In honor of Father’s Day, this week’s episode is an ode to all the dads out there who are doing their best.

Part 1: Pediatrician Ken Haller goes off script when a father comes into the exam room with his young son.

Ken is a Professor of Pediatrics at the Saint Louis University School of Medicine and Cardinal Glennon Children’s Hospital. He serves on the boards of the Arts & Education Council of Greater St. Louis, the Saint Louis University Library Associates, and the Gateway Media Literacy Project. He has also served on the board of the Missouri Foundation for Health and as President of the St. Louis Pediatric Society; the Missouri Chapter of the American Academy of Pediatrics; PROMO, Missouri’s statewide LGBTQ civil rights organization; the Gateway Men’s Chorus, St. Louis’s gay men’s chorus: and GLMA, the national organization of LGBT health care professionals. He is a frequent spokesperson in local and national media on the health care needs of children and adolescents. Ken is also an accomplished actor, produced playwright, and acclaimed cabaret performer. In 2015 he was named Best St. Louis Cabaret Performer by the St. Louis Post-Dispatch, and he has taken his one-person shows to New York, Chicago, Denver, and San Francisco. His special interests include cultural competency, health literacy, the relationship of medicine to the arts, the effects of media on children, and the special health needs of LGBT youth. His personal mission is Healing.

Part 2: After years of Mikala Jamison’s dad helping her with her mental health struggles, the roles are reversed when her father is diagnosed with early onset Alzheimers.

Mikala Jamison is the creator and producer of The Body Show, a live storytelling show that debuted at the Capital Fringe Festival in July 2022 and was a "Best of Fringe" pick by DC Theater Arts. She also publishes the blog/newsletter Body Type [bodytype.substack.com] about navigating body image in today's world. Talk to her about weight lifting, cats, and the recent finale of "Better Call Saul."

Episode Transcript

Part 1

The young father, his eyes downcast, sat across from me in the exam room. On his lap sat his six‑month‑old daughter, brightly dressed, whom he gently bounced on his left knee. His son Malik, five years old, was standing by the exam table in an exam gown. He was the one who was there actually for his checkup.

I said to the father, “I'm Dr. Haller. So, you're Malik's dad?”

“Yeah,” he said, still looking at the floor.

“And who's this,” I said, pointing to the baby.

“It's my daughter. She's coming in in a couple of weeks for her checkup.”

“Okay. Great. Anyone else here to help you with them? Their mother?”

“Their mother is not involved and it's just better that way.”

And that's kind of a big deal. I needed to be silent for a moment. I got to tell you, as a doctor, silence can sometimes seem like the enemy because we have so much information we have to get and give and we have so little time to do it. But patients don't like silence either, so I wanted to see what he might say.

“Yeah, and it's getting to be a problem because I have this job and it's part time and it's just enough for me to make enough money to pay the rent and feed these kids. But if I don't have someplace for the kids to go during the day, I lose the job. And if I lose the job, then I lose the kids,” which was a lot bigger. How do you respond to that?

Now, I have been a primary care pediatrician for 40 years and I've been on faculty at SLU med school for 25, but my answer came from a completely different place.

I'm also an actor. I've done musicals and dramas and improv. The key rule, the cardinal rule of improvisational theater is the, “Yes, and…” response. This means that in an improv situation, every response from one of the actors has to take a form where they agree with some part of what's been going on to add to the scene and to develop character and flesh out the entire scene.

So, what I might have said in that situation is something vaguely compassionate and really easy, like, “Yeah, that's tough. I know how you feel.”

And he would have taken one look at me and said, “You’re full of crap.”

Ken Haller shares his story at the Public Media Commons in St. Louis, MI in February, 2023. Photo by Joe Martinez.

What I finally said was, “You know, I've never been in a situation like that. I cannot imagine how stressful that must be.”

Finally, he looked up and looked at me, really looked at me and said, “Yeah, it really is.”

About 15 years ago, a couple researchers at Vanderbilt University in Nashville wrote a paper called Healing Skills for Medical Practice. What they did was they surveyed the community to find out who people felt the best doctors were. And they interviewed these folks. They got a list of about 50 people and they found out that these people had certain aspects in common.

