Zach West - Storytelling & Reflection in Medicine

From Green Beret Medic to Stanford PA: Dr. Zach West on Storytelling, Writing, and Burnout

Dr. Zach West, a Butler DMS Bridge graduate and hospital medicine PA at Stanford Medicine, shares his path from philosophy and history major to Fulbright English teacher, rare book seller, Green Beret combat medic, and paramedic during the 2020 pandemic before PA school at Stanford. He discusses the Pat Tillman Foundation and the Tillman Scholar community’s focus on service, education, and impact. West explains how creative writing electives at Stanford—especially courses with Dr. Laurel Braitman—helped him process stress, build empathy, and strengthen communication, emphasizing that clinical documentation is fundamentally storytelling. He describes short writing prompts and trusted writing groups as practical tools for reflection, vulnerability, and fighting burnout, and offers advice to new grads to expect a brutal early learning curve and push through it.

Transcript

Copy Transcript Copied

SPEAKER_01 0:00

Today we're joined by Dr. Zach West, a Butler DMS Bridge grad who currently works as a hospital medicine PA at Stanford Medicine. He's a Fulbright and Tillman scholar and a former combat medic in Green Beret. Today you'll hear more about his experiences and the power of storytelling and reflection in that. I think that's so valuable, even, you know, in the working in the ED. You can always tell when it's a student's first day and, you know, it's a loud place, it's raucous, people are, you know, screaming and yelling sometimes. And so just that sense of, I mean, I'm sure it's the same, you know, on the wards in the hospital, just having a sense of being around in the space has to be hugely, hugely helpful. We were just discussing how uh our guest today, Zach West, is starting to work a bit with the Stanford PA program and helping facilitate their program to get their didactic students some early clinical exposure. So Zach, thanks for joining us. We're glad you're glad you're here. I'll provide a little bit of a maybe a brief, very brief sketch of so Zach's a graduate of the the Butler DMS Bridge program a couple years ago now, and and is is now working at Stanford. And with that, before I set up any of your introduction, I'll just turn it over to you to hear to share a little bit about your your background and maybe starting with what led you to to becoming a PA.

SPEAKER_00 1:18

So I I actually had a very unconventional path to becoming a PA. In college, I was a philosophy and history major, had no inkling I would ever go into medicine. And in my 20s, I had a series of random jobs. I taught English and Germany on a Fulbright grant, and then I came back and I was working as a rare bookseller in a famous rare bookstore in Manhattan, had a couple office jobs, but I didn't I wasn't finding my direction or or a purpose in life, and I was I was really seeking that. I wanted a career that was more meaningful. And then I read a book on the Green Berets, Army Special Forces, and I was instantly like, oh, I I think I want to try this, you know, I want to try out for this. So I enlisted and went through several years of training, and I became a Green Beret, but every Green Beret has a specialty, communications, weapons, things like that. And their medics are among the most highly trained pre-hospital medics in the world, not only with battlefield medicine, but advanced procedures, basic surgeries, anesthesia, you know, also you can practice medicine in an austere environment far from any higher level of care. And as part of that training, I did hospital rotations. And on those rotations, I worked with PAs. And honestly, before that experience, I could not have told you what a PA was. I was not really aware of the profession at all. But as soon as I was in the hospital working with these extremely talented, driven, smart PAs, I was seeing what they were doing on the wards and in the emergency room, and I was like, I think this is the career I've been looking for, you know. So after I came off active duty, I I moved to New York and I was working as a 911 paramedic there while I was knocking out the prerequisites for PA school. I was still there in 2020, so I worked 911 during the pandemic and then later that year moved out to California to start PA school at Stanford and finished up and then, of course, did the Butler program, which was great. And now I've been working for about three years as an internal medicine PA at Stanford Hospital, and also getting started with a faculty role there as well.

SPEAKER_01 3:39

And another part of your which kind of I think is maybe a little bridge between your military service and your career as a PA is is your your selection and work as a as a Tillman scholar. Can you tell us a little bit about what that kind of what that's all about, maybe a little bit about Pat Tillman, who's such an interesting, interesting story?

