Dr Vivek Murthy — Former Surgeon General on Combatting COVID 19, Loneliness, and More | Transcription

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Introduction

Intro (00:00)

At this altitude I can run flat out for a half mile before my hands start shaking. Can I ask you a personal question? No, what is the appropriate time? What if I did the opposite? I'm a cybernetic organism living tissue over a metal endoskeleton. Lead to Paris show. This podcast is brought to you by Trello.

Guest Introduction And General Discussion

Trello sponsor intro (00:27)

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NutriBullet sponsor intro (01:52)

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Dr. Vivek Murthy intro (04:57)

What we're looking for are habits, routines, thought patterns, frameworks, etc. that you can hopefully ponder and test and apply in your own lives. And my guest today, and I'm going to massacre this name, but I will do my best, is Dr. Vivek Murthy. That's M-U-R-T-H-Y on Twitter @vivekmurthy. That's @vivek_murthy on Facebook, Instagram @drvivekmurthy and vivekmurthy.com. Dr. Murthy served as the 19th Surgeon General of the United States between 2014 and 2017. As the Vice Admiral of the U.S. Public Health Service Commissioned Corps, he has a uniformed service of 6,600 public health officers globally. During his tenure, Dr. Murthy launched the Turn the Tide campaign catalyzing a movement among health professionals to address the nation's opioid crisis. He also issued the first Surgeon General's report on alcohol, drugs, and health calling for expanded access for prevention and treatment and for recognizing addiction as a chronic illness, not a character flaw. In 2017, Dr. Murthy focused his attention on chronic stress and loneliness as prevalent problems that have profound implications for health, productivity, and happiness. He has co-founded a number of organizations, Visions, an HIV/AIDS education program in India, Swastia, a community health partnership in rural India training women as health providers and educators, software company Trial Networks, and the grassroots physicians organization Doctors for America. Since leaving government service, Dr. Murthy has continued to focus on loneliness and social connection. His brand new book is titled "Together, the Healing Power of Human Connection in a Sometimes Lonely World." Dr. Murthy received his bachelor's degree from Harvard and his MD and MBA degrees from Yale. He completed his internal medicine residency at Brigham and Women's Hospital in Boston and later joined Harvard Medical School's faculty in internal medicine. His research focused on vaccine development and later on the participation of women and minorities in clinical trials. Dr. Murthy, welcome to the show. Thanks so much, Tim. It's great to be on with you. I have really enjoyed getting to know you over the last handful of years, and I thought we should start with how to pronounce your name properly. And I know we had a warm-up pre-recording, but perhaps you could describe how you have trained people to say your name in the past.

How to pronounce you correctly? (07:26)

I'm happy to. Well, there were many years where I just gave up and didn't correct people, but when I was in business school, I started teaching people to say my name the following way. It's spelled V-I-V-E-K, and the V-I is pronounced like the V-I in Victor, and the V-E-K is pronounced V-E-K, so it rhymes with lake. So that's what I used to tell people, but instead of calling me Vivek, they just called me Victor Lake for the next two years. So much for that.

Priya on loneliness as a kid, encountering it in adult patients, and encountering it herself (08:07)

Well, we have a lot that we can explore, and a lot we will explore, and I thought we could start with loneliness, and that is certainly a perennial topic. This is something that I have struggled with personally over decades, certainly struggled with as a kid. This is something that also many people are acutely struggling with because of SARS-CoV-2, COVID-19 at the moment. And to place things in context, we're recording this on March 24th, 2020. Both of us are at home, and we'll have time to talk about certainly COVID-19 and so on, and we'll dive into that, but I'd like to focus on loneliness first, and let's start at the beginning. Is this a topic of interest to you because it is something personal that you have experience with, or is it from observing the impact of loneliness on health on a wider scale? Well, Tim, my interest in this initially stemmed from my own personal experience, and I'll tell you a little bit about that, but I'll just say that I think when a lot of people are lonely, they don't realize how common it is, and they can think that it's just them, and somehow their loneliness is evidence that they're just not likable or evidence of a character flaw or maladjustment. But the reality is that there are a lot of people I came to see in later years who struggle with loneliness, and we're all around each other just in silence and often feeling a bit ashamed of how we feel. For me, the feelings of loneliness began in elementary school. I was a pretty shy kid growing up, and I wanted to hang out with other kids. It wasn't that I wanted to be alone and by myself, but I just had a hard time kind of getting conversations started and breaking in to other cliques and into the in-group, and that persisted for a long time, and I still remember going to elementary school and feeling this pit in my stomach when my parents would drop me off, and I wasn't scared about tests or teachers. I was just worried about going to the cafeteria and not knowing who to sit with, and I was worried about being on the playground as the last person picked for a team, despite the fact that I was actually quite athletic and had good athletic skill. I was worried about feeling lonely, and I would wait every day until 3 o'clock when the bell rang in elementary school, and then I was just feeling of relief. I could finally go back home where I knew I was loved and where relationships were just so easy. My parents and my sister were just the best and continued to be just extraordinary, loving family members to me, but that was my first experience of loneliness. It's funny how these experiences stick with you for years and years and years. Even later in life, when I was able to build beautiful friendships and feel quite secure in my relationships, I still felt sensitive to those experiences of being lonely or sensitive of being in circumstances where I might be by myself. So it's taken a while to process and work through some of those feelings. And what does that look like for you as an adult? Is that something that you were able to compartmentalize or put on the side, for instance, for a period of time? Were you reminded of this--I'm just making this up. This isn't something you've said, but for instance, looking closely at the opioid crisis and a lot of, let's call it, comorbidity with depression or other types of conditions that might be associated with perceived loneliness, how did this come to play out in your adult life? Yeah, so it played out in two ways in my adult life. The first was in a really direct way. So as I got older, I was able to build friendships in high school. I enjoyed those friendships. I felt like I started to blossom socially in terms of becoming the person on the outside who I felt like I was on the inside. But there were still patches in my life where I felt lonely. It was a state that was easy to fall back into, and it was a state that was self-reinforcing in a way. When I felt lonely, I would actually get down on myself. I would draw even further from other people, which would deepen the loneliness. But there was a second thing that was happening when I was an adult, which was that I was going through my medical training and starting to encounter patients in the clinic and in the hospital. I trained in internal medicine, and I assumed that the people I would be seeing and caring for would have issues like diabetes or heart disease or infections like pneumonia or complications of their cancer treatment. I certainly saw many patients with those conditions, but what I did not expect to see were so many patients who were alone. This is how it first showed up. I began seeing patients who would be admitted to the hospital and wouldn't have anybody with them. I would often ask in the routine course of taking an initial history and physical, I would ask about their social circles. Do they live alone at home? Do they have somebody that they can rely on in terms of friends or families in the area? I was finding often that people were saying, "No, there's nobody there." That was one thing. But then when urgent situations would come up, when we would get a test result, for example, that was really concerning, that showed maybe somebody had a new diagnosis of cancer, and I would want to talk it through with them, I would often ask them, "Is there somebody you want us to call so that we can share this information together so you have some support so we can make some tough decisions together?" Very often people would say, "I wish there was, but there's nobody." There were even times, Tim, at the end of life where on many occasions, it was just me and my colleagues, my fellow doctors and nurses, who were the only witnesses to people's passing away. Those really struck me deeply because in those most important moments in life, birth, death, and the critical moments in between when you either have success at work or have major breakups, et cetera, you hope that there will be people there for you, though you'll be surrounded by the people you love. But for so many of these people, there was nobody at the end. That was a very heavy feeling that lingered with me for a long time. So I came to see in my adult life that not only was loneliness something that continued to affect me in waves, including during the time I was Surgeon General, but it was also something that I was encountering quite commonly among the patients I cared for. Keep in mind, Tim, I had no training in how to deal with loneliness. There was no class on loneliness in medical school. It was not really part of our curricula to think about how to ask people deeply about their social connections. So I felt out of my league, in a sense, that I was encountering problems that I frankly had no idea how to solve, but they seemed important because they kept coming up and they seemed to fill people with sadness. I would love to ask you about several facets of what you just shared.

Being there for patients at the end of life (15:21)

The first is being the only person or along with your colleagues, the only people with someone who is going to die or who is in palliative care. I suppose those are synonymous. Or who has just been given a very grave diagnosis. I've found you over the last handful of years to be very calm, very soothing, and I'd be curious to know what you did in those circumstances to help these people psychologically. What types of things would you say? What would you do? Are there any particular examples that spring to mind that were difficult? I'd love to just, if you're open to it, talk about really any specific example that jumps to mind because that strikes me as a potentially difficult circumstance to navigate. I don't know how long these people were in the hospital, but it's possible that they'd been alone or felt alone for a long time.

How do you fully inhabit your heart in someone else's time of need? (16:25)

Really, the strongest tether they had at the time of the diagnosis or before passing would be with you or one of your colleagues. I'd just be very interested to hear you speak to that. Those moments, Tim, are so deeply etched in my memory because they impacted me a great deal as well. In those moments, as a doctor, you're trained to use your head and your heart. But I found in those moments in particular that I had to get completely out of my head and just try to fully inhabit my heart and be there not as a doctor but as a human being. I do think that all of us, regardless of what stage of life we're at, we've got three basic needs. We all want to know that we matter. We want to be seen for who we are, and we want to know that we're loved. In those moments, what I tried my best to do is to help people feel that they were seen, just simply by sitting there and focusing on them and listening to them, by putting my pager aside, by not standing at the door, but actually pulling up a chair and sitting with them, by holding their hand. Often, the physical contact is such an important part of our human connection. I tried to just listen to whatever it was that they wanted to talk about. There were times where I struggled. Maybe I should say something insightful or thoughtful or empathic, but when I look back on those conversations, I think the most important part was just showing up and being there and being fully present. That's what I tried to do. I had this ritual that I would do also, like when they passed, which is when a patient passes away, you're always called as a doctor to pronounce them, and so you have to document that the heart has stopped, that there's no corneal reflex, and there are a series of steps that you have to take like that. I would do that, but I would also then take a minute to just stand by their bedside in silence with them and to just imagine the energy of the universe just washing over them with love and with kindness. That was my special moment with them. Even though they passed, I would hope that it was meaningful for their spirit. It was certainly meaningful for me, but those are some of the things that I would try to do at the end of life. I don't know if they mattered or made a huge difference in people's lives, but I hope that it may have eased the pain of their passing just a little bit. Thank you for sharing that.

