Jerome Adams: We Belong to Each Other
Dr. Jerome Adams is the 20th Surgeon General of the United States. His mission as the “Nation’s Doctor,” is to advance the health of the American people. Dr. Adams’ motto as Surgeon General is “better health through better partnerships.” He is committed to strengthening relationships with all members of the health community, and forging new partnerships with members from the business, faith, education and public safety and national security communities. Dr. Adams received bachelor’s degrees in both biochemistry and psychology from the University of Maryland, Baltimore County, a master of public health degree from the University of California at Berkeley, and a medical degree from Indiana University School of Medicine. He has been a leader in numerous professional organizations, including the American Medical Association, the Indiana State Medical Association and the Indiana Society of Anesthesiologists. Dr. Adams is also the former Health Commissioner of Indiana, where he led the State’s responses to Ebola, Zika, and to the largest ever HIV outbreak in the United States related to injection drug use. Dr. Adams has pledged to lead with science, and facilitate locally led solutions to the nation’s most difficult health problems. He also feels his toughest, but most important job, is being a father to two teenage boys, Caden and Eli, daughter, Millie, and dog Bella.
Follow Jerome on Twitter.
If you are struggling with an addiction, just know you are not alone. There is help. Call the substance abuse and mental health services hotline at 1-800-662-4357.
Kate Bowler: I got lost at an event last year, and I mean really lost. It was at night and I could barely see anything, and then I suddenly realized that there was somebody beside me and that he was also lost. “Oh, hey,” he said, “I’m Jerome.”
“And I’m Kate Bowler,” I said, “and this is Everything Happens.” Just joking, but I introduced myself and as we wandered around trying to figure out which roads were where, this very nice stranger told me that he had heard about my story and wanted me to know that he was praying for me. It wasn’t one of those pleasantly pitying throwaway lines like, “I’m so sorry you’re tragic.” It was more of a, “Hey, from one human to another, I’m down there with you.”
And then at some point I figured out that I was talking to the US Surgeon General, so that was something I told my Canadian family for sure. “Hey Mom, Vice Admiral Jerome Adams, the US Surgeon General, became my friend and then he played Lego with my kid the next day for an exceedingly long time.”
So here he is today. He’s an anesthesiologist, my very favorite kind of doctor obviously, and before being the 20th Surgeon General he was the Indiana State Health Commissioner, and he is great at Lego. Hey, I’m so glad you’re with me today.
Jerome Adams: Oh my gosh, we’re going to start off this podcast with me crying. It’s so funny. I’m thinking back to when we met and you know, that was just an amazing experience and it goes to show you the power of just having a shared experience with someone, so thank you for giving me the opportunity to be on today.
K.B.: Well, thanks! And if you don’t mind, I was almost hoping we could pick up where we left off, because when we got to know each other it was as people who both knew what it was like to experience cancer firsthand, and I wondered if you would mind sharing a bit about that.
J.A.: Oh, absolutely. About a year ago, right after we’d moved to Washington DC as a family, soon after I’d been named the United States Surgeon General, my wife felt a lump in her groin and we kind of blew it off, you know? Not a big deal. We get lumps and bumps all the time, and a few weeks later it was still there and so my wife got it checked out, and the really short version of the story is that that lump ended up being melanoma.
She had to get surgery for it and then a year of immunotherapy, and that’s superimposed on top of her husband trying to figure out how to be the US Surgeon General and protect the health for the entire nation when his own wife is developing cancer right under his nose, and coupled with raising three kids at home, young kids. They’re 14, 13, and 9 now, and so it was a lot thrown at us but we learned a lot through the experience.
It’s interesting. I’m a physician and one of the things that I tell my residents and medical students all the time is that it’s important that we try to see things from other people’s vantage points and that we try to sympathize, but you see people really change when they go through it themselves, when they can really feel that empathy and understand what it’s like to really be the patient, to be the family.
K.B.: Yeah. I often wondered if it would be better or worse to be the doctor if you’re also the caregiver, because you know so much but then your wife isn’t your patient. I imagine that’s kind of a surreal experience, too, when you’re officially America’s doctor. You’re sort of seeing things from so many sides.
J.A.: Well, we often say that doctors, nurses, people in the healthcare industry are the worst patients because we often know too much, but on the flip side we’ll also often blow off things that the average person would say, “Hey, we think this is something.” And the problem from the caregiver’s point of view is you’ve seen that a million times and nine hundred thousand of those times it’s been nothing, and so you just think, “Eh, it’s nothing,” and so there are a lot of interesting juxtapositions there.
It’s also hard to separate yourself from your caregiver role, and one of the best things that my wife remembers her oncologist saying was, “Look, your job is just to be the strongest you can be, mentally and physically, and let us worry about the actual medical treatment. Don’t try to treat yourself because that’s what we’re here for, and if you do that then we’ll get through this.”