SPEAKER_00 3:57

The Pat Tillman Foundation is an amazing organization. For those who aren't familiar with Pat's story, Pat Tillman was a football player for the Arizona Cardinals who after 9-11 in walked away from a million-dollar NFL contract to enlist as an Army Ranger. And unfortunately, he lost his life in Afghanistan, but he was such an inspiring figure, not only because you know that that headline story about him walking away from the NFL to enlist is such a striking example of living up to your own convictions. If you read about his life, he was such a thoughtful, generous, humble, kind person. So the the foundation carries on his legacy with the Pat Tillman Scholarship, which is for military veterans and military spouses attending any kind of higher level of education, usually grad school. So you've got like law students, business students, med students. In my case, I was a PA student, and and the what they all have in common is they've all served in the military, they're all pursuing higher education, and they want to use that education to make an impact in the world. And it's a really extraordinary community of very smart, passionate, talented people. And I've I've been fortunate to stay active with that community even after completing my education. There are Tillman scholars who keep coming to events, you know, 10 years after they earned their degree. So it's really rewarding.

SPEAKER_01 5:27

Yeah, I I recall at some point there's a biography, a Pat Tillman biography, Warmen Win Glory, which is I recall it being a tremendously fascinating read, but this was it's really, really a remarkable story. So thanks for sharing um so much of that. And what do you think about the I mean, you know, you kind of your history towards the entering the PA profession is really what the PA profession kind of uh had been you know for about 15 years. Was there anything that you found through that experience, having some some some life experience, some lived experience that other students maybe didn't have that made it kind of a unique, unique experience for you, or a compare and contrast you saw with, you know, some of the experience of your classmates and colleagues?

SPEAKER_00 6:13

Now that I'm getting a little more involved with the admissions process at our PA program, one thing I've noticed reviewing applications is that when people come in with more life experience and you know, even in their 30s, so sometimes a decade older than some of their classmates, they're not there by accident. They they are there for a very deliberate reason. You know, they've they've considered their choices in life and they've decided this is what they want to do. And so I I know I'm extremely biased because I started PA school at 37, so you know I I'm I'm I'm biased towards people who who have that later start. I do think that having more experience behind you means that you're a little more grounded and might have had experiences that led you to choose PA very specifically instead of MD or nursing or paramedic or some other path. And I I actually bonded really well with some of my classmates who were also a little older than the rest of the class.

SPEAKER_01 7:14

Yeah, I I recall as you're talking, I was thinking back to my own experience as a as a PA student at what, I don't know, 24, however old I was at that, however young and immature I was at that point, and having classmates who were who had kids and families and spouses who were in other medical programs or other, you know, demanding careers, and and there I was just taking care of myself and had just such just such respect for for that. And I think that you know, you saw how that the the real commitment that they you know had made because you know they were they were trying to be a great mother or father, and this and that, and you know, all of those roles. And so there's just like a real a real respect for the intention that they brought to that. Sure. Change gears just a little bit. I think this is, if I'm remembering correctly, is also part of your Stanford experience uh where you were you were connected with Dr. Laurel Breitman, who let me let me also say last correct me if I'm wrong on the timeline here, but I think this was last fall at the PA Education Association's annual conference. Uh Zach presented and and introduced one of the keynote speakers who was who was Dr. Dr. Breitman. And, you know, it's a like a thousand-person conference, so it was kind of a cool, like all the butler factors like, we know him, we know him. And but maybe share a little bit about how you came to connect with her and kind of how that relationship and that experience kind of evolved over time.

SPEAKER_00 8:41

I think this was one of the more memorable and special aspects of my PA education, in part because it's so unusual. When I was applying to PA school, Stanford, I think, was the only program that encouraged or even allowed elective courses. You can take medical electives within the medical school, but you can also take classes across Stanford University. So you can take a business school class, you can take a computer science class, as long as these electives don't conflict with your core PA curriculum. I love, I love the fact that I could kind of follow my curiosity outside of medicine while also pursuing my PA studies. So I took classes on leadership in medicine, on COVID-19, medical etymology, but the the best ones I took were in creative writing. So I took two really fantastic creative writing classes. One was a class for creative writing for military students. So it brought together veterans from across Stanford to practice creative writing and meet veteran authors like Tobias Wolfe and General Jim Mattis. And that was really special. And then, of course, I took Laurel's class on creative writing for medical and PA students. Dr. Laurel Breatman is a fantastic writer in her own right. She's very accomplished, has written two amazing books that I recommend to everyone. Her class was really remarkable because it was all PA and MD students. And we got together every week to write fiction, nonfiction, poetry, whatever your particular interest was, was what you could write, and share our work with others and learn from Dr. And what I found amazing about that experience was that, you know, we were all tremendously busy people. We were all so burned out, you know, we're studying medicine eight hours a day, ten hours a day, taking tests every week. Med school and PA school is not a chill time in your life, but no matter how exhausted all of us were, we all looked forward to that weekly session with Laurel. I mean, those evenings ended up being some of my most memorable experiences of PA school. And it was actually far from taking away energy, I felt like it refreshed me for the whole week. Like it was, it was kind of a source of spiritual sustenance, if you want to put it that way.

