the tube you know we don't want to eat anything dangerous or poisonous you know we want to choose what we eat even choose who we kiss well we seem to be motivated by what comes out of the tube as well in part that's not just output it's a feedback mechanism seemingly like we're also monitoring the functioning of the output we're not just obsessed about the input we're very obsessed with the output you're absolutely right about that people you know have medical complaints about their output very often that are you know i'm never i never cease to be surprised by a new kind of complaint or observation about the output i think people have gone to wars over the output and uh maybe sometimes the lack of the output or the desire for output for the particular other humans that you fancy the brain and the eyes that sprouted somehow convinced the the rest of the body that this one particular other tube is fanciful so you're going to go to major wars and lead global suffering because because of the fancy and the desire for additional output with the other uh tube okay so that's so uh on the throat that part of the tube is it uh you said the design is not you could have thought of maybe a little bit better options because it's too multi-functional is that can you sort of elaborate on the multifunctional nature of this part are a lot of parts of the human body multifunctional or do you find that more specialization is going to get the job done better there is a lot of organs for instance do have multiple functions you know the pancreas has two it's like two organs in one one you know secretes hormones like insulin into the bloodstream and the other aspect of it secretes uh digestive enzymes into the gut to help you digest and absorb food the liver is like 15 organs in one it's just amazing how many different things it does but the throat you know so basically the problem with the throat is as i said we have two tubes that are right next to each other in the throat one is for food drink saliva mucus snot whatever you're gonna swallow all of that stuff must go down the esophagus the food tube and end up in the stomach and right next to the esophagus millimeters away is the windpipe or the trachea which goes down to the lungs and your your throat does these daily gymnastics to keep everything but air out of the windpipe because you know you slip up once and you can die uh you can choke you know you laugh or speak while eating and its curtains unfortunately so it seems like you know every aspect of the body when i was learning about it in med school seems so brilliant and so perfectly designed by evolution or whoever you might think designed it um to you know favor survival to enhance life uh but the throat seemed the opposite it seemed set up almost for failure and uh you know we developed all these mechanisms as a compensation right we have the gag reflex whenever food or something is headed towards your air pipe your windpipe or down to your lungs your throat has this sort of like rejection of it it pushes it away in a gag reflex at the same time we have a cough which is something our body does when something inappropriate does get down the windpipe you know when we get a little food down the wrong pipe uh we end up coughing and the coughing does usually flush it out and get rid of it we even have something called the mucus elevator in our lungs which is this constant flow of mucus up the airways up to the trachea dragging with it all kinds of particulates that we've inhaled and perhaps some food that went down the wrong pipe and drags it up into the throat and we swallow it kind of unconsciously all day every day is the truth even the mechanism of swallowing is super complicated you know uses a number of cranial nerves it uses over 15 different muscles um it's this coordinated act to keep food out of the airway you know it you can see someone's adam's apple and their neck kind of jump upward when they swallow which helps lift the airway up against this kind of the the epiglottis which plugs it closed and allows food or swallowed drink to kind of skirt just past it but every time we swallow those things do come within millimeters of going down the wrong pipe and it's just thanks to these kind of compensations these adaptations we have to the danger of the throat that keeps us alive as i actually took a sip of uh water it's it's kind of it makes you appreciate the wonderful machinery of it all uh by the way we have uh pulled up your instagram that people should follow you have a post about the throat and then just showing so many different components from the tongue to the trachea the esophagus just the entire machinery of it all the teeth for the chewing it's so interesting and so a lot of the structure of this the anatomy and the physiology does it echo other mammals are we so are we just basically borrowing a lot of stuff from evolution and maybe making small adjustments maybe due to the fact that we're not using our mouth to murder things as other predators might we use our thumbs exactly we have hands we don't need to bite them um yeah there's a lot of overlap between different animals which i find uh very comforting and fascinating you know someone asked me is there any animal in which the throat is better designed and i my first thought was whales because the blowhole is kind of up on the top of their head so i was thinking oh maybe maybe they are set more separate but when i looked into it actually no you know the paths do come very close just like in us and i saw a paper about some new discovered organ that actually helps keep food and drink out of the airway in wales that they hadn't ever noticed before so it's a different mechanism but the same kind of basic problem is that you know where tubes and the air tube and food tube are right next to each other how well do we understand so just even lingerie on this little part is there still some mysteries about the complexity of the system because you mentioned just even for swallowing all these parts in the brain that are responsible and all all the different things that have to like an orchestra play together do we have a good sense from both a medical perspective and a biology perspective or is there still mysteries there's definitely still mysteries we understand a lot about for instance how the swallowing mechanism you know is coordinated it's in the brain stem sometimes using some higher levels of the brain but it is a very thoughtless thing as you mentioned when you drink the water you know it's not something we have to think about thankfully or we'd be thinking about it all day there's a lot we don't understand about the basic mechanisms perhaps about how the nerves fire and how they kind of you know coordinate on them on the microscopic level how ions rush into and out of nerve cells to kind of create that electrical signal but we sure understand a heck of a lot and it's very fascinating so moving on to chapter two and we'll jump around uh he actually said the liver um does a lot of things i also saw you retweet something where it said uh you know showing that the liver is bigger than the heart which is the body or the universe's way of saying you should drink more and care less it's a good line uh so you you give props uh like you said to the kidney to the liver to the maybe to the organs to the parts that don't often get as much credit as they deserve but let us go for time to the human heart we get chest pain we talk about it when we talk about love for some reason why do we talk about the heart when we talk about love there sometimes can actually be some chest pain involved in love i remember when i was a med student i was very smitten with another medical student it was totally brilliant and beautiful and it actually does cause this kind of burning in your chest i don't know what that is i don't think it's from the heart itself i don't know if it was like acid reflux because i was so nervous i'm not really sure but i definitely felt something in my chest whenever i saw her i don't know what that is but you could see why someone might think oh you know maybe it is your heart that's kind of the most prominent organ in your chest when people come to the er with chest pain you know the big question is is it my heart and that's my main job is figuring out if it is or not so i could see why um you know the way ancients saw the functions of different organs is fascinating but often hard to explain would it be fair to say that if you look at the entirety of human history the way most people die has to do with the heart well like in america today um cardiovascular disease and and cardi you know coronary artery disease is one of the most common perhaps the most common cause of death you know a 100 years ago 200 years ago it was probably not people were not living as long and people were dying of infections that we tend to die less of these days sure um that's true but in terms of things to stab so i'm trying to sort of introspect like why why talk about the heart and love my thought would be that is because the heart was seen as the most important organism it would be like the origin of life comes from the heart the originator of life and the way you figure that out from sort of an ancient perspective is uh when you stab things what is likely to lead to issues it's like it's possible to imagine that the brain is not as special as we might think from when you don't understand modern biology or um physiology or neuroscience all those kinds of things especially because pain you know is painless too uh if you stab it the brain i mean yeah um yeah anyway so that's that's really interesting i'm sure there's a there's a kind of a poetic answer to maybe the way people wrote about it but what to you is the wisdom in the design of the heart i mean the main function of the heart basically is to push blood through the cardiovascular system through the branching blood vessels to feed every cell in the body you know when our i believe our ancestors started off as single-celled organisms floating in some ancient brew and they were surrounded by the medium that would bring them all the nutrients they needed so there's no issues there and then once you start getting multicellular organisms the kind of that are thicker and the ones on the inside aren't in contact with that sort of nutritious brew that they're growing in you kind of need a way to distribute those nutrients to every cell and so that's what the heart and the branching vascular tree do so the heart you know it's i the most the biggest disconnect between how the organs talked about in poetry and through history versus his actual function is probably the heart because we ascribe all these things like love and passion and life itself sometimes to the heart but actually it's just a simple mechanical pump you know that's all it is i don't want to downplay it it's amazing but um you know it just pushes it fills the blood and then squeezes it fills the bone squeezes it and just that squeezing that pushing creates the blood pressure that you need to get blood to every cell in your body especially when you're standing upright to get blood to your brain you need a certain amount of pressure to get it up there isn't it amazing to you how much volume of blood just gets pushed through by this by this pump absolutely they say every red blood cell takes about five minutes to circulate and come back to the heart um and that circulation kind of you know starts at in the womb and continues and kind of until the moment that we die but the volume is tremendous and it can never see you know take a break basically and it's sort of uh propagating all kinds of stuff throughout the body it's a delivery mechanism blood for all kinds of good stuff and bad stuff nutrition drugs all that right medications too medications such a fascinating design and it also takes the waste away you know it kind of brings the nutritious stuff brings the nutrients especially oxygen but many other things and then it also as it passes the cell takes the cell's waste so it's sort of the the fresh water and the sewage system in one so about blood what what to use fascinating about blood so we talk about the pump that spreads the blood but the blood itself right so the blood itself is sort of i mean it's the most important bodily fluid of course it you know from moment to moment every cell in the body needs a flow of blood um to bring it most importantly oxygen but also again all the other nutrients and to take away waste and if that stops for even a few moments you can be in big trouble so blood is sort of you know the the most important medium it's also doctors use it to kind of evaluate the body it does have this kind of all-seeing quality to it where um you know we can evaluate organs through the blood i can tell you about your liver your heart your kidney just by taking a sample of your blood so it's sort of like this crystal ball in a way and we use it kind of all the time you know to assess someone's health to assess their disease is it also the attack vector for diseases for bacteria for viruses and all that kind of stuff so viruses seem to attack either the throat maybe you can correct me but they seem to attack different parts of the body depending on how easy it is to access and how easy it is to uh get in deep depending on what you prefer if you want to do a little bit of hard work but you get in deep or you don't want to do the hard work but you don't get in deep those are the choices viruses have but is blood one of the sort of attack factors what's like if you were trying to break into the human body uh like a parasite a virus a bacteria how would you do it like what would you what would be the attack vectors you would explore right so you got to look for the body's weaknesses of course um you know we have inherent weaknesses for instance like our respiratory tract we have to breathe we have to get air in from the outside and so that's one of the entries into the body and so you know when we inhale let's say a poisonous gas you know it's it's an easy way in you have to breathe can't hold your breath very long but you know air in our lungs is still kind of contiguous with the external atmosphere it's not really inside the body until it does cross across the lining of the alveoli into the blood as you said that's when it really gets inside and the other besides the respiratory tract the gastrointestinal tract is another way kind of a in the armor you know we have to eat we have to drink and therefore we're taking the external world into ourselves into our gut in order to extract from it what we need and let the rest kind of flow out so those two the gastrointestinal and respiratory tract you know there's a reason that you know respiratory tract infections and gastrointestinal infections are kind of the most common that afflict us because those are the ways in to the body so i would definitely pick one of those not just be a lazy cold in the nose but really a more aggressive pneumonia down deep in the lungs and get across that barrier into the blood but also the whole sex thing uh that humans