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Description

What started out as chronic pain for David Smith’s father, ended in a fatal opioid overdose. In the years that followed, David lost a brother and sister to opioids. Like so many families, David feels like the healthcare system failed his family. He tells Nzinga how he feared he would become his Dad one day. The two talk about intergenerational trauma, David’s fatherhood journey, and how we can redefine healthcare to actually prevent sickness instead of waiting to treat it.

 

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Transcript

SPEAKERS

Dr. Nzinga Harrison, David Smith & Claire Jones

Dr. Nzinga Harrison  00:03

Hey everyone, welcome to IN RECOVERY. Today we’re talking to my friend David Smith. David lost his father, his brother and his sister to opioids. Those experiences led him to a career as a healthcare economist. He’s on a journey to find the ways we can fix our bankrupt and broken healthcare system. And today, we’re going to talk about all of it. Without further ado, welcome David to IN RECOVERY.

David Smith 

Thank you, Dr. Nzinga Harrison.

 

Dr. Nzinga Harrison 

That’s all right, call me doctor

David Smith 

The whole time?

Dr. Nzinga Harrison 

The whole time for the entire podcast.

David Smith

Thanks for having me.

Dr. Nzinga Harrison 

First of all, I introduced you as a healthcare economist, and some people might have been like, what? If we were all in seventh grade? How would you describe a healthcare economist to us to make us understand it?

David Smith 

Yeah, I think the reason I become okay with calling myself that is the real description of a healthcare economist is, I think, kind of cool. It’s this intersection of how money works in this system against how human behavior works in the system. So you’re constantly looking at incentives and what motivates people you won’t find anywhere in this country where we’re worse at it than health care.

Dr. Nzinga Harrison 

Yeah, right. That really tickled my bones, how money intersects with human behavior.

David Smith  

Human behavior, sociology.

Dr. Nzinga Harrison

Whenever I hear human behavior, you know, I’m a psychiatrist. So laying on the couch, going all the way back to the beginning of what forms, you know, the experiences that inform our motivations. And so let’s start back there with you. Just tell us about you and growing up and how that led to you becoming a healthcare economist.

David Smith

The general backstory for me is I kind of won the socio-economic genetic lottery, right? I’m born a white male in a middle-class family in Salt Lake City, Utah. Like that’s top 0.3% of anybody in the world kind of has those features, which we know our systems generally favor, economically and otherwise over other groups and had a very normal childhood up until my early teens where my dad was diagnosed with a chronic illness. And that just kind of plunged our family into this chaos that persisted really until I was in my early 20s. And that chronic illness led to an addiction to opioids led to a full unraveling of the man that I had known earlier in life as being this kind, gregarious witty guy to somebody who became paranoid and vindictive and depressed, and just a shell of his former self.

David Smith 

He ended up passing away from that substance use disorder when I was about 20. He was in his early 40s. He overdosed one night and was found by my little brother, who, subsequently a couple years later also died of an opioid overdose from Oxycontin, when he was taking for Fibromyalgia, and that very kind of blown up. Destroyed family setting can create the environment for my sister to also engage in substance use challenges and she overdosed one day with my mother in the kitchen, she passed out hit her head, and a week later had a brain aneurysm that ultimately resulted in a removal of her own life support.

David Smith  04:01

And so she slipped away as well. So we have a pretty tremendous amount of volatility and trauma preceding these deaths. The deaths themselves, of course, took the family apart at the seams. through all of that, I had dropped out of high school so I could work in help provide for my mother and sister prior to Emma’s passing. And I didn’t I didn’t go back to college until my mid-20s. Until I kind of made this big decision to drive across the country on New Year’s Eve one night and I packed everything I could in my car and left at 12:05am and went back to Utah and just started my life over from scratch and wound up meeting a guy named Mike Leavitt ended up in healthcare and have just had a chance to do some really amazing things that I never thought I’d end up doing.