That they took time to listen to patients. That they formulated care plans with patients rather than for patients. That they found something to like or to love about the person across from them. That they were dependable and trustworthy. What's interesting is that none of these aspects had anything to do with medical knowledge or with procedural skill.

Now, those things are important. And when I tell learners about this study, I tell them, “That doesn't mean you don't need to know your stuff or know how to do stuff. It's just that that's what will make you an adequate physician, a good physician, a board‑certified physician. But these things, these communication skills, these interpersonal skills, that's what will make you an outstanding physician and a true healer.”

So with all this going on, a dozen years ago I decided to create a course, an elective course of first‑year medical students called Acting Like A Doctor. And so each semester, I offer this course. It's six three‑hour seminars and I get up to 10 students per semester. What we do is we spend that time using the skills of acting and particularly improvisational theater to help them become more mindful, empathetic physicians.

The thing that really struck me as I was developing this course and going on with it is there are really three aspects to this that it boils down to. The “Yes, and…” response is just the first and maybe the most important. The second is reading the room.

Now, all of us come up here, we're reading the room. It's like what are all these people at? Is this a hot room or a cold room? Are they on my side or did some friends say, “I got a ticket to Story Collider. Come with me,” and like, “I don't know what that is. Sure, I'll go.”

And, frankly, being a doctor walking into an exam room is really not that much different. So when I walked into that room and I saw that dad looking down at the floor, I saw this kid looking down at the floor, separated in space and in emotion and in spirit, I knew that I had to be a little bit mindful of that.

So rather than just walking in with my usual, “Hi, I'm Dr. Haller. How's everyone doing today?” I walked in quietly and I walked over to Malik. I put out my hand and I said, “Hi, I'm Dr. Haller. Are you Malik?”

He kept looking at the floor. He didn't say anything. He didn't shake my hand.

So I sat down across from dad and started our conversation. A few minutes later when we had gotten to that point where he told me about the stresses he was under, I said, “You know, we do have a social worker here. When we're done, would it be okay if I had her come in and talk to you? Maybe she can find someplace for the kids to go during the day so you can keep your job.”

He thought about it for a minute and was like, “Yeah, okay. Okay. That should be fine.”

I said, “Okay. Good, good. Well, let's talk about Malik then. What does he do well?”

“I don't think he does anything well.”

I was stunned. I'm like, “Dude, he's standing right there. How can you say that?” But then I had to think, why would he say something like that?

And this is the third thing that I've learned that is really important and that is when an actor has a script, it's the key line that the character has that reveals who they are.

Now, I've been really lucky over the years. I've gotten to play some really cool roles. I played Herr Schultz in Cabaret. I played Herbie in Gypsy. I played Claude in Hair. Yeah, I did the nude scene. That was many years ago. I even got to play the title character as well as six other characters in a three‑actor version of the Scottish play. That was awesome and that's a whole other story.

At any rate, I had to wonder where did this come from. Why would he say that? He obviously loved his son.

Then I thought, “Maybe that's what he's heard his whole life. Maybe what he had heard is, ‘What's wrong with you? What's the matter with you? You'll never amount to anything. Can't you do anything right?’”

Now, despite his love for his son, he was passing that on to him.

Now, Cardinal Glennon, our clinic is part of a nationwide organization called Reach Out And Read. Are you familiar with it?

Anyway, Reach Out And Read is an organization where kids who come in for their well‑child visit between six months and five years, they get a free children's book that's age‑appropriate to emphasize the importance of reading and of reading together. The book that day was Margaret Wise Brown's book Goodnight Moon, one of my favorite books. Applause for Goodnight Moon. Illustrations by Clement Hurd.

Anyway, so I said to dad, I said, “Well, let's see what he knows. Why don't you show him this book?”

“Okay.”

So he opens the book and Malik starts looking at it. His father's pointing at stuff and he's going, “Mice, bunny, fireplace, moon, cow, green, orange…’ and his father is looking at him like, “Whoa.”

