Dr. Sanjiv Chopra - Dharma, Happiness and Living with Purpose

Good morning and welcome to Surgery Grand Rounds. Uh, this morning, we have the honor of welcoming Doctor Sanjeev Chopra to the podium. Doctor Chopra is professor of medicine and served as faculty dean for continuing medical education at HMS for 12 years. He serves as a Marshall Wolf Master Clinician educator at Brigham and Women's Hospital. Doctor Chopra has more than 150 publications and 9 books to his credit. Um, he is the editor in chief of the hepatology section of Up to Date. Um, and a sought after speaker, uh, worldwide and across the United States, addressing diverse audiences on topics related to medicine, leadership, happiness, and living with purpose. He's received numerous accolades, including in 2003, the American Gastrentological Association Distinguished Educator Award. Ah, as well as, uh, elected as a master of the American College of Physicians, uh, which is, uh, as, you know, a singular honor which is bestowed only to, uh, individuals who have, uh, served as citizen physicians, educational innovators, scientific thinkers, and humanists to inspire those around them and set the standards for quality in medicine. Um, he's written 9 books, including a book with the title that we're about to hear about today. Um, as well as another book called The 10 Principles of, uh, Great Leadership, which, uh, is where I first got to hear Doctor Chopra a few years ago as a resident at BI. Um, I still recall, uh, rather vividly that talk, and I'm certainly hopeful that we will all have, uh, similar memories of the talk today. Welcome, Doctor Chopra. Good morning, everyone. Thank you so very much for that kind introduction. I'm delighted to be in your midst. And to share with you some reflections about something I've been thinking about for a very, very long time. We all hear about success, we wonder what's happiness. We were sitting right now and we heard people laughing, laughing in the back. We'd all sort of want to quit listening to this talk and gravitate there. So we're all hardwired for happiness. I also believe that these three tenets, Dharma, happiness, and living with purpose, are inextricably linked. Now many of you have probably heard of the word karma. This is very different. What is dharma? And how did I chance upon it at a very young age? So I was 12 years of age studying at St. Columbus High School in New Delhi. My brother, who's 2 years older, was also in the same school. We were staying with an uncle and aunt. My parents were 300 miles away. Our father was a very distinguished cardiologist, professor of medicine, subsequently a dean. Absolutely brilliant clinician. And on a very hot, sultry weekend, I played a cricket match. And on Sunday evening, I'm a little exhausted. I take a nap. I'm reading Reader's Digest. I used to have a competition with my brother about vocabulary and the meaning of words. And I take a nap and I wake up and I'm terrified. I look and I can't see. Everything is dark. So I nudged my brother, I said, Deepak, I can't see. And he must have done visual threat and figured I wasn't faking it. Then he started to cry. He said, I have one brother and he's turned blind. My uncle took me to the military hospital in New Delhi where the doctors examined me, I believe, including an ophthalmologist. And they didn't have the foggiest idea of what was going on. There was talk about hysterical blindness. I was a very happy kid. I was a decent student. I was a very good athlete. And finally they connected with my father some 300 miles away. This is 1961. He's in an army jeep, those long distance phone calls. And very calmly he said, Tell me everything that's happened to Sanjeev in the last two months. And they said he's been fine. He said, no, I want to know everything. Any injuries, any accidents, any meds. Oh, yes. He had a laceration to his right leg. About 6 days ago, he was taken to the casualty ward and he got stitches. And my father probed further. He said, did he get an antibiotic? So they looked in the records and sure enough, they'd given me an antibiotic. Then he asked another question, did he get a tetanus shot? So very proudly they said, yes, he got a tetanus shot. And he said, what kind? ATS or ATT, anti-tetanus serum or anti-tetanus toxoid? So they looked in the records and they said anti-tetanus serum. And I have no idea how my father divined it, but he said to them, Sanjeev is having a rare idiosyncratic reaction to the ATS. It perhaps occurs less than 1 in a million. He has severe bilateral optic neuritis. It's a localized form of serum sickness, reaction to the ATS. His optic nerves are ready to burst. Start an intravenous and give him massive doses of corticosteroids. And that was done, and about 8 hours later my vision returned. And that's when I decided that I want to, wanted to pursue a career in medicine to fulfill my d Dharma, to practice medicine, and to teach. I've told these stories to professors of ophthalmology all around the country at Stanford, at Duke, at UCLA, professors at EME, Massachusetts, Pioneer. And they're all befuddled. They say incredible. How did your father even know that 1961 