do so speaking of which let us go for time to the genitals chapter so uh what are genitals i think i've heard of those i think i've read about a penis and a vagina can you explain to me how those work just asking for a friend but also um what do you use fascinating about it and maybe what's misunderstood or little known about them sure so i'm they're very unique organs i would say one of the things that i like to point out is that you know while every organ from moment to moment keeps us alive and ensures our survival the genitals are in a way the opposite you know we don't need them from moment to moment you don't even have to use them at all um and in fact they often make us do stupid things that are the opposite of kind of enhancing survival so and they you know they've affected the brain and you can become sort of focused and nuts based on those desires that kind of stem from the genitals so they can be dangerous organs too um but you know i mean sexual dimorphism helps with genetic variability um as it does in so many other organisms you know you take two people and mix them together their genetics you just get a lot more variation and more opportunities to try different genetic codes and see what'll enhance survival as we talked about sex and death i talk about in the book a lot of for instance the female genital tract how the uterus is very unusual because you know it doesn't even sort of wake up and start doing its thing until the second decade of life you know it's um even though uh babies uh baby female babies are born with all of the eggs they'll ever have in their ovaries already they're just sort of in this stasis until they start waking up uh kind of once a month and it's this this cycle you know there's so much in our bodies that are cyclical and rhythmic the heartbeat the breathing but menstruation is kind of the a very strange rhythm that takes over a decade to start and only you know the rhythm beats once a month which is very slow compared to every other rhythm of the body the other unusual thing is you know in in medicine when rhythms of the body cease when they stop those are emergencies right when your heart stops that's a cardiac arrest you need cpr maybe an electric shock to restart it when your breathing stops you know you need a breathing machine to breathe for you or something to reverse whatever might be causing the suppression of your breathing but when the menstruation stops it's the point of menstruation in the first place the whole reason that the uterus grows the lining and sheds it each month is to one day you know get get fertilized fertilization for to implant in the lining and then the rhythm ceases and that's obviously not a medical emergency unlike most other rhythms you know cessations it's the point of the whole thing in the first place so these particular penis and vagina are that whole thing the uterus whatever am i not using the wrong terms i don't know i'll just keep saying you use those terms there's more technical there's parts various various parts in medical school you learn every bump and you know every little part of every little organ and including the genitals so i never really uh thought of it this way as you said is that most organs are kind of full-time employees like uh 24 7 they're doing something and then there's some organs uh penis vagina being uh representative of this they're not functioning all the time they're only functioning every once in a while and then get us to do stupid stuff or awesome stuff and all that kind of stuff but they're not essential for human survival on a second by second basis and that the whole cyclical nature of the human body how many other cycles are on a monthly basis like that far apart that's a that's a fascinating design that the human body would do that and wouldn't start until the second decade a decade of life it's almost like what do i want to say there's some kind of meta planning going on like this is the optimal solution for the sexual selection mechanism among uh like somewhat intelligent species like it's useful to after the brain has developed sufficiently long to now be making sexual selection decisions like you need time for this computer this really powerful computer to load in the info interesting you also need the body to develop you know a child simply isn't big enough to get pregnant and deliver a you know another baby i wonder if there's animals in which this happens much more accelerated pace in different stages definitely especially you know certain kinds of insects you know like um drosophila a lot of the fruit fly a lot of experiments are done on because their life cycle is so rapid you know a lot of kind of insects and other creatures are almost ready to mate as soon as they're born not us not us is there any improvements to the design so a lot of people are very interested in these particular body parts if you were to sort of step back as a geneticist biological designer or maybe a computer scientist computer engineer trying to build a human 2.0 or maybe a robot how would you improve the penis and the vagina well the penis for starters i mean let's also discuss the testicles you know they're very important too i mean okay so they're yes right so they're fragile and they're important and yet they're hanging off the body in danger basically so um does that make sense you know they begin in the womb they begin inside the abdomen and they slowly descend and and sometimes before birth sometimes in the first year of life sometimes never they pop out of the body and end up hanging in the scrotum there's a reason because the chemical reactions that create sperm function best at a few degrees cooler than body temperature and so that's why you might notice in the warm weather they might hang further down and in the cold weather they scrunch themselves up to get closer to the body to maintain that ideal temperature a few degrees cooler so it's hard you know if you could create a sperm production mechanism that did not rely on that lower temperature that would be great keep them inside the body protected like the ovaries are um oh then you wouldn't rely on the lower temperature i thought you meant create some kind of weird internal cooling mechanism no well no i guess that would be one solution but just maybe a different type of chemical reaction or you know would not be reliant on the lower temperature let's say um you know it would be great to design the spermatogenesis or sperm production process that would function best at body temperature and then we can keep those delicate organs inside the body and not have them hanging out in danger or maybe the argument for this design is uh maybe it's nice to put them in danger so you uh are constantly concerned about it could be maybe that's beneficial for male psychology i'm not really sure there's a psychological element here about the evolution that could be so that's the testicles uh uh penis um a better way to do it you know i i mean it's pretty good as it is you know it kind of when it's time for it to work it it grows and stiffens and when it's time for it not to work it it kind of shrinks and yeah hangs out um saw this on a seinfeld episode so i know how it works shrinkage yeah that was a good one but you know that's that's also a bit unique i suppose that uh you know the way it's it has this erectile tissue actually they're similar in the mouth of certain baleen whales there's a certain similar kind of erectile tissue that helps um cool cool them off um because they have so much blubber and creates so much heat and moving around and feeding that they have actually a similar similar to the penis organ in their mouth that helps cool their bodies because it's a big problem they have to store all that blubber for fuel but it makes them too hot so as a compensation they have this kind of erectile organ in their mouth okay uh what about vagina you know the fact that miscarriages sometimes happen because of sexually transmitted diseases because of trauma you know it would be great if the uterus where the growing fetus is is sort of even more protected from those things um you know i guess that's that's a side effect of the fact that uh people still have sex when they're pregnant are still you know exposed to injury if there's a way to make it more protected perhaps that would be even better i did see an article recently about artificial wombs which are rapidly becoming a reality and in in animal studies they're able to prolong the gestation of a fetus by a month in an artificial womb can you explain the artificial aspect of the artificial one sure it's um i believe it it acts almost like a a heart lung bypass machine so when someone's getting like bypass surgery their heart is stopped literally they throw ice in the chest and they um give a potassium infusion through the blood which stops the heart um but the blood is run through a machine that basically does what the work of the heart and lungs together gets oxygen into the blood and then pushes it in back into the body so it's i believe it's a sort of similar mechanism to keep blood and nutrition flowing to this fetus and so it's just not inside the body of a parent it's in some kind of other device but i think that science is going to rapidly improve one benefit is you know babies are born premature and while you know neonatology is able to continuously kind of lower the age of viability through better technology and understanding how what you can medicines and other things you can do to premature babies when they're born you know ideally if let's say premature labor begins you can't stop it that baby's coming out one way or the other if you could just then stick it into an artificial womb where it can continue its development that would save a whole host of problems often those babies born very early suffer from damage to various organs including the brain you know for the rest of their life so that could be a very important technology so some aspects of the human body we can develop technologies that outsource them sort of uh offload some of the stress and the workload from the human body to do it elsewhere like dialysis does that for kidneys you know people can live decades without kidneys as long as they get dialysis which does the work for them not every organ can do that for instance the liver there's no dialysis version for the liver like if your liver fails you need a liver transplant and that's the only thing that's gonna do it for you so that's the world's first artificial womb for humans and we're looking at a picture of what looks like gigantic balloons matrix here we come this is very matrixy how are they floating what are we even looking at there's giants red spheres this really looks like the matrix i wonder where it's from so there seems to be a paper on this too i don't know too much about it but i did see that there it's advancing very rapidly the world's first artificial wound for humans scientists in the netherlands say they're within 10 years of developing an artificial womb that could save the lives of premature babies premature birth before 37 weeks is globally the biggest cause of death among newborns but the development also raises ethical questions about the future of baby making and so on and so forth wow we're going to be facing a lot of ethical questions as we start to mess with human biology in in in an effort to help human biology we might start to mess with it and it's going to be very interesting let's take steps towards um towards the matrix all right what about the neighbors poop feces there seems to be a lot of interesting stories in that particular output as well um what what to you is fascinating what um what to you maybe is misunderstood or a little known about poop well it's hilarious for one thing yeah that we do okay the word is great as well yes there's so many different words i do you know when i'm talking to the parents of pediatric patients i use the word poop i don't often when i'm talking to adult patients try to choose a more mature word but um poop is amazing i mean i guess it's uh you know it's sort of the most the dirtiest the most vile the most hated aspect of our bodies it's the grossest we don't want to think about it talk about it have an it anywhere near our you know food or in social interactions uh with good reason you know i mentioned gastrointestinal infections are one of the most common infections the human body suffers from and you know what we call uh the way they spread from person to person grossly enough is referred to as the fecal oral route which is means a bit of someone's stool is getting into your you're swallowing it um you know through water supply for instance diarrhea is actually quite a brilliant mechanism of these microbes right if you let's say you're in the intestine of one person your goal is to get into the intestines of another person brilliant to just trick their intestines into secreting all this fluid into into the intestines to increase the volume of stool and its runniness so that when they do poop it gets into the water supply and then everyone else kind of ends up getting infected as well wow it's genius just the same way like you know tuberculosis or coronavirus kind of infects your lungs and makes you cough and you send it out into the air and it ends up in other people's lungs that's all evolution yeah it's brilliant so diarrhea is intelligent um is a big takeaway lesson it's one of the most intelligent things we can do uh as an entirety of an organism not just the particular cognitive organism but there's there's you know we're we're made up of bacteria and viruses and there's a lot of visitors and so on as the entirety of the system diarrhea is one of our better accomplishments that's fascinating um well i wonder why is poop funny i think a lot of that is socially constructed just how it's sort of supposed to be hidden away yet something we always do something you know we chuckle about as children and but even in healthcare you know it becomes this big topic of conversation because you end up talking about it constantly like in the er people come in i there's complete strangers sometimes like a nice old lady who resembles my grandmother and all of a sudden i have to ask her all about what's happening in the bathroom like is she straining what color is it what what you know what's the consistency does it float on top of the water more than it should is it hard to flush i mean there's a million different questions you learn as a as a medical student and you're like this poop detective when people come in with issues and so it's it's funny i guess you know in the exam room with the doctor-patient relationship there's sort of no barriers you know you talk about everything and you're talking about the most intimate details of a person's life even though you just met them a second ago it's so different than normal social interactions yet there is this social aspect a lot of what i do is social you know it seems like doctors what they do is mostly scientific but actually it's just relating to another person and you have to maintain you know your