Mclean Hospital

Podcast: Physician Wellness and Dr. Leonard Su’s Life After Medicine

November 27, 2018

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Leonard Su is a fully trained, fully licensed, fully retired vascular surgeon.

After 4 years of college at Yale University, 4 years at the University of Pennsylvania School of Medicine, 3 years of laboratory research, 7 years of residency at the University of Pennsylvania and the University of Washington, AND 10 years of clinical practice, he hung up his scalpel and picked up a keyboard. He traded OR lights for stage lights.

His clinical career was cut short by mental illness, but he remains ever willing to help others. Only now instead of sutures and stents, he uses words and the power of talk. He speaks on the issues of mental illness in society, particularly in the medical profession, and strives to start conversations about mental illness.

His background, while clearly steeped in medicine, also includes experience with performing, such as with dancing in a local production of the Nutcracker, improv comedy, and small episodes of trying stand-up comedy.

Episode Transcript

Trevor: And here we go, episode two of Deconstructing Stigma. Welcome back, listeners, and welcome to new listeners, I hope. How are all of you doing? It’s Monday after Thanksgiving, one of those trigger holidays for many of us out there. Certainly one for me, but actually it was prior to the holiday that was pretty stressful for me.

And I want to talk about a word. I know it’s a bit of a buzz word right now, and I know it can turn people off, but for me it’s been a real necessary part of my therapy. Being mindful. “Mindful” is the word. The last couple of weeks prior to the holiday, I’ve been very stressed, and when I get stressed, it’s really easy for me to slip into a borderline episode, and that certainly did happen.

What happens during those episodes is that I have a tendency to speak my mind a little bit more than I should, and I don’t take other people’s feelings into consideration. And there’s a difference between speaking straightforward and being cruel. I’m cruel when I’m like that, and usually the quickest way to get out of it is to be mindful of somebody else’s feelings. But when I’m in an episode, that is the last thing that happens. I am completely consumed by my own feelings, and frustration usually brings on feelings of sadness, anger, and I get filled with these feelings, and it manifests itself physically. I get not headaches, but pressure in my head and in my face, and it’s like a snowball rolling down a hill, and it just keeps getting worse and worse and worse.

I made a person cry. I’ve done that more times than I care to admit, but somebody at work who knows what I’m going through and empathizes said to me ... and they didn’t come at me. They took a very diplomatic approach, empathic approach. Is that the right word? I don’t know. But they came to me and said, “Hey, listen, I know you’ve got a lot going on right now, but are you considering other people’s feelings?” And I immediately snapped out of the episode, and I went on an apology tour. I’ve done a few too many of those, and I’m sure I’ll do more in the future. And everything’s settled.

What I forgot to do was do my daily mindfulness exercises, which keeps me in the present so that I’m not consumed with all of my worries about what’s coming ahead of me and worries about things that I did in the past. And they’re real simple exercises, and I’m not one for meditation and stuff like that, but these things work for me. And I’ll give you an example of one. It may sound silly, but it helps.

One of the things that I do or that’s been taught to me, I sit down for a couple of minutes, and I solely focus on a shape. I pick a shape, circle, square, basic shape, and I look around the room, and I count. Let’s say I choose a square, I count how many squares that I see all over the room. And if I find all the squares, then I start again from the beginning. I usually end up finding more squares.

I think people assume that this helps me focus on one thing, and that’s great and all, but what it really does, and I’ll use an old Windows 95 reference here, and hopefully those that don’t get it will kind of catch onto the metaphor. But what these exercises kind of do is that they defragment my mind. One of the problems that I have is that my mind is going in countless directions at all times, and that takes a toll on me and makes me very tired. And what it does is it’s not so much gives my brain a break, but it just kind of de-fragments and and just kind of collapses all those paths into one single path. And you’d be surprised, or I was certainly surprised, how much pressure that takes off my head and my thoughts and my feelings and kind of gets me back to a more grounded level. It helps.

You can also do it with colors. Sit there, pick a color and find everything within that color. And that helps. Sometimes if I’m coming home from work or if I’m coming back from somewhere, and I’m really stressed out and on the verge of an episode or in the middle of an episode, it really helps. Maybe give it a try.

On today’s show, we have Dr. Leonard Su. Now, Leonard Su used to be a surgeon based out of Seattle and a very, very talented one. He suffers from mental illness, and he made the decision, a very, very powerful decision to retire because he knew his mental illness was getting in the way of his job. And, if you’re a surgeon and lives are on the line, I get that. And that must’ve been a really, really hard decision for him to make, and we talk about that.