At this point, I suggested to his dad, “You know, you're the most important person in his life.”

He said, “No, no, I'm not.”

I'm like, “Who's more important than you? You make sure he's fed. You provide him a home. You love him. What do you say to him now is going to make him the man he's going to become.”

That's when he gave me a, “Yes, and…” response. He nodded. He smiled.

Malik smiled. We all smiled. I found birds in his ears.

We did the whole schtick. We had a great time. Malik looked great. I went. I wrapped things up. I went to find the social worker and I hoped for the best.

A couple weeks later, I was walking through the waiting room and I heard some guy say, “Hey, Dr. Haller.”

I looked over and there was someone standing there holding a baby, waving at me, hand on his hip like this Superman pose. I didn't recognize him at first but it was Malik's dad. He looked so different.

And I said, “Hey. How are you doing?”

He goes, “Ah, good.”

I said, “What are you doing here?’

He goes, “It's her checkup today.”

“Oh, that's right. That's right. Six months, yeah. Okay.”

He goes, “Listen, I got to tell you. That social worker really helped us out. She's in daycare. He's in preschool. I get to keep my job.”

And I'm like, “Yay, social worker.” But I said, “I'm really glad to hear that. Well, listen, I'll see you in the room in a couple of minutes.

He goes, “I gotta tell you one more thing. I've been reading Malik that book every night. He's a really smart kid.”

Now, there's this saying that I've heard and it's attributed to a lot of people. Life is not a dress rehearsal. I believe completely the opposite. I believe that life is nothing but a dress rehearsal. It's a continuous improv full of choices and variables. It never ends.

Every time I leave an exam room I think, “How can I tweak that for next time?” After four decades I still do that. Maybe that's why what I do is called ‘medical practice’. But I know that if we really do it with mindfulness, if we allow ourselves to say ‘yes, and…’ and allow other people to say ‘yes, and…’ back to us, that maybe, if we're lucky, we might just get it right.

Thank you.

Part 2

Years ago, I was at home with my dad watching a movie. I don't remember which one but, if it had been his choice, it was either Saving Private Ryan or Armageddon, dad classics. When, all of a sudden, I had this feeling of doom coming over me.

Just minutes before, I had asked my dad, “Pass the popcorn so I can mix it with the Sno Caps candy which you really should try.” Then, suddenly, it's like the walls were closing in and my heart was racing out of my chest. I had the terrible sensation that I was going to have a bathroom emergency right there on the couch.

I hysterically described all of this to my dad and he jumped into action. He was trying to calm me down and he was saying soothing things and trying to get me to regulate my breathing. He gave me an aspirin because he thought I was having a heart attack. I was like 19. And it was so bad that I went to the hospital.

Mikala Jamison shares her story at Smitty’s Bar in Washington, DC in September, 2022. Photo by Ellen Rolfes.

I had the humbling experience of getting there just as all of these symptoms subsided, kind of like when you take your car to the shop and that's when the noise stops, right?

So, later, I debriefed with my dad. And he wasn't making me feel weird about it. It wasn't like a big thing. He didn't get it. He's like, “We were chillin’. We were fine. Everything was good and then suddenly this happened.”

And I said I didn't understand it either. They told me at the hospital I had a panic attack. But I didn't understand how I could have been in this calm moment, in this supportive space and then suddenly feel all this terror.

It wasn't until later in college that I started understanding my own mental health a little bit more and understanding that even if I wasn't having these really bad panic attacks, I was having really bad anxiety all the time. I kind of never felt calm, brain always racing at a thousand miles an hour. I was always paranoid about like my health and my safety and I was having a really terrible experience being marooned in college, feeling like nobody else was really talking about this yet like I feel like they are now.

At some point, I called my parents and I'd wanted to talk to my dad about this. I said, “I don't really know what's wrong with me. I just feel like I have this anxiety all the time.” And I was using that word for the first time. It was like a new word in my lexicon.

My parents and my dad especially, to their credit, were so cool about it. They just said, “Okay. Next time you come home, we're gonna talk about this like a family. We're gonna figure out how to get you help and calm you down.”