professional demeanor and this normal human level interaction even though you're talking about poop um and that's a skill that's an art and a science well okay actually i want to linger on that because i'm a fan of just diving into conversations right away with strangers just getting no small talk and this is like the ultimate i don't know if it's the ultimate but it's one version of no small talk you get right to the point i um that's really powerful from a psychology perspective you're a kind of therapist or you have the power to be a therapist i don't mean just about the medical condition of the body but the psychological there's so much fear connected uh to to this concern also self-doubt um insecurities even uh sort of existential thoughts about your mortality all those things are right there in the room um so i think one way doctors deal with that is they kind of have this cold way about them they almost have to do a mode one is like i'm going to be friendly on the surface and cold about the brutal honesty of the biology but i wonder if there's like um a skillful middle ground this dangerous place where you can help people deal with their psychological insecurities concerns fears all those kinds of things is that just really tough to do yeah it's it's a huge part of being a doctor is is dealing with the psychological aspects of whatever is going on with the patient's body i mean in the er you deal with psychiatric emergencies kind of left and right more than ever these days and um you know that's a huge issue not to mention sort of drug use alcohol-related stuff you know that gets into sort of psychology and the human love of intoxicants and changing the brain's chemistry um and you know inhabit of course we're creatures of habit and that plays in as well i mean a big part of for instance pediatrics is reassuring parents and kind of convincing them giving them the confidence that what's going on with their child is not serious will go away on its own does not need any particular intervention and but adults too you know reassurance is a huge part of the game um yeah you know in the er you see humanity at its most raw i feel like you get this tremendous insight into people how they live what they worry about what they think about how their body works and also how their mind works that you almost don't see anywhere else it's a really interesting um place to work and also the way our society is shaped the er is where people go for almost everything when they're suicidal they come to the er when they're too high on drugs to walk they come to the er you know children who have been abused sexually abused physically abused come to the er for us to investigate uh it's sort of like the the all-purpose waste bin for the dregs of society what people do to themselves and what they do to other people you know you mentioned you're interested in the darkness of humanity it made me think of the er where you really see uh what human life is like um in the er okay you've uh you tweet about you write about you think about the emergency room er that's really fascinating just a little window you uh give to that world it's fascinating what lessons about humanity do you draw from this place where you're so near to death there's so much chaos there's so much variety of what's wrong so little information um or the the the urgent nature of the information inflows such that you can't really reason sort of thoroughly and deeply and collect all the data all those kinds of things you have to act fast and then everybody's freaking out can you just speak to the human condition [Music] that you get a glimpse at through the er experience yeah i think you do see all those things i think on on one end of the spectrum it is this very unique place where you get all these unique insights on the other end it can become a ho-hum workplace just like any other which is sort of surprising as i mentioned before humans seem to be able to get used to almost anything and doctors can get ho-hum used to oh dying of a heart attack oh actively in labor and the baby's half out oh you know just ho-hum i know what to do going about my job and go home at have dinner with my family and not think too much about it that's amazing i do i do try to maintain you know both my fascination you know as i think writers in general tend to think more about what they see write more about what they see maybe draw connections with what they see to other things so i do think that writer's perspective does help me uh kind of maintain my fascination and my kind of more of an insightful perspective than just a ho-hum water cooler conversation um but you do see a lot you know um in a way medical problems are sort of the great equalizer right um class race culture background you know the failings of the human body the way it fails and what we can do to help in those situations is almost universal i always like this quote from you know chekhov was a doctor and a writer and he uh saw treated a lot of peasants very low class and also treated a lot of aristocrats and he he wrote that they all have the same ugly bodies basically which i think is really uh right on and you know it's sort of you can see people underneath a superficial layer of clothing maybe it's the most expensive clothing bought from the fanciest places but underneath their body is still failing in the same way and they still have the same anxieties the same worry about mortality the same concerns about whether poop turned green today all these things that they bring to the table so in a way it is this great equalizer um where people are kind of all the same in some ways yeah i feel like people sometimes class money fame power makes you for time forget that you're just a meat vehicle and uh and just as good and just as bad as the other meat vehicles all around you in that sense uh there's this question sometimes raised are some people better than others and i usually answer no to that question because of that yeah some people might be better at math some people might be better at music but at the end we're just meat bags beautiful as we are there's a poem that just uh a small tangent i want to take i just saw it just acting that you have uh written i have to uh would you classify it as a poem yeah at first if i may read it at first you enter the clinic shoulders weighed down by white coat pockets book stuffed timid you act out a roll your white coat a costume your questions a script your demeanor a rehearsed act no one is going to buy this but then as you play the role again and again repeating the lines and the motions the script slowly dissolves and the interaction becomes thoughtless and the rehearsed act slowly fades into a profession you suddenly find yourself unable to tell if you're still acting or if you're doing it for real and now you're a doctor jonathan reisman md harvard massachusetts general hospital medicine and pediatrics department beautiful so that is what it is to be a doctor you're just acting fake it till you make it exactly fake it till you make it and i think i imagine every medical student has this feeling when they first go into a room like i talked about asking this nice old lady about the color of her poop for the first time and you're just like what am i doing here like what did does she believe i'm a doctor you know this just feels absurd but then it's again ho-hum becomes normal now there's not a sperm chapter in your book this uh you mentioned offline that this is the second and the third book that you're working on all about sperm no i'm just kidding um but or maybe i'm not uh humor tends to make way for reality um so the the tweet was that a human average human male produces 500 billion sperm i believe which is about four to five times more than the number of people who have ever lived and each of those sperm is genetically unique so you can think of them you can kind of imagine the possible humans they could have created and they're all different they have similarities of course but they have peculiarities that make them different and you can think of all the different trajectories all the einsteins the feynmans the hitlers and all the people who have died who would have died during childbirth would have died early in their years given the different diseases it's fascinating to think about an average human yeah we're all winners of a very competitive race so the people who make it we're winners hashtag winning um is there something that you find fascinating interesting beautiful ugly surprising about sperm i think sperm is um yes it is a very interesting bodily fluid maybe i'll write about it in a second or third book we'll see but uh you know i guess sperm is interesting because it's kind of the only projectile bodily fluid um from the body um you know vomit can be projectile usually that's a disease state that's not the expected kind of normal healthy state oh sneezing would you classify that or no true i guess there's it's yeah there's some particles in the air i guess it's not a fluid i mean not a liquid um but true i mean cough in addition to sneeze right sneeze is how our nose gets rid of something that shouldn't be there cough is our lungs get rid of something that shouldn't be there vomiting is sometimes our stomachs get rid of something that shouldn't be there all projectile sometimes in their own way sperm is sort of interesting it's created with the food for its journey sperm mostly feed off of fructose the kind of sugar um you know for the few days that they live inside the female genital tract but it's sort of i like comparing our genitals to the genitals of the plant world which is flowers and in the same way that uh you know a touch me not uh for instance the kind of flower where when you brush up against it it sort of launches seeds into the distance to try to um survive in a way kind of the sperm is doing something similar launched into the female genital tract and then all trying to find this uh competing against each other to find this egg it's really amazing and when you learn about it from the biological perspective the most amazing thing is how many things can go wrong you know just in the sperm not surviving long enough for it making it to the egg and then some genetic abnormality causing a miscarriage it's sort of astounding that it works as often as it does and i think the lesson there is just that people have a lot of sex and so statistics just favorite's going to work out a good number of times yeah and there might be intelligence in the design of just the sheer number of sperm maybe that's yet another way to inject variety into the system and redundancy i guess you know we have two kidneys we have two hands if we lose one we can still go on we have you know however many millions of sperm get sort of launched in every ejaculation is uh you know if a bunch fail or don't make it inside there's papers on this by the way uh that i read for some reason not read but skimmed for some reason which is uh talking about which sperm usually wins like what are the characteristics of sperms that are winning and it's not the fastest it says apparently there's some kind of slaughter that happens early on people will correct me but it's not the fastest it's there's a aspect of it's the luckiest it really is like the body tries to make it a random selection it tries to make it fair in making it as random as possible interesting and also interesting that they're fueled by fructose i didn't really think about that so they're a um they're a car bloated athlete right with food for the journey food for the journey because i'm somebody that actually does a lot of running on um i guess you would call me a fat adapted athlete so i do sort of meat heavy diet and so you could do a lot of endurance kind of stuff when you don't eat any carbs any glucose any of that kind of stuff and you're very low it's interesting to think that sperm are like nope they're total bros let's go to the gym sprint performance short term performance is everything all right well that's sperm returning to the liver the place that deals with all our poor decisions no um many of them many of the are poor decisions is there um you said that deliver does uh quite a few things uh what do you use fascinating beautiful about the liver i would say its primary function seems to be as the sort of gatekeeper for what we eat and absorb um you know the entire gastrointestinal tract from the esophagus to the rectum the blood flows from it not back to the heart but to the liver where it's first examined kind of things are evaluated packaged you know processed detoxified perhaps and it's kind of this great overseer of what we digest and absorb and so it kind of keeps keeps track of of what's coming in you know the outside world that comes in and become will become part of us you know why that's why partly the liver suffers sometimes the injury from uh certain certain toxins like alcohol but beyond that the liver is also the place as i said it metabolizes things too so it metabolizes alcohol and why it can be injured by alcohol it metabolizes drugs like tylenol which is why tylenols uh can be very toxic to the liver when taken out as an overdose so the liver you know even beyond that the liver produces a lot of different you know things that float in the bloodstream it packages cholesterol and fats and sends them to where they're needed it deals with protein in the blood it deals with clotting factors in the blood helping the blood clot um you know processes things like bilirubin and other things that really as i mentioned there's like 15 organs wrapped into one maybe that's why it's sort of the biggest internal organ the skin's bigger but it's not an internal organ right the biggest organ in the human body is the skin right but the liver is the biggest internal organ and it really is a powerhouse and and does a lot which is why when people suffer from liver failure kind of everything goes wrong in a way and uh in terms of replacing organs what what are organs that are easily replaceable which are not like on the list of things that are hard to replace and not where would you put a number one where would you put it like at the bottom well i'd say the kidneys are you know nothing's easy but kidneys are easiest in a way partly i mean maybe a big factor there is that other people have two of them and can give one to you so you don't have to wait for people to die which is the case with hearts and livers sometimes you can take a part of a liver from someone who's alive and the liver does have this kind of mythological ability to regenerate itself um in the myth of promise prometheus he's you know chained to a rock and the bird eats his liver every day and it grows back every day and that's uh actually biologically accurate not that you can completely get rid of it and it'll appear again but when pieces of it are removed or injured it does regenerate itself pretty amazingly um so i'd say the kidneys the fact that they're more around also it's you know the kidneys a smaller organ it's often just you don't have to put a transplanted kidney where the kidney should be in