As a lung transplant program director, Dr. David Weill was able to grant a new chance at life to patients facing certain death. He was also forced to witness tragedy when patients died while awaiting transplant, during complicated surgery, or after the failure of a transplanted organ.
Weill’s memoir, Exhale: Hope, Healing, and a Life in Transplant, due May 11 from Post Hill Press, contains riveting tales of the extreme highs and lows that accompanied the physician’s first 20 years in the fast-paced, often miraculous, sometimes dangerous field of lung transplant. Weill details how the demands and pressures of his career led to burnout, and how a series of people, lessons, and faith set him on a path to becoming a better human and physician.
Weill’s rich compilation of stories, delivered with compelling honesty, offers universal lessons in slowing down to foster the connections that allow us to positively affect our world.
Weill’s Life in Transplant
At the outset of Weill’s career, he feels that seeing critically ill patients through transplant, recovery, and post-transplant life is “the best feeling in the world.” Propelled by the adulation of successfully transplanted patients, Weill believes he can “control [transplant] outcomes if [he] just work[s] hard enough and smart enough.”
Feeling responsible for outcomes like sickness and death, however, leads Weill to withdraw from loved ones and colleagues. His solitude offers little time for recuperation or contemplation.
At home, he is peppered with calls about accident victims whose organs might provide a chance at life for one of his patients awaiting transplant. Weill often spends quiet moments poring over his transplant waiting list, filled with the superstitious belief that doing so might conjure up a much-needed set of donor lungs.
After he moves to California to direct Stanford’s lung transplant program, Weill’s ingrained stoicism is put to the test. His acerbic inner monologue demonstrates mounting frustration paired with dwindling emotional reserves.
After the death of one patient, Weill retreats to a supply closet to cry. His rage also makes regular appearances. In one memorable anecdote, a surgeon on the transplant team calls at two A.M. with second thoughts about harvesting a set of donor lungs from a smoker. Weill writes:
‘I tried to count to ten, but only made it to three before I lost it. ‘Sure, Donald, if he smoked every day of his life! He smoked a few cigarettes in high school. Who didn’t?’
‘I still don’t think we should take the lungs, David…’
Standing in front of my house in my robe, my entire body was shaking with rage. ‘Look, no disrespect, but it doesn’t look like you can pull the trigger. It’s time to do this transplant. This girl is going to die. Meaning dead. Meaning not coming back. Let’s do what we’re paid to do.’
‘Seems risky, David.’
Now I was on the move in our cul-de-sac, walking in the middle of the street, arms flailing, my billowing dark green robe like a tent about to blow off a mountaintop.
‘You know what’s risky, Donald?’ I paused for full effect, took the phone away from my ear, and held the speaker up to my mouth. ‘Not doing the [expletive] transplant!’ I was now leaning toward the phone, bent at the waist. ‘Not giving the girl a chance. Now take these [expletive] lungs, and let’s get it done!’’
After several devastating losses, including the loss of his beloved father, Weill seeks purpose by becoming a Catholic, and taking a sabbatical. On his return to Stanford, the extent of Weill’s unmanaged trauma comes to light when he must inform a young woman’s family that she has become too sick for transplantation. He writes:
‘I stumbled for the words, even though I’d had this talk thousands of times in the past. I felt nauseated….I leaned against the wall to steady myself.
‘She can’t, I mean, we can’t…she can’t get a transplant,’ I mumbled. I was seeing spots…I grabbed [the patient’s husband’s] forearm, less for his sake than for mine. I felt tears running down my face, and I reached into my pocket for a tissue…This kind man who was about to lose his wife put both arms around me, and I sobbed uncontrollably. [The patient’s] mother handed me a tissue, as I apologized over and over for the mess I had become.’
Realizing that his work had become a “toxic addiction,” and that his patients deserve a physician who is not in crisis, Weill leaves his position and moves his family to New Orleans.
Undergoing therapy, and focusing on slowing down and creating connections with himself and his loved ones, Weill combats what he finally recognizes is a case of physician burnout. Simultaneously, he recognizes that he bears neither personal guilt for the incredibly sick patients who died under his care, nor sole responsibility for the patients whose transplants were successful.
In a denouement that tidily and beautifully tightens the themes Weill has woven throughout Exhale, the physician ultimately returns to the field of transplant with renewed love for helping achieve life-changing outcomes for his patients. His work, he says, is “the education of a lifetime…in how inherently good people can be.”
A Universal Message of Healing
In Exhale, Weill strips away the infallibility that often cloaks our perception of physicians. His recollections portray doctors as humans, replete with flaws, prone to errors, and, most importantly, deserving of grace.
Rather than a sign of brokenness, Weill says that burnout, which affects half of all physicians, is proof of physicians’ humanity. An understandable result of a workplace culture that insists on the deadening of emotion, and inflicts massive demands on personnel, burnout can lead to “alcohol abuse, depression, suicide, and poor interpersonal relationships.”
Weill’s memoir is well-timed, as a recent Medscape survey found that 64 percent of doctors reported the “pandemic had intensified their sense of burnout.” Exhale could provide insight and strength for physicians looking to heal themselves in order to become more effective at healing their patients.
Exhale’s lessons resonate far beyond the medical community. Weill’s methods for finding peace in his profession may be particularly helpful for law enforcement personnel, service members, veterans, and first responders, whose losses, traumas, and high-stress, high-energy work environments bear remarkable similarities to the working conditions Weill describes.
Those who have worked in government or with large corporations will feel a kindred sense of frustration as Weill struggles against layers of bureaucracy — and individual colleagues — to obtain the greatest number of positive outcomes for the greatest number of patients on his waiting list. Readers will almost certainly feel deep empathy for Weill’s patients, who desperately long for the simple, vital ability to breathe easily.
The crowning achievement of Weill’s memoir is that its deepest messages are truly universal. We need to examine the effects of workplace cultures that award badges of honor for jam-packed schedules and long overtime hours. Everyone from high-level executives to stay-at-home moms like myself can appreciate how our busy-ness and distractions keep us from being present with those we love.
Repeat encounters with life and death “[took] a chunk out of” Weill. They also gave him the tools to appreciate key aspects of the human experience and distill them succinctly and memorably. Exhale is a compelling antidote to our perpetual motion and pursuit of toxic addictions. Above all, it is a reminder to savor our connections with those around us, and to do good for ourselves and others.