Dr. Nzinga Harrison

Yeah, they would say the rest is history, but actually the rest is like your day to day. Right? You started out saying the way money interacts with motivations. And so I can hear that life story. And first of all, like, your ability to survive and be resilient is clearly superhuman. I mean, I would say superhuman, except that I have the honor of talking to people who have had this level of trauma and loss and is like, never lost on me how resilient the human spirit can be. But you were a kid like 20 as a kid. And this started before High School. So like, if you think about even you said, the chaos took the family apart, your father’s death, your brother’s death, your sister’s death took the family apart at the seams. Like if you just take a now 2020 hindsight, look back, how did your family before the chaos started handle emotions, and coping? And how do you think that has informed kind of your ability to be resilient and survive and cope through all of that disaster?

David Smith  06:11

Oh, it is such a great question. I grew up in a faith community, in the Church of Jesus Christ of Latter-Day Saints, which is kind of the long title for being a Mormon. And both of my parents were really devout in that faith. And the church itself, I would say even today does not have a very evolved or progressive sense of mental health and social factors that can really have a significant impact on who we are as human beings. But there was, you know, for much of my growing up, there were tools and resources through the faith that people through all faiths access and being able to use spiritual pathways to try to make sense of complex things. And for much of my life, it was, I think, constantly looking for the purpose and why certain things were happening and trying to reconcile that purpose with who I was or who I wanted to be.

David Smith 

And I think, you know, it wasn’t until a couple of years ago when my wife and I started to have some pretty strong disagreements about the doctrine of that faith and decided to suffer from it that, that I found myself exiting a system that helps make sense of that complexity. And I have under estimated the effect of that. And when you break from that kind of a system that has kind of come to define your ethos, and how you’ve survived trauma, for decades, to suddenly not have that is jarring. And so now I think I’m learning new mechanisms to not only reconcile my past, but to deal with things that still happen in life and will happen down the road. But faith, I think, was an important part of my journey. And I’ll be grateful for that forever. Despite not believing in the doctrine.

Dr. Nzinga Harrison  08:08

Yeah. So we have this concept of intergenerational transfer of trauma, meaning, the traumas that one generation experiences actually get transferred down to the next generation, whether that’s through biological mechanisms like epi-genetics, that’s a whole episode in itself, through psychological and social and cultural and spiritual mechanisms through relationships and environment. So talk me through not just because it hit me when you said my dad developed opioid use disorder, unraveled, died, then my brother unraveled died, then my sister, right, the generational component is there between your dad, your brother, your sister, even though thankfully, you haven’t developed opioid use disorder. We know that it’s sharing neurobiology, with depression, anxiety, trauma, all of those.

Dr. Nzinga Harrison

And now you have your own kids. So we have a next generation to try to protect, right? And so how do you navigate kind of your understanding, as a high schooler in early 20s, including your Mormon faith, now that you’ve broken from Mormon faith, how are you navigating trauma and understanding the complexities of what life brings? I love the way you put that. And how are you thinking about that? All of us is always trying to interrupt some cycle for our kids. Yeah. And so like, how are you thinking about that? From your brother to you and your sibs from you now to your kids?

David Smith 

Yeah, well, I want to I want to zero in on one thing you said cuz it’s so profound that the memory of that intergenerational transfer is it’s so powerful and it can go back, it can go back generations, and you can find echoes of that whether it’s in the genetics or it’s in history or even just things like geography, these things persist, and they have a really big impact. I would say a huge part of this for me Nzinga has been, I’ll tell you just a quick story that I think typifies it right around the time that I had this kind of severing with the church. I also became acutely aware of some of the same things that I think my dad must have gone through around my age, I was beginning to go through I found myself entering just an existential crisis, no idea who I was, what my purpose was, and just felt detached from any kind of a core.

David Smith  10:46

And the question you just asked, was the question. I knew I needed the answer. I woke up on a Thursday morning, and with my survival instincts in full gear, and told my wife, I needed to go, and I didn’t know where I was gonna go exactly. But I knew I needed to go figure I needed to find some space, and answer those questions. And that trip ultimately led me to visit some of my father’s siblings who I had not ever met before, in a meaningful way. And I spent three weeks I drove through 27 states, I’d put 8000 miles on my car, and I spent three weeks trying to get at the fundamentals of okay, how did I come into this world? What are my predispositions for depression, anxiety, chronic disease addiction, who was high as a 4, 5, 6-year-old kid before the world really got me and started to imprint on me.