the back of the abdomen you can just kind of stuff it into the pelvis there because it's a smaller organ the liver would be hard because it's huge and i guess we just have the most experience with kidney transplants because they are the most common and then the heart and the brain are probably quite difficult brain as far as i know hasn't been successfully done the heart is is done um and uh definitely i've evaluated a lot of patients with a heart transplant it does work pretty well the mechanical heart substitutes are also advancing quite rapidly these days for a failing heart there's certain kinds of devices they can surgically implant like when a failing heart isn't able to push hard enough you know that's the heart's job is pushing blood with sufficient pressure to create blood pressure when it fails there are actually these devices you can strap onto the heart to help it pump harder those are rapidly advancing many of those were not available even 10 years ago when i was a got out of med school and now they're commonly used so maybe heart transplant won't be as necessary in the future if those mechanical things do advance and as i said the heart is basically a mechanical pump so perhaps it would be the easiest organ to replace with some mechanical device now for something completely different returning to testicles for time you posted uh instagram posts of uh testicles as food perhaps eating them doesn't help libido because ingested testosterone is totally metabolized in the liver returning to our liver leaving none to reach the bloodstream that is why testosterone only comes as injection or topical foam not as pills on the other hand estrogen and progesterone can be absorbed orally hence the pill but testosterone is mostly responsible for libido in women too i was not expecting for this biology lesson when i was looking at an instagram picture of are we looking at testicles yeah are these like which species i believe all those are from cows from cows sexually female so bulls yeah well uh speaking of which just we'll jump around a bit but you've also traveled the world quite a bit uh what have you what is the craziest food you've eaten across the world what what have you learned about the extremes of the culinary arts by traveling the world i would say i guess i've always been extra fascinated with the diets of of natives of the far north um i spent some time there in russia and in alaska and always loved their diet so when i was i worked in alaska an emergency room and did some other travels in the antarctic alaska and you know they eat a lot of fat and traditionally before contact you know more than half of all calories in the inupiat eskimo diet came from blubber marine mammal fat or you know also fat from fish fat from ducks and other other birds that go up there to mate in the summer so things like raw whale blubber um was especially uh interesting for me and very exciting you know i had some uh beluga beluga whale chowder things like that there's just all these very unusual dishes uh you know they uh there's a dish called mickey yuck which is whale uh meat fermented in whale blood which is quite delicious actually so is it uh cooked does it eat in raw is it what how do they like their fat like in in uh and then same in up north in russia as you mentioned so they often eat it raw so the raw whale blubber is called muktuk um and it's often just sliced thin and it's like it's sort of cold but not frozen often when they eat it and they slice it thin and a lot of people assume it would be very chewy but it's not that chewy it's quite pleasant actually and has this kind of sea smell to it as you're eating it i quite like it and what's the culinary culture like meaning is it just source of energy or is it art well there's you know traditionally there's not a lot of cooking um in you know in the in the arctic uh a lot of things are eaten raw partly because there's not a lot of fuel for making fires so um they will you know some in some of the big rivers in russia for instance that flow north they will bring trees you know dead trees and logs up to the north and they can get some wood that way and same thing and some of the rivers kind of flowing northward from the brooks range of alaska you do get some trees but just not enough to really produce a culinary art that requires cooking with heat you know they do have um traditionally blubber lamps where the blubbers of seals and whales are used to create a little flame often that's for light and for a little bit of heat and and less for cooking but eating things raw is definitely a huge part of the culture there and while i was i went on a whale hunting trip out on the spring ice um in the arctic ocean by barrow alaska and uh two of the guys the inupiat guys who had invited me were kind of talking about how eating things raw is sort of the most essential characteristic of an opiate culture and the one guy who's half white half an opiate said people often doubt his ethnicity because he looks like a white guy so he'll you know bite the head off of a raw bird uh to show them that he's truly a nupia is what he said that's how you prove you're legit we're looking at instagram pic as a doctor i was used to knowing fat as the most maligned of all body parts and the culprit in an obesity epidemic but in arctic alaska fat has always meant health and survival in fact the entire story of life in the arctic especially human life is basically a tale of fat and in borough what's a.k.a alaska alaska okay uh uh a lawn covered with the whale blubber is still equivalent of a plush green lawn in temperature suburbia swelling in uh its owner with pride and that's what we're looking at is a lawn full of will uh blubber a beautiful this so this is i mean there's a lot of calories there oh yeah and this can feed a lot of people a lot of energy a lot of warmth absolutely and it's delicious this was like uh i was a kid in a candy store basically i rounded a corner and barrow so when people do get a whale during the spring uh whaling season they raise a flag or the whaling captain raises a flag over his house and everyone in town is welcome to come try some and so before i went inside to try some i was kind of playing around with blubber and i saw the this is a bow head whale um i saw its heart which was huge like the size of a yoga ball um and that was for me just like amazing i spent probably the next 45 minutes just looking at all aspects of it and the stump of aorta that was attached to it was the size of my thigh that was really fascinating it's similar alaska and northern russia like siberian out there so where were you um i think you have some picks from that time where were you in russia so i spent a lot of time in kind of western russia as well but i did um take two trips to kamchatka including northern kamchatka um i didn't go far enough nor i didn't go to chukotka for instance until more recently when i was a ship doctor on a wildlife cruise that sailed from anadir russia up to through the bering strait and to wrangel island and we stopped in some villages in jukotka and i got a chance to to try some some whale and stuff like that northern kamchatka where it's more of the koryak are the indigenous people they do a lot of seal hunting so i had a lot of seal blubber but they i don't believe they do any whale hunting um quite there but the chukchi in a way are sort of you know similar to the nupia um in their diet and their life ways of course everyone's diet all these people's diet has changed dramatically in the last 100 years as it has for actually everyone living in kind of modern societies but for them perhaps more than anyone else since their diet was the most extreme i think of any human culture on earth just to stay on the wild travel you did and i should say i'm using the word travel but it really you were a doctor there first of all can you just comment on the decision to go to such places and to help people to be adopted there what was the motivation what was the thinking behind it well i think i got the travel bug before i ever went to medical school and even wanted to be a doctor so right after college i kind of wasn't very into college didn't enjoy things kind of wanted to get out there and see the world get out of new york city where i was a student at nyu um the first thing i did after finishing college was i was invited to be a intern at a research center in saint petersburg russia i spent six months there my first trip and went back four more times to russia traveled all over including to kamchatka twice um and other parts of the country i'd never heard of cities like petros of voldsk and sikdivkar and scoff i didn't even know a word could start with psk like the city of scoff but it can yeah and i was sort of fascinated i was actually studying uh the international environmental movement and how it came to russia after the fall of the soviet union and how organizations like greenpeace and world wildlife fund and the world bank are trying to kind of uh push the timber industry which is huge in russia toward a more sustainable path and so sort of evaluating how is it working if not why not and that seems like such a little niche such a small detail about russian society but in a way researching that in depth was almost this window into the entire country and the history in a place i knew nothing about and i learned the language traveled all over the country you know got to know the food the history the literature is just a immersive and amazing and life-changing experience that made me want to see every every spot on the globe basically learn about every culture so i took that desire with me to medical school i decided i would go to medical school and uh from the very beginning i was intent on traveling around the world so a lot of my career has been fashioned so that i'm practicing medicine in a place with an interesting geographic context an interesting place with an interesting cultural context and that just makes it more interesting i find not only are medical services often more needed in these remote and rural parts of the country and world so i feel like i'm you know taking my knowledge and education experience to places where it's needed but also for me it's just such an enlightening experience the way culture history geography climate affects medical disease but just getting to know people getting to know their culture being a very useful traveler by you know providing medical services in that place and that's taken me to arctic alaska to pine ridge reservation south dakota i currently work in a few different parts of pennsylvania appalachia which you know for me is a unique geography and culture that i didn't grow up with wasn't familiar with so in some ways it's it's exotic for me as well i mean i worked in other places too like calcutta india and nepal um just i think my love of travel has shaped my medical career and and being a doctor does give you these opportunities to go to places and travel in a unique way you know through the medical profession you know there's a documentary happy people here in the taiga or something like that um i think uh warner herzog voices it it tells a story of a simple life of survival in the taiga and i think they're trapping for food and there's a lot there's an alcoholism problem too as well there's like a very basic life of survival of loneliness of desperation but also there's a i think the underlying claim of the documentary is that um that simple life actually has a kind of simple happiness to it um hence the name happy people is there can you speak to the life that people live in in those places when it may be simpler than you would in uh sort of big city life it's definitely very different for sure um you know i guess i found like in some of the remote villages of kamchatka i was actually surprised how similar they were in that you know there was i saw the same family strife the same fights the same you know kind of pairing of relationships and bickering and politics and you know in a way i'm from the new jersey suburbs and yet being in this remote you know uh village of north northern kamchatka i remember writing an email to my friend about how just it seemed so similar even though on the surface it was this exotic other world the incredible material know-how they must have to get their food from the land you know that the number of animal species plant species the behaviors of the animals seasons um how to live that way in a way it's more complicated in a way that i find fascinating how people live on the land and the knowledge and experience it takes to do it well and survive you know obviously other aspects of modern life in a city are are much more complicated um than they would be there but i guess it's that was something that struck me too that it's simpler in some ways but more complicated in other ways so some of the complexity that happens in life is from originated from humans not from the technology or the all that kind of stuff around us you can take the human out of modernity but they're still human they're still human and they fill the empty space with their own human complexities um are there people that just stand out memorable people memorable experiences from those places some people that maybe made you smile made you cry um change who you are as a man change who you are as a doctor anything jumps to mind i think you know when i was is interesting when i was in russia i found that most of the people i hung out with were old women i'm not sure why i mean they're actually i didn't meet a lot of old men in russia which might speak to kind of life expectancy there for men in particular but i found uh women older russian women including you know russian from saint petersburg or some of the elderly women in kamchatka who were you know some were koryak some were half koryak half russian some were chukchi i just found them to have to be so enlightening the way they talked about history about people so insightful about humanity you know all they've lived through in the last 50 years in some of these parts of russia like the upheaval societal upheaval the destruction the building up it's just something i could not even imagine and i think their insights were just very i'm not thinking of anything in particular but i just remember i could listen to some of these elderly women talk about their lives for hours and hours i remember there was this older elderly blind koreak woman who you would have thought was the you know most country bumpkin of country bumpkin and yet she couldn't stop talking about how much she loved reading dostoevsky and tolstoy and which might also speak to the soviet education system and it's just sort of surprising and fascinating and just uh those stories and perspectives on life really stayed with me yeah with uh uh there's a there's a wisdom there's a kindness i mean i suppose that's true for older people in general but there's something about it's not just russia it's eastern europe it's like this kind of look of wisdom and not just like sort of uh middle class wisdom or something like that it's like i have seen