And fortunately, the punchline is that about two weeks ago my wife finished her year of immunotherapy. She was getting treatments every couple of weeks. She got to gong the bell, which is what they do at the cancer center when they’re done, so we’re blessed right now and I’m knocking on every piece of wood around me at the moment to say that we’re a cancer free family.
K.B.: Wow, I’m so thrilled for you. Man, it feels like such a long season when you’re in the thick of it. I know you don’t really have a lot of benefit of retrospect because it’s been like 1.2 seconds, but did you develop good roles in your family for how to care for each other? You know, there’s the role of patient and caregiver and I’m just thinking about the parts that kids play. I think it’s so lovely that your wife’s oncologist gave her her own role like, “Your role is the patient.” And then I’m sure there’s all kinds of other roles, like mom and dad.
I’m just thinking this through because this morning, my son who’s 5 was looking at my stomach and he saw all these scars because I’ve just had a bajillion surgeries, and I was trying to figure out the right way to give him the right amount of information. Like, “Oh yeah, sometimes when mom wasn’t feeling well she went to the hospital, and then they did this thing.” So I’ve just been trying to figure out what are some good rules for how to give everyone the right roles in the family.
J.A.: You know, that is a great question and one of the things I would say both as a physician and being on the patient and family side is that kids are smart. Kids are so much smarter than what we give them credit for and we have to understand that you’re not going to hide anything from them, that you have to take a lot of this head on and give them the information in a way that you think they can digest it, because if not they’re going to get it or assume it from someplace else and it’s not going to be in an ideally helpful manner.
But the other big thing that I’ve learned is the importance of support systems and we’ve learned this through my personal experience, but also advocating in regards to the opioid epidemic, that we often focus on the individual who is the sick person and rightly so, but the folks around them… there are so many people who are affected around them and it’s important that we think about those folks from how can we lift them up, the spouses, the family, the kids, but also the support that they can provide. And what was really valuable to us was having so many people come forward and say, “Yes, we’re going through the same thing,” or, “We’ve been through it and we’re praying for you,” and it was just really humbling to my wife and I when we traveled around the country, and I travel a lot, and people would say, “I’d heard about your wife. We’re praying for you.” That just lifted us up so much.
K.B.: Yeah. Well, it certainly helped when you said it to me. It builds the bridge across so many kinds of difference and I know especially when I’m feeling really sick, it makes me… Yeah, I guess the loneliness and the isolation from that is always a bit overwhelming.
J.A.: One of the things about sickness, no matter what that sickness is, it’s easy for the individual to feel that they’re the only one going through this, that they are completely alone. It’s so powerful just to hear from other folks that again, “We’ve been through this. We’re going through this. We’re here with you. We’re here for you.” It’s so interesting.
When you look at the communities across the world that live the longest, the feature that is the most outstanding is that they have a sense of community, that they gather together, that they lift each other up. If you have three friends who you can call when you’re down, you actually have several years extra of life expectancy compared to someone who doesn’t have someone who they can call, and so really important that we lift up that component of health, that social connection, and it’s especially important when you’re dealing with sickness with a potentially deadly diagnosis.
K.B.: Yeah. Three is a reasonable number. I like that. I can totally come up with three really good people. You mentioned the opioid epidemic.
K.B.: And you’ve taken on a number of issues that are especially personal and one of them is the opioid epidemic. I wondered if you could give people a sense of the scope of the problem.
J.A.: Well, we have 2.1 million people suffering from substance use disorder in this country and that may not mean a lot to some people, but one of the more shocking statistics is we have a person dying of an opioid overdose every 11 minutes in this country and over 50% of those people are dying at home. So we like to think of individuals who misuse substances as being these bad folks, these loners who are in back alleys shooting up heroin, but the reality is they’re dying in bedrooms, in bathrooms, and in garages.
My own family, I’ve been personally affected by this. My baby brother is actually in prison right now serving a 10 year sentence for stealing $200 to support his addiction, and he got started with unrecognized, untreated anxiety, depression. He self-medicated with alcohol, then tobacco, then marijuana, and then one day at a party someone gave him a pill and that was a rapid descent afterwards into injecting heroin. And so I share my story because it’s amazing how insidious and dangerous stigma can be, and if folks understand that the Surgeon General of the United States is going through this and that even our family wasn’t immune, it gives them permission to feel like, “It’s not my fault.”
Just one of the more amazing things that happens to me when I travel around the country is when I tell that story and then people come up from the audience afterwards and say, “Oh my gosh, my son,” or, “My brother,” or, “Me, I’ve been through this and I’ve been so ashamed of it and I haven’t told anyone about it. You’re the first person outside of our immediate circle who we’ve told about this.” It gives people again that permission to stop blaming themselves and to recognize addiction as an illness and not as a moral failing or a choice. No one wakes up in the morning and says, “Hey, I want to be a heroin addict today.”