SPEAKER_01 11:11

So that's excellent. And what do you, you know, obviously we do a lot of writing as as PAs, a different sort of writing, but more can you talk a little bit about in the context of being a PA? What what is storytelling and what is writing? What does that what does it mean? What does it look like? What does it feel like? Like how do you how would someone feeling like, yeah, I'd really like to connect in something that's reflective and something that helps me put things into perspective or process or whatever the need might be? How does what does that even look like to engage in that kind of work?

SPEAKER_00 11:47

I think I mean all humans are storytellers. All of us tell stories every day of our lives. I mean, you you show up in your office and you t start telling your coworkers a story about how this morning you couldn't get out of bed and then you know you couldn't find your car keys and then you were stuck in traffic. That's that's a story, you know. And then when you start seeing patients, what is an HP? An HP is a story, it's the story of what brought this patient, you know, and it it's always, you know, once upon a time there was a patient with these conditions, and they were in their usual state of health until one day, I mean, it's a story. It's it's maybe not as as literary as we're used to thinking of stories, but it absolutely is. And and ultimately stories are just a way that we give structure and meaning to to experiences and and to to what happens. And so I, you know, as someone who writes HP's progress notes and discharge summaries for a living, I mean, sometimes I feel like that's like most of my job. I I think a lot about that because it's so vital for us to be good storytellers because we need to be able to tell other providers what is going on with this patient, what happened during this hospitalization, what do you need to know? And we also need to be able to communicate clearly and effectively with our patients and tell them what's going on in a non-medical or jargon-heavy way that they can understand. And so I think storytelling through creative writing is a fantastic way to process what you experience at work to get better at communication and the use of language, and I find it really fun and rewarding.

SPEAKER_01 13:31

So, what would you tell, you know, as you mentioned, being a PA student is a full-time job with uh and and I think you had mentioned your experience was that that it helped fill the cup, not not drain it. Yeah, um, what would you say for a student? What sort of what would a a reflective sort of writing experience look like?

SPEAKER_00 13:52

Well, first of all, it it certainly doesn't have to be big and intimidating. No one's asking you to sit down for two hours and you know write your memoir. One of my one of the my favorite things about the classes I took at Stanford were how you know you could you could start with something really small. So in the veteran writing class I took, every class we did a seven-minute writing prompt, and it was just seven minutes. So we would get a prompt and start the timer, you have seven minutes, and the beautiful thing about that was for a perfectionist like me who wants to sit there and be like, Well, do I write about this or that? No, you don't have time for that, you just have to start moving that pen across the page. And when you do that, something magical happens where you know you you start writing things that you you didn't know you had in you, and and and you know, you I I often surprised myself with what I was able to accomplish in seven minutes of just frantic, you know, writing under a prompt. And and seven minutes is is a very manageable task, you know, it's not it's not a big and intimidating. I think I think it's good because a lot of PA and medical students are perfectionists. We're people who were drawn to this profession because we're high achievers and you know used to getting the best grade on the test and you know doing all the studying. And so creative writing can be very uncomfortable because when you write a first draft, it's far from perfect, and you just have to be able to drive on and say, okay, like it doesn't look pretty right now, but I can I can edit it later. You can edit a bad draft into a good draft, but you can't edit no draft into something. So so yeah, I would just say it it can be a a source of energy and and inspiration and and not take away from your other studies, but it it doesn't have to be a big commitment.

