Many of the guests on this podcast have emphasized the importance of awareness. Awareness of how we think can help improve how we think. Awareness of implicit bias can improve how we implement our true values. Awareness of emotions can improve how we react or don't react to different situations. I find awareness difficult to cultivate, and I have always admired Dr. Earl Glusac's ability to be present, calm, and steady. Dr. Glusac has been meditating regularly since 2005 (as well as when he was younger), and he shares his view on meditation as well as tips for a productive career in academic medicine. Dr. Earl J. Glusac, MD is a distinguished dermatopathologist and esteemed professor at Yale University School of Medicine. He has actively shaped the field through his roles on various medical board. He has served the American Boards of Pathology and Dermatology and the editorial boards of the Journal of Cutaneous Pathology and the American Journal of Dermatopathology; he was program director and president of the American Society of Dermatopathology, and he is an author for the World Health Organization’s Classification of Tumours of the Skin. He attended Michigan State University for his medical degree, spent time in California for his residency training as well as dermatopathology fellowship, and has spent the majority of his dermatopathology career at Yale. Much of his research relates to the problem of overdiagnosis, especially as related to benign lesions that mimic malignant melanoma.
[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I am very happy to be with Dr. Earl Glusac. Dr. Earl Glusac is a distinguished dermatopathologist and esteemed professor at Yale University School of Medicine. He has actively shaped the dermatopathology field through his roles on various medical boards. He has served the American Boards of Pathology and Dermatology and the editorial boards of the Journal of Cutaneous Pathology and the American Journal of Dermatopathology. He was Program Director and President of the American Society of Dermatopathology, and he is an author for the World Health Organization's Classification of Tumors of the Skin. He attended Michigan State University for his medical degree, spent time in California for his residency training as well as dermatopathology fellowship, and has spent the majority of his dermatopathology career at Yale. Much of his research relates to the problem of overdiagnosis, especially as related to benign lesions that mimic malignant melanoma. I will also say that Earl is a personal mentor of mine, and I have hugely benefited from his teaching over the years. Welcome to Earl.
[00:01:03] Earl Glusac: Thanks for having me on Christine.
[00:01:04] Christine Ko: Would you share a brief personal anecdote?
[00:01:08] Earl Glusac: I thought I would relay one that's relevant to meditation. Eighteen years ago, 2005. I was 45 years old. I was being promoted to full professor at Yale after 11 years. To give a little background, I was traveling a lot. In the previous year I had given invited lectureships on five continents, and I was the director of the program for the ASDP that year. I wasn't president of the ASDP yet, that would be a few years later. All was going well at work, had a happy family life. So I was sort of surprised by this mental event in which I realized something was missing in my life and had to make some changes. The mental event occurred in my basement while I was riding my exercise bicycle watching a taped concert of Cat Stevens. At the end, there was an interview with him that I had not heard before. And in it, Cat Stevens related his story about leaving his musical career entirely, in 1976, and devoting his life entirely to spiritual devotion and practice. Cat Stevens had this deep need to meet his spiritual calling, to find what he really was at core, or to borrow his words, to find God. This resonated with some deep unmet need in me.
[00:02:30] So what I did was I didn't really change any of my clinical work, which I consider to be the most important part of what I do, but wrote a few less papers, gave a few less academic talks, this sort of thing. And devoted an hour a day to meditation and a week, twice a year, to going on silent meditation retreats. And then after a few years, this gradually brought more balance back into my life.
[00:02:56] Christine Ko: Thank you for sharing that. Can you talk about meditation, like about the impact on your life or career or, you did mention how you started, but what someone who doesn't meditate, like me, might do to get some positive benefits?
[00:03:09] Earl Glusac: I'd be happy to. I did have a background in Zen Buddhism. When I was 19, I picked up a book at a used book sale called Zen Mind, Beginner's Mind. The author was Suzuki. I carried this book around, it was always in my backpack at school, and I underlined passages. In my early twenties, I cultivated this, spending a few months as a trainee at a Zen Buddhist temple. As I got into medicine, as the time demands increased, meditation played a much smaller role in my life. By the time I was 45, really wasn't doing any of that at all.
[00:03:42] When I got back into this, I decided to go the Tibetan Buddhist route. There's a Tibetan Buddhist group in New Haven that I liked. There's a variety of other types of meditation, including ones from the Christian mystical tradition. There's just so much out there available on the internet. For instance, there's hundreds and hundreds of sites with different kinds of spiritual practice and meditation. And many of them are great.
[00:04:10] A very clear starting point can be reading a particular book, which is called Mindfulness in Plain English. It is written by Gunaratana, who is a Thai Buddhist master. He wrote this book in English, but it was recognized to be such a gem that it was retranslated back into Thai. And Thai school children are actually now required to read this book as part of their education.
[00:04:35] Regarding the benefits of meditation, for myself or for others, I'd say most of the things like improved concentration, improved emotional awareness of one's own emotions and therefore those of others as well, a sense of centering or calmness, health benefits... these are talked about a lot in our media today. Most of these, I would consider side effects of meditation. Beneficial side effects, to be sure. And those are all great. The primary effect that I think meditation brings about is, one, it meets a need that I think we all have, however deeply buried it might be, to get closer to the core of what we really are, deep inside, as a mind. That, I think, is the primary benefit.