And so just want to let you know, this is one podcast that we recorded on the road, not in our studio. So it’s going to sound a little different, little echo-y. We tried to do the best that we could, but Leonard Su’s story is very compelling. I was quite moved by it, and I hope you will be too. So here we are. It’s me interviewing Dr. Leonard Su. Enjoy.

So usually what I do is I pre-interview people before, and we didn’t have a chance to do that.

Leonard: Right.

Trevor: And I don’t know about you, but that gives me a lot of anxiety now, going cold into a podcast. I feel like I’m kind of just leaping here. When you were a vascular surgeon, before you retired, how much prep and research would you have to do before going into an operation?

Leonard: It depended on the operation. There are some that are very routine ones we do over and over and over again. And so, for those, of course, I didn’t have to really prep, like read a book or anything, but I did have to, of course, study the patient’s films, the CAT scans, whatever they had, so that I’d be prepared for that particular patient’s case.

And vascular surgeons, we always assume bad things are going to happen. So we always come up with a plan A, B, C and D and then assume that we’ll have to go to plan E. So that’s the kind of prep we would do.

Every once in a while, you get a case that you just don’t do that often, and you’d be surprised. There’d be ... of course, we go to our textbooks to make sure we brush up on the key fundamentals. But sometimes you’d be surprised how many of these things are on Google, YouTube, and things like that. So sometimes we would just search the web to see how other folks, other surgeons had done it, that kind of a thing.

Trevor: So, from what I understand, and correct me if I’m wrong, surgery requires some sort of emotional distance.

Leonard: Yeah, I think that’s not hard. I think, from even as early as medical school, you start to ... I don’t want to say distant, but more you just put up that kind of a shield. It no longer feels like your ... like the significance of the fact that you’re cutting into somebody no longer has that “Oh my gosh” feeling, you know?

And it’s not to say that we think of patients as a piece of meat that we’re just doing operations on. It’s just that you kind of have to ... you can’t be shocked obviously by the sight of blood, but you need to have a little bit of ... well, yeah, it is a little bit of depersonalization so that, especially when you have to go to plan B, C, D, and E, you’re not fazed by it at all.

Trevor: So did you find with your depression that, let’s say you went into an operation, and you were already emotionally worked up or amplified, did you ever find that that got in the way of your work, or were you able to compartmentalize that?

Leonard: Totally compartmentalized. When I got to the hospital, even though I still had some of the trappings of depression, this sort of sense of hopelessness, the sense of darkness, when I got to the patient’s room, when I got to the operating room, when I was in the break room, wherever, I completely compartmentalized that off, and to the outward world, I was able to put up a front of just very cheerful, personable and whatnot. And then, when I went to operate, it was very, very much that’s all I was there to do is operate.

Trevor: Would you say that you felt emotionally your strongest or more centered when you were operating?

Leonard: I think so, yeah. I mean, because you kind of had to have that focus, so—

Trevor: And maybe in other aspects of your life, you weren’t able to have the control and the precision.

Leonard: Yeah. There was so much that you had to keep in order. There’s a lot of control, a lot of pre-planning and a lot of structure.

Trevor: So I’m the same way as a filmmaker, and I do, as you saw, I do a one-man band. I’m the same way because the process of building the set and the lights and shooting it, it’s my way of controlling the outcome. And I don’t have that control in other aspects of my life.

Leonard: Yeah.

Trevor: And when people help me, which is great because you know, doing it by yourself, it takes a long time.

Leonard: Sure.

Trevor: And when people helped me, it took me a long time to recognize that I need help, but it’s still ... I get emotionally flustered because I feel like I’m losing control of the outcome. And that’s just not the case at all.

Leonard: It’s interesting because I thought ... surgeons are often thought of sometimes the ultimate control freak, right? Because they like to be the captain of the ship.

Trevor: That’s how they’re portrayed on all medical dramas on TV.

Leonard: Yeah, they like to be captain of the ship. Some of them have the God complex or whatever. They are in charge. And I was in control. I told people what to do. I needed it done a certain way, but I wasn’t a freak about it. And in that, like if something didn’t go the exact way I wanted it to go, I didn’t lose it. I didn’t throw instruments. They portray that on the TV. That does happen, by the way, the. It’s usually just flashes of anger from surgeons.

For me, I wasn’t micromanaging, nor was I getting hugely anxious if things got a little out of control or went a little sideways. Of all the surgeons that I know, I probably have one of the most, or the least egotistical personalities. You have to have some egotism to be a surgeon. You’re just bred that way. But I was probably on the lower end of that scale. I know some who were way on the other end of the scale.