Advancing Carnes perspective on death from the bedside as a doctor (19:09)

How do you think about your own mortality or relate to mortality? I don't mean to take this in a metaphysical or esoteric direction, but as someone who has witnessed a fair amount of death and no doubt thought about the finite time that you have on this planet, at least for now, how do you relate to mortality or think about it? That's a really good question. I think about my mortality often, not in a morbid way, but in a way that I hope will remind me to appreciate the present moment. When I was in residency training, I remember one week being on the oncology service where half of the patients I was taking care of were young people in their 20s who had end-stage gastric cancer. I was in my 20s at the time, and it was really a stark experience for me because I could have been lying in that bed instead of them. These were accidents of fate. There's something about training in medicine in those years and then caring for patients afterward that made me continually recommit to trying to be as present as I could, recognizing that tomorrow is not guaranteed. We don't know how long we have with the people we love, but we can make choices today to dramatically improve the quality of our life and the depth of our happiness. When I think about my mortality, I try to think about being fully present now. After my residency training, I made a significant change, for example, in how I spent my leisure time. So I made it a point to try to come home to see my family in Miami every two to three months. Prior to that, I used to go about twice a year. There's no right number of visits to make to one's family, but for me, I realized that I wanted to be there as often as I could for the people who had given everything so that I could live the life that I have. To me, that was well worth it, and I look back on my life. We all look back on our life and we wonder if we made the right decisions. I'm the same. I'm not always sure I made the right decisions on things, but in that one area, I feel like, yes, that was the right thing to do to come see them more often. As a dad, it's a little different now also.

Why Carnes thinks about his mortality a lot (21:32)

I think about more mortality, and it's bittersweet because I think about the things I may miss if I'm not here in terms of my children's major milestones in life. They're moments of great joy and happiness. I want them to find true love in life. I want to be there when that happens. I think about those moments with a tinge of sadness. I would be sad to not be there, but that makes me all the more want to live my life in a way where the time I'm spending right now is time well spent. I'll focus on relationships and focus on giving and receiving love. There's a fantastic essay, if people listening have not read it, by Tim Urban called "The Tail End" that I certainly recommend everybody read. That had the same impact on me in the sense that I ended up dramatically increasing the amount of time per year that I spent with parents in particular and also my brother. If you don't mind, I'd love to zoom out just to provide some context and maybe define what the surgeon general does.

Office of the Surgeon General: What it means and the responsibilities of the role (22:33)

I would love to hear you describe the role of the surgeon general and then how and why you ended up the surgeon general. Well, this is a good thing to talk about because I think very few people actually know what the surgeon general does, even though many people know the position exists. That frankly includes people in government who don't necessarily know what the surgeon general does, even though they may have a working relationship with the office of the surgeon general. I'll tell you, when I actually became surgeon general, it was a fascinating process which I'm happy to talk about, but at very few, if any, points in all of the conversations I had with people in the administration, did somebody sit down and say, "Okay, this is what your job will entail." One of the first things I did when I became surgeon general is I went to the general council at the Department of Health and Human Services. I said, "Look, I have a sense of what I want to do as surgeon general, what the job entails, but what I really want to know is what does the law actually say about what my job is because everyone seems to have a different idea here." What the law says is it says that the job of the surgeon general is to be the commanding officer overseeing the United States Public Health Service Commission Corps. This is one of the uniformed services in the United States government alongside the Army, the Navy, the Air Force, and the other uniformed services. The officers in the commission corps are doctors and nurses and public health engineers and physical therapists and other health practitioners. But overseeing that service and serving as the vice admiral of that service is the statutory responsibility. But there's another responsibility that has evolved over time, which is that the surgeon general is supposed to provide the public with the best possible information on health so people can make good decisions for themselves and their families. That's taken on many forms. Some surgeons general have published reports, and surgeon general reports have become these iconic publications that spark major changes in policy and in practice all around the world. Others have taken to being out in the public often to issue PSAs and to talk to people directly about steps they can take to be healthier. But all of this comes down to the fact that the job itself is actually quite flexible, and that was one of the things that I certainly appreciated about it, is that unlike most other political appointees, your allegiance is not to the president. Your allegiance and your highest responsibility is to the public and to science, and I like that. So if there's a disagreement between what the president says and what science says, you're supposed to side with science, even if that puts you at risk of being fired. So I liked that. I liked being able to create your own agenda and being sort of attuned to what the people want and being out there in communities across the country. That really spoke to me. It was exciting to me and one of the reasons I ultimately felt the job was a good fit.

When and why the general public might cross paths with a U.S. Public Health Service officer. (25:51)

When would a listener, if ever, encounter one of these 6,000-plus public health officers who were under your command, so to speak, as vice admiral? I'm just wondering in what context we can imagine these people working. I ask in part because I'm hearing currently, of course this is late March, of the National Guard potentially building field hospitals and so on. So would they end up at a field hospital, or are they working exclusively in government and don't have contact with civilians? Could you describe what types of work that uniformed service of 6,000-plus do? Yes, so they do a variety of jobs throughout the federal government. Some are stationed at the Centers for Disease Control and Prevention, the CDC. Some are at the Food and Drug Administration. Some are at NIH, the National Institutes of Health. So they are throughout the Department of Health and Human Services, but they also work at other agencies in government. They provide a lot of the healthcare in the Bureau of Prisoners to people who are incarcerated. They also work in the National Park Service to help guide the Department of Interior on matters related to health. So these are the people, just to keep in mind, who help build and preserve and execute the infrastructure for public health throughout the country. Where you may have encountered them are actually during times of crisis. So we deploy our officers to disaster areas when there's a major hurricane or a tornado that comes through or a major flood. After 9/11, we sent many officers to New York to help provide basic medical care and to help stand up the medical and public health infrastructure. When the Ebola crisis hit in the Obama administration, we sent hundreds of officers to Liberia to help open what was called the Monrovia Medical Unit and provide direct care to people there. The reason we did that was because prior to setting up the Monrovia Medical Unit, countries around the world were not sending their volunteers to Liberia even though the Ebola outbreak was ramping up at a really scary pace. But they weren't doing that because they were worried their volunteers would get sick and no one would be there to take care of them. But when we set up that unit, when these commissioned corps officers started caring for people, then countries opened the floodgates knowing that if their volunteers got sick, someone would be there to care for them. So these are some of the many circumstances in which you see commissioned corps officers. But they are often invisible. We talk about them as one of the best-kept secrets in the U.S. government. Personally, I don't think they should be a secret. I think they should actually be much more out there and visible, and that's something as leadership we've got to do a better job on. But they are a critical part of our health infrastructure in the country.

What was involved in setting up the Monrovia Medical Unit during the Ebola crisis. (28:47)

If we take a closer look at the Ebola crisis for a second, what was the term you used? The Monrovia medical unit. There we go. Medical unit. What was it like making that happen? Was that difficult to create this tip of the spear/vanguard to go to Liberia? Was that challenging to navigate inside the machine of the United States government, or was that relatively straightforward or somewhere in between? What was that experience like for you? Well, it was a very complicated experience, and it was an experience and an endeavor that was begun shortly before I entered office and that continued long after I got there. But it was not easy for us to pull together because it required a fair amount of legal work to make sure that we had the authorities to go abroad and to set up a medical unit like that. That was one piece of it. Second is we had to think deeply about how to make sure that these officers who had not been deployed to West Africa before had the training and the support they needed to be effective and to achieve and accomplish the mission. But we also had to deal with real human factors, factors that affect any soldier or uniform officer who goes overseas during the theater of war, whether that war is with visible soldiers or invisible agents like the Ebola virus, which is that there's trauma that comes with it as well. And it took us a while to get a full, I think, handle around the extent of the trauma that was involved that officers experienced when they went abroad, knowing that their life was on the line and tried to care for people who had Ebola. So these were complicated missions. They're also complicated because while government has powerful mechanisms for implementing change, they're complicated mechanisms. They're big ships that turn slowly and having to move quickly without breaking something, having to collaborate with multiple arms of the uniformed services, especially the Army in West Africa, and with the legislative branch and the executive branch. This took a lot of conversations, a lot of collaboration, a lot of putting out fires. So it was messy behind the scenes. This hostage-making often is, but it was worth doing because it was a key part of turning the tide on the Ebola crisis. If you don't mind, I'd love to chat a little bit about the pink elephant in the room, which is, just for the sake of simplicity, I'll call it COVID-19.