some wisdom i've seen it all and on the other side i'm left here with a pragmatism and a compassion and also an ability to cook really well that's for sure absolutely there's just this balance of just deep intelligence and deep kindness and um yeah i mean i uh part much of who i am is because of the relationship i had with my grandmother who is a um a russian ukrainian-born uh russian grandmother did you learn the russian language i did it's quite rusty at this point but um i did uh one of the one of these wonderful elderly russians in in st petersburg sort of adopted me i think that was another thing that a lot of these elderly women on every side of the country kind of adopted me or saw me as this real curiosity you know it's sort of just not i mean this was around 2002 2003 it just wasn't common for this sort of strange american to suddenly show up in the middle of kumchatka or even saint petersburg and just cure absolutely ravenously curious about everything they had to say so i often got adopted and one of them taught me russian and how to ride a horse um so the same same babushka taught me both of those things and like you said also i i should mention that there's something about the soviet education system where yeah everybody reads tolstoy dostoevsky it's exceptionally well read no matter where life has taken you no matter where you come from the literature the mathematics the sciences they're all like uh extremely well-educated and that creates a fascinating um populace like then you take that education that excellent early education and you throw a bunch of hardship at those people and then they kind of um cook in that hardship and come out really fascinating people on the other end um it makes me surprised sort of that for instance like russian medical science is not doesn't you don't see a lot of sort of studies uh medical studies advancing of medical science come out of russia which is sort of i'm surprised sort of i wish that it would you know i visited academe goradak outside novosibirsk which is an entire city the soviets created just for the study of science and it's like there's the geology building and there's the biology building and there's the chemistry building and i just feel like russia has this potential to be a science powerhouse or even in the medical sciences but i guess you just i don't see it i'm not sure why i mean you can certainly guess as to why and i i see the same thing in the other in the sciences i hold the dearest or in computer science in engineering fields i kind of long held this uh desire by long i mean last couple years because a bunch of people reached out to me from yandex and moscow state to give lectures there to sort of connect you know why why so little science is coming out of there why so little um that we hear about and it feels like we should be able to bridge the scientific community like uh the science let's even say even in turmoil of geopolitics even in global conflict i feel like science should be bigger than that um but why do we not hear from the scientists is because of the limitations on human freedoms on scientific freedoms i feel like in in china in russia in any regime of its sort you should give freedom to scientists to to flourish and to interact with others and you can only grow from that you shouldn't suppress that the sort of cold war ideas we should put those aside as a somebody who spent time in russia as somebody who's learned russian do you have some thoughts that you want to say about the war in ukraine currently it's tragic of course um seemingly pointless to watch the destruction of a country in real time um i guess it's you know when you read russian history and ukrainian history i guess it just it's sort of you know destruction is a big part of it the populist being beaten down is a big part of it you know from the mongolian hordes um through the tsar and the soviets and putin i guess you know it's just in science in particular medical science it feels like this sort of unrealized potential you know the the culture so beautiful the people are so smart and well educated i think the word unrealized potential is kind of how i feel that's why i wanted to celebrate that part of the world is there's so many beautiful people so many brilliant people um and i just happen to know the language so i'm able to appreciate the beauty of those people i'm sure the same is true in china i'm sure that that's one of the things that makes me sad is there's all these cultures that i don't know about i can't fully appreciate their brilliance even japan and places like that that are sort of uh there's channels of communication wide open and there's a lot of interaction it's still not knowing the language i feel like i miss some of the culture or portuguese and you know looking at south america and all that kind of stuff but anyway in russia there's there certainly is that unrealized potential in ukraine so many brilliant scientists engineers came from ukraine from russia and i hope um i hope to get to flourish soon and i hope we put this um i hope we stop this war because all war is hell um is there something to comment about the biology of war um is there echoes of the emergency room experience um do you have you have you dealt with um with patients that have been touched by wartime definitely war and medicine has a very intricate and complex relationship i don't know if it was walt whitman who said it though he was a nurse during the civil war that war is the best medical school but some people have said that um and you know even advancements in medicine are come from war you know the wars in iraq and afghanistan have in some ways really revolutionized certain aspects of the way we treat trauma patients in the civilian world as well the importance of tourniquets uh the importance of transfusing whole blood instead of you know red blood cells isolated from serum and platelets etc uh the importance of pain control in the battlefield that's changed dramatically everything from ketamine injections defending the lollipops in the battlefield so war has really improved medicine in many ways in another way you know the department of defense spends a lot of money on medical research and kind of really pushes the envelope you know darpa is a one aspect of the military budget that really funds these moonshot experiments that are really fascinating and to really push the frontiers more than seemingly most you know kind of universities doing doctors and researchers doing their research so in a way you know the space program which sort of was military initially then became civilian under nasa also has led to a lot of advances and understandings of of health you know on earth and in space um so the military's uh or war in general is a huge way that um that medicine advances not to mention the epidemics that come you know um my grandmother was from what's today moldova what was then romania she got typhus during the during world war ii so there's typhus outbreaks there's cholera outbreaks you know all these uh even infectious disease things can advance in war which you wouldn't expect you expect sort of trauma to be the sort of main problem but actually infection is a huge problem throughout history and war so we can learn a lot it's this kind of horrific natural experiment in in medical uh care yeah and i've recently been reading about some of the horrific medical experiments performed by uh nazi scientists nazi germany it's um i'll talk about it another time perhaps but nothing reveals the honesty of human biology like war um just to stay on your wild journeys for a little bit longer um you have a tweet about shackleton saying here's a photo of shackleton's medical kit from his storied expedition to antarctica in the 1910s some perigoric for pain some laxatives only the essentials would you put laxative under the essentials anyway sorry to interrupt when i worked as a ship doctor in antarctica in 2018 i had a huge cabinet full of meds and even ekg machine so if you can comment sort of on that contrast first of all your own journey how harsh was it how difficult was it and given that context can you think about how hard shackleton's journey was i think the difference is unimaginably stark um one thing i do want to point out is that the use of laxatives early in the 20th century and before that it was they were used for a surprising number of ailments where they probably did not help at all but i think that was a holdover from sort of the old theory of medicine the humoral theory where you have to balance the fluids in the body and so causing people to vomit causing them to have diarrhea or purposely taking blood out of them in bloodletting was a big part and i think that crazy use of laxatives was um maybe a holdover from that time but that being said they were probably not eating very high fiber food on that expedition so perhaps laxatives could have been helpful you know there's a lot of seal um penguin and seal meat being eaten which is not super high in fiber so i don't want to discount the importance of laxatives in that setting but that wouldn't be the essential thing if you're thinking if you're thinking of a tiny kit that has only the essentials i mean pain yes laxatives maybe not i think the the medical kit possibilities were much now narrower back then you know this was um before antibiotics before i think germ theory might have been you know it was known but um there wasn't much to do about it um so the availability of medicines i mean that's something that exploded over the course of the 20th century so what i can put in a backpack today filled with modern medications whether injectable or to be taken orally is you know just um many orders magnitude greater than what they had back then um so when i i mean when i went my expedition was nothing like shackleton's i was on a huge cruise ship um with 160 japanese passengers who came with their own translators um and as i said i had a cabinets not just one cabinet many cabinets full of medications both injectable some patches uh some pills um i was very impressed actually with what was available there um and i didn't have to use a a lot of it thankfully though i did use some of it for people um but uh and i i slept and you know i got free room and board um on the ship so ev every southern summer cruise ships go take people to antarctica the southern atlantic islands like the falklands and other other parts of the south pacific and then in the northern summer the same kind of cruise ship uh explosion happens you know going to greenland and iceland and svalbard and franz josef land and other parts of the north alaska so and every ship needs a doctor um so it's a great opportunity they want specifically er doctors you know to deal with emergencies but uh you're really working in the middle of nowhere and all you have is the medications there on the ship and supplies and your knowledge and experience and so it's it's a very different experience than working in a high-tech modern hospital with every bit of technology and every sub-specialist consultant available but i sort of like that challenge i mean i like going to the ends of the earth it's beautiful it's exciting it's fascinating um practicing medicine in those settings is extra challenging and really makes you hones some of your skills which is part of the reason that i sought them out do you uh see echoes of some of that same effort i've gotten a chance to interact with astronauts and those kinds of folks working on space missions do you see some of those same echoes of challenging efforts going out into space maybe landing on mars and maybe beginning to build a small colony on mars yeah i think the health care that is needed will be a big part of that you know obviously we're probably going to send overall quite healthy people but there's a lot of medical decisions to make about what should be brought what should be expected you know to some extent a lot i've had a lot of doctors say oh my goodness i can't believe you work in the middle of nowhere what do you do if someone you know gets a brain bleed like falls hits their head needs a neurosurgeon i mean the obvious answer is they die you know things when you're in the middle of antarctica things kill you that wouldn't if you're inside a university hospital that's fully equipped to help with every problem that arises mars takes that to a crazy extreme obviously i know that even going to antarctica different countries have had different strategies i believe it was australia used to kind of just in anticipation remove people's gall bladders just so that it wouldn't get inflamed because that is a very common medical emergency so they would just remove it beforehand even though it was not diseased at all just so that while they're stuck in antarctica over the winter for instance that wouldn't be a problem you know there's many other issues that can arise but so those are some decisions to make maybe the people who go into mars should have their appendix removed their gallbladder removed maybe they should have a cardiac cath to see if they have coronary artery disease just to know their chances of getting a heart attack there though it's not always predictive you know it's hard to predict who's going to get a heart attack but maybe with all the data around today we'll get you know better at predicting but that would be a huge part you know we can't have people the few peop few pioneers in a mars colony dying of heart attacks and things like that stuff would you go you've gone to some harsh conditions to be a doctor would you go to mars to be a doctor um it would definitely be amazing i think because i have a wife and two small children probably not in the cards for me at this point but you humans with your human attachments sex and death if you just put more priority on the death than the sex i think would be uh better off no i would love to go to mars and actually i you know i practice high altitude medicine in nepal space medicine is sort of an extension of that you know the air is just much thinner like non-existent you know as you go higher in the mountains the things that happen to human physiology are very bizarre and strange and still not well explained by science and in space it's just like a crazy extension of high altitude if i could just return to the we didn't really i think we mentioned a little bit about the food you had just if you can high level say what is the greatest meal you've ever had so your last meal let's go if one more meal i get to uh murder you after this is your last day we get this planet together where in the world would you go what would you eat i would say the most delicious thing is bone marrow and i would love a full meal of bone marrow for my last last dish i did on my birthday in 2002 ate a kilogram and a half of crab meat in kamchatka and that was also amazingly delicious uh the king crab they have there is incredible but i would go with bone marrow which is um i think just one of the most delicious foods and it's sort of this weird body part you know it's basically all your stem cells not all of them but