SPEAKER_01 15:59

One of the things that I recall from both the experiences you shared in in introducing and wrapping up Dr. Brayton's presentation, but also in her presentation was she kind of she shared really powerful stories of loss and grief. And what I think I what I think I came to that part of her presentation with was a sense that she's uh well known in her field. I think that's that that was one of the things that I took away from your presentation was the you know, we we all have a much more, generally speaking, shared experience than I think that there are some times where some of that hidden curriculum in medicine forces people to kind of or encourages people to suffer in silence. And I think there's much more that we share. And one of the things which has been really a part of my career that I've enjoyed is as I've done more qualitative research, you start to explore these things. And I think maybe in kind of in some of the same way, through that interview sort of process, sometimes collecting journaling and those sorts of things, you start to see that I mean, I think it's kind of to your point that seven-minute writing, like there's so much there that we don't tap into. Um, and whether that's a very informal reflection or conversation with friends or family, those sorts of things, that commonality was something that I really took away from that presentation. Like we've all we've all had grief, we've all had loss, we've all had challenging things that we've we've dealt with. And it and it sounds like your experience through that, um, you know, developing your skills and or just having the opportunity and platform to to write, to, to, to think, to, you know, process those sometimes emotional things that we kind of sometimes kind of push down is a really powerful anecdote to maybe some of the things that as providers we're we're challenged by, whether that's burnout or you know loss or any one of the number of pressures that that you know a PA or medical profession would face on a daily basis. Would you say that's that's accurate?

SPEAKER_00 18:05

Oh, absolutely. I think coming together and doing the creative writing in these classes was a good reminder of how everyone is facing their own struggle in school and in life. I mean, you know, people would share very personal stories, and I would think to myself, like, oh, I didn't know she lost her dad last year. Oh, I didn't know that this person had, you know, came from a really tough upbringing. And there was a certain universality to challenges we all face in PA school and med school, and challenges we face in healthcare. I mean, I don't know of a single job in healthcare where you don't face challenging situations. Being able to process all of that through a creative medium like writing, I found so valuable. I've been continuing to meet with a group, not at Stanford, but the Tillman Foundation. So we now have a Tillman Scholar writing group, and so we meet every couple weeks, and it's whoever wants to join from the Tillman Foundation. It's been really rewarding to kind of keep that going because I do find that writing about the things that I'm experiencing or that I'm feeling is a good way to fight burnout and keep myself going.

SPEAKER_01 19:24

Yeah, that's actually a great segue to what I was just going to ask. So you're Green Beret, you're like, you're the man. And in you know, like a lot of this are the you know, we focus on kind of the, you know, in PA training generally, the medical knowledge, and that some of that humanity gets lost. Yeah. But do you have any thoughts about what that like, you know, when you're meeting with with other folks, you know, other children scholars, let's say that experience of of being willing and being able to be a little bit vulnerable with your own thoughts? I mean, you just probably in and of yourself with your own thoughts, but also with with others. Do you feel like that's uh is that a tricky thing to do? Is that where you feel like there's there's real growth that happens through that or healing? What's that experience like where we're kind of trained to be maybe sometimes oh I don't know if more cold is the way to describe it, but a bit more straightforward or matter-of-fact and in sometimes really impactful situations? I wonder if you have any thoughts on that.

SPEAKER_00 20:27

Detached, maybe like yeah, yeah. I I definitely identify you with that because in the military and in medicine, both of those careers are ones that expect you to be able to switch off and just do your job and not have emotion get in the way of doing what needs to be done, and so it can be really hard to flip that switch back on later. So I do find that writing is a good way to do that, to kind of get in touch with what is really affecting you and what experiences you haven't processed yet. With regards to a writing group, I think it's essential to have a group that you trust and you feel safe with. And I think that was one of the things I was most impressed with Laurel's class. She brought in this huge group of PA and MD students, like 15 of us or so, and somehow made all of us feel very safe in sharing even the most vulnerable parts of ourselves. And some of us had never opened up in a group setting that way some of these personal experiences that we're writing about. She did a fantastic job of making it a safe environment to do that, and so that's kind of why it felt a little like therapy was was was you're you're able to share that and get support from your peers, and you know that everything that is shared there stays there. That's that's a rule that I've actually brought from Laurel's class to the Tillman Scholar group, which is that, you know, it's understood that anything anyone shares here is it stays here unless the author, him or herself, wishes to share it with the wider world. And so I think having that safe environment really allows you to to probe the depths and and and write about as personal an experience as you want.