Discussion On Covid-19 And Crisis Response

Importance of still developing science around COVID-19 (31:21)

There's a virus and then there's the disease and so on and so forth. But how are you currently thinking about COVID-19? What are people missing or misunderstanding? Or really, what would you like to share in terms of your thinking related to COVID-19? Actually, there's so much that COVID-19 is teaching us, not just about science and health, but about our infrastructure and about society more broadly. One of the key things to recognize about COVID-19 is, as we're having this conversation, we've learned a lot about the virus, but there's still a lot we don't know. Several weeks ago, during the early days of this outbreak, there was an assumption that young people don't have much to worry about and that this is an illness that primarily affects the elderly with other complicated medical conditions. But the data that we're starting to get now shows that perhaps that distinction was too stark and that, in fact, younger people are more affected and get more seriously ill than we had previously thought. So this is a humbling virus. It's teaching us new things about it, and we've got to keep that in mind and make sure that we approach it with caution and that we err on the side of being too cautious and too aggressive in addressing it. I think the second thing that's important to realize about COVID-19 is that this virus is not the flu. This is a very different virus. It's much more contagious. It's much more deadly, and we don't have any tools in terms of medications or vaccines to address it at the current moment, and hopefully that will change over time. But right now, we don't have those tools, and we also don't have natural immunity in the population because this hasn't been circulating for years. I think the other part to remember here is that every now and then, there is a moment in the world's history where we are faced with a challenge that's far bigger than any one of us or that any one country can solve on its own, and COVID-19 has presented us with one of those challenges. And the question is, how are we going to respond? As a world, how are we going to collaborate to not only develop therapeutics but also to help each other overcome shortages of masks and other protective equipment? How are we going to share data so that we can learn together about how to prevent catastrophe as the virus spreads across the world? It's a real test of the relationships that we have between countries, but it's also, and I think perhaps more poignantly, a test of the relationships we have in our communities. We're coming to realize that with a virus that spreads really easily where there is no treatment yet, one of our most effective mechanisms of preventing spread is to physically distance people. As painful as that is, as lonely as that can be, it is one of the more effective strategies. And so as we speak, we're currently implementing that here in the United States. And this is not an easy thing to do, but one of the things that it's already started to illuminate and remind many of us of is that we really do need each other. But as much as we live in a world that, and in a country, I should say, that's built on an ethic of individual responsibility and that's built on a narrative of the single entrepreneur who builds the company or the single scientist who solves a major disease and finds a cure, the reality is that we are far more interdependent and interconnected than perhaps those narratives might suggest. And I think that this experience of COVID-19 is a powerful reminder of that. And finally, Tim, I think COVID-19 is pushing us to confront some messy, difficult, but important questions, and questions around what we believe people need to support them and what role government has in providing those supports. In a scenario like this, for example, when somebody may get sick and they've got to stay home for a couple of weeks because they have COVID-19 infection, what if they don't have paid sick leave? Then how did they take care of their child and make sure that he or she has food on the table? If they're an Uber or a Lyft driver and they're depending on that income in order to help put their child through college or take care of an elderly relative, what do they do when nobody's out on the road taking rides because they're worried about safety? The truth is we don't have as robust a net to catch people and support people when they fall as we perhaps may have thought we had in the United States. And so this, I think, is a deeper moment for us to grapple with that and to ask, well, if we truly are interdependent, how can we best support each other as individuals and as a government? What do we need to do to ensure that people have the best shot at living a healthy and fulfilled life?

A 3-point guide Borrowing best practices on crisis response (36:34)

It certainly is bringing up a lot of inconvenient and important questions, some of which you mentioned. And on one hand, it's been very uplifting as a silver lining to see how much certain communities have rallied or coalesced, grown stronger as a result of this, where the importance of community and seeing each other's faces and so on has increased. And I was struck earlier today, I had a team call with my employees, and there was a very fast rotation where each person spoke about one thing they were proud of and one thing they were happy about before getting into the business matters. And what came up most often was seeing communities come together. That was the happy-about point that came up the most. And I do want to talk about that. I'm going to ask you about remembering your anchors, and I have a whole host of other questions that I'd like to ask. But I'd also like to dig into COVID-19 just a little bit more, if you're open to it. Sure. And again, as a snapshot in time, as we speak, New York City's Javits Center is being turned into a disaster hospital for COVID-19 patients, or maybe overflow from other conditions. I don't know. I imagine it would probably be dedicated for COVID-19. There's a lot of movement right now. There are some people who would argue that the United States has really been caught on its heels in a lot of respects and has not taken aggressive enough actions from the playbooks of South Korea, etc., China, other places. If you were the benevolent dictator of the United States and your team came to you and asked what should be done at this point in time, is there anything that comes to mind that you would tell your team? Well, yes. I would tell them about the three important principles that you have to make sure you adhere to in disaster response. The number one, you have to lead with science in your decision-making and lead with scientists in your communication. The number two, you've got to be transparent with the public, even when it's painful, not only because that's how you build and maintain trust, which is one of the most important assets you have in fighting a crisis like this, but also because that transparency creates the accountability that you need as government. And the third thing I would tell them is that our job, and even more than that, our sacred responsibility in a crisis like this when people are putting their lives on the line, is to make sure that we pull out all the stops to get resources to people on the front lines, and those are the doctors and nurses and healthcare workers and hospitals. Those are the public health workers and communities across the country who are trying to trace contacts and coming in contact with people who are ill. Those are the individuals who are impacted economically as we pull back on social interaction and as businesses shut down. Those are the three principles that have to guide us, and in particular, when I think about the circumstances in our hospitals, it's so deeply painful to me because we are encountering a pandemic that we haven't seen the likes of in over a century, and we are not prepared for it. We have certainly done some preparation for major disasters, but this is not a typical disaster. This is far greater in scale and scope. And so we right now, as we speak, have doctors and nurses who are reusing masks in hospitals who are going to see patients, in some cases doing surgeries, without masks, which is bad for the doctor and patient, but because there is no other option. We have hospitals that are running out of gowns and gloves. We have doctors who are trying to figure out how to take one ventilator and somehow rig it so that it can care for two patients at the same time because they're running out of ventilators. These are the realities that we're facing in our hospitals today in 2020 in the richest country in the world. And this is sobering. It's painful to recognize this, but that's the situation that we're in. What that means to me is that we have to do everything within our power, avail ourselves of every authority and mobilize every resource that we have access to, to ensure that we close the gap between what those healthcare settings have and what they need, because here's the truth. It's not just a moral responsibility we have to protect those on the front lines, but on a very practical level, as doctors and nurses start to get sick in larger and larger numbers because they don't have the protection they need when they're caring for sick patients, that also pulls people out of the workforce exactly when we need them in our hospitals and it further deepens the crisis. So this is how I would frame the challenge to my team. These responses are never easy. I was in the administration in the federal government during the Ebola response and during the Zika response, and those were not easy either. We hadn't quite dealt with those kind of crises before. And so there are always stumbles in these instances. But the question is not do you stumble. I think the more important question is how do you get up? How do you get up quickly and how do you learn from your mistakes and ensure that you are serving even better as a result of what you've learned?

What Dr. Murthy would do differently. (42:21)

Thank you. And feel free not to answer or we can punt, but I'd be very curious, adhering to those three principles of crisis response, since you're the benevolent dictator, you can on some level insist and enforce those three principles. At this point in time, what types of interventions or actions, whether statewide or nationwide, would you be considering implementing, knowing what you know? Well, so a couple, I mean, there's a lot. I'll just mention a couple of things that come to mind. We have all the time in the world. Fortunately, this isn't morning TV. So we have the luxury of space. Take all the time you want. You have more than 30 seconds to make profound statements about the world? Okay, that's great. So a couple of things I would do. Number one, I would make sure that as a federal government that we were providing clear directives to states and localities about when to pull the trigger on various measures that they may take to protect their population, including closing schools, shutting down businesses, issuing shelter in place or stay at home orders. One of the great challenges that states and local governments struggle with is how to make these decisions based on what criteria. And what you see right now is a very uneven response across the country. And so people are confused. They're asking, well, why is California issuing a stay at home order? But other states aren't, even though they may have a similar number of cases. It's because there's confusion in part. And so that's one thing I would do is to make sure that as a federal government, we were putting our nickel down, so to speak, and providing clear criteria to states and local governments about when to implement some of these restrictions. The second thing that I would do is I would take the responsibility as a federal government to make sure that we were filling the gaps in terms of materials and space that hospitals needed. That doesn't mean that we have to provide everything directly ourselves, but it does mean that we need to be responsible for solving the problem. So if, for example, New York State and California State and Washington State are short on masks, it would be inefficient for them to spend all of this time looking for gloves, calling vendors and effectively competing against each other for a limited supply. This is a place where it makes sense, actually, for the federal government to step in and to use its power to procure what's needed. And so that's the second place where I would exercise authority. The third place where I would do it, the third area that I would focus on would be to ramp up domestic production of the materials that we need, particularly around personal protective equipment for health care workers. This includes masks and gowns and gloves. Now, we have authorities that the federal government can use to compel private industry to produce these products if they're in the national interest. In this case, they are. Now, I think we should only use those kind of authorities as a last resort because they are disruptive. But part of what real leadership is about is about bringing people together to do voluntarily what we need as a country to have done. And in this case, I think if we had a clear and compelling call to private industry with clear directives on what is needed and the specs for what needed to be produced, I think we would start to see more and more businesses voluntarily switch over their production and start to produce masks and gloves and gowns. This isn't actually theoretical. Even as we speak, I've spent the last five or six days in touch with multiple companies that have sought me out and are seeking other public health experts out saying, "I have a shirt factory," or, "I have another type of apparel factory. I want to help. Give me the specs. I will start producing today." This is the spirit of America that we're seeing with people standing up in every corner of this country raising their hand and saying, "How can I help?" And part of what we need to do as government is to give them the opportunities to help to make it easier for them to step up and to make a difference. So these are just a few of the things I think that are essential to do right now. But I think one of the last things in the really, really important role of government in these kind of crises is to be, in a sense, both the data keeper as well as the storyteller. And let me explain what I mean by that. In moments like this, there are key questions that people want to know the answer to. They want to know how many people have the illness, how many people have survived, how many people have been tested, how many of those tests are positive, are there shortages of tests anywhere, and how quickly can we meet those shortages. These are data questions. And in the absence of having a clear place where people can go, it makes a response much harder. And we don't have full clarity on some of these critical data questions right now, but that absolutely needs to be something that the federal government steps in to help solve in partnership with states. But the storyteller side of the coin is also very important. Storytelling is essential. It's not just entertainment. It's how we process events. It's how we anchor ourselves in an experience. It's how we find meaning and make sense of really confusing times. And the role of a leader in a crisis, whether it's an individual leader or an organization, like in this case, at the federal government that's taking the lead, is to be able to tell a clear, honest, transparent, but compelling story about the journey we've been on and where we're going. You need to be able to tell people what we've seen and experienced, what the real costs of it are. But you also have to provide a hopeful path forward and help people see how we can emerge from this, what the path to doing that actually is, and how we can actually get there together. None of these things I've described are easy, but they are necessary. They're essential during crises. And these are some of the areas that I would focus on if I had the privilege of serving.