the stem cells that produce all your blood cells so they are spitting out billions of white blood cells red blood cells and platelets every day and there's a bunch of fat in there as well just one of the places the body stores fat and so you basically add heat and that's all you need it's like the perfect food you add heat the fat for frying the stem cells is already there there's a naturally a bone vessel to contain it all probably add some flavor too it's like the perfect food what does it matter which which uh which animal i prefer a larger animal just so there's more of it i actually like well that's true i actually really like sort of bone marrow from like chicken bones right just sucking it out of the bone yes i'm i'm known for leaving absolutely nothing edible on the plate except bone itself there's one other human i know that loves um bone marrow as much as you do and that's joe rogan so go unnatural how much that man loves bone marrow i understand why i love the steak part the bone marrow like you know what let me um let me argue with you because i don't know um it could be an acquired taste but there's just too much it's like too much with too little work for it like it's as if you gave me lobster meat without the lobster having to clean the lobster and i just feel like i'm spoiling myself there's so it's very fatty it's i don't know maybe i want to work for something that tastes like that well if you start from the whole animal you do have to work to get at it right a lot of animals have the um teeth and the jaw muscles to chomp through bone we do not so um you know when you buy it from the store it's already sawed up but i've definitely gotten marrow out of deer bones you know with a hatchet just chop off just chop off the fat end and start spooning it out or maybe i'll revisit it that's fascinating and where where would you eat it where in which place of the world is is there something about who cooks it who you eat it with um you're not allowed to pick your family right [Laughter] so like which place in the world rural or in the city those kinds of things you've been to so many fascinating places i would say i'm antarctica i would say is one of the most picturesque places i've ever been i really did not and i didn't know how mountainous it was and i guess i knew there'd be the ice but just i didn't know how much ice it was you know it's ice and mountains just overwhelming i just you know as as kind of overwhelming bone marrow might seem to you sort of that feast for your eyes um and just ice in general is amazing like the icebergs floating around antarctica is just astounding like the different shapes the sizes are uh incredible there's actually a i believe it's u.s navy website that tracks the largest icebergs and you can read about each of them and how big they are and just the formations you see similar up near green land though i have not been to greenland um just ice in general is just amazing so i could just look at its different forms while eating bone marrow forever until you kill me that is yeah and afterwards we go it's back to the death of the death and sex i what is it about the ice is it uh sort of the enormity of nature it just reminds you that it's going to be there before you and after and then you get to partake in the eating of the um the thing you need for maintaining of your biological temporary biological organism yeah i think it's a few things one is just the shapes that you see you know the wave action just eating away at these pieces of ice you get these arches and just these shapes i mean it's just like geometry the geometry alone is amazing i studied math as an undergrad and i've always appreciated uh geometry and just the shapes alone are just look like brilliant works of modernist art and just obviously no two are ever the same not to mention a lot of them are this unearthly blue color that is just um really startling and fascinating the same color of glaciers you know in various parts of the world that blue color is just really amazing and i also just love how it's sort of this constant shedding from our antarctic continent from greenland you know it's this constant process of snow falling inland and pushing the glaciers further out to sea and them breaking loose i mean obviously it seems to be happening faster these days but it's sort of this constant shedding and sort of i always like thinking about how the body has something similar you know we're constantly shedding and renewing and rebuilding everything um and so ice is sort of this constant similar process yeah i did not know you were a math undergrad so that i mean you're just keep getting more fascinating can you maybe take a small step into that direction what do you find beautiful about mathematics why did you journey into that part of the world for a time so i liked math i especially liked so college math i did some calculus in high school when i got to college math i was amazed that there were no more numbers you know the digits disappeared it was just variables concepts you know um there was almost no more numbers at all it was like this totally abstract um you know kind of way of thinking but that sort of reflects the natural world and teaches you about the natural world though it's sort of this perfect you know platonic ideal perhaps of the natural world that can still sort of help explain what happens in the natural world but um just these concepts are so abstract from like life and from um you know the natural world and i was actually getting interested in the natural world at the same time when i was in um at nyu studying math you know i took a tour of central park that was pointing the guy steve brill was pointing out these wild edible plants and i was learning to identify the first plants and knowing what's edible what's not that was totally fascinating and sort of this kind of thing that i felt like was connecting me to nature and it was balanced with this utterly abstract science you know or early abstract lessons i was getting in in math class where i was thinking through series you know as we approach infinity what happens to these equations and concepts of like rings and abstract algebra i don't know it was just this uh dichotomy that i i enjoyed both aspects of yeah the concepts but so so different this kind of logical rigorous view of the world in the world of biology why the big how did that feel to take the leap into the the biological the mushy mess of the human body from the mathematical which is all very clean right it does it does feel like a big step i think there's more connection than you think you know we talked about symmetry of the body earlier that is a real thing you know fluid dynamics of how our various bodily fluids flow and what makes them not flow as well and what makes them flow better and you know all these different aspects of science go into the body um you know everything from hard bone to softer kind of flesh to liquids of various consistencies you know a lot of science does and math does teach you about kind of how the body works how it can work better what happens in sort of disease states yeah i suppose there's a there's a connection there's also kind of a sort of uh computational biologist this computational equivalence of each of the disciplines which are becoming more and more fascinating with all the work the deep mind is doing in the work of genetics all that kind of stuff simulating different parts of the body to try to gain an intuition understanding of it that to me is um super fascinating but sometimes it does feel like an over simplification of the way the body really does it because the body is is an incredibly weird complex system and it finds a way the adaptability the resilience the redundancy that's built in it's it's weird it's it's and it's incredibly powerful and so unlike the kind of uh computer-based systems that we build at least we engineer in the software engineering world which kind of starts to make you think how can we engineer computer systems in a different way that make them more resilient in the real world that's sort of a robotics question what do you think about that what does it take to build a humanoid robot or robots that are as resilient as the human body how difficult do you think is that problem having studied the human body how hard is the engineering problem of building systems like that guy over there the legged guy that is as resilient as the human body to the harsh conditions of the real world i think it's very hard and we definitely haven't gotten there yet i think we could probably learn lessons from people who are trying to grow artificial organs in the lab to eventually you know transplant into people which would solve the huge problem of needing to get those organs from others and you know the rejection of putting a foreign material inside your body your immune system tends not to like that um you know that has advanced a lot recently i think i think um some advances actually have been where you know we pay a lot of attention to stem cells stem cell stem cells we can grow whatever we want out of stem cells but now there's sort of a recognition that the what we call the extracellular matrix which is sort of the you know foundation of the body the thing that holds all the cells into their proper shape and keeps them where they should be um that is actually crucial and there's probably a lot of signaling that goes on like you stick a stem cell on the right extracellular matrix it will turn into the kind of cell that you want and take the right shape and position and start functioning i think that's been a huge uh huge advance knowing that it's not just these you know celebrity stem cells that are the answer it's this kind of part in the background this sort of just like laying the foundation the system that you put these cells onto and we're not there yet but there's definitely a lot uh happening a lot of research happening and i think there'll be some advances probably soon so now on the topic of interaction of uh computational systems with biology so if you look at a company like neurolink or the the whole effort of brain computer interfaces now there's a neurosurgery component there we have to connect electrical systems with biological systems so just even the implanting is is difficult um then the communication is difficult what would you say from what you know about the brain what you know about the human body and all the the beautiful mess that's there how difficult is the effort of neural link do you think it's feasible i think it's it's definitely feasible i think there we need to probably know more than we do um and and know how to connect it you know in all these ways i think some advances for instance you know much less sexy but really already impacting medical care is something called deep brain stimulation which is done for parkinson's disease and others where neurosurgeons implant this this device that electrically stimulates the part of the brain that is not functioning in parkinson's disease and it's quite dramatic how effective it works and i remember as a med student watching a neurologist literally like turn the electricity up on this handheld thing and you could see the person's parkinson tremor go away and you could see them start to walk in a more steady fashion and i know there's studies there's actually studies or there may be studies in the future studying the same deep brain stimulation for everything from eating disorders to severe oc like severe ocd like paralyzing ocd not just like i want to wash my hands three times but um and uh so i think the you know the potential is there but i guess connecting the brain in a microscopic way in sort of a multi-faceted way you know there needs to be sort of a million connections or some some very high number of connections for them to work fluidly as far as i know i'm not an expert in the area first of all i i believe and i trust in the adaptability of the biological system to whatever crazy stuff you try to shove in there so it's going to potentially reject things but it's also going to if it doesn't reject things adapt and if we can create computational systems that also adapt ai systems that adapt and can kind of both of them reach towards each other and figure stuff out but actually our current ai systems are not very adaptable uh to the what like in in the wild way that biology is adaptable like adaptable to anything and if we can build ai systems like that i feel like there's some interesting things you could do but of course there's ethics and there's real human lives at stake and there you can't quite experiment you have to have things that work and maybe simulation can help but reality is it's uh it's a dangerous playground to play on it is messy you tweeted that quote if you look back from far enough into the future every doctor today will look like a total quack um first of all that's humbling to think about like we don't know what we're doing in the great like there's been so much progress that we kind of have this confidence that we figured it all out if you look at history and you read how people thought i mean there's so many moments in history where people really thought that they figured it all out it's almost like there's nothing else left to do at every stage in history and uh and then you realize no progress often happens like exponentially and every moment you continue to think you figured it all out but if you're being honest if you're being humble then you realize we're just shrouded in mystery so what do we make of this like how should we feel that how should you feel as a doctor how should we feel as scientific explorers of the human body the fact that we're probably going to be wrong about everything we currently know right there's a saying actually by the time you finish med school half of what you learned is wrong um which is quite illustrative and becoming more true as time goes on you know so much medical research going on so much learning going on is really wonderful in a way but in some ways we still learn these concepts you know from the past and i know when you take a test as a medical student sometimes you know they want to ask you they want you to give the old answer but you know there's a new answer because of recent science but you know to give the old answer that's now incorrect to get the question right on the test that happens actually quite a bit because things change so quickly um yeah you know when i look back at doctors from centuries past i mean it's absurd what they were doing to their patients i mean for probably for most of human history they were doing more harm than good you know they're draining people of their blood uh that was you know bloodletting was a huge part of of medical care you know um george washington died of a peritonsillar abscess an abscess right next to the tonsil which has the great name of quincy and they bled him to death you know i mean kind of adding insult to injuries doctors are menace and do a lot of harm i mean hopefully not intentionally you know even medical errors are still a huge problem cause of death