Trevor: What was your process after an operation was done, whether it was successful or not? Did you go celebrate? Did you go drink? Did you have to go be alone? Did you have to listen to music?

Leonard: Mostly, I had a routine. You have to write up what you did. You document everything, and that’s done electronically now. And then we have to put the orders in, what you want to happen for that patient and what medicines they get to have and not have or whatnot. So there was a definite computer time that had to happen, and I did that in a room just off where they were recovering. I would always go to the patient because it took me 10, 15 minutes to do all that charting and documentation.

By that point, the patient was usually a little more awake coming out of their anesthesia, so I can come by and just say hi and said everything went well or whatever. But usually it was, “Everything went well. You’re here in the recovery room, we’re all done.” And then I’d go out and talk to the patient’s family member, whoever that might be. So I had a routine down. I didn’t feel the need to sort of decompress. I certainly didn’t drink, but I didn’t need to go and be alone or anything because I usually, a lot of times—

Trevor: Oh, I do, I have to.

Leonard: Yeah.

Trevor: Absolutely. Not this, but a personal project, like the second it’s cut, we’re wrapped for the day, everybody celebrates. I’m out the door, I’m out the door, and I don’t want to think about the film. I want nothing to do with it. I want to push it away. And then I don’t look at the footage. These are my personal projects.

Leonard: Yeah, sure.

Trevor: I don’t look at it for three weeks. I don’t want to face it. I don’t want to deal with it. I want to just emotionally just cut myself off from that experience because those personal projects, it’s a day of not just controlling everything, but creating and really putting myself out there emotionally, and I need to go.

Leonard: Yeah. I think, with surgery, there’s so much more. Again, a lot of it’s compartmentalized because, as soon as I’m done talking to that one patient’s family, I’m going and seeing the next patient and getting them ready.

Trevor: Right.

Leonard: For the next operation. So there was always a turnover. There was always something else to do.

Trevor: Some before you addressed your mental illness, did anybody approach you suggesting that you, that there may be a mental illness issue?

Leonard: Not that I can remember because, for the most part, like I said, I was a pretty good actor. And it wasn’t so much acting—

Trevor: Do you think you always knew?

Leonard: No, I definitely did not know. And then there was a time when I was denying a lot. “No, that couldn’t be me. These other folks are depressed, not me, I’m just stressed.” I could always hide in it’s just work. I’m tired. I’m stressed. Yeah.

Trevor: Were you abused as a child?

Leonard: No.

Trevor: Emotionally?

Leonard: I had a strict upbringing, the classic Asian parents sort of thing. But they were never degrading. They never put me down like, “Oh, you’re useless or a failure.” It was always pushing me harder though.

Trevor: Did you have sisters?

Leonard: I had two brothers.

Trevor: Two brothers?

Leonard: Yeah.

Trevor: And were they older?

Leonard: They were older. And I would say they were pushed even a little harder than me.

Trevor: Have they shown any signs?

Leonard: No.

Trevor: No?

Leonard: No.

Trevor: Or do you think they’re acting maybe as well as you used to?

Leonard: Because we’ve had this discussion, now that I’ve had my episodes, and they can genuinely feel that they do not have mental illness.

Trevor: What did they think when you told them?

Leonard: They were shocked.

Trevor: Were they supportive?

Leonard: Oh, yeah, yeah. Very supportive. They were mostly shocked that I was leaving medicine because—

Trevor: I want to get to that eventually, yeah.

Leonard: Sure. Both my parents were physicians, so being in medicine has always been a big deal in our family and so to leave that was pretty earth-shattering.

Scott: Can I ask that? Sorry to interrupt. I’m wondering if, because you brought up the Asian ... Yeah, the family dynamics, things like that. I wondered if ... would you call it shame. That’s what we get as Western ...

Leonard: No, I don’t think ... I wasn’t worried about bringing shame upon our family or anything like that.

Scott: Okay.

Leonard: That being said, mental illness is just not something that Asians talk about.

Scott: Sure.

Leonard: It’s kind of like you were saying, in other countries, you’ve met folks that don’t talk about it.

Trevor: So, if shame is not a component of not bringing it up within the family, what is it?

Leonard: Most of it’s denial, I think. I really think that, at least in my family, there was no shame per se. It was, “Oh no, you’re just sad. You’re just having a bad day.”

Trevor: But denial is some sort of avoidance thing. I’m not trying to say it’s shame. I’m not trying to, “Oh no, it’s really shame.” But do you know what you’re trying to avoid?