David Smith 

Even pre-Mormonism pre-faith, like who am I, as a human being? And what have I done since then what can be learned from that? And if I try to put all of that together, can I try to chart, can I try to project what my path is as an independent, a systemic person who thought he was mission focused, but really just needed to be sure about the work I do and why I do it. And what motivates me and it was a significant experience, I don’t know that I would have had the experience had it not been for the pandemic and the ability to just like, go do zoom calls on the road for three weeks. But I had that and I’ve probably had the most profound year of personal growth ever in my life, by being able to put those pieces together.

Dr. Nzinga Harrison  12:37

Okay, we’ll talk some more about that when we come back.

Claire Jones 

So David, you said that this was the most profound year of personal growth, because you were able to put all of these pieces together about your father. What were some of the things that you learned?

David Smith 

About myself? I’ve learned several things about my dad, you know, it’s funny. Tell a story in COST OF CARE in the first episode about meeting my uncle Eddie. And to see I’d met him as a kid, but I didn’t remember him at all. And my wife and I visited with him in San Diego. And I was asking him to describe like, who my dad was before my dad went through his own my dad had some harrowing family experiences also. So before life got to him what was he like, looking for these patterns. And he was described as this kind, thoughtful, would do anything for you, focus, hardworking guy, like a person with all the character attributes, you know, I’m trying to have and, and the way Eddie described him was with such tenderness and fondness, that for the first time in my life, I didn’t think, oh my god, I don’t want to be like my dad, like, that’s been my clarion call for decades.

David Smith  14:11

I don’t want to turn out to be like my dad. And we stood up at the end of this time together, and he looked at me and he said, you’re the spitting image of your father. And I would have fought a guy for saying that five years ago. But it moved me and so the first thing I learned was that some of those echoes are really positive and that and that some of those exists within the word past intergenerationally to me, you know, the second thing I think I’ve learned, let’s just throw a remembrance for myself of like back kid, I was as a four or five, six-year-old I look at my kids today with this lens of we’ve done a good job at protecting them from how much the world can suck. And we won’t be able to protect them from that forever. But who they naturally are. They’ll say hi to anybody in a grocery store. And they’ll just unprompted.

David Smith

One of them will walk up and give the other a hug and a kiss on the head and say, I love you. And that was kind of I expect all kids are like that to an extent. But I, I see my kids and I think I can see parts of me and that, like, that’s who I was four- or five-year-old. I think it was just going back to those basics for me and defining who I fundamentally am when you peel away, the profession, the education, the religious, the stuff, the community, the trauma, and then being much more willing and capable of meeting life’s demands and needs on the basis of the confidence in that person.

Dr. Nzinga Harrison 

Yeah, I love the way you answer that question for a couple of reasons. Claire asked, what did you learn about yourself? And you started with what I learned about my dad.

David Smith 

Yeah.

Dr. Nzinga Harrison  16:12

And you said your clarion call for so long, had been I will be nothing like him, but the tenderness and the fondness that uncle Eddie allowed you to remember about your dad allowed you that’s healing, right? Like That was an unconscious, joining, have you and your dad in your heart in your mind when you answered that question like that from Claire, like, beautiful, beautiful. And I heard your voice choke up. Right? Like, it’s a big deal. I heard your voice choke up. If we weren’t on zoom. If we were in person, I feel like I could probably see the tears pricking the back of your eyes, like I could hear it in your voice.

Dr. Nzinga Harrison 

And then I heard it again, talking about your kids. And what I really want to emphasize there is that what you just shared about your kids is the generational transfer of resilience. So we spend so much time talking about the generational transfer of trauma, and kind of what that trip did for you. And even before because this trip sounds like it was recent, and your kids are not your kids are older than the pandemic. So even before the pandemic, you were transferring resilience to your children, right, that resilience that has carried you through.

David Smith 

I love the way that you termed this transferring resilience, I’ve never thought about it in those terms. I think you’re exactly right. And I’d like to think that before the pandemic, I was transferring some of that to a degree. I don’t know how the alternative version of this would have played out. I felt, you know, a year and a half ago, I’ve used the term doomsday clock, there’s this doomsday clock ticking in my own brain, it’s getting louder and eventually it’s going to hit a crescendo and I’m going to light my life and kerosene the same way my dad that I can feel I have felt that my entire life not just a worry or a fear, it was like an eventuality, it’s, going to happen. And I can reflect on the kind of Dad I was before the pandemic and Nzinga you know me I’m a nice, I’m a good person. I’m a good dad. I’m fun.