may not even have been a footnote in one of these textbooks of ophthalmology. So dharma is a distillation of right, action, duty, ethos, moral compass. Truth, vocation, we all have a dharma. We have a dharma to our family, to our society, to our synagogue, our church, our temple, the mosque. As the chair of surgery, Havid Dharma to the residents and the faculty. Uh, patients And if you follow a Dharma, You will find that you're anchored in happiness. There's a true story. I'll get to that, which also very nicely. Embellishes the meaning of d Dharma. So at age 16, I was fortunate enough to enroll in this prestigious medical school, All India Institute of Medical Sciences. At that time, 10,000 people sat for an entrance exam. And you got a score and then you were interviewed 90 people and 35 got in and my wife to be Amita, who by the way is a pediatrician. And was on the faculty here at Children's years ago. stood first in the entrance exam and then she stood first after the interview. I also stood first. I was first on the waiting list. And I was on my way to fulfilling my dharma. So here's the story of Lakshmanan Singh and smallpox inoculation. So they've gone around the country in India some 40 years ago and inoculated 80-90% of the population. There are a few holdouts. And one of them is Lakshman Singh. He's a poor, uneducated farmer in a village in the foothills of the Himalayas, and he says, You cannot inoculate me or my family. God ordains who'll be diseased or who'll be healthy. So they're stymied. They don't know what to do. They actually have a conversation with the World Health Organization. And then the local group decides, you know what, we're going to go to his hut tomorrow morning. We'll take the police with us. If he refuses, we'll forcibly inoculate him. So they go the next morning and he again says, you cannot inoculate me or my family. I believe God ordains who'll be diseased and who'll be healthy. So they pin him to the ground, rip off his shirt, and jab him with a needle. His wife is screaming. The kids are screaming. 15 minutes later they're all inoculated. The entire village is awake. He turns to the team and he says, please sit down. He turns to his wife and he says, go make tea for them. And he himself goes to the back of his little hut. There's a vegetable plot. Picks the juiciest, ripest cucumbers and radishes, cleans, and offers it to them. And they go, What are you doing? We forcibly inoculated you, and you're now treating us like royalty. And this uneducated villager says, I believed God ordains who will be diseased, who will be healthy. I upheld my dharma. You obviously believed it was your Dharma to forcibly inoculate me and my family. It is now over, and you are guests in my home, and this is the least courtesy I can offer to you. So Dharma can change. It can change here on the wards. We have a patient and then there's a massive complication, aspiration, pneumonia, stroke, and now we are talking about comfort measures instead of perhaps curative surgery. So Dharma can change. Let's move on and talk about happiness, and I want to make a distinction between happiness, joy, and bliss. So happiness is the sensation of feeling good, being pleased. It's an internal experience which we express outwardly. We smile. You see somebody smiling, you know they're happy. Unless they're faking it Joy is the experience of extreme happiness, euphoria. It's much more intense and exuberant. And bliss is the experience of intense joy anchored by a sense of connectedness with others and with nature. It's been called perfect happiness, great joy. You want to watch Bliss. All you do is go to a playground. You see the kids playing on the swings and the slides, and next minute somebody gets hurt, they bruise their knee, they cry. Two minutes later. They're back in bliss. Now all the research has shown that meaningful experiences surpass the acquisition of expensive objects in creating happiness. You buy a brand new Mercedes or a Tesla, you know, you're happy for a few months. At the end of 2 or 3 months, it's a car. You move into a huge mansion, the same thing happens. You adjust to it. This phenomenon is called hedonic adaptation. In contrast, meaningful experiences partaking in charities, doing volunteer work. Traveling You don't have to go. What's shown here is Milford Sound in New Zealand, one of the most beautiful spots in the world. I've had the fortune of traveling there with my wife. But you could Go to a cafeteria with friends. Break bread, have coffee. That's a meaningful experience that will give you more happiness and more joy. Now, how many of you have had a recent vacation? Can you raise your hands? OK, very few. How many have a vacation coming up? Very few. What's wrong with the rest of you? So the ones who have a vacation coming up, can you raise your hands again, please? OK, you look around and they usually have a smile. Just the thought of the vacation will create happiness while you're there, if you're mindful, if you're grounded, you're not taking 1600 selfies. You're enjoying the sunset, the sunrise. The crash of the water in the ocean, the birds chirping, a round of golf, a cup of coffee. You'll be happy, and when you come back, your best friends or your family will say, How was your vacation? And as you're reminiscing about it, you'll be happy. So what happens to lottery winners? All the research has shown that a year later, you could win 10 or $20 million on a scratch ticket, and a year later, you're back to baseline. Sometimes you're worse off. Your friends and your family have come out of the woodwork. They've actually resented your being so lucky. Some even say that. Demand you pay their mortgage. You've may have used it in acquiring. Expensive objects and then of course hedonic adaptation. 