Mandates and enforcement regarding COVID-19 in the US. (48:46)

Thank you. It's been fascinating to observe, at least on the state level, Cuomo's daily briefings, which I think seem to be certainly a step in the right direction. But that would be needed, if I'm hearing you correctly, more so on a national level. God, I hope we can get our act together. I'm optimistic and pessimistic, depending on the hour in which you happened to catch me. But do you think it is possible in a country like the United States—and we won't spend too much more time on the nitty-gritty of this— to implement some of the aspects of the playbooks from countries like, say, South Korea or China that seem to have played roles in somewhat— I shouldn't say necessarily completely containing, but lowering the R0 of the SARS-CoV-2 in these places. For instance, there's contact tracing and so on, which seems like it would run into privacy issues in the United States if we're using private cell phone data and geolocation and so on. You have, say, in South Korea, actual penalties. In other words, enforcement of shelter at home, which I believe escalated over time to the point where they got to something in the thousands, between $5,000 and $8,000 per infraction. I mention that just because a friend of mine told me that looking at satellite data of San Francisco, after the shelter-in-place command, the foot traffic was roughly 60% of normal. That doesn't strike me. It's a very leaky condom that you're using to practice safe sex, metaphorically speaking. That doesn't really give me a super high degree of confidence in a compliant population without enforcement. Do you think we are simply too culturally different and too politically divided to implement some of these stricter measures? Or would you, if you could, implement some of these things in the United States? This is such a good question. Some of the extraordinary public health measures that have been taken in South Korea and China to really stem the tide of COVID-19 would be hard to take here, for sure. But I think what we have in the United States, in part as a result of our cherished preservation of freedom and individual liberties, is as a government, we have a greater burden of responsibility to ensure that we are explaining things and making our case to the public of what needs to be done. That is an important, but not always an efficient way to achieve behavior change. You mentioned that foot traffic in San Francisco was 60% of what it was after the shelter-in-place order was issued. That's not good. That means that we're going to still see continued spread if there indeed is a lot of virus in the city, which we have reason to believe there is. And so I think the burden of responsibility on government and on leaders to really communicate in a clear and compelling way what has to be done, I think is much greater in society here. But with that said, I do think that there are moments when the national interest is threatened where we have to ask ourselves what trade-offs are necessary in terms of individual liberties to protect the national interest. And we make these decisions all the time. For example, we don't say that individual liberty means that you can drive whatever speed you want on the highway. We've also said that individual freedom doesn't mean that you can drive without a seat belt. We've made mandatory seat belt laws a thing in states all across the country. So as much as we may pride ourselves on being a country that preserves individual liberty, we have made thoughtful, calculated decisions in many occasions on what trade-offs are worth it for our own benefit and also for the public benefit. And I think when it comes to epidemic responses, what we're going to have to do in the aftermath of COVID-19 is I think have a much deeper discussion about what kind of trade-offs we need to make to make sure that something like this does not wreak the kind of havoc on our country that it very well may and seems poised to do. And if that means that we may need to consider contact tracing and our location tracing as part of what needs to be discussed, then we should have that discussion. I'm not saying that everyone should give their data over to the government, but these are the conversations that we need and debates that we need to have.

Governmental power, political polarization, and 9/11 (53:48)

We also have to ask ourselves what kind of power we want to give to different levels of government, like what should a local government be able to impose in terms of restrictions on your movements, what about a state government, what about a federal government. So these are tough and complicated questions, but I think part of the challenge we have with difficult issues in the modern-day setting in the United States is that when things are difficult because of the polarized environment in which we live, we tend to move on and just focus on other issues. So we don't deal with climate change because it has become a politically polarized issue. We don't deal with many aspects of healthcare because they've become politically polarized. And I think that if we really want to overcome that kind of polarization, we actually have to do the opposite of what we hear recommended a lot. I live in Washington, D.C., and I hear many pundits say, "Well, what we really got to do is get people with different views in the same room, have them really talk to each other and understand what their points of view are, and then maybe they can find a point of agreement or convince each other." That really never works. The way people overcome these barriers, the way they sort of bridge the polarization that they're experiencing right now is actually by building relationship first. That has nothing to do with the actual issue at hand, whether it's climate change or gun violence or reproductive rights. But when we build a relationship with each other, we're better able to talk to each other and listen to each other. That's why many of us who may have an aunt or an uncle or a grandmother or grandfather who has views that we find to be disagreeable and despicable, we can still have them over for Thanksgiving dinner. We still want to have them over. We can still respond if they're in an accident because we deeply care about them because there's a foundation, which is the relationship on which we're building our conversations. The problem right now in America is increasingly we don't have those bonds between each other. We don't have those relationships to build conversation and discussion on. So what ends up happening is we're having discussions about polarized topics with strangers who are easy to caricature, and those discussions don't often go very well. That's reflected, frankly, with what's happening in Congress, where members of Congress increasingly don't have relationships with each other. It makes not a surprise that it's harder for them to come together and broker real solutions for the larger public. I've been thinking quite a lot about this polarization and what at least temporarily can suspend or make irrelevant that polarization. 9/11 would be perhaps one example. These acute losses of life, these very graphic events that seem to unite people at least temporarily to take certain steps.

Could COVID-19 act as a catalyst for bringing people together? (56:55)

Pearl Harbor probably another fantastic example. The Japanese attempt to destroy Pacific Fleet, underestimating dynamic qualities and variables that could change when the United States united and suddenly changed all of its production and so on to then later turn around and exact vengeance a thousandfold. I am on some level darkly optimistic that, I mean this sounds terrible, but anticipating that there could be something that graphic and awful, particularly given the nature of every cell phone having a video camera and still camera embedded that would perhaps suspend the polarity, the political polarity long enough to take really decisive action. Do you think there's anything that comes to mind as it relates to COVID-19 that could act as such a catalyzing event? I mean, what would it take if anything comes to mind to temporarily give us a political ceasefire so we could take really decisive unified action? Well, I do think, Tim, that COVID-19 could be a catalyst for greater unity and for stepping back from the polarization. And part of what gives me hope is that I'm already starting to see that happen here and there in communities across the country as people reach out to each other and help each other. As people check in on neighbors who are struggling now without anyone to help them because they're alone. I've seen, even on a local level, even though this doesn't get a lot of press, I've seen local officials step up and put traditional partisan issues aside to work together because they recognize that there's something much, much greater at stake and much more urgent, which is the lives of the people that they're there to serve. And so I do think it can happen. What I worry about is this. Does it always have to take a crisis, particularly one that involves a loss of life and great suffering, for us to realize that we truly need each other and that we need to come together and put our collective well-being over our individual interests? I hope it won't always take that, but I do think that given the magnitude of what COVID-19 has already done and what it stands to do to the United States and to the world, that this could be a wake-up call. This could be an opportunity for people to come together. The real question, though, Tim, is will they stay together? And if you look back at 9/11 and at many of the tragedies we've experienced as a country, we do come together, and what we see in those moments is, I think, the actual, authentic, intrinsic human spirit, which is a spirit of togetherness, a spirit of interdependence, a spirit of compassion and generosity and joy. But that gets quickly eroded as we settle back into our day-to-day lives. And there are many reasons why we settle back, and there are forces, I think, in the messaging we see in media and from work and in the larger culture, which keep pulling us back, I think, away from a focus on relationships.

Workplace Culture And Interactions

Our greatest foundation for joy, fulfillment, and health (01:00:33)

You know, Tim, what I find interesting is if you and I went to a street corner in any major city in the United States and we pulled 100 people aside and we asked them all what their top priority in life was, I can almost guarantee you that all of them would have a person as their top priority, maybe their spouse, maybe their child, maybe their mother or father. But if we look at how we live our lives, if you look at where we put our time, energy, and focus, if you look at what society tells us constitutes success, it's actually very different. Like the message that society sends us, and in particular that young people get through various forms of media, is that success is driven by your ability to acquire wealth, power, or reputation/fame. And if that is what worth is connected to, then we'll build our lives around that. That's where we'll spend our time. That's what we'll be thinking about when we go to sleep at night. That's what we'll invest our energy in. But in reality, I think what gives us the deepest joy and fulfillment in our life is actually our relationships. And when I think back on the people that I had the privilege of caring for in the hospital at the end of their life, I think a lot about what they talked about in those final days. And what they talked about were not the promotions that they received or how big their bonuses were. They didn't talk about how many followers they had on Instagram or how many friends they had in the world. What they talked about really were the quality of their relationships. They talked about the people they loved, about the relationships they wish they had spent more time with. They talked about the joy that the people in their life brought them. And I think that is a very powerful signal to us of what really matters. That's not something that I'm seeing. That's something that people in all walks of life who spend time with people in their final days, this is what they focus on. They focus on people. And so I think that if we want to ultimately address the deeper issues we're facing as a society, whether it's the polarization we're dealing with, whether it's the challenges we face on the health front with chronic illness, particularly with mental illness and with addiction, I think we have to ask ourselves, what role does social connection and loneliness play in the outcomes that we're worried about? And what I have found over the last few years in thinking about this issue and talking to people who have studied this for a lifetime, in hearing and listening to the stories of people all across the world who have struggled with loneliness but who have also built lives a rich social connection, is that it is our relationships that are the foundation on which we build everything else. Good health, fulfillment, and a good life.