and morbidity so we do a lot of things that are not great but you know our knowledge yeah it's it's very imperfect at this point i do have some confidence you know i guess perfect scientific studies that try to get at the reality of the universe are essential because when i think of why a certain medication works for a certain condition it might make perfect sense in my head knowing the biology the biochemistry the anatomy it makes perfect sense it must work i gave it to the patient they got better and that's happened 20 times in the last year but it's you know i'm wrong like when you actually do a study it actually doesn't help maybe it hurts um and that's really i think the way we explain medications working in our minds is often wrong when you end up finally doing the the study and some of the most interesting experiments um involve what we call sham surgery so for instance people who injure their knee you know arthroscopy where an orthopedic surgeon goes in there with a scope gets bits of bone out shaves down the cartilage you know cleans things up and it helps some people but they they actually did some studies where one group of people got the true arthroscopy and others just got sham surgery where they put them to sleep made little cuts in the skin so they woke up with scars and then it turned out that it's not clear arthroscopy's actually helping and the same there was a recent huge study of doing putting a stent in someone's coronary arteries if they have stable chest pain not like i'm having a heart attack you need a stent like right then but you know kind of chronic coronary artery disease where every time i run up the stairs i get chest pain and then when i rest it goes away like obviously you put a stent you increase blood flow to the heart like how could that not work but then when they did the sham catheterization it actually looks like it might not actually help better than the sham so i think those placebo-controlled studies are essential i mean it is shocking and this has been driven home during the last two years how hard it is to figure out what the hell's going on in the universe and with especially with our bodies like it is really hard to get at the truth and what you think makes sense like often turns out i mean his the history of modern medicine is littered with examples where it made perfect sense and it seemed to help some patients and it turns out it's not doing anything or it's harmful yeah there's all kinds of narratives swimming around we convinced ourselves as a human civilization that something is true there's uh propaganda machines there's just self-delusion there's uh centralized communities like there's a scientific community that believes a certain thing there's the conspiracy theories that believe a certain thing sometimes the scientific community writes sometimes the conspiracy theories uh theorists are right throughout human history i mean and we now think the scientific community well now the science has really figured it out we're way smarter than we were in the past and then there's these like interesting studies that i've seen i think uh roman hanson mentioned to me that if you look at the entirety of medication like the effect of medication on human health if you do those kinds of broad studies does it actually help like does quality of life lifespan certain measures of the well-being does if you and you look at human society as a whole does taking medication or not actually help and those studies find there's no positive or negative effect with medication and there that's a very kind of uh interesting perspective that means you could probably argue uh you know a lot of ways but the point is uh because you can bring up literally a billion cases where medication has significant positive impact on a particular patient but you have to kind of zoom out and honestly look at the positive effects of medicine um of lifestyle choices diet choices of uh exercise or not you know maybe we'll find a venture that exercise is actually bad for you but maybe like there there's all kinds of things that we're going to um uh i feel like we're going to figure out one of the things i think we're going to figure out everything i've learned about my body is that aside from it being adaptable there's a lot of very unique parameters that are opaque to me that i'm measuring through this feedback mechanism by trying stuff and learning about it and one of the things we might learn is that medicine cannot be done without collecting a huge amount of data about each individual human so like it's absurd to be like if i show up uh and see a doctor it's absurd for that doctor to have just a couple of minutes with me like with just like looking at basic symptoms looking at such like crappy uh data like first of all no long term data no longitude no data no historical data no detailed analysis of all the possible things not just the related to your symptoms but related to other things that you're not complaining about just giving you a full picture of the data and then using ai to help the human doctor highlight the things that you should perhaps pay extra attention to i think we'll look back at this time is ridiculous that doctors will expect it to help anybody whatsoever without having the data without having a huge amount of data about the human body like you're you have to do so much with so little data it's very 19th century it's very 19th century so it relies on the brilliance of doctors and of course the intuition the instinct you build up over time right and that's quite powerful the human brain is pretty pretty damn good for using experience to teach you how to make good decisions but still it's it's uh it's you might as well be bloodletting like it's humbling to think about that it's humbling it is humbling and it's important i think doctors sometimes lose that uh humble perspective on what they do and i think it's very important because as i said you know medical history is just medical dogma has been tossed into the trash bin so many times something doctors were sure of was the case is not and it's important to um to be cognizant of that um you tweeted about somebody that had a big impact just by reading about him on my life as well i still think about him uh rest in peace dr paul farmer a big inspiration to me his medical career was a testament to what one person can do to improve the world so who was paul farmer and what made him a great doctrine a great man and somebody who was an inspiration to you so paul farmer was a kind of pioneer of global health he um started partners in health which is a kind of an international health organization that operates it originally in haiti also rwanda and elsewhere and i think he was just so a zealot for getting health care to some of the poorest people in the world and he i remember reading some of his books and a book about him by tracy kidder that's really great mountains beyond mountains about how even when he was a medical student he was flying back and forth to haiti in between exams and just with this really intense uh focus and interest in in getting healthcare to where it's where it's not and i think traveling around the world especially to poorer places like india calcutta nepal you really see how unevenly the benefits of modern medicine are spread over the surface of the earth not only if you're because if you're in antarctica and have a heart attack you're in serious trouble but um you know just medications that cost pennies a day um can help people you know a lot of children in india under five die of diarrhea and all they need is oral rehydration solutions to uh to stay hydrated you know most of them can't afford iv fluids for instance to get admitted to the hospital and really dehydration just kills hundreds of thousands of kids throughout the world not to mention bacterial pneumonia also is a major uh cause of death in children under five and many of them not all would be saved by amoxicillin which is just pennies um and i for me you know i i took a had a path and i wanted to have a career in global health and i started traveling abroad to india and elsewhere when i was a medical student and i continued doing that paul farmer was sort of one of the first to kind of open everyone's eyes i think about the good you can do with just money that we would you know change that we would throw away just you know put in a person forget it or wherever we accumulate change these days um so that's very eye-opening um and while medical science advances and that's good you know we shouldn't forget that hundred-year-old treatments could save lives in parts of the world where they're just not available people should definitely read mounds beyond mountains just um for me at least sort of a person from outside all of it it was the first person to make me realize how difficult and the amount of humanity that's involved in being a doctor so it's not some kind of cold economics-based argument about where to send treatments and so on that is there too like you said basic treatments can help hundreds of thousands millions of people in many parts of the world but it's also when you have a patient in front of you there's some aspect of you that's willing to to give a lot of your time a lot of your money a lot of your effort to uh saving them even though it doesn't make any sense it's uh it's irrational in some sense but it's also human and that's the struggle of every doctor like when you have to choose how to allocate your time how to allocate your mental energy right it's a tough it's a tough choice that a doctor has to make and it's a human choice it's not some kind of cold game theoretic choice it's also a human choice and it can be irrational in some sense right people are asking you for help that's basically what every patient interaction is someone's asking you for help so your inclination is to help them and even if it means going above and beyond you know i mean a lot of factors affect how compassionate a doctor might be in any given day or you know point in their career their own stress and burnout etc but it's someone asking you for help and so you do what you can to help them you've done quite a lot of things in your life it's an interest it's been an interesting journey and of course there's a lot of story yet to be written but what advice would you give to young people today in high school maybe undergrad college starting out on that journey maybe trying to pick majors trying to pick uh jobs careers dreams and goals they can pursue what advice would you give them to have a career they can be proud of or to even have a life they can be proud of well i think um having passion which isn't always a voluntary thing you know you just have it or you don't perhaps but becoming passionate about something and following it uh no you know wherever it takes you i think is really important um you know when i i finished college and sort of went to russia for the first time that was in some ways the beginning of my whole career and passions in my life and um i didn't know what i was going for what was going to happen what kind of career it would turn into what kind of job would it help me get when i got back i wasn't thinking about any of that i was i'm very fortunate i got that opportunity i was very fortunate to you know be able to go and see those places and have my mind opened and i think that really just the fuel from that uh passion that was created during that time is still 20 years later going strong you know i'm partial to health care i love being a doctor i think it's the perfect combination of kind of intellectual problem solving being a detective while also working with your hands you know when you do procedures especially in the er it's sort of the perfect combination i'm not a surgeon but i do use my hands quite a bit um whether you know for a variety of reasons and so i always loved working with my hands i loved crafts especially prehistoric crafts before medical school and i just love kind of problem solving getting clues figuring out what's going on you know following your nose using your instincts your knowledge and also just keen observation of the patient you know after seeing patient after patient hundreds of patients maybe thousands over years you do get this sort of innate kind of sense this just dalt about what might be going on and you know it's not always a numbers thing that's the thing there's always there's gestalt is actually a big part of medicine you know you often in ers or in hospitals hear a nurse or doctor say something like this patient just doesn't look good and it's sort of you can't point to a number a value a level in their blood you know a test but something about them and i a lot of that i think has to do with the color of their skin believe it or not um which can change and in certain disease states but i think that uh it's just medicine combines this observation uh the skills the knowledge it's art and science it's human and it's robotic you know algorithmic at the same time and i think it just uh yeah combines kind of all my passions all in one and i would you know if anyone's going into health care i would strongly encourage them to do so but i'm very biased so with that early passion whatever that little flame was that uh brought you to russia were you able to vocalize it or was it just something like a gut that pulled you towards some exploration of the unknown or something like this i think it was a combination of things one was just going to a different place that was different from where i grew up you know the suburbs you know when you're in high school you hate them later on they don't seem so bad but um you know i just wanted to get i mean i'm very fortunate how i was raised and um never wanted for anything that wasn't rich but just to get out and see a different place a different people with a different culture and history and language and literature and to see different climates and geographies and ecosystems i just wanted to see something different and that i guess that's what i've you know sought after ever since so just that was just so fascinating like my trip to kamchatka in 2003 where i was there for four months and um i didn't speak english for i think two months out of it and just i remember lying on the floor some wooden floor in a hunter's cabin in the middle of northern kamchatka just being like what am i doing here this is i'm just so grateful for like the experiences i was having what i was seeing and realizing and learning it was just i was so grateful even though i was lying on this hard uncomfortable floor it's just like this is so amazing and that i don't think i'll ever have another travel as meaningful and life-changing as that particular trip to genjaka was um though i'm still striving after it you know you never replicate that first high but you always try um so i just think that seeing something different is kind of the game and there wasn't really a plan because i got a chance to talk to the ceo of qualcomm recently and he his advice is always have a plan and it sounds like you're saying uh don't have it don't have a