3 months later it's an object. And the only lottery winners who are happy are those who give away about 10% of their winnings to a meaningful charity. And partake in meaningful experiences. Now look at the flip side. What's one of the worst fates that can befall a human being? You break your neck and you become a quadriplegic. Remember that happened to Superman Christopher Reeves playing, participating in an equestrian competition. And he was a paraplegic, and for the first few months, There's always this sort of victim mentality. Why me? Why did God do this to me? But at the end of a year, before the end of a year, he was happy, and this is what he said, very remarkable. He said, I'm not living the life I thought I would lead. But it does have meaning, purpose. There is love, there is joy. There is laughter. Human beings are amazingly resilient, and I think we in medicine are very fortunate and privileged. To see this unfold before our eyes with our amazing and courageous patience. Rabindranath Tagore. was a poet He was a Nobel laureate. In 2012, he wrote a series of poems in his native language, Bengali. The next year he translated it into English, and that year he received the Nobel Prize. He's the one who coined the term Mahatma for Gandhi. He said Maha means great. Atma means soul. He's a great soul. Gandhi's book Gitanjali, it's the most spiritual poetry, if you like poetry that you can ever read, and Gandhi once said, Tagore once said, I slept and dreamt that life was joy. I awoke and saw that life was service. I acted, and behold. Service was joy. Think about our profession. What an amazing privileged profession, day in, day out, weekends, nights, middle of the night you're on call. We have the privilege of being of service to our patients and the community. Now Socrates claimed that his wisdom and insights arose merely knowing that he knew nothing. It was a very prevalent view that happiness. It was not for the common man. Happiness happiness was bestowed upon a select few. These were the poets, the philosophers, the princes, the noble people. And he's the one who argued that no, it's not just bestowed on a select few, but could actually be begotten by human endeavor. He also believed very strongly that happiness and virtue. are inextricably linked. The ancient Greeks actually did not use the word happiness. They used a term called eudaimonia. And literally translated this means human flourishing. Success is not the key to happiness. Happiness is the key to success. This is what Albert Schweitzer. Nobel laureate, physician, theologian, humanitarian once said, Now, in my reflections and talking to many colleagues around the country, around the world. Some philosophers have come to the conclusion that the happiest people on this planet have 4 traits in common. And the first one is they have a cadre of good friends. Some of your family could be your best friends. But your friends are your chosen family. He hears some amazing quotes about friendship and friends. Thoreau, friends, they cherish one another's hopes. They are kind to one another's dreams. Robert Louis Stevenson, a friend is a gift. That you give to yourself. Khalil Gibran, friendship is a sweet responsibility, never an opportunity. So celebrate everything small or big with your friends. Somebody gets an award. Somebody gets a promotion. You know, meet with them, break bread, have coffee, go see a movie, go to the opera. It's amazing how much joy that will bring to you. There's a bestselling author by the name of James Ran. He said once famously, he said, you're the average of the 5 people. You spend the most time with. Let me repeat that, you're the average of the 5 people you spend the most time with. So select your friends carefully. Eleanor Roosevelt once said, small minds discuss people, average minds discuss events, great minds discuss ideas. So select your friends where you can discuss events and discuss ideas. Now, here's a remarkable story, and it's a local story. It's called the Harvard Grant Study on Happiness. It started almost 80 years ago. They enrolled 600. Boys, young men in the between 18 and 20. And 200 were at Harvard. The other 400 were from Roxbury and Dorchester. They've followed them all these years. They're 19, still alive. They're 92 years of age. Annual physical examinations, blood tests, questionnaires, home visits. Functional MRI, EKGs, cholesterol, CRP. Now they're following a cohort of their children. Robert Waldinger, who's a professor of psychiatry at Harvard, has given a wonderful TED