Fostering connection in the workplace (01:03:32)

How would you suggest, because we've been discussing, we've sort of zoomed from the macro into the micro, which is where I would like to stay for a bit, rather than looking at the federal level, let's talk about a company. If you're talking to a CEO or a C-suite or a leader of a large group of people within a company, what are things that they can do to help improve the sense of connectedness or worth as a sort of counterweight to loneliness, which I think is a challenge for a lot of people and will increasingly be a challenge for a lot of people, certainly over the next few weeks. And therein lies an opportunity to sharpen the saw as it relates to developing countervailing or counterbalancing forces opposing isolation or loneliness. So what types of tools or advice would you suggest with business leaders, people who run companies, whether it's five people or 500 or 5,000? I'm really glad you asked, Tim, because I think that the workplace is an incredibly powerful place for us to cultivate human connection, and I think when we don't have workplaces where people feel like they have strong relationships, that has a measurable impact on productivity, on retention, and on overall satisfaction at work. There are some fascinating researchers who have been working in this area, including Segal Barsed at Wharton, who have found that loneliness in the workplace is just as common as it is in the general population. Somewhere around 20-25% of people in the workplace seem to struggle with loneliness, and the consequences are substantial. So whether you care about the bottom line or you care about the happiness of your employees, loneliness and social connection matter. And I think there are a couple of things that we can do in companies that would really help. I think one is to create opportunities for people to really see and understand each other for who they are beyond the roles that they play in the workplace. All of us have a fundamental desire to want to be seen for who we are, not just as Tim, who's great at pricing strategy, or Vivek, who's good at, God, I don't know what I'm good at, not sure, but we want to be known for more than a skill set. We want to be known as human beings who've got a story. I'll tell you one example of something we did when I was a surgeon general, is we created this exercise called the Inside Scoop exercise, and we did this when, after a year of working really hard to try to create a family environment in the office, we realized that people still were not as connected as they could be, despite all of the weekend picnics and the happy hours and all of that. Quick question before we get to the practice, the Inside Scoop, how did you ascertain that you had that problem? Does that make sense? How did you diagnose that or observe that before we get to the Inside Scoop? I want to get there, but I want to also know how you diagnosed it, because I would imagine there are plenty of business leaders who think everything is just hunky-dory going along swimmingly, whereas in fact, it is perhaps not. So if you could speak to that. Yeah, so you know, what we didn't do is we didn't have a very specific survey tool that we used to assess in a quantitative way whether people felt connected or not. Those kind of tools actually exist, but we didn't use them. What we were going on was actually a much more simple observation. From my perspective, I was observing the office and feeling that people were not stepping out of their lanes enough to help each other. Now, that's a voluntary thing. It's not their job description to help someone else with their job. But it wasn't happening to the extent that I thought it should be happening, and I started to wonder why. And to me, when I think about the workplace, a lot of my thinking comes back to the model of the family. In a family, people help each other. Why do they help each other? Because they feel a sense of commitment and connection to each other, because they know each other deeply. So even if somebody messes up, there's a deeper well of knowledge about who that person is that makes you more likely to forgive them and to give them the benefit of the doubt. In a workplace, I think you can ideally create a similar kind of environment. So the fact, though, that people were not stepping out of their lane enough to help each other made me think that their connection to each other was not as strong as what we wanted it to be.

The Inside Scoop exercise (01:08:23)

And so this Inside Scoop exercise that we instituted was actually very simple. We used five minutes in our weekly all-staff meeting where we picked one individual and we asked them to show us pictures for those five minutes, pictures of anything they wanted, except it couldn't be connected to the work that they were doing right now to their current job. So some people showed examples of careers they had before. Others showed pictures of their families. People picked what they wanted. What was really powerful about this, despite how simple it was, is it gave people a chance to share who they were without any pressure in the sense that we weren't telling them to fill some criteria, to generate some sort of response, to have a list of questions that they could pose to the group. There was none of that. It was just very simple. Show us something that you'd want us to know about your life. I'll tell you the one gentleman in particular who was my aide de Camp and was in the Marine Corps prior to joining the Public Health Service, we all thought that he might show pictures of his time in the Marine Corps. He had a strong allegiance to the Marine Corps. He talked about his experiences there a lot. He was also very stoic. He still had the same crew cut and haircut that he had in the Marine Corps he had maintained over all those years. He was what people in the office called a guy's guy. When the day came, though, for his exercise, he didn't show pictures of his time in the service. What he showed were pictures of his mother and pictures of his father. He said that he could see the musical talent of his father living on in his children as they tinkered with the piano. He said with his mother that when he was in those moments of grave danger in the Marine Corps, when he was deployed on missions where he wasn't even sure if he would come back alive, that in those moments when he felt the fear rising in his stomach, that it was his mother that he would think of because she was his picture of strength. She had raised him and his brother largely on her own. She had fed them and clothed them and got them an education and helped them build a successful life. That, to him, was real strength. When he shared that story to him, it was so deeply moving. That five minutes of sharing built relationships that we had not built over the past year. Within a few weeks, we started to see people stepping out of their lanes and helping each other. We started to see people who had previously been quiet in meetings start to raise their hand and participate because they felt that they were seen and that they were appreciated for who they were. That was a very powerful moment for us. There are workplaces that can create opportunities like this, semi-structured opportunities, for people to share more about who they are. That is very powerful. There's one other thing, Tim, that I want to mention also, which is that there's great power in helping each other in the workplace. One of the stories that I came across when doing research on loneliness was the stories and the research of a gentleman at the University of Michigan, Wayne Baker, at the business school there, who has done a lot of work on relational energy, on understanding what our interactions with other people do to the energy we feel and how that energy translates into productivity in the workplace. One of the things that he has found is that high-quality connections, which can be lasting friendships or momentary interactions, both can be extraordinarily powerful in raising our energy level. One of the things that really boosts that relational energy is the experience of helping someone else, but also the experience of receiving help from someone else. What he did is he, along with Adam Grant and a few others, put together a structured tool through a company now that they've built called Givitas, which allows organizations to have an organized setting where people can be a part of a community, where they submit a need that they have and other people can submit answers or offers of help to meet that need. You can do this online. You can actually do it in person and regular gatherings in groups and companies. The point is that the experience of being able to identify people's needs and then have people step up to meet those needs in a structured way can be extraordinarily powerful and can significantly boost relational energy. But the final thing, Tim, which is hard to put into a specific protocol has to do with culture in the workplace. Creating a culture of kindness and compassion is extraordinarily important if you want to build human connection in the workplace and have people build strong connections with each other. That is not something you can just put on your mission statement or your value statement, stamp it on the wall and just hope it happens. That's a place where leadership by example really matters. People, despite all the cynicism that we have in the world, people still do look to their leaders for examples. When the leaders in organizations treat each other with kindness, when they look to people throughout the organization, give them time and actually listen to their concerns honestly and empathically, that makes a difference. People take note of that. And so I think these are some areas that can be extraordinarily powerful in the workplace in terms of how we build connection, creating opportunities for people to see each other for who they are, creating opportunities for people to give and receive help, and helping to build that culture of kindness and compassion through example and through practice. These, I think, are the key ingredients to building a connected workplace.

Finding the quiet voices at work. (01:14:23)

I love the Inside Scoop exercise and I have a question about the specifics in one respect because I want to try this and I will try this with my employees. I am lucky in the sense, well at least in one sense, that I have a very small team. How many staff members did you have in these all-hands meetings? So these meetings were meetings of our immediate office, so there were about 20 people. How did you pick the people who would go or how were they chosen? The goal was to go through everyone in the office, but we started with the people who as we saw it were the least seen in the office, either because they were the quietest or because they maybe worked from home often and people didn't see them very often. So that's how we started. Hmm. Makes a whole lot of sense. And the company you mentioned, I believe, co-founded by Adam Grant, if I heard you correctly, is that Givitas, like gravitas? Yes. Okay. Could you spell that? I can take a stab at it. Sure. Yeah, if you wouldn't mind. Sure. We'll put this in the show notes as well so people can find it, but just so that people know the spelling. Yeah, so it's G-I-V-I-T-A-S. Alright, we will put that in the show notes for everybody at Tim.blog/podcast along with everything else. If people wanted to poll their employees or ask questions of their workforce, are there any questions that you would suggest?

Questions to ask your team to check the pulse. (01:15:46)

I know that that's not how you approach this. You were basing it more on the observation that you described, but are there any questions or tools that you would suggest for people who want to check the pulse of their team? So a couple of things I would suggest. If you were looking for an actual survey, the Gallup organization actually does polls around social connection in the workplace, and you can look to their questions as a survey tool that you could use. The other survey tool that you could use is the UCLA Loneliness Scale, which is a different version of it. There's a 20-question version of it. There's also a three-question version, both validated tools, but that may give you a sense of how much loneliness there is in your organization. If you were looking for one or two simple questions, one of the interesting ones that has actually been found to be quite useful as an indicator in the Gallup polls has been the question, "Do you have a best friend at work?" It turns out that people who do not have a best friend at work, people who answer that question know, have significantly lower engagement in the workplace, and that engagement is tied to productivity at the end of the day and also impacts how people feel about the company and their colleagues. I'm writing it down. I promised earlier, lest I get chastised by my listeners, that I would ask you about anchors and remember your anchors. Could you please speak to what "remember your anchors" means and also describe your anchors and why they're your anchors? That's so interesting you're asking me that. Can I ask you where that question came from, Tim? Yeah, the question came from homework. I was reading a Forbes piece, and that is where the mention of anchors came up. But you can't believe everything you read on the internet, so perhaps I have been reading an interview of Victor Lake and mis-attributing. But I'll read what I have in front of me, and we can use that as a jumping-off point. I know what you're talking about. That was actually Vivek Murthy, not Victor Lake, so we're on solid ground here. Perfect. Tim, "remember your anchors" is a piece of advice that I developed to remind myself, actually, of often when I was in residency. When I was in residency training, it was a really intense experience for me. I was both dealing with life and death every day. I was seeing people who were gravely ill, who were my age, and who very well could have been me. I was also, though, trying to figure out a lot of stuff in my own life. I wasn't sure what I wanted to do. I was kind of going through yet another identity crisis of trying to figure out, do I want to be a doctor 100% of the time? Do I want to be something else? So I was trying to figure out a lot of stuff, and I was dealing with a tumultuous, sort of intellectual and emotional experience. And in that very unsettling, ungrounded time in my life, I found that what I really needed was some force that would ground me in my life. And I began to think of those as my anchors, the forces that would keep me tethered, that would make sure that I didn't float off in these moments of hopelessness and worry and anxiety. And those anchors ultimately were people in my life. They were my mother and my father and my sister. They were a few close friends, like my friend Akhil, who was my roommate in college. These became my anchors, and what I tried to force myself to remember in the years that followed well after I finished residency is that I need to be keeping track of whether or not I'm remembering those anchors and reaching out to them and staying connected to them.