[00:05:23] I think it's important to keep in mind impediments to meditation because these are significant, and it seems that most people who try meditation give up relatively quickly because they find it either boring or difficult. It's important to recognize that this is absolutely expected. And some of my teachers said that the definition of a successful meditation is, you decide to sit down for, say, ten minutes, and at the end of those ten minutes, you're still sitting. Even if your mind still wandered for 9 minutes and 59 seconds, that's a successful meditation. Because more clarity will come with time. Of course, there will be good days and bad days, always. But it will get clearer. And in the meantime, it's a lesson in how the mind actually works.
[00:06:10] Christine Ko: I know you've self taught yourself to play piano. I've heard that playing an instrument is also, in a way, akin to meditation. Since you do both, can you comment on that?
[00:06:23] Earl Glusac: Meditation is certainly a tried and true way to reconnect with what is deepest within us. Even though that might not be their primary objective, music works for many people too. At the best moments when you were really into it, you can lose yourself in the music and just connect with something a little bigger than yourself. That can happen. I don't think music's the only route to that, and certainly meditation's not the only route to that. There are football players. Famous quarterback John Brodie would talk about how in the three seconds that he had to throw a pass, he was just so mentally there that it became like an hour for him.
[00:06:59] Christine Ko: And when you talk about this deep need, and maybe it's super buried, to connect. At one point you said with mind, but then just now you said with something bigger than ourselves. Can you explain that a little?
[00:07:12] Earl Glusac: The language is always challenging. The deepest part of ourself, you could talk about it as mind, as spirit, or if you're a religious person, connecting with God. There's many different ways to connect with it. I think everybody in their life has a sense of having a time when they completely opened up with something. Say it was a piece of music or something, and completely lost yourself in it, and you're transported. And at that point, you're not really aware of your body. You're not aware of time. You're not aware of any other factors. You're completely just with that thing, whatever it was. You've lost your barriers. I think we all have that. We all deeply resonate with it. It's somewhat buried deep, and I think we all have parts of us that really want to get back to it, even as there are other parts that are fighting against that and really don't want to get close to it at all, but it's important to nurture the parts that do want to get back to whatever you might want to call that.
[00:08:06] Christine Ko: So that kind of, the way you described it, sounds like flow.
[00:08:11] Earl Glusac: Absolutely. Flow is an element of it and I think the word flow can be used in a lot of different ways. But we're talking about the deepest possible flow.
[00:08:19] Christine Ko: So flow, you're right, has different definitions, but when people talk about expertise, like when you mentioned the quarterback who felt like, when he's really fully present and about to pass, it could feel like an hour. That's sort of my idea of true flow, which I think is really hard to reach.
[00:08:40] Earl Glusac: Absolutely. That would be, a good, I think, example of true flow.
[00:08:45] Christine Ko: So when you meditate, do you feel that?
[00:08:49] Earl Glusac: Sometimes. I do not make any claim to be a great meditator. I'm certainly a frequent and diligent meditator. I do it every day, and I miss it if I don't get it. I have days of clarity, and I have days of absolute non clarity and muddiness. So yeah, it comes and goes.
[00:09:07] Christine Ko: My next question is if you have any tips for a successful career in medicine and or academia?
[00:09:14] Earl Glusac: Three things that I would say about that. An important thing about having an successful career in medicine, or really in anything, is having good people to work with. And I've been blessed to work with people like you, Christine, and our great group at Yale Dermpath, and that has helped really make my career, frankly. If you're a young person that might be going to a place that has a more senior, seasoned person who is a willing mentor and help you to learn the nuts and bolts of the actual everyday practice. I think that's key.
[00:09:46] Second point, regarding learning, I found it useful to identify people who I really resonated with. And in the early 90s when I was learning most of my dermpath for the first time, that was for me, Bernie Ackerman and Phil LeBoit. And so I attended as many talks that they gave as I could, read as much of what they wrote as I could, and that was very helpful for me.
[00:10:12] Thirdly, I would say regarding academics, find your passion, but be patient. An example for that is what I experienced in my career. I was at places, at Stanford and at Yale, that had a lot of cutaneous lymphoma. And so it was easy to fall into working on cutaneous lymphoma, which was fine, but I didn't ever really love it.
[00:10:34] But in 1996, I read Robert Swerlick's paper on overdiagnosis and melanoma, which hit me like way harder than any other paper had, it was like I almost had to put it down. It was actually compelling and disturbing to me. So I put it down and picked it up a few years later, read it again, and said, this is an area that I need to work on. So I found my passion in working on melanoma epidemiology, talking about that, and in identifying histopathologic lesions that might be contributing to this unfortunate over diagnosis of melanoma. I guess, in a nutshell, find your passion, but be patient.
[00:11:10] Christine Ko: I like it. Do you have any final thoughts?
[00:11:14] Earl Glusac: Final thoughts. If you have an inclination for meditation or other spiritual practice, it probably comes from someplace very deep inside. Try to nurture that. There'll be other parts of you that will want to get in the way of that and not want to make that happen. But since it comes from very deep inside of us, it's worth nurturing. For instance, try a meditation practice, and it doesn't work, try another. There are literally hundreds and hundreds of them out there. There's not just meditation, there's prayer, there's music, there's just all kinds of different routes. And if there's anybody in the audience who wants help with resources, I'm not any great expert, but certainly happy to lend what knowledge I have, just email me at email@example.com. I'll be happy to correspond about resources.
[00:12:01] Christine Ko: Thank you so much for doing this with me today.
[00:12:03] Earl Glusac: It's my pleasure. My pleasure. Thanks for having me on Christine.