Leonard: I think—

Trevor: And is that inherently cultural?

Leonard: I don’t know that we were avoiding it so much as just wanting to push through it.

Trevor: Was it a matter of two plus two equals five? Like it was just out of the realm of just the reality.

Leonard: There is a little bit of that. It’s just not part of the psyche. At least for my family, the way we were brought up, we don’t talk about our mental health. We don’t talk about whether we’re happy or sad. We’re not overly emotional when it comes to expression.

Trevor: I can tell you, as a filmmaker, I also watch a lot of films, and especially in the 90s, still to this day, but especially in the ‘90s, I watch a lot of Asian cinema, from all over the place.

Leonard: Sure, sure.

Trevor: And if there’s one topic that is avoided like the plague, it’s mental illness.

Leonard: Yeah.

Trevor: And if there is somebody mentally ill in a film, they’re just written off as some amplified, crazy person. I’m aware that this is fiction.

Leonard: I’d say, at least from what I’ve gotten from my upbringing, it’s either you’re completely normal, meaning no mental illness at all, or they’re one of those crazy people that really went off the deep end. You know, the ones who are wearing tinfoil hats. So, there was no in between. There’s no gradation.

Trevor: It’s literally a duality, almost like a one—

Leonard: Binary.

Trevor: Yes, exactly. It’s almost binary.

Leonard: It really is.

Trevor: It’s that well-defined.

Leonard: And so, if you’re not wearing the tinfoil hats and that “crazy,” then you’re normal. And therefore if you’re saying you’re have depression, that just means you’re sad. You’re not tin foil hat, you’re just sad. There was no gray zone for them. There was no in between. It had to be one or the other. And so it gave no room for allowing someone to have mental illness other than the mental illness. There was that stigma because people with mental illness were only the ones that were locked away.

Trevor: Do your parents know?

Leonard: Oh, yeah, yeah, yeah.

Trevor: My parents don’t know, 20 years, and my parents ... I’ve been outpatient at McLean Hospital twice. They know nothing.

Leonard: Wow.

Trevor: Nothing.

Leonard: Yeah, no. Well, once I quit medicine, my mom definitely knew something was up.

Trevor: Okay, so you quit. I’m fascinated by this because I did the same thing. First time I was outpatient, I was in a group meeting. We meet in groups. It’s almost like going to school every day. You go to school, and you take classes on how to manage my emotions. And one class hit me so hard that, at the end of the class, I was beyond crying. They said, “Why don’t you stay here in the room and do what you need to do because there’s no class coming in after?”

Leonard: Sure.

Trevor: And I sat there and wept, and I realized out of the blue, I can’t be a filmmaker anymore. And that made me cry even harder. And then it almost felt like something was released.

Leonard: Right.

Trevor: Now, something changed between that and today.

Leonard: Yeah.

Trevor: It wasn’t that I needed to give up filmmaking. I needed to give up that I defined myself as a filmmaker so I can still go and do it. And I have not achieved the career that I wanted, but I’ve now realized, and I know it sounds cliché, but this is where I’m supposed to be.

Leonard: Yeah.

Trevor: But I no longer define myself as a filmmaker because if I did, there was this goal, there was this role that I had to play that I just couldn’t achieve. And so now, what do you do for work? I work in mental health. I work in media. What does that mean? I produce videos and podcasts and stuff like that.

Leonard: Yeah.

Trevor: And jobs prior to this, I’ve said the same thing on. The word “filmmaker,” I try not to use it unless it’s just a catchall term. Where were you when you made the decision? How did you come about it? And if you could remember that moment you accepted it. Was there an emotional release or what happened?

Leonard: There was a little bit. So, the thing is I still say I am a doctor, I am a surgeon because I—

Trevor: You are a doctor. You’re always going to be a doctor.

Leonard: Yeah, I will always. And so, at least the words are there, but I can tell you I never felt comfortable in my own skin as a doctor.

Trevor: Why?

Leonard: I don’t know. I was good at what I did. I was very good at treating patients. I was good at comforting them. Patients really appreciated my bedside manner, the way I taught them, the way I helped them. I never felt any fulfillment from that. So I could save someone’s life, and I never felt that fulfilling, “this is why I’m on Earth” type feeling.

So, for me to leave it, there was a little bit of a release because I just knew this was not what I was meant to be doing. And it wasn’t like a sudden light bulb or anything like that. It was just I’ve known this for a while. I’m meant to do something else.

Trevor: Right. You talked about having some sort of tunnel vision when you were deep in it.