Intrusive notions that can arise when your identity is tied to your position. (01:20:07)

Because at times in my life where I have felt anxious and worried, the times where I've felt just lost, frankly, of which there have been many, including very recently, those moments are often when I've lost touch with the people in my life, the people who are really the ones who know me almost better than I know myself, the people who can remind me of who I am even in those moments when I forget. And I want to say that last part again, because that to me is a true definition of a friend. And this came from somebody that I spent some time with in college on an overseas trip to India to do HIV work. And in one of these late-night philosophical discussions, I just happened to ask him, "Hey, man, what do you think real friendship is about?" And he said to me, just pause for a moment, he said, "A real friend is somebody who reminds you of who you are even when you forget." And that has stuck with me. And those people are our anchors. They're the mirrors that we need during moments in our life when our vision is foggy and we can't really see our way out of the fog and we don't know who we are, we don't know where we want to go, we're just lost. And so anchors, to me, those are people, those are relationships, that's what we've got to hold on to regardless of what stage of life we're at. It is easy for me, at least, to forget who I am. It's easy to lose the plot. I suppose there are probably shared characteristics that typify the episodes in which that's most likely to happen. You mentioned a recent experience of feeling lost. What was that? What happened or what caused that feeling to come up for you? Well, it was when I ended my stint in government, when I was no longer a surgeon general and I was back to being a civilian and I was trying to figure out what to do with my life. That was a time of real difficulty for me. I was lost, I was lonely, I was probably depressed, I was unsure if I had any value to contribute to the world. And if I did, I was unsure how to actually deliver that value. It was a really hard time. And part of it was that, and I even told myself this during my time in office, I was like, I'm here as a custodian of an office and I'm the custodian of the office of the surgeon general, but the surgeon general is not my identity. That's not who I fundamentally and intrinsically am as a human being. It's an office that I'm occupying. But despite all of those warnings and admonitions, if you will, there was still a shift in identity that had happened to me when I was in office. Where I think almost just by necessity, I don't want to say we, I should say I took on the trappings of that role and came to identify very strongly with it. I wanted to be a good shepherd for the office. I wanted to set the office up to be stronger for the person who inherited it after me. I wanted to do those things, but it became kind of part of who I was. And when I was no longer surgeon general, which happened, I mean, we're being open here, it happened in a fairly traumatic way, which I'm happy to delve into if you'd like. But when it happened, it was difficult to sort of process all of that and there was a part of me which felt like because I no longer occupy that office that somehow people wouldn't want to engage with me. Or maybe they wouldn't think that I had any value to add the word to the world. Or maybe the same very things that I had said back then, if I said them again, would somehow be less valuable because they were not coming from somebody who held that position. They were all of these thoughts, often irrational thoughts, that were going through my head. And it was really, really hard, Tim. It was one of the loneliest times I've had since my childhood.

Trauma And Healing Through Connection

Why the transition was so traumatic. (01:24:28)

I want to ask you how you found your way through that or out of that, the things that most contributed. Certainly, there might be a component of regression to the mean, but I would love to ask you about pieces of the puzzle that you found particularly helpful for getting through that period. But just so my listeners' minds don't run wild with all sorts of imaginative scenarios, could you speak briefly to why the transition was so traumatic? You don't have to share, of course, any detail you're uncomfortable sharing, but I do think a little more context would be helpful. And frankly, I'm also curious myself because you and I haven't spoken about this. No, we haven't, Tim. Yeah, so I'll tell you. So the office, the Surgeon General is an unusual appointment in government in that it, even though it's an appointment made by the president, the term does not end when the president leaves office. So the vast majority of political appointments will end on January 20th when the new president takes office, and you submit your resignation letter, and then you move on and you give the new president the opportunity to appoint their people. That's how it works. But there are a few positions where that doesn't happen. They are called term appointments. So you're given a four-year term, and that may run into the next administration, but you serve that term, but you still serve at the pleasure of the president. So if the new president comes in and they say, "You know, I've got my own person that I want to appoint, and I would like you to step down," then you make room for the new person. So the Surgeon General is not the only position that's like this. The FBI director is another. There are several in the federal government that have term appointments. In my case, what had happened is that my term technically ran until December of 2018. There was a new administration that started in January of 2017. And for various reasons, I knew that it was a possibility I might be asked to leave. And if it came to that, I wanted to make room for the president's pick. But the way it sort of happened was a bit surprising to me because there was—it was one of those things. There was really no discussion sort of about it. Often there is. But it was sort of in the early days, you know, probably four months in, three, four months into the administration, where things were still a bit chaotic. People were finding their footing and figuring out the building. So one day I had a meeting at, I believe it was three o'clock on a Friday in April. And I was supposed to be meeting with one of the assistant secretaries. And I walked into the room and the assistant secretary was sitting on the side, not in his chair. And I was surprised, but there was somebody else sitting in his chair. And he said to me, he said, "Well, you know, as of three o'clock, you know, we are going to terminate you unless you resign right now." And I was puzzled because the same person who was in that chair had actually—I had had meetings with him before. And he had said, "Hey, we're really excited to work with you on your opioid initiative because the opioid epidemic is a big problem. It's a bipartisan issue. And we know you've been doing a lot on the issue. You've been leading a lot in the country on it. And we think this is going to be an area of collaboration." So I was thinking to myself, well, yes, you know, it would be great to work together on that because it's still a huge issue for the country. So I was gearing up to keep working on the opioid crisis. So I literally did not expect that message, nor did I expect it from this person. And so I looked at the clock at that moment, and it was 3.07. And I said, "Wow, if I would mean terminate as of three o'clock, then that means that I'm already terminated. So I guess there's no point to having a discussion." But he seemed insistent on trying to get me to resign. And so it was this sort of awkward back and forth where I said, "Well, you know, I respect the president's decision. The president would like me to move on to bring his own person in." I said, "But it feels like it would be inauthentic for me to resign and try to claim that I wanted to spend more time with my family or something like that." It didn't feel authentic. It didn't feel like it was real. And I said, "You know, with respect, if you want to pursue a termination and if you want to appoint your own person, then just do that. It's within your rights. No one's going to question that. It's fine." And that's how I left. And so it was abrupt. I never had a chance to say goodbye to my team. And I didn't have a chance to kind of, you know, process what all of this meant. So it all happened very suddenly. I remember going home and I had a few minutes to pack my belongings into a box. And I got into a cab and started going home. And you know what my first worry was that popped into my head on the way home was, "What are we going to do for health insurance for our baby boy?" Sounds like a difficult, difficult ride. It was. It was. Yeah. It was.

What credits and critiques do people have today? (01:30:00)

And I was aware in that moment, Tim, that what I was worried about then in terms of health insurance for our boy and for the family was a worry that a lot of people have around the country every day. We're teetering on the edge of not having the health care they need. But in that moment, you know, I was just a dad who was worried about his child. And there were a lot of practical things to figure out in the days that followed. One thing I didn't really do in those early days is, as I busied myself with trying to figure out a lot of the logistics, is I didn't really, I think, fully give myself the space to process everything that was happening. To sort of re-anchor myself, not just in my identity, but in the people in my life who had for so many years helped me to remember what my real identity was. That my real identity wasn't being a doctor, it wasn't being a surgeon general, it wasn't any of the titles that may have held at other points in my life. My real identity was the human being I was as a friend and as a brother and as a son to the people that I loved. It was the values that I cherished in my better moments, the values of compassion and kindness, the values that are intrinsic to all of us, I think, in our best moments. Like, that was really who I was. That was my identity. But I didn't give myself enough space and time and frankly I didn't, I think I blamed myself also for what had happened in some way. Even though on a rational level I knew that it wasn't my fault per se, I think I blamed myself somehow maybe if I had done things differently. I maybe still would have had the opportunity to serve and to finish so many of the campaigns that we had been building around the opioid epidemic, around loneliness, around emotional well-being. And you know, I was doing all of this, Tim, in the absence of community. It wasn't because my friends had shunned me. It was more the other way around. You know, during my time in office I had convinced myself that it was so important to pour myself into the job because I never knew how long I might have and I wanted to do as much as I could and make as much of a contribution as I could. And I convinced myself that I should just leave it all on the floor and sacrifice everything for that, which meant not keeping up with friends, not talking as often with my family. And also, I'm somewhat ashamed to say, meant that a lot of times when I was with people I loved I was distracted, just trying to keep up with messages and get deliverables out the door. And I look back on all of that and I started to realize what a toll that decision, that approach to my work had taken. I started to realize how lonely I had become and how little community I actually had. And so I had to live with that for a while. I had to figure that out. And it was not easy. It was painful at times. I felt ashamed, you know, of having done this. I knew I could just call up those friends and reconnect again. These are friends for life. But I felt embarrassed that I had disappeared for a few years.

How did Vivek find his way out of this trauma? (01:33:27)

And it took some time for me to summon the courage to reach out and to actually pull myself out of my shell and my sort of downward spiral to just say, "Hey, let's just pick up the phone and call a friend. Let's make it a point to go visit." You know, somebody who's been really a dear friend to me for years but I haven't seen. And doing that bit by bit, Tim, that helped.

