Track 2, Side 1: Once in a Lifetime by Talking Heads

Hoping I don't end up in a shotgun shack

My dad taught me every epic journey deserves a great soundtrack. My PalliMed Mixtape is the story of my Palliative Medicine Fellowship year, told in 15 songs.

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Once in a Lifetime on Apple Music

And you may find yourself living in a shotgun shack / And you may find yourself in another part of the world / And you may find yourself behind the wheel of a large automobile / And you may find yourself in a beautiful house / with a beautiful wife / And you may ask yourself, ‘Well, how did I get here?’ 

My dad, philosopher that he is, pointed out to me one day that this wildly catchy song is actually pretty thought-provoking. He told me that he would sometimes look around at how his life had unfolded and the beautiful wife on his arm and ask himself the very question at the end of this opening verse—Well, how did I get here?

It’s certainly the question I am asked most often this year…Well, Tyler, how did you get here?  People have really wanted to know why in the world I am making this change. What led me to switch from emergency medicine to palliative medicine—these two fields of medicine are a world apart!

I myself didn’t see this change coming. I never would have predicted it ten years ago.  But life throws us its curveballs.  Over the last couple of years when I looked around for what I was wanting, no, needing, in medicine—slower pace, deeper dives into patients’ lives and stories, more human connection—I stumbled upon palliative medicine and realized it was checking every box.

Or so I hoped. I really had no idea where this would lead.

And you may ask yourself, where does that highway go to? / And you may ask yourself, ‘Am I right, am I wrong?’ / And you may say to yourself, ‘My God, what have I done?’ 

Making a big change necessarily involves some risk.  Maybe this change wouldn’t work out at all.  Maybe this would be a huge tornadic disaster like the lyrics allude to as the songs winds down—here comes the twister…

Maybe this plan would backfire, and I would end up slapping my forehead over and over like Talking Heads’ lead singer, David Byrne:

(GIF Source: GIPHY)

Fortunately, no need for head slapping so far.

I love the music of Talking Heads. I love their concert film Stop Making Sense—still mind-blowing after all these years. It’s amazing to me that the music of a band that, on the surface seems so silly, is really quite profound.

A couple of months ago when my wife and kids had gone to bed, I was sitting in a comfy armchair in our house with a small pour of bourbon. It was dimly lit and quite still for a change. The record player crackled and popped quietly while it spun the Talking Heads album Speaking in Tongues. I thought about this year of transition, this strange, new work I get to do, helping patients at the end of their lives.

The song This Must Be the Place (Naive Melody) began to play on our record player. Wacky song. Amazing song. Oliver Stone used it as a perfect needle drop in his 1987 movie Wall Street. During the performance of this song in Stop Making Sense, lead singer David Byrne dances gracefully with a tall lamp atop a Persian rug. Believe it or not, it’s quite moving.

As I sat there that quiet evening, my heart felt full. Very full. More at peace than it had felt in a long time. The lyrics “Home—is where I want to be / But I guess I’m already there” had never resonated quite so strongly. I knew I was where I was supposed to be. What a feeling.

I’m still not sure where this highway goes to, but I know there’s nothing quite like the profound silliness of this legendary ‘80s band to voice for us our existential crises. 

Same as it ever was. Same as it ever was.

Tell me, Crash Cart Campfire friends:

• When have you made a big change that could have totally backfired? How did that feel?

• What’s on your mixtape?