K.B.: Yeah, and that’s part of why I’m so glad we’re having this conversation is like you, I’m really hopeful that there’s more room in the American narrative to talk about suffering without just reverting to this myth of American triumphalism, like the can-do spirit where everything can always be overcome because it leads to tremendous shame for people who can’t simply try harder or pray more or magically be better.
J.A.: If I could accomplish one thing while I’m Surgeon General, if I could just pick one thing it would really be to help folks understand that addiction is a disease and not a moral failing. And you know, and this fits under the broader umbrella of kind of all of these deaths of despair, life expectancy has been going up for the last 50 years, meaning that you and I as parents for the 50 years in a row could reliably count on the fact that our kids would live a longer life than what we did.
But for the past three years in a row, we’re now seeing life expectancy go down in this country, and one of the commonalities is despair. It’s lack of hope and that leads to overdoses, substance misuse. It leads to suicides. It leads to alcohol related diseases that people are dying from, and all of those diseases come from again lack of connection, lack of hope, and stigma. The stigma that prevents people from saying, “I have a problem. I need help,” before they reach the point that they’re at death’s door.
K.B.: Yeah. I’d love to know how we can be more compassionate toward people dealing with addiction.
J.A.: Well again, I think one of the important things for everyone is to share their own stories if they have a connection, and what’s amazing is if you talk to people enough you realize that everyone’s got a connection to someone who is suffering from substance use disorder of some sort, whether it’s tobacco misuse or alcohol misuse or heroin misuse, and so everyone’s got a story and that’s the way we lower stigma because stigma is when we separate people into us versus them. When we normalize things, then that’s when stigma tends to go away.
But one of the other things that I’m trying to do is help people see that even if you do think it’s us and them, that whenever anyone anywhere suffers from any sort of health disparity, any sort of poor outcome, that it affects all of us and so we’re focused on community health and economic prosperity, making the case that when your community has poor health that it affects your ability to bring jobs into town, that it affects wage growth, that it affects productivity.
I mean, if someone at work is worrying about their child who has substance use disorders, they’re not going to be as productive. They’re more likely to miss work. That affects the company’s bottom line, it affects the stock portfolios, and by making that connection, helping folks understand that, “Hey, if you don’t take the time to lift up that individual who you’re walking by on the street or who you think can do it on their own or should do it on their own, then it’s going to come back and it’s going to affect you.”
K.B.: Yeah. I know you’ve seen the doctor side of things and then the caregiver side of things and you hear your wife describe the patient side of things, so how do we make it easier for people not to feel like a loser for suffering in America?
J.A.: That is a fantastic question, and it’s one of the things that I’ve struggled with but one of the things that I’ve really taken on as a charge during my time as Surgeon General, and it’s by sharing those stories. So I’ll give you one example: Jonathan, who I met in Rhode Island.
Jonathan’s father died of an opioid overdose. Jonathan’s brother died of an opioid overdose, and then Jonathan overdosed and fortunately, someone had Naloxone there, which is an opioid overdose reversal agent. So Jonathan’s life was saved, but then he was connected to a peer recovery coach immediately, someone who had been through it and was in recovery and got Jonathan into a treatment program, and the short version of that long story is that Jonathan is now out there as a peer recovery coach himself.
So sharing those stories of hope, that’s really what I’m focused on and that’s why I’m so public about my wife’s melanoma situation. It’s why I talk about my brother’s situation. I think the more we share those stories and normalize diseases, the more folks understand that the disease is something you have. It’s not something that defines you and it’s something that can be overcome.
K.B.: Yeah, and also for those things that can’t be overcome like chronic illness, that if we belong to one another that we really can ease each other’s suffering.
J.A.: Absolutely, absolutely, and we also have to understand that in many cases things happen to folks that aren’t avoidable, and that’s when it’s especially important that you’ve got that social connection, that community around you however you come to it, whether it’s through faith-based communities or family and friends or other support systems. Part of what I do is help folks understand how they can be their best selves when something has happened to them, but also how they can be their best selves in terms of lifting up others in the community and supporting others. And you know, it really comes down to love yourself and love each other. It’s that simple.
K.B.: Yeah, be the best you within the constraints of talents and possibilities, and then the obligation just to love. I like that.
K.B.: Yeah. I am so grateful that you sat down to talk with me today. Thanks so much.
J.A.: Well, thank you. I’m grateful to call you a friend.
K.B.: Yeah, me too.
J.A.: You lifted me up at a difficult time and that’s what it’s really all about is finding some way that you can lift someone else up or finding someone around you who can help lift you up and accepting that help, and if we do that we’ll all be in a better place emotionally, spiritually, and hopefully physically.
K.B.: Yeah, I totally agree. Well, thanks so much, friend.