plan don't need to have a plan just listen to your gut your passion and follow that and see see where that takes you because it's telling you something yeah i think you know i guess the plan could be specific or could be as general as i just want to go far away and see something very different that's my plan and i did just one line it just followed my nose um from one thing to the next just being interested following my passion and again very fortunate i could do that are there places in the world you're kind of thinking about that your life might take you at some point just um to be a doctor there for a time to explore for a time that you haven't yet you know i have some colleagues who do kind of global health work in various countries in africa and central and south america i would really love to go to some of those places not just for a short trip but hopefully for an extended period of time with sort of the healthcare being the ticket in um but then maybe even bringing my children or just you know i guess at this point some of the travel i dream about is sort of replicating what i did and showing it to my kids in a way um but there's still a lot i haven't seen and would love to see as well but um i think those opportunities sort of lend themselves well um you know as a doctor with kind of the ability to go there and sort of help but help patients but also teach medical students and residents um teaching is actually a huge part of being a doctor that's um underappreciated but that's actually part of the fun of being a doctor is that you're also a teacher of course the word doctor means teacher but um it's come to mean something else um but uh you know i in some of my jobs i'm working alongside medical students and residents and i'm giving them my knowledge my wisdom sharing with them stories and so that's a very uh satisfying part of the job if we can take a brief step into uh a dark place together for a time is there um what is a dark place you've gone in your mind in your life what would be the darkest place you ever gone for time for a moment um and how did you survive how did you overcome it that's a very good question i i would say um i haven't had as dark moments as many of the people who i care for in the emergency room i'm fortunate in that way i've had a pretty you know enjoyable satisfying life you know i think everybody um has dark moments though including me one of the most shocking things i feel like becoming an adult my two big realizations have been one no one knows what they're doing and two suicide is incredibly common like in in all humans in all societies and that i just find shocking i mean i've never seriously contemplated myself but i wouldn't say it hasn't crossed my mind during some more stressful um times of life um i think it crosses everyone's mind and sort of as a kid i found that i never would have guessed how common suicide is it's an important question to sort of the uh the camus question like why live why because like life especially when you're struggling especially when life is like why am i doing any of this and then on top of that chemistry of your brain it could be as simple as diet and nutrition and aforementioned exercise and things like this that affect the chemistry such that you're more predisposed to go to the places of asking the question why and maybe um struggling to find a good answer because it's actually a question with no good answer except something in your chemistry says well i kind of like it but there's no good intellectual answer and especially if day to day it's pain you get to see these stories of um you know robin williams these people that are on top of the world from an external perspective but from an internal perspective it's struggle every day is pain it feels hopeless and yeah that's a that's a question we all have to struggle with or learn how to ignore maybe because if you ask the question too much you're not gonna you're not going to find a good answer that's a choice you make i personally think you should ask that question a lot um but maybe because i have the luxury of the chemistry i have where i'm not in danger of uh seriously contemplating suicide but why liv is an important question to answer constantly and struggle to answer that constantly but people i am uh i've gotten uh i've been extremely fortunate to meet people over the past couple of years that are really struggling and you have probably met people who are really struggling like orders of magnitude more people who are really struggling some of it is psychological a lot of it is biological and man life life is a it's pretty tough very true i do think also past trauma is a plays a big role there like we talked about um you know war wounds and ptsd and a lot of people grew up i mean which is horrific childhoods they're abused in one way or another and i think a lot of people who have not not a major i'm not saying a majority but a lot of people for instance who i see in the er uh coming in for threatening suicide or actually trying and failing and being brought to the er you know a lot of them just have really traumatic experiences um you know saw their parent commit suicide uh were abused you know these leave scars in the in the human brain and mind and a lot of the sub their subsequent lives of whether it's substance abuse alcoholism etc is almost trying to escape from their own memories and it's sort of such this overwhelming um battle sometimes like sometimes people get ruined it seems and just can't be fixed you know what i mean yes you can improve diet and health and your life choices and seek out your passion and exercise and those definitely will help but sometimes just like you know you bear the scars of the past and there's no getting rid of them yeah i think it's possible to live with them i think there's a struggle i would never say give up you know um keep fighting it is a constant it can be a constant battle for some people i know it can be and i've talked to many of those folks i know it can feel hopeless but keep up the good fight hopelessness the good fight hopelessness is kind of one of the big suicide risk factors that you sort of ask about as a as a doctor you know do you feel hopeless and that sort of uh can be a harbinger i have uh quite a few dark moments so if you if you if you're listening and you're struggling we're in this together brother and sister keep up the good fight um life is a as you said it's it's really harder i think as a kid you know in a joy-free childhood you don't realize like obviously there's a ton you don't realize about life but then when you get to be an adult you realize just how complex and hard it is is it this hard for adult animals i don't know i don't think it is um so having seen the honesty of biology before you do you think about your own death do you contemplate death are you afraid of your own death how do you make sense of it definitely thought about it especially maybe while doing certain risky things um ice climbing and others where every time i look down i thought about my own death but um i think you know i think having kids changes the equation for sure um should change the equation perhaps so i think a lot of now when i think about what will happen when i die you know there's a lot of um worrying about what will happen to the people i care for you know you think about things like insurance policies like life insurance and you know yes disability insurance that's not related to death but more just injuries and that's part of the weight i guess that um you know you feel as an adult um that i think grows rapidly when you have kids though not only you know there's other people you can care for your own parents and loved ones like a lot of people depend on individuals and so you think about what will happen to the other people when you die but also to push back that weight might be something you've convinced yourself to think about it's an important way to think about but you focus on that way to escape the other weight which is that's one point this consciousness just comes to an end and it's hard to make sense of of that we kind of delude ourselves and thinking okay it just yeah it's ends that's the natural way of things and so on that makes sound so we're good okay that's the way that's the way of life but like i don't think it's like cognitively easy to just realize how terrifying that is we we we love life so much that the end of it it just um it's something that makes no sense and if you linger on that thought i think it's a painful it's a it's a painful i would say even terrifying thought not scared of like uh in a way that's almost like philosophically terrifying like it just reminds you maybe humbles you that you don't know any of the anything about anything but one of the things we do as humans really well is we uh especially with kids you realize okay we start caring for others in the community and the family and so on and that distracts us because then we can at least focus on other people's problems and not deal with our own uh when i was a medical student i was particularly fascinated with kind of what actually happens as people die like in the last minute seconds of life it's sort of surprising sometimes like what actually kills people you know like um you can get a let's say a bad head injury and you know what kills you sometimes it's just your consciousness decreases and you become kind of comatose you aspirate your oxygen plummets and you get cardiac arrest you know that kind of sequence of events or you know a heroin overdose let's say you stop breathing similarly your oxygen goes down then you get a cardiac arrest so i was really fascinated with what actually happens what makes people die and it was sort of a morbid fascination obviously like most of med school is and i had many instances where i've had patients pass um and as a medical student i was sort of sort of learning what's actually happening watching it happen and you know not always always being able to prevent it it was sort of a scientific uh exploration then the patient's family comes in and are just devastated and then it's like rips you out of this scientific perspective and you just realize how horrible death is but the person's fine you know it's the family i guess and that's why um it's always i guess that pointed out just how what people leave behind is often kind of the horribleness of death like just becoming unconscious and staying that way doesn't seem i guess to me personally so bad sort of like going to sleep not waking up not counting the pain and stuff that precedes it so the actual pain the actual suffering is often felt by the people who love the person who died right so both financial pain psychological pain for years missing them all those kinds of things right never forgetting the anniversary of their death you know just having flashbacks or something reminding you that sort of brought home to me sort of what death means and it was more about what people leave behind than what happens to them specifically see i like those concerns because i feel like i can do a lot about those those make sense to me then just be if you're a father just be a good father uh if you're sort of you mentioned some insurance yeah there's like financial stuff to take care of what i don't know what to do with is is uh the philosophical excellent existential crisis of the fact that this freaking thing ends it doesn't like i don't know how to deal with the mystery that's beyond death why are we here why are we born at all what is consciousness and you just look at yourself what is this why do i have the capacity to suffer um why why all these kinds of why questions that don't have answers speaking of which let me ask you a why question the biggest ridiculous one what do you think is the meaning of life having with this book studied the incredible beautiful biology of life this the components the engineering components they make up this human body but when you look at the entirety of it what is why why are we here sometimes probably more often than not feel like the question of why is a trick of the human brain and and outside of our thoughts there is no why why is not a something that's in the universe it's just this trick happening inside our brain um so what why is a game that the human brain plays on itself and then the reality of life doesn't have wise i do wonder if asking why is sort of an evolutionary adaptation like um why you know maybe hunting gathering why does this plant grow there and not there why do i see the same deer tracks and by the same tree every three days what you know why is this why is that um why does this plant uh make me vomit and that plant doesn't i guess those y's are very practical and oriented towards survival but then obviously you know we not only use why you know we use it to maybe hunt better gather better survive better but then we sort of extrapolated into these unanswerable questions you know um about why like why does life exist and it's possible that they're not unanswerable in the long arc of science and history it's we're just striving for the really difficult questions right now we just don't know much about anything and so we're striving but there there's long so most of human history you were asking why questions for which we now have very precise answers including with biology and physics and all those kinds of things and maybe the whys this cutting edge of science of the explorer of the curiosity of the human mind like man's search for meaning is the sort of the ultimate driver of the why and it's almost like it could be an evolutionary adaptation of asking exceptionally hard-wired questions that will never get answered like so you should always have like it's like a cue it's a it's a stack of questions why questions and that thing should never come to the bottom should always be striving and that's that's useful for humans to come up with better and better ways of survival and uh maybe from in a bigger perspective for the universe to figure out something about itself and it's just humans just a useful tool for that or life on earth as a useful tool for that well john this your your uh [Music] for people who should know you're from philadelphia i'm from philadelphia so it's an it's an honor that you would travel all this way from a place i love to the new place i love and uh that you will write this really incredible book that celebrates the human body in the most honest of ways and uh thank you for everything you do for being a great educator for being a great doctor for being a great person and for spending your really valuable time with me today thank you john thanks for having me lex thanks for listening to this conversation with jonathan reisman to support this podcast please check out our sponsors in the description and now let me leave you with some words from paul farmer the doctor who has inspired both jonathan and me with the way he practiced medicine and the way he lived his life the idea that some lives matter less is the root of all that is wrong with the world thank you for listening and hope to see you next time you