David Smith  18:36

But look, I spend a lot of time on airplanes and a lot of time in other cities and going to dinners and working really hard. And it’s not to say that parents that do those things are bad. But there were things for me that mattered as much or more than a family dinner five nights a week or things of that nature that the experience of the last year, both on the personal side and then just the whole world slowing down. I think I can and will transfer far greater resilience to my kids than might have been done in the past not only that, but also staving off what could have been, you know, a traumatic experience for me that might have just reset that intergenerational cycle and put it out another 30 years.

Dr. Nzinga Harrison 

Yeah, in some ways. We’ve all built our lives to be running. Constantly running. And so sounds like the pandemic and I know a lot of people have had this experience also slowed you down. And like if I lay you on my couch right here, I would say maybe part of what you were running from was fathering in an attempt to protect your kids from that absolute eventuality that you knew without question was coming.

David Smith 

I think you’d be right. And I think my wife would probably agree

Dr. Nzinga Harrison  20:00

Yeah, so let’s use this as a segue into healthcare. Because there’s no way all of these dynamics that are David is not informing your thoughts on healthcare and the work that you said, like, I wouldn’t have necessarily guessed this would be my day-to-day work, but like the universe brought me here. So I know one of your central tenants is that you’re not really interested in healthcare, you’re interested in health. So walk us down that path. What’s the difference?

David Smith 

There’s a definition of health that exceeds I think what a lot of us have come to understand through life. Health is essentially a what percent can I function to my highest and best capacity as a human being. And I think a lot about that, in the context of my kids, you know, they have this unlimited potential on the horizon in front of them. And some things happen as a matter of choice. Some things happen, as a matter of circumstance, some things happen, just because and these things limit our ability to be at that capacity, it can be chronic disease, or an accident or depression, you name it, there’s hundreds of these things. And every time one of those things happens to us, we lose a little piece of that asset, we lose a little piece of that health, sometimes we can restore it, but not all the time.

David Smith 

The second thing is that the things that either dial that capacity back or up, really only 10% of those things are affected by health care by the thing that kind of patches us up and puts us back together. 30% is just hardwired into who we are coming out of the womb and our genetics, and the other 60% deal with how we grew up in our environment and our access to friends and family and so on. And the things that do you think about intergenerationally?

Dr. Nzinga Harrison

That’s the cycle social, cultural, political…

David Smith  22:02

So 90%, 90% of like who we are as human beings, and being able to reach our capacity, be healthy, is determined outside of healthcare. But we’re putting all of our money in the 10%.

Dr. Nzinga Harrison 

Oh, you got to take me to church.

David Smith 

Like, who does that?

Dr. Nzinga Harrison 

It makes no sense.

David Smith 

No. And again, it’s not to minimize the incredible men and women that do the work you do. And staff, the emergency department and train for surgeries like health care is important. It’s needed. Is it $4 trillion needed, is it double the rate of the rest of the world to get $5 less than life expectancy needed. No, we have communities all over this country that are mired in socio economic decay one generation after another, then we turn around and tell them to pick themselves up by their bootstraps. But we don’t give them basic access to health services across that bio psychosocial spectrum. And then we’re so surprised things don’t get better.

Dr. Nzinga Harrison

I felt that so deep in my skinny little bones. So one of my best friends is an obstetrician. And she actually almost made me cry when she said this to us. And we were just having like, some regular conversation, and then you know, you fall into philosophy or whatever. But she said, Every time she delivers the baby, she feels like the pure joy of the infinite capacity that that baby has. And then in the next moment, she’s like, and that starts to decay right now because of all. And she’s practicing like, you know, in a needy community. And she’s like, I’m about to send this baby out into what do you say the mouth of the wolf or whatever. And it’s exactly I love that concept, David, that health is how close you can get to your maximum capacity. Only a sliver of that is blood pressure medicine, or knee replacement. Right? Only a sliver.

