TEDxBerkeley - Neha Sangwan - The Communication Cure

He was an impressive looking, middle-aged Saudi physician. And he asked one of the most articulate, and thought provoking questions I had ever been asked in a public forum. It was 2008, and my mentor and colleague, Jim Gordon had just been invited to speak in Saudi Arabia. The invitation read: The Prince Sultan Cardiac Center is honored to invite you to speak at our second international conference on the advanced sciences. It was the King of Organs conference, focused on the heart. Jim had just published his new book, called 'Unstuck'. It was the seven stages out of depression without medication. The Saudis loved it. So they wanted the author to come and discuss his findings and research. Jim called me up: "Hey, Neha. I have a conflict and I'd like you to represent my work in Saudi. You available?" "Really, Jim? Hm, you're a world renowned expert in depression and trauma, and you happen to be a 60-year-old white male. I am a 38-year-old, single Indian female -- Do you think they're gonna notice it isn't you? (Laughter) He leaned into the microphone, and began: Doctor Neha, it is my understanding, that your country writes more than 200 million prescriptions for antidepressants -- for adults, children and pets. (Laughter) How is it, that your country has come to believe that a pill can cure an ailment of the soul? I walked across the stage to buy myself some time, and sat down, next to the empty seat in the audience right next to him and I said: "I understand, this is part of the reason I am here." After spending a decade in the hospital, in my sleep I could recite the protocol for a stroke, a heart attack, or a pneumonia. But there was something else that I did as a physician that was a little bit strange. The night before I discharged my patients, I would ask them a few questions: "Why you? Why this ailment? This heart attack, this stroke, this pneumonia? And why now in your life? Are there any messages that you're getting from this?" Unbeknownst to me, their answers to these questions will change the trajectory of my career. Brandon was a 52-year-old gentleman, he answered with, "I've always wanted to make my father proud. I've had an ideally good education, I'm married, with two children, I am a triathlonee, and I just sold my company for millions of dollars. And how come I just keep trying? You know, the craziest part doc, is -- my dad's been dead for 5 years. And I haven't slowed down. This stroke -- oh, I know what this stroke came to tell me. It came to tell me, that I need to listen to my body. I am exhausted." 74 -year-old Wan answered, "I don't think I ever remember crying in my life. Not when my children were born, not when my parents died. I look around in the world, and I am dumbfounded by the connections people seem to have with one another, I have always felt isolated. This heart attack, oh, I know what it came to tell me. It's the first time I have been able to express my emotions. I have cried for two days. I feel weak, doc. Am I gonna be OK?" And then there was 62-year-old Lilly. She said, "[I disowned my son]", she said "My son married outside of our faith. So I disowned him. I have never held any of my six grandchildren, I've missed their graduations, and two weddings. This pneumonia and almost dying from it, has thought me to open up my heart again, breath back in the beauty of life. Do you think they're gonna forgive me if I could reach out now?" These are only three of the thousands of answers that I heard. And what struck me the most was, my patients weren't afraid of dying. They were afraid that they had never lived fully. So they thought me what 13 years of medical education did not. That it wasn't just the anatomical and the physiological breakdown of their bodies that I was dealing with. Something had begun long, long ago. They had either stopped listening to themselves, and their body, like Brandon, they had shut down their emotions, like Wan. Or they had given up all the things that mattered to them. Like Lilly. And then somehow this catastrophic event happened. And they showed up, metaphorically on their knees, with all of us together realizing that these things were all connected. So I wish I could tell you that I am smart enough to have used these patients' stories and learned myself, But the truth is, I wasn't. I had this awakening that began in me, and I knew that this authentic connection that I was creating for them was something I needed to take long before they showed up in the ICU. How could I impact them long before? Except I want to squash that thought. Listen, I had great security and stability with a partnership, and a paycheck. Okay, people payed me to take care of them after everything had happened. Would anyone pay me to do what I loved? So I began numbing out my own symptoms. I had a perfected equation to get me through my hospital shifts. It was two ice-cold 16 oz Mountain Dews, plus a kings size Snickers bar, and I can get through any shift you gave me. So I heard some laughter out there, and I wanna know, I think that's coming from the students, because you know what it takes to get you through the finals' week. So you have your own equation, and I want you to think about what that is. You know this is not gonna end well, right? So, here I am, I burned out, I was on medical leave, 17th June, 2004. And I had to ask myself the questions, that I had so often asked other people: "Neha, why you? Why burnout, and why now? What message had it come to give you?" The answers didn't come right away for me. I checked it out with some colleagues, to see if they had ever experienced something like this. I then began to listen to my mind and my body and I started journaling. And what I read on those pages, scared me to death. I didn't just want to help people before they ended up in the hospital. I wanted to create self-care and healthcare. I wanted to help heal the healers. I wanted to become a master in communication and even combine it with my knowledge of health and I wanted to use that to go and bridge nations -- that scared me. So you can imagine when the call came from Jim Gordon to go to Saudi Arabia, that all of those experiences are what gave me the courage to say yes. So I'd like to share just a few of those stories while I was there, and I got emotional a little earlier so I'm gonna flip through two slides here, and bring you up-to-date. I landed in Saudi Arabia, and I gave my talk. I gave my talk for Jim Gordon on "Unstuck in Depression." And it was fantastic. They were gracious and they asked the questions that the Saudi physician asked. And then, there was a second scheduled talk, which was Clear Direct Communication for the women. I walked in