The power of honest, authentic relationships. (01:33:54)

There's another pact I made actually during that journey with two friends in particular when we met at a fellowship retreat. We were walking around this lake together and these are two guys I love to death and they're like brothers. And we never see each other that very often because we live in different cities and we were just saying how awesome would it be if we could just get together more often. And I was like it's never going to happen unless we do something different. So we made a pact then. We said, "You know what we're going to do? We're going to once a month we're going to video conference with each other. We're going to make that commitment right here, right now to each other. And when we video conference, yeah, we'll have fun. We'll shoot the breeze here and there. But we want to make it to a point to talk about the hard stuff with each other. The stuff that doesn't normally come up between friends. We want to talk about our health. We want to talk about our relationships. We want to talk about our finances. The kind of stuff that everyone worries about but that not many people often feel comfortable talking to friends about. But we want to be real with each other. And I felt this hunger for that kind of realness. I was like I'm tired of trying to think about who I should be. I'm tired of thinking about what my identity is, what my brand is, what brand I should build. I had all these people afterwards telling me, "Okay, you've got to get on social media and really build your presence. You've got to establish a brand so that you can get consulting gigs and get on boards and do all this kind of stuff." And I just felt so unhappy with that kind of approach. It just didn't feel authentic. It didn't feel real. It didn't feel like who I was. And what I created was that realness. And so when I saw these guys, I was like, "Let's just make a commitment to not just spending the time but to be real with each other." And we've done that now for about a year and a half. And I'll tell you it's been one of the most powerful forces in my life at helping me re-anchor, remember who I am, what my real identity is. And commit to working on the things that truly feel like they're in alignment with my values. The stuff that I would be proud to tell my children about when they grow up.

The paradigm around strength and dependence in this country. (01:35:56)

That's the power of what honest, authentic relationships can do. And I'm just so grateful for it. I really appreciate you being so vulnerable and transparent with all that you just shared. I think it's really easy speaking as someone, I shouldn't generalize, speaking personally as someone who's struggled with depression during which the response to feeling lonely and isolated is often to isolate further which deepens the feeling of loneliness. As you said very early on in this conversation, it is a prominent feature of, I think, or common experience at the very least, of the majority of humans who walk the face of this planet. It's not a reflection of being uniquely flawed to have these emotions and to experience these episodes. And I just applaud you for sharing because it's so incredibly powerful when someone like yourself who, even though you don't necessarily identify as such, who has achieved very high levels of success in multiple areas, former Surgeon General, are willing to share that in fact you also have gone through these experiences. I think in a way ennobles and normalizes that experience for other people. So I really appreciate you sharing all of that. And it actually leads to a question for me, maybe a comment and then a question. So I was doing homework, as I always do, for this conversation. And before I get to my comment and my question, I'll give a pre-comment comment, which is, you should, if you don't already, I feel like you could impact millions of people very effectively and authentically with a podcast. So to be continued as far as conversation, you may already have a podcast and I'm just putting my foot in my mouth, but quite a number of people have been on this podcast, Jaco Willink, Cal Fussman, Peter Attia, and others who have started podcasts. And I so far have a 100% success rate at predicting which guests can do well in this format. So to be continued and we can chat more about that if you ever wanted to. Thanks, Tim. I'd love to. Of course. And the comment is related to a Washington Post piece. This is from 2017. And I'll quote here, please feel free to fact check, of course, but this is attributed to you. I was at a well-known university about nine months ago when I was in office and I asked an audience of 400 faculty and students the following question. How many of you look at emotions as a source of weakness versus a source of power? And nearly every hand went up. This is the paradigm we have to flip in this country. Could you comment on that, please, or share anything that comes up as I mentioned that? And also speak to how you, if you have been able to view your own emotions as a source of power. Yeah, Tim, you know, that was a surprising moment for me. And when I saw all of those hands in that room of 400 people going up saying the associated emotions with weakness. And I think one thing I've noticed in my own life is that I have been in that camp often as well. If I think about growing up and the messages that I absorb from the stories that were around me, whether those were on TV or told by people or in movies. It was that especially if you're a guy, that strength is associated with suppressing emotion. It's associated with stoicism and with not needing other people, not being dependent. That's what strength is. And what I realized is that that didn't work for me. Like I didn't enjoy being the guy who's out there and didn't need anyone else for anything because I actually did need people for stuff. But I just felt embarrassed to say that because I was told that somehow that wasn't manly or wasn't strong. Similarly, in terms of emotions, I have always been an expressive person. I've always thrived on emotions. I've engaged in intellectual pursuits, but I know I'm primarily driven by emotion. And I feel like that has been my source of power, not a source of weakness. In thinking about this and in talking to others about it, I've just realized that our emotions are not a source of weakness. They are, in fact, if used well, our greatest source of strength. Like when you look at an elite athlete, for example, you look at someone like Serena Williams or LeBron James, people I don't know personally, but I'm using them as examples. My guess would be that they recognize that the difference between good and great is not just how much time you spend in the weight room or on the treadmill. It's about your ability to translate your negative emotions into positive emotions, into a source of power. And that's what we do in our better moments. Like you look at parents, for example, who go through extraordinary lengths, even putting themselves in harm's way for their children. It's because that's driven by the emotion of love, an emotion that's far more powerful than anything else, I think, that we have out there. Our emotions are our greatest source of strength. And so I think part of what we have to do as a country, especially for our boys, but especially for boys and girls, is we have to redefine strength as vulnerability, as human connection, as belonging, as emotion. If we recognize that strength can be drawn from those moments of emotion and vulnerability, then we can draw upon, I think, one of the greatest resources that we actually have. You know, it struck me many times when reflecting on my own life and thinking about others that it seems like there are two primary forces that drive us in our life and that drive the decisions that we make. And those forces are love and fear. And fear shows up in a bunch of different ways. It shows up as insecurity or jealousy or rage or anxiety. And love also shows up in different ways as compassion, as kindness, as generosity, as warmth. And when we lead with love, then we can transform other people's lives, we can transform the organizations that we are leading. When we lead with fear, then that's corrosive. It infects the environments in which we work and the people around us. And when we think about the decisions that we make, as I have in recent years started to do, I ask myself that question, "Am I making this decision because of love or fear? Am I making this decision because I'm scared of something or because I'm being inspired by compassion or by generosity or by kindness?" And I find almost always, if not always, when I make decisions that are driven by fear, they rarely make me feel good. They often lead to poor outcomes. But when I make decisions that are driven by love, even if they're risky, even if the outcomes are unexpected, I almost always feel better and I almost always grow in some way as a result of those. I mention this in particular, Tim, because I think it is so important for us as a society to be able to talk not just about emotions but about love. Because love is the greatest source of strength that we have. You know, I as a doctor have written many prescriptions for powerful medicines and antibiotics, but there is no medicine that's more powerful than love. And you don't need a medical degree or to be a nurse to be able to deliver the power of love to other people's lives. What you need is the very human and universal ability to respect and be in touch with your emotions, to summon what's already inside you, and that's the power of love.

Dr. Murthys new book, Together: The Healing Power of Human Connection in a Sometimes Lonely World. (01:44:45)

Well said, sir. And I cannot think of a better possible time for your new book. And I say that with the utmost sincerity. I mentioned it earlier at the very top of the show, but together, that's the title, subtitled "The Healing Power of Human Connection in a Sometimes Lonely World." I feel like this is, along with the message that you just shared, possibly very good medicine for our times, certainly with what we're facing, which is in some ways just bringing to the surface and magnifying that which is already there, I feel. The loneliness, certainly. A pervasive loneliness. And I would love to hear anything you'd like to say about the book. It's a hell of an undertaking to write a book. You know Tim. I do. I specialize in writing phone books, for God's sake. So to write a shorter, less-than-phone book is even harder, since one could argue that I should better edit my own writing. And I'd love to hear anything you'd like to share about the book and why you would pursue such an undertaking, given what's involved. You know, Tim, this is not the book I thought I would write. I had a couple of ideas for other books that I was convinced would be the places I should focus on. But a funny thing happened to me. In 2017, in the summer, I wrote an article for the Harvard Business Review on loneliness in the workplace. And I wrote it at the request of the editorial staff who thought that their audience would be interested in loneliness. I said, "Are you sure?" And they said, "No, we're not sure, but we think it would be of interest." And I wrote that article thinking, "Okay, I'll do this and I'll move on to the next thing." But I was really struck by the response to that article from two groups, from members of the media who said, from around the world, who said, "Hey, we think this is a problem in our country," to the messages from individuals who said, "You know, I've been struggling with loneliness for a long time, but I never knew that there were so many other people out there. I never knew what the consequences of loneliness were to our health." And even despite that response, the universe kind of had to whack me over the head a few times to make me realize that this is actually where I should be putting more of my efforts. Because even during my time in office, it had just kept surfacing again and again, this issue of loneliness. The stories that I would listen to in living rooms and in town halls all across the country, they were stories about addiction. They were stories about trauma and abuse, stories about chronic illness and about violence in communities. But in the back of those stories, almost hidden from view, were these threads of loneliness that would often come up. And what people would say was not, "Hi, I'm Tim. I'm struggling with loneliness." What they would say were things like this. They would say, "I feel like I have to deal with all of these issues in my life on my own. I feel like nobody out there really cares about me. I feel like I'm invisible." These are the kind of things that people would say again and again. And what I come to realize over time is that loneliness is more than a bad feeling, but it has real consequences for our health. And if you look at the research that's out there, you find that loneliness is associated with a shorter lifespan. You find that it's associated with an increased risk of heart disease and dementia and depression and anxiety. The mortality impact, if you will, of loneliness is similar to the mortality impact of smoking. Fifteen cigarettes a day, it's greater than the mortality impact of obesity or sedentary living. These three issues, smoking, obesity, sedentary living, these are issues I spent a lot of time on as Surgeon General and so do my predecessors. I spent far less time on loneliness, even though the health consequences are quite significant. And I just started to think about this issue more even after I came out of office. I started to realize that this is an issue that doesn't just affect our health. It affects how we show up in life, whether that's how we show up in the workplace or how our kids show up in school or how we show up in the public square in dialogue with other people. And so it turned out that our social connection is in fact the foundation on which we build everything else. And I came to see that I wanted to work on strengthening social connection in the world because if we could do that, I really feel that we have a better shot at improving people's health, at enabling them to live the kind of fulfilling lives that all of us ultimately really want. But I think to do that, to build a world that is powered by human connection, we've got to make some difficult and very intentional choices about the kind of culture we want to live in and about the kind of workplaces and schools that we want for ourselves and for our children. And if I had a credo, Tim, for this book, it would be this. It would be put people first. That simple philosophy, put people first, is I think at the heart of what we need to build a people-centered life and a people-centered world. And that's the kind of world where we put our time and energy into our relationships. It's where we design our workplaces and our homes and our lives around relationships that matter. It's where the dominant culture, whether that comes through in the media or in the stories that we tell, recognizes the power of relationships and inspires us to be real with ourselves and with each other. It's where a culture that recognizes that it's when we're authentic and when we're vulnerable that we build the true connection that powers everything else that we do. That's my hope for the world. That's my hope for my children and the kind of world that they will inherit. And one of the things that pains me most as a dad is thinking about the moments where my children may encounter hardship or pain and knowing that I may not always be there to support them or to hold their hand or to hug them. I know that that will happen. Every parent deals with that pain of knowing they can't always be there for their child. And that's why I think it's so important that we build the kind of world that will lift our children up when they fall down, where people will reach out to them when they're feeling alone to provide them with the support that all of us need at various moments in our life. So what I'm talking about is not a subtle change in policy. It's not a new law that we pass that suddenly changes the nature of human connection. This is a fundamental shift in how we think about our lives and how we think about our institutions and how we think about society. But it's the kind of shift that puts people back at the center and I think can ultimately power us to a much, much higher level of fulfillment and achievement than what we've achieved so far. And that's what I want to do, Tim. You know, I want to work on things that will build a better life and a better world for all of us and for our children. And if I can contribute in some small way to that, then hopefully I can in the final days of my life, like the patients I cared for at the end of theirs, I can talk about the relationships that I had. I can talk about the kind of world that I hopefully made some small contribution to help create and that would feel very good.