David Smith  24:12

We went to an art exhibit in Chicago last night, Van Gogh celebrating Van Gogh’s work. And I had this thought to myself, how many Van Gogh’s or music artists or Lin Manuel Miranda’s, Nzinga, that writes the next Hamilton, right? Like, how many of these people have we never seen have been obscured and hidden from the world? Because they were born into circumstances that didn’t allow them to reach that potential. And this we have this. I don’t know how much worse it is in America then compared to other countries, but we have this terrible thing in this country that yes, we can be a free market and yes, we can have principles of capitalism and work hard, be rewarded. Like that’s all well and good but we seem to think that one of us has done really well. It’s because of the hard work and the grit we’ve put into it and that we are more deserving than someone else.

David Smith 

Like, I’m sorry, I’ve done well. But I’m not working any fucking harder than the single parent out working two jobs or putting themselves through school or somebody that grew up and couldn’t go back to school till they were four like that. There are millions of things that other I’ve had a hard life in my own way. But shit, I’m still a middle-aged white guy. Like there’s still a lot of things that are open systemically to me that are not open to others, we have to stop pretending that that is some kind of a thing. I’m doing better versus everybody else.

Dr. Nzinga Harrison 

So now you’re talking equity? Would you know I’m all about when we come back from the break. I definitely want you to personalize this for us. But first some ads.

Dr. Nzinga Harrison  26:04

We’re back. So David, I want to hear how if there had been a different concept of health and equity in health care, how might that have changed your family’s experience? I want to hear about how it potentially changes the experience of that single parent working two jobs, like walk us down that path.

David Smith 

Two great questions, on the family experience. Look, my dad was very devout and very dedicated to the faith. And culturally had the faith been more encouraging of him to seek professional help, to seek therapy, to manage pain and other ways. Even just process his own trauma and develop tools of resilience, I think it would have changed the map for him. And it would have changed the map for all of us. And we wouldn’t have had this fissure blown open in our family for years. And that really, irrevocably changed all of our courses. I don’t fault the church for that. But I do fault the broader culture of not putting those things together. We don’t. But you said bio psychosocial. And you know, somebody hears that today. And they’re like, oh, that sounds like such a cool new term. Like we’ve known about this stuff for 100 years.

Claire Jones 

I’m wondering like, what would it mean to invest in healthcare? Like, where would the money go? If we wanted to make healthier Americans?

David Smith 

we place a tremendous amount of assets into a system that does really, really well when people are sick. Well, what if we started to create a financial incentive structure that paid people really, really well when they promoted better health? When you walk into a facility, and we’re not, we’re not met with a steinway piano and the waterfall, but we’re actually doing screaming. And we have a technology system that can say, well, there’s a data point over here, when the script was filled in a data point over here, when I saw the primary care doctor, and those two data points means something’s going on.

David Smith  28:08

If we invested in systems that allowed us to think and function and profit, I’m putting profit in quotes, because you have capitalism, I guess, then what’s different, and I don’t know Claire, that that changes everything. But we start to move the system away from one that does really well when people are sick. And we start to give people a different set of tools and resources, and more advanced time before they hit the crisis of renal failure, or diabetes, or some other terrible illness. And that’s how you start. That’s how I think you start to build intergenerational resiliency in communities, which we got to do.

Dr. Nzinga Harrison 

Yeah, incentivize self, incentivize health. So we have this concept on the show the magic formula. And so what is currently your magic formula that’s helping you in today, function at your maximum capacity that you have today. And then help us conceive of a magic formula for health that we can start thinking about from a systems perspective also.

David Smith 

That’s a great question, I think for myself, it’s still evolving, and I suspect it will be for some time, maybe for the rest of my life.

Dr. Nzinga Harrison 

It has to be.

David Smith 

I would say for me, number one has been like truly a different level of involvement and engagement with my children. Like that’s such an easy thing to say and not really be sincere about but it is the truth. I have been more involved in their education, their hobbies, having conversations that they want to know what do they want to just talk to dad about a fear anxiety and it’s been it’s been incredible. It’s has been incredible. And I’ve gotten to this place where it’s like anything else in life could just go to shit. And if I’ve got that kind of relationship with my kids, then everything’s gonna be fine. Because nothing else really matters. And that’s been a really special gift. The other thing for me on the personal side is balance, like I have hobbies now, and like I’ve never had hobbies before. And the third is that I’ve approached the work I do, I think in a renewed way, and with a renewed vigor.