SPEAKER_01 22:27

I was struck in her presentation. I think some people have those just innate skills to make people feel comfortable and she really modeled that even in that presentation in a big conference room of I don't know a thousand people or whatever. And so I think that makes it easier for other people to have that same vulnerability or introspection. And I was listening to a podcast that was talking about kind of some of these strategies and how oftentimes we we run loops in our heads and by putting it down on paper, it kind of short circuits that and I think that was just a those are two big takeaways from for me from hearing her speak was just that by by offering some openness or some vulnerability you welcome it as well. And then and then that idea of you know small just small little efforts can really help put things into perspective and refocus and kind of reframe around some of those things which are big and weighty and and kind of sometimes hard to articulate in conversations with others, I would say.

SPEAKER_00 23:29

I agree completely. I am definitely someone who gets things going on a loop in my head things that bother me or things that stuck with me that I just can't shake and so if I've had a tough week at work or I'm dealing with something I do find that writing getting it down on paper like you said is such an effective way of getting it out of my head and onto something external and in the process of writing you're processing it emotionally. So that's really helpful. And then I also what you said about Laurel's you know empathy I think you know her her ability to to kind of model that processing grief and everything I I one of the things I said when I introduced her to that that crowd was that you know in hindsight I realized that she didn't just help us develop our writing skills like our skills in dialogue or narrative voice or exposition. Her class really when it comes down to it was an exercise in empathy and what could be more important for medical providers to practice and strengthen your empathy and so I I think that was a big big kind of benefit of of doing that work.

SPEAKER_01 24:47

Yeah what a reinforcing thing for anyone who's listening who's a PA student or you know new grad that we focus so much on what's it going to take to pass pants what's the next exam I have and to not lose that that you know that shared humanity that you know hopefully as you know mentioned earlier is what brought us to the profession and and hopefully that you know keeps people keeps people there. So one piece of advice that you might have for a new grad maybe a a new grad or a a current PA student or someone who's more advanced in their career feeling kind of like disconnected or overwhelmed by you know just the daily grind of practice do you have any any advice for them as they're thinking about what they do?

SPEAKER_00 25:35

I think for new grads something that I tell all the PA students I precept who come through our service is that your first few months on the job are going to be rough. They're going to be brutal because there's just such a learning curve and there's no way around it. There's no way PA school can prepare you for this particular job because they don't know what specialty you're going into, what hospital system you're going to be working in that kind of thing. So you just have to learn all the nuts and bolts of your job and for those first couple months you just feel useless. I mean I would come home every day and ask my my fiance like how do people do this job? How is this even possible? And and then after a few months you you turn the corner and and suddenly you're doing the job and and not asking for help and and you're able to handle it. So I always tell PA students like just be prepared for that don't let that scare you or think that you made the wrong choice you just have to get over that hump. And I think writing can be a great way for people in that situation and also people farther on in their careers just to process what you're going through and and kind of come to terms with it. One exercise I recommend to everyone is called Morning Pages if you've ever heard of that. So it comes from this book called The Artist's Way and it's an exercise that you're supposed to do every morning and you sit down and you take a legal pad and you write three pages and the point is to never stop writing it's stream of consciousness you just keep moving that pen across the page and even if you're writing I don't know what to write today you just keep writing and that I find so therapeutic because you know things come to the surface that you've been thinking about ruminating on you know unable to get out of your head like we were saying earlier and and sometimes I'll come up with an idea for a short story or I'll come up with an idea for an essay just just by by kind of getting everything down on the page it it it feels it feels kind of cathartic to to do that on a regular basis. So that can be a a useful tool for avoiding burnout.

SPEAKER_01 28:05

Yeah I imagine some of those days where you're you just start writing I don't know what to write suddenly you do know what like the words just come and I wonder if sometimes those might be the most the most impactful or or best experiences that that you know I I've gotten got something. Yeah and you know I I think the certainly writing is one of those creative outlets but there are others too right Dr. Adrian Banning in in on our faculty is is in I think a couple of weeks leading a process painting uh program where you're just letting the letting the spirit move you and and you know putting something creative together and using that those pieces of our brain that oftentimes as medical folks scientists clinicians we're not we don't engage with as much. So that's that's excellent. Definitely well Zach really appreciate you you joining us and spending some time sharing your story and the impact that you're making.

SPEAKER_00 29:05

So thanks so much for joining yeah absolutely thank you for having me this was great and it was nice to see you again yeah likewise