Leonard: Yeah.

Trevor: I know exactly what you’re talking about. It might not be the same, but, when I was so deep in it, there was a circle that I could see through, and everything in my peripheral was kind of blacked out.

Leonard: Yep.

Trevor: And also this was something that I realized. I never looked at the sky, and I never looked at trees. And I would notice people would do that, and I never did.

Leonard: Yeah, I know.

Trevor: I didn’t look at the ground, but I was forward.

Leonard: Straight forward.

Trevor: Everything was blocked out, and I was only capable of seeing—

Leonard: Right. I think I was very much like that. I could see because I knew where I needed to go next. I needed to go back to the post op area or the pre-op area or my office. So that part I could see.

Trevor: And people can see that in your face.

Leonard: Yeah.

Trevor: And they won’t approach you. And in a way I kind of wonder if I took on that way to isolate myself even in a social—

Leonard: Maybe so.

Trevor: Yeah.

Leonard: I know that tunnel vision is a great way to describe it because everything else felt black.

Trevor: Black.

Leonard: Just ink black.

Trevor: Absolutely.

Leonard: So, yeah.

Trevor: What about your children? I don’t have children.

Leonard: Yeah.

Trevor: I’m afraid to have children. I’m afraid this was passed on to me from my parents, and I’m afraid. Are you watching them closely? Too closely?

Leonard: I’ve already ... My second child already has depression.

Trevor: How old, if you don’t mind me asking?

Leonard: 14.

Trevor: 14.

Leonard: She’s being treated for it.

Trevor: Not to invalidate, could it just possibly be teen years, or is it—

Leonard: It’s just—

Trevor: You know it’s depression.

Leonard: Yeah, she’s on medication, psychiatric evaluation, that whole—

Trevor: How does that make you feel?

Leonard: For a while, I actually felt guilt over it, like it was my fault, like it was my genes, as if I had any control over that.

Trevor: Right.

Leonard: But that was my own depression and the way that my self-loathing loves to kick in whenever it can.

Trevor: Right. Science does not back up what I believe that I’m going to pass it down. But I firmly, firmly believe, and I treat it like it stops with me, and it’s such self-destructive thinking on my part.

Leonard: Right.

Trevor: But how have you been able to not suppress the guilt but cope with the guilt?

Leonard: The biggest thing is I talk all the time with her. I talk about it. We share stories, we compare medications. We talk about “Did you take your meds because I forgot mine,” that kind of thing. So I try to be as open and plain about it as possible. And when she’s having a bad day, I can tell, and I’m like, “All right, let’s stay home from school.”

Trevor: As an adult male coping with mental illness, as a parent of a child with mental illness, any advice on how to approach it?

Leonard: Talk and listen. Be open about it. If you have your own story, tell that story. Don’t be hiding it. Listen to their story and understand.

Trevor: So your daughter knows your story?

Leonard: Oh, yeah, yeah.

Trevor: I assume it brought you closer.

Leonard: I think so quite a bit, yeah. If nothing else, it gives us almost like a language that we can speak because that was one of the hardest things when I was in the worst parts of my depression is that I felt like I couldn’t explain it to anybody. And that’s one of the most exhausting things is to try to explain depression to somebody who doesn’t have depression. So it was nice that I could speak the same language with her and comfort her, I think. If nothing else, let her know that she was not alone.

Trevor: We need to wrap up. Is there anything you want to add?

Leonard: No, I think this has been fun.

Trevor: At some point in the future, we are going to finish this conversation because I feel we have a lot to talk about.

Leonard: Can we do to talk about phone or how do we—

Trevor: I don’t know. I’m just saying, at some point, we’re going to see each other again, and we’re going to finish this.

Leonard: Maybe I’ll move to Boston.

Trevor: Yeah, exactly. If you do for any reason, let us know.

Leonard: Absolutely. I need a Maine lobster.

Trevor: Yes, exactly. Absolutely.

Leonard: Can’t get them out here.

Scott: With a buttered roll.

Leonard: With a buttered roll.

Yeah.

Trevor: Thank you so much. I really appreciate it.

Leonard: Thank you. It’s been great.

Trevor: So what did you think of that, huh? Dr. Leonard Su’s a very compelling individual. I wish I had more time with him. There seemed to be a really good connection between him and I, and I hope you all enjoyed it.

Thank you for listening to Deconstructing Stigma. If you have any suggestions for special topics or future guests, please email us at mindfulthings@mclean.org.

And don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, 877.870.4673. And you can help us change attitudes about mental health by visiting deconstructingstigma.org.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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