and I saw 200 sets of eyes looking back at me. It was like a sea of black, accented with designer handbags, and shoes. About an hour into my 2-hour-workshop I started hearing a familiar voice in my head, "You don't know what you are talking about, everyone told you this wouldn't translate cross-culturally. What are you doing?" And in that moment I realized how much I depend on nonverbal communication in your facial expressions to know that I am connecting and engaging with you. So I could have just road it out for the next hour, but I probably wouldn't have given a very good talk, so I stopped and I said, "I wanted to check and see am I on track is this useful to you?" They erupted with, "Doctor, Sangwan, this is so important, we never learn this. Continue, please continue." So as I continued we had -- I finally relaxed, and I probably started to enjoy it as much as they were. But the most important thing that I didn't realize was how relevant this would be to my work back home. People in the same room, no body language, creating all sorts of miscommunication and judgments in their heads, but if they didn't check out would become a big problem. A huge parallel. Another story that I'd like to tell you about, that had a huge impact on me, was my interaction with doctor Abdullah. He was the chairman of the conference. He asked me if he could consult me about something that was weighing heavy on his heart. "Neha, you remind me of my daughter, except you are very different than she is. You're incredibly strong, you travel the world, and you speak at international conferences. I see you taking on challenges with ease. My daughter on the other hand, she is weak. Whenever she faces a challenge I know that she's weak, because she cries. I'm only afraid, that she is not gonna make it in the world. Is there any way that you can help her?" I thought for a moment, I had known him for about seven days. So, I said, "Doctor Abdullah, what if I don't think that this is about your daughter?" "Well then, who would it be about?", he asked. "Well, I've been in your country for seven days now, and I have watched you flawlessly orchestrate a conference of international scientists. I've spoken to your colleagues, and your patients, who speak incredibly highly of you. And I've even spent time with your family, they too revere you. I am curious if you love your daughter so much, that in the face of her tears, it's one of the only times in the world, that you're not in control?" The longest 60 seconds of silence in my life, happened following that comment. And then he said very thoughtfully, "This is absolutely correct, thank you my friend. I have much to learn about communication." You know it's interesting, I think as our society we are pretty biased against tears, cross culturally. That we have a lot of judgments about whether they make us weak, or it's just showing emotion. There's some recent medical research out now, that shows that tears are actually healing. William Frey out of Minnesota now reports that you can measure stress hormone in tears. And endorphins are actually released when you have a good cry. And endorphins are the feel-good hormones that you get after you exercise, so listen -- cry away, you're gonna feel good! (Laughter) The last story I'd like to tell you about is, I had a rare opportunity to chat with Prince Abdullah Aziz. And he asked me, "Neha, what is it that the media has thought you about our culture that you find to be true? And what is it that you find not to be true?" "Well what I find to be true is that the separation of men and women, both at the conference and at the society, is real. What I find not to be true is that I don't -- that you and everyone I've met this week have treated me with so much honor and respect, I didn't expect that. My parents were raised in India amongst a lot of Hindu-Muslim conflict and they feared for my safety. They also worried that I might not assimilate very well in a culture that was so different from the one I had been raised in. My colleagues told me, that I would feel like a second class citizen. Because I was a woman. I have not had that experience. The second thing that I find not to be completely true -- I'm sure there's some truth -- is that the women they told me -- Okay, let me tell you again. The second thing that I find that the media says that might not be totally true, the women that I spoke with actually told me, that they love their abayas, and burqas. They say, "Doctor Neha, it's our fashion, we get rhinestones on it, we get Chanel abayas, we love our abayas, and you know what else it does? We feel like precious jewels, because we don't have to deal with that unwanted attention from the men. Ughh. I thought, well, that certainly could be true, because it's how they have been raised. Many of them felt very comfortable there. So that I definitely didn't expect to hear." "Now it's my turn, I get to ask you some questions. Why is it, that when I have violated rules that you, your moral police could send a woman to jail for, why is it, that you honor and respect me so much?" "Okay, I cheated. When I heard that you were coming I actually didn't know what to do, but when I got the word, that you got off the plane, you were in black, and you had covered your head with a scarf. I knew that your intention in coming here was to honor our culture. In that moment I knew my job was not to make you part of our culture, it was to honor the culture from which you come." And a simple act of covering my head with a scarf, to honor the Saudi culture, had made it possible for them to open their hearts to me, and be more authentic that I could have ever imagined. That night at the airport I got an email as I was leaving, from my parents. "How is our daughter, is she home safely in California?" "Mom, dad, I had the most amazing adventure of my life. I can't wait to tell you. These are generous, loving, honest and open people. They treated your daughter with the utmost of honor and respect. And I can't wait to show you my rhinestone studded abaya." It wasn't until the wheels of the plane landed in JFK that I saw their response. "Thank you for helping heal us so that we could see them through a new set of eyes, we are so proud of you for listening to yourself." So, I'd like to leave you with one thought. What if communication is the cure that we are missing? What if, how we talk to ourselves and do or don't receive messages and then in turn whether we choose to lean into that discomfort shows up in how we communicate with the people we love? And in turn all of us collectively choose to show up in the world, is actually the prescription for health, long before I need to write you a prescription? Thank you. (Applause)