I've had friends of mine say that when their similarly Boomer age parents have heard about these mental health struggles, my friends have not always gotten like the best feedback. They'll say things like, “What are you anxious about? Just calm down.” Thanks, I'm cured, right?

“Calm down. You're depressed? Depressed about what? Didn't I give you a good life?” So they don't really get it.

But I wasn't worried about that with my dad in particular, because he's always been really understanding when I've talked to him about my issues with my mental health. And when I talked to him about this anxiety I was feeling, I said, “I feel like I'm not in the driver's seat anymore. I feel like my brain has a brain of its own. Or whatever this disorder is, whatever it is I'm dealing with with my own health and in my body, that's what's in control and I'm not.”

He kind of nodded and I could see that he really understood this.

So my dad has bipolar disorder. He has ADHD. He's been medicated for both of those things for as long as I can remember. He is a recovering alcoholic of more than 20 years. And his father, my grandfather had schizophrenia. So there's just a lot of potential genetic concerns on that side of the family and that is the Irish side. The other side is Italian, so on top of all of this we just have a lot of chaotic energies in the household anyway.

Mikala and her father pictured together. Photo courtesy of Mikala Jamison.

And even though my dad had these issues with his health and he never talked about it with any shame. He was very open about all of this. He didn't talk about anxiety. He didn't talk about having anxiety attacks. He didn't really get what was happening when I had mine. But when I was having issues, I could talk to him and know that he would understand and just be an ear to hear me. He would offer me that support.

So in October 2020, my dad was diagnosed with early onset Alzheimer's disease when he was 61. Terrible year. At this point, he is still very much the person I've always known. He knows who he is. He knows who we are. He can do activities of daily living by himself. It's just the short term memory. Very forgetful. Executive functioning not great. He can't juggle a lot of tasks. And this is very frustrating to him, of course. Very overwhelming. Very sad.

One time or about a year ago, I went home to visit my dad, because the name of the game right now is just know that there's going to be bad days but try to increase the good days and value the good days. So we're hanging out and we're in the garage and I ask him how he's feeling in general.

He starts to cry, which is a very hard thing to see but it's also something I'm kind of glad he lets me see, because my dad never had any of this like ‘real men don't cry’ nonsense when I was growing up. There wasn't any of this macho energy. It was very like be okay with your emotions. Make a career out of writing about them if you need to. So he was always very sensitive and emotional and had no shame about that. And since I am also a sensitive emotional person, it made me feel very much at home in my own family.

So we talked about how he was feeling and he said, “I know. I just I keep thinking about this diagnosis and I'm thinking about the future and I'm so stressed and I'm walking around with this tension. I can feel it in my body and I just, I just have this anxiety.”

So he said it for the first time. That's the first time I ever heard him use the word much like I had all those years ago. And so I got to have the anxiety talk with my dad.

This was my time to shine. I was like, “Dad, we got coping strategies. We got breathing exercises. Let's talk about therapy, meds, podcasts. You want books? I got so many books.”

And in this moment, I could watch. I just saw this relief on his face. I kind of felt like I saw his shoulders relax and he just calmed. What a gift that was to see that relief, that relief that I had experienced back when he helped get me into group therapy when I was in college or now when I talk to friends of mine who are going through the same kind of mental health stuff.

And that relief is the relief of knowing you're not alone and the thing that you're going through has a name and it's very common and you're not crazy. So, seeing him understand those things was really a very special moment.

Also that day, standing there in that garage with my dad, I felt like something else was happening. It was like this torch was being passed to me and I was assuming this new role in my family. Years before, I think I imagined that I would take it on. And that role is being more of a caregiver like he had cared for me for so many years. He raised me. I was raised in this wonderful supportive space and he was instrumental to that. And, now, he needs me to be understanding and empathetic and a shoulder, literally, to cry on.

I feel very confident. As hard as this is and as long a road as I know this will be, I feel very confident that I can be that supportive, empathetic, understanding, loving person because my father taught me how to do that.

Thank you.