Talk on this. The previous principal investigator, George Valiant, wrote a wonderful book. It's called The Triumph of Experience. So it's all about this study, but what's the major conclusion of the study? Loneliness is toxic. And that your satisfaction with your relationship with friends at age 50 is a better predictor of health and longevity and happiness three decades later. Three decades later at age 80, Better than what? Better than your blood pressure, better than your cholesterol, better than your C-reactive protein. So one of the things I'm encouraging my colleagues and especially the junior faculty and house staff at the Brigham and at the BI. is at the end of the interview, when you see a patient, just ask a question. How many friends do you have? Do you spend a lot of time with them? Nurture your friendships. Just plant the seed. If you have time, you can talk about this study. The second trait of the happiest people on this planet is the ability to forgive. If you hold bitterness or rancor in your heart, you cannot be happy. If there's anyone in this room who's holding a grudge, Against a family member, a neighbor, a friend, a colleague, my plea to you, get rid of it. The moment you make the decision to forgive that person. You'll feel the weight come off your shoulders. The Buddha once said resentment is like holding a hot coal with the intent of throwing it at somebody who's hurt you. That person's moved on. Meanwhile, you're burning your hand. Now how many years did Nelson Mandela spend in prison? Anyone? Many, many years, right? It's mind boggling. 27 years. Can you fathom 27 hours, days, weeks, months, 27 years, and when he's released, he's asked the question. Mr. Mandela, do you have a resentment? Against your white captors, and he gave the most elegant answer. He said, I have no bitterness. I have no resentment. Resentment is like drinking poison and then hoping it will kill your enemies. He also said As I walked out the door towards the gate that would lead to my freedom, I knew if I didn't leave my bitterness and hatred behind. I'd still be in prison. Right, the prison of the mind. So friends and forgiveness. Gandhi once said, the weak can never forgive. Forgiveness is the attribute of the strong. And the third trait, Albert Schweitzer. Now we at the Beth Israel have been privileged that this hospital in Gabon started by Albert Schweitzer and his wife is a sister hospital. And about 4 years ago we celebrated the centennial. Lachlan Farrow was the president until recently of the Albert Schweitzer Foundation. Lachlan is a primary care physician, associate professor, and one of my good friends, somebody I look up to. He inspires me. He's an ethicist, and I've learned a lot about. Schweitzer from Lachlan. Schweitzer once said, I don't know what your destiny will be, but one thing I'm certain of, the ones amongst you who will be truly happy are those who have sought and found how to serve. Right, so helping others. There's this whole now concept of servant leadership. Leaders are there to serve. So I've distilled it into three F's friends, forgiveness, and for others. But there's a 4th 1, and it begins with G. And it's not God. What is it? You know it. Anyone? Gratitude The word gratitude is derived from the Latin root gratia, meaning grace, graciousness, or gratefulness, a highly prized tenet in all the major religions, and I'm defining gratitude as the experience of something positive gain, but coupled with the realization. That somebody else was responsible for that. And I strongly believe that gratitude and compassion can be cultivated. One of the ways we can cultivate gratitude is to start a gratitude journal. Go to CVS, Walgreens, buy a little notebook, put your name on it, call it your gratitude journal, sit down every Sunday evening and reflect on what's happened to you in the past week and write down what you're grateful for. There are studies that show that it will increase your happiness. I'm going to come back to that. Now this is a landmark study. It's called the Catholic nun Study. It started in the 1930s. Notre Dame convent, about 180 nuns joined, and the Mother Superior said to all of them on one piece of paper, write down. A little bit about who you are and what you're looking forward to. And 60-70 years later, the researchers could authenticate the handwritings and they classified them into low. And high gratitude. And I'm not going to read it, but you can see, I think the first one is sort of neutral, not necessarily low. But in the second one you can see the words happy, eager joy. Love divine What happened? They were all 22 years of age when they joined. They're all single. Nobody smokes. Nobody drinks. They eat the same food And on average, the nuns that expressed high gratitude lived 10 years longer. It's pretty phenomenal. This was published, positive emotional content in early life autobiographies strongly associated with longevity six decades later. And this has been duplicated in other studies. Happiness positively correlates with academic achievement. Small study from the Harvard Graduate School of Education looking at young kids. Now here's something that was