David Smith  30:35

I’ve been working on these kinds of things Addiction and Mental Health and Medicaid. I mean, I’ve been doing these things for years. And I’ve always cared about them, it’s never been lip service. But now, like, I’m pissed off about them. Because it doesn’t have to be this way. On for the magic formula for the system, we have to change the way we move $4 trillion through the system. We have created such a Byzantine network of pathways with different rules, and permutations. And then at every layer of this, we kind of pretend like normal economic rules apply to the system, and they don’t, we have to figure out how to balance our economic systems with the economics of goodness, and health and maximum human potential. And stop pretending like those things are just choices, good choices, or bad choices people make.

Dr. Nzinga Harrison

That was beautiful. I just wanted to wrap up how I heard your personal magic formula. If I could put it in one word, I would say acceptance.

David Smith 

Got me there Nzinga. That’s right.

Dr. Nzinga Harrison

All right. So hopefully everybody recognizes why they would be absolutely crazy not to listen to your podcast. It’s called the COST OF CARE. And we’ll have patient stories, a little history, and more in-depth conversations about prioritizing health, and fixing our broken healthcare system.

Claire Jones  32:13

You can listen to more of David on the cost of care, wherever you get your podcasts.

David Smith 

Appreciate it.

Dr. Nzinga Harrison  32:20

So good to see you. Thank you for coming.

David Smith 

Thank you both.

Claire Jones 

Thanks, David.

Claire Jones 

That was a great conversation.

Dr. Nzinga Harrison 

Yeah, I mean, he’s just share so openly and really kind of like makes you think about things from a little bit of a different lens.

Claire Jones

Yeah, totally. I want to share some of my biggest takeaways, mostly just this idea of health within healthcare, and how he focuses more on that. And thinking about the magic formula in the systemic way of health. How can we invest more on the health side of things, and I just, I’m sort of curious about concepts of like, housing and food and these ideas of health that almost become more preventative for people. And I’m just sort of wondering, like, what your thoughts are on that, because we talked about and like we talked about mental health law, you know, for trauma and PTSD, if we, and stigma, like, those are all concepts that we talked about on the show all the time that if our approach to that from the get go was really different, then even if substance abuse comes up, and even if heart disease comes up, and even if diabetes comes up, which is inevitable, like those things are still going to happen. There’s a totally different system that is a little bit softer landing for people to go to.

Dr. Nzinga Harrison 

Yeah, that’s exactly where it took me too, Claire. So I think what’s really powerful about focusing on health instead of healthcare, is that health care comes from illness. Yeah, right. So the entire central premise of that system is managing illness. Whereas the concept of health starts from, like you said, the very beginning, it’s preventive. And if I really loved like his definition of health, I was like, how do we being the system, the world, the culture, all of us maximize the potential of this little human? Yeah. And so if you think of it that way, of course, you have to think about housing because you don’t maximize potential with lack of safe housing. Lack of comfortable housing. Of course, you have to think about education.

Dr. Nzinga Harrison  34:51

Of course, you have to think about nutrition. Of course, then you have to think about coping and mindfulness. And so if we’re rearing entire communities deplete of safe housing deplete of warmth and compassion, those basic neurobiological needs we have deplete of healthy water and nutrition deplete of coping skills depleted education. Then when another traumatic insult comes, there’s no foundation, there’s no skill set to try to reach for your maximum potential. And then you transfer that to the next generation instead of being able to transfer resilience. So I love I think focusing on health starts us where we need to start, which is with the maximum potential of that little human being.

Claire Jones

Yeah, totally agree. Thank you everyone for listening, and we will be back next week.

Dr. Nzinga Harrison

Talk to you next week. Bye.

CREDITS

IN RECOVERY is a Lemonada Media Original. This show is produced by Claire Jones and edited by Ivan Kuraev. Jackie Danziger is our supervising producer. Our theme was composed by Dan Molad with additional music by Kuraev. Stephanie Wittels Wachs and Jessica Cordova Kramer are our executive producers. Rate us, review us, and say nice things. Follow us at @LemonadaMedia across all social platforms, or find me on Twitter at @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help to stigmatize addiction together.