Closing Remarks

How Dr. Murthy fosters inspiration by putting people first. (01:52:34)

Well, Vivek, I must also say thank you for not only the conversations that we've had, including this one, but also for your emotional support and compassion. Last week, in my case, you're a deeply compassionate, kind, and also calm and calming person. And I appreciate you last week when I had a fever, shortness of breath, and dry cough for 24 to 36 hours. Then shortly thereafter, sort of coinciding my dog having what appeared to be exactly the same symptoms that you were so available and understanding, as of course we ended up rescheduling given that I was feverish and not in a proper state of mind to conduct a good interview. So I want to also just publicly say thank you for that, which is a sort of microcosm of the macrocosm in the sense that it's reflective of what you are hoping for and aiming for and helping to foster with your, certainly your message and also the book, which is together. And I just appreciate you being you. So thank you for both the personal help and also what you're trying to do in the wider world. Well, thank you, brother. I appreciate that. That's incredibly kind of you to say. And I know people will want to wave hello and ask questions. Thank you for the interview.

Concluding remarks (01:54:21)

They can find you, I suppose the home base is vivekmurthy.com. I'll spell that, vivekmurthy.com. They can find you on Twitter at, I'm so self-conscious about saying your name now, on Twitter at vivek_murthy and then Facebook, Instagram at drvivekmurthy. I think the key is just for me to say it quickly and not get too tangled up in my own vocal cords. I'm just glad you didn't call me Victor Lake, Tim. I'm saving, I'm reserving that for special occasions. And the book, as mentioned, is together subtitled The Healing Power of Human Connection in a Sometimes Lonely World. I certainly recommend, among other formats, get it in all formats, but make sure you get it in e-books so that you can highlight. I'm sure there will be ample opportunity. Is there anything else that you would like to share with my audience or say before we close this first conversation on the podcast? Well, I just want to say thank you to you, Tim. I think what you've done through your podcast and through the work you've done through your books is you've created spaces for people to show up, to be authentic, to have deeper conversations. And that's incredibly valuable in a world that's moving faster and faster and faster, where who we are can get lost so easily. So I appreciate so deeply what you're doing. And maybe I'll leave you with one of my favorite proverbs, an old African proverb that says, "If you want to go fast, go alone. If you want to go far, go together." And I'm reminded of that as we talk, because I think that what we need to do in our lives, but also in the world, is we need to go far. We're facing some pretty big challenges as a society, and they won't be easy to overcome. But moments like this, whether we're facing a pandemic or longer-term crises like climate change, moments like this, I think are opportunities for us to find each other, to reconnect with each other, to refocus on relationships, and to put people first. And my hope is that we will use these challenges to do that, and that when we emerge out of them, that if we are intentional about spending time with the people we love, if we're intentional about making the quality of that time high quality time by reducing distraction and really just focusing and listening to people, if we're really intentional, Tim, about serving and recognizing that it is through our service to others that we ultimately pull ourselves out of loneliness and build strong connections, then I actually think we can emerge from these crises stronger than we were even before. And that's why I remain hopeful about the future of humanity, because I think we were designed to be there for each other.

Outro (01:57:25)

We were designed for connection. And if we refocus on the relationships in our life, I think we will go farther and have a much more fulfilling experience than we could even imagine. So thank you for this time together, Tim. I really, really enjoyed it. Me too. Thank you so much. And for people listening, I will have links galore, lots of resources, anything that was mentioned in this conversation, you'll be able to find in the show notes at Tim.blog/podcast. And you can find Vivek, VivekMirthi.com, of course. Remember your anchors. And until next time, thanks for tuning in. Hey guys, this is Tim again. Just a few more things before you take off.

NutriBullet (01:58:19)

Number one, this is Five Bullet Friday. Do you want to get a short email from me? Would you enjoy getting a short email from me every Friday that provides a little morsel of fun before the weekend? And Five Bullet Friday is a very short email where I share the coolest things I've found or that I've been pondering over the week. That could include favorite new albums that I've discovered, it could include gizmos and gadgets and all sorts of weird shit that I've somehow dug up in the world of the esoteric as I do. It could include favorite articles that I've read and that I've shared with my close friends, for instance. And it's very short. It's just a little tiny bite of goodness before you head off for the weekend. So if you want to receive that, check it out. Just go to 4hourworkweek.com. That's 4hourworkweek.com all spelled out. And just drop in your email and you will get the very next one. And if you sign up, I hope you enjoy it. This episode is brought to you by NutriBullet. I have my NutriBullet about seven feet away from me right now. I'm going to be using it for a bunch of stuff tonight and probably tomorrow night. NutriBullet is the affordable, easy to use, easy to clean. The easy to clean part is super important. Blender. It was first recommended to me by entrepreneur Noah Kagan when I interviewed him for this podcast. And specifically what I asked him was, "What is the purchase that you've made in the last, say, six months for $100 or less that has had the greatest positive impact on your life?" And his answer was the NutriBullet. NutriBullet has sold more than 60 million units worldwide. You can start to do the math on that. It's pretty frickin' bonkers. And once you've used one, it's easy to understand why it became so popular. With other blenders, cleanup can be a huge pain in the ass. NutriBullet makes it really, really, really, really simple. And if you're not familiar with the classic NutriBullet, it's effectively a single-serve cup that blends and then you flip it upside down, you detach it, and you can drink it, eat it, chug it down right there. So it is intended for, at least in the classic sense, smaller portion sizes. But give me a second here. So with NutriBullet, as I mentioned, cleanup is truly hassle-free. And their signature blending process transforms whatever you might have, high fiber veggies, nuts, seeds, fruits, of course, into silky, nutrient-dense smoothies, if that's what you like, that are easy to digest and absorb. I use them for nut butters, I use the NutriBullet for soups of different types, I use it for all sorts of stuff. Now, the engineers at NutriBullet have created a convenient and upgraded version of the NutriBullet called the NutriBullet Blender Combo. This is their most versatile device yet because it allows you to switch between single-serve, as I was describing, and full-size blending. It's also a bit more expensive, of course, than the classic version, but it gives you a lot more. And from smoothies and protein shakes to savory soups and dips, the NutriBullet Blender Combo does it all. And there is a recipe book that comes with it, there's all sorts of stuff that you can play with. This next-gen NutriBullet gives you everything you know and love about the classic device, yes, I'm reading copy in this particular sentence, plus all the performance and capacity you would expect from a full-size blender. Don't settle for blenders that leave your smoothies filled with chunks or anything filled with chunks that you don't want chunks in. So, get the NutriBullet Blender Combo and introduce your veggies and fruits and whatever else you might have to 1200 watts. It easily just smashes the living hell out of them and blends into whatever you would like to create. And for you, my dear listeners, NutriBullet is offering 20% off of all products on their website. To get your 20% off, just go to nutribullet.com/tim. If you don't have a NutriBullet in your kitchen, you are missing out. It does a lot in a very small package. Nutribullet.com/tim for your 20% off.

Sponsors

Trello (02:02:28)

This podcast is brought to you by Trello. During tough times like these, one thing that brings us together, of course, is our common humanity. And another, which helps to harness that, is technology. More than ever, teams must come together and work together virtually to handle challenges, opportunities, and everything in between. That's why Trello is here to help. Trello, part of Atlassian's Collaborative Suite, is an app with an easy-to-understand visual format and tons of features that make working with your team more functional and more fun. Teams of all shapes and sizes, and companies like Google, Fender, as in Fender Guitars, and even Costco, all use Trello to collaborate and get work done. It's one of the few tools that has also made the cut with my team, and I just have a handful of folks. So it can work all the way from tiny to gigantic. With Trello, you can work with your team wherever you are, whether it's at home or in an office. And no matter what device you're using, computer, tablet, or phone, Trello syncs across all of them so you can stay up to date on all of the things your team cares about. So keep your workflow going from wherever you are with Trello. Try Trello for free and learn more at Trello.com/tfs. That's T-R-E-L-L-O dot com slash TFS. Trello dot com slash TFS. Check it out. Thank you.