taught to me by my younger granddaughter, Mira. They live in New York. And she's now 11, but she was 7 years of age. They come to Boston. They're spending the weekend with us, and we're about to have dinner. She says, Nana, which means maternal grandfather, before we have dinner, we're going to play a game. I said, Mira, what's up? She says, it's called Thorns, Buds and Roses. I said, I don't understand. She said, I'll explain. My plan for today is my cousin was coming for a play date. Her father got busy. She couldn't come. My bud is she's coming tomorrow. And my roses are, you took us this morning for breakfast, and you took us to Barnes and Nobles. You got me 3 books and Nana after dinner. You're an amazing storyteller. You're going to tell us some spellbinding stories, horns, buds and roses. You can do this with your kids, your grandkids, your nieces, nephews. It takes 1 minute. You go around the room before having dinner. You must finish with the positive. The roses, and there's a very interesting ratio. That is close to 3. This is called the Losada ratio, named after Marcel Losada. And his research led To the conclusion that negativity is very heavily weighted. If you say something negative. You now have to say 3 positive things simply to neutralize it. And if you say something negative to your spouse, you probably have to say 6 positive things to neutralize it, and a ratio between 3 and 6 has shown to be beneficial. In many different studies, whether they're college students or managers or nursing home residents. So here it's shown In a different way, you're in the danger zone if for every negative thing you say you only have one positive thing. And you flourish back to Eudaemonia, Socrates. If you're in the 3 to 6 range, whether business teams, managers, college students, nursing home, residents. 11, interestingly, is also a danger zone, and I only can speculate. I think these are people who are manic. They haven't been diagnosed and treated yet, so they're in the danger zone. Some ancient reflections in emerging science about gratitude and happiness, Cicero said gratitude is not only the greatest of virtues, but the parent of all others. GK Chesterton, I would maintain that thanks are the highest form of thought and that gratitude is happiness doubled by wonder. And Gertner, to speak gratitude is courteous and pleasant, to enact gratitude is generous and noble, but to live gratitude is to touch heaven. This is a very interesting formula. It's called the happiness formula. This is based on the study of monozygotic twins and comparing them to dizygotic twins. What it says is that 50% of our happiness is genetic. The set point, it's like the thermostat in this room. And amazingly, only 10% is living conditions. Whether you live in a mansion in Beverly Hills or the slums of Calcutta or the shanty towns of Joburg. Doesn't matter 10% as long as you have a roof over your head, some running water. And 40% is voluntary action. What we can do To express gratitude, to be of service. To make others happy, but even that set point of 50% is dynamic. And fluid and can be modulated. And we know that, right? Exercise, behavioral cognitive therapy, antidepressants, meditation will all increase that set point. And very importantly, expressing gratitude. So Robert Emmons is considered the father of modern positive psychology. And he's written a wonderful book called Thanks. How the new science of gratitude can make you happier. If you express gratitude on a regular basis every day, write down 2 or 3 things you're grateful for for 6 weeks. That's it, randomized controlled study. The others didn't do that Your set point can increase by an astounding 25%. Here's a book The Power of Thanks How Social recognition Empowers Employees and Creates the Best Place to Work. Now Google some years ago took their top managers and instead of giving them a bonus of $500,000 to $100,000 said we're going to take you to Costa Rica. Bring your significant other. They spent 8 or 9 days. They got to meet colleagues they'd only met by email. They bonded. They networked. They played golf. It's a beautiful country, Costa Rica, the only country in the world without a military. Oscar Arias, a very enlightened leader, he got the Nobel Peace Prize years ago. And they were then asked, how did this compare to previous years when you've received a $50,000 bonus. It cost Google $18,000 per individual to take care of all their travel and hotel and food and so on. And the majority of people thought that was much more meaningful and a much happier 7 day, 8 day excursion. No, I think they do well at Google and they probably have stock options, but that's what they voted on. Right, here's another reference, counting blessings versus burdens, an experimental investigation of gratitude and subjective well-being in daily life. What's the number one, what's the one day in the week when we have the highest incidence of Acute MIs in our country. Which day of the week? Monday. Which part of Monday? Monday morning, you know who published the study, Bernie Laun. Harvard School of Public Health, Brigham and Women's professor. Eminent cardiologist, Nobel laureate, New