When Jerome talked about the stigma of disease, it reminded me of my whole obsession with casserole illnesses. What kinds of problems prompt people to make you a casserole? People struggling with addiction and those who love them often live without the compassion and support that other diseases have. They have to struggle with the secrecy. “Should I admit this? Would that make it worse?” And then all the shame of feeling like you’ve become stuck in something that’s now controlling you.
I recently read a beautiful obituary of a woman, Madelyn Linsenmeir, who was a daughter and a friend and a mother and a sister and also battled addiction. The sum of Madelyn’s life wasn’t her addiction. It was all the particularities that made her deeply human and deeply loved. Her sister, Kate O’Neill, wrote those beautiful words and she has generously agreed to read what she wrote for us so that we can get to know Madelyn too. If you are struggling with an addiction, just know you are not alone. There is help. Call the substance abuse and mental health services hotline at 1-800-662-4357.
All right, here’s Kate.
Kate O’Neill: Our beloved Madelyn Ellen Linsenmeir died on Sunday, October 7. While her death was unexpected, Madelyn suffered from drug addiction and for years we feared her addiction would claim her life. We are grateful that when she died, she was safe and she was with her family. Maddie was born on March 31, 1988 in Burlington, Vermont where she grew up and lived on and off throughout her adult life. Maddie was a born performer and had a singing voice so beautiful it would stop people on the street. Whether she was on stage in a musical or around the kitchen table with her family, when she shared her voice she shared her light.
She was a member of FolKids of Vermont, a dance and musical troupe that toured the world. Maddie visited Russia and Thailand with the group and as part of their exchange program hosted kids from other countries at home in Vermont. She loved to ski and snowboard, and she swam on the YMCA swim team, winning medals at the New England regionals. When she was 16 she moved with her parents from Vermont to Florida to attend a performing arts high school. Soon after, she tried OxyContin for the first time at a high school party and so began a relationship with opiates that would dominate the rest of her life.
It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie. When they saw her addiction they stopped seeing her, and what a loss for them because Maddie was hilarious, and warm, and fearless, and resilient. She could and would talk to anyone, and when you were in her company you wanted to stay. In a system that seems to have hardened itself against addicts and is failing them every day, she befriended and delighted cops, social workers, public defenders, and doctors who advocated for and believed in her till the end. She was adored as a daughter, sister, niece, cousin, friend, and mother, and being loved by Madelyn was a constantly astonishing gift.
Madelyn loved her family and the world, but more than anyone else she loved her son Ayden who was born in 2014. She transformed her life to mother him. Every afternoon in all kinds of weather, she would put him in a backpack and take him for a walk. She sang rather than spoke to him, filling his life with song. Like his mom, Ayden loves to swim. Together they would spend hours in the lake or pool, and she so loved to snuggle him up, surrounding him with her love. After having Ayden, Maddie tried harder and more relentlessly to stay sober than we have ever seen anyone try at anything, but she relapsed and ultimately lost custody of her son, a loss that was unbearable.
During the past two years especially, her disease brought her to places of incredible darkness, and this darkness compounded on itself, as each unspeakable thing that happened to her and each horrible thing she did in the name of her disease exponentially increased her pain and shame. For 12 days this summer she was home, and for most of that time she was sober. For those 12 wonderful days, full of swimming and Disney movies and family dinners, we believed as we always did that she would overcome her disease and make the life for herself we knew she deserved. We believed this until the moment she took her last breath, but her addiction stalked her and stole her once again. Though we would have paid any ransom to have her back, any price in the world, this disease would not let her go until she was gone.
If you yourself are struggling from addiction, know that every breath is a fresh start. Know that hundreds of thousands of families who have lost someone to this disease are praying and rooting for you. Know that we believe with all our hearts that you can and will make it. It is never too late. If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness, and chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support.
If you work in one of the many institutions through which addicts often pass, rehabs, hospitals, jails, courts, and treat them with the compassion and respect they deserve, thank you. If instead you see a junkie or thief or liar in front of you rather than a human being in need of help, consider a new profession.
We take comfort in knowing that Maddie is surrounded by light, free from the struggle that haunted her. We would have given anything for her to experience that freedom in this lifetime. Our grief over losing her is infinite, and now so is she.
K.B.: So many thanks goes to our amazing partners who make all this possible, the John Templeton Foundation, the Issachar Fund, the Lilly Endowment, North Carolina Public Radio WUNC, Faith and Leadership: An Online Learning Resource, and Duke Divinity School, not to mention my favorite team, Beverley Abel, Jessica Richie, and Be The Change Revolutions. Find me online @katecbowler or at katebowler.com and I’d love to hear what you thought of this conversation. It would mean so much if you left a review on Apple Podcasts. This is Everything Happens with me, Kate Bowler.