England Journal of Medicine 40 years ago. You don't like your work, you don't like your colleagues, you're stressed, you're caught in traffic. And There's road rage Adrenaline goes up. Platelets get sticky. You form a clot, maybe rupture a plaque, you get an acute MI. Monday morning. It's another review, the heart's content, the association between positive psychological well-being and cardiovascular health. Now Viktor Frankl. Wrote Man's Search for Meaning, an amazing book. If you haven't read it, I urge you to read it. In 9 days Holocaust survivor, he said happiness cannot be pursued. It must ensue as the unintended side effect of one's personal dedication. To a cause greater than Oneself And as I mentioned earlier, Schweitzer once said, success is not the key to happiness. Happiness is the key to success. Now we were very privileged some years ago to welcome Thich Nhat Hanh as a keynote speaker at the Harvard CME course. And he's now in his 80s, very regal. When Martin Luther King Jr. met him decades ago, he was so impressed he nominated him for the Nobel Peace Prize. And Thich Nhat Khanh's books, the small books full of a treasure trove of wisdom and sayings. And Thich Nhat Hanh once said, there is no way to happiness. Happiness is the way. This is John Lennon Beetle at age 5, he goes to school. And the teacher gives the kids an assignment. He says, write down what you want to be when you grow up. So he writes happy and he hands it to the teacher. And the teacher says, John, you did not understand the assignment. And John Lennon looks up at him. He's 5 years of age, and he says, and you don't understand life. His mother, every night when she tucked him into bed, said, John, when you grow up, I want you to be happy. That's what he remembered Really, if you want to. Have fun. Ask. Family members of yours or, or friends, kids who are 345678 years of age, to complete the sentence, happiness is. And you'll be amazed at the wisdom. That these children will offer. This is what I gave a version of this talk at Assumption College in Worcester, and one of the deans I share my slides wrote to me six days later, Dr. Chopra, thank you so much. I shared and went over your talk with my husband, but I took your cue and asked my 5-year-old daughter, what is happiness? And my 5-year-old daughter said, Mommy, happiness is when the heart feels bigger. And I gave it at surgical grand rounds at the BI. And the program director wanted to meet with me. A week later we sat and we had coffee, and he said, Sanjeev, I have a son. He's not even 3. He'll be 3 in a couple of months. And I asked him, what makes you happy? And he says, Daddy, I'm most happy when I'm sharing my toys with my friends. Now in which country do these kids live? It's a very unique country, a small country in the Himalayas. And it's Bhutan. What's so unique about Bhutan? The ruler, very enlightened leader some 30 years ago, said, Gross national happiness is more important than gross National Product. They have a ministry of happiness. They track every single subject's happiness on a yearly basis, year after year after year in the top 12 happiest countries, Bhutan is there. In America we are about 22nd to 28th. So here's what some of my friends and colleagues have said. Complete the sentence happiness is being in the moment and being grateful. Again, gratitude, breaking bread with friends. Friends, a choice, knowing you have been good to others when my nest is full, when my kids return home, and I sleep in their own beds. No clinging, no grasping, no regrets, no anticipation, just being in this moment. As it is, being content with what you have, putting a smile on a stranger's face every day. This is a friend, the last one, who together with her husband and Marc Anthony, the Latin American singer, started a foundation called Maestro Cas, and they have now built 9 orphanages around the world. Amazing work that they do. So I decided some years ago when I was first giving this talk, I said, you know, Siri has the answer to every question. So let me ask Siri, what is the secret of happiness? And the answer came back, it is unequivocally short-lived. And you won't believe this. 2 days later, I was invited to Mayo Clinic visiting prof and I go early in the morning. I put my suit on and I go to a coffee shop. I get my coffee and there's a chocolate shop next door, which is of course closed. It's 6:30 in the morning, but there's a sign in there and it says Money can't buy happiness, but it can buy chocolate, which is kind of like happiness. So these are the happiest countries, Denmark. And Norway, almost always the last 20 years, the two happiest countries. But you see, there's Australia, there's Bhutan, there's Austria, Costa Rica, Singapore, Switzerland, Sweden, Canada, Iceland, New Zealand. Something remarkable happened in 2014, 2014. None of these countries were there. Only Costa Rica. All 12 countries were Latin American. Uruguay was #1. Colombia was #2. Really an an anomaly. I, I think there's only one logical conclusion. I think for the first time they asked the questionnaire in Spanish. All right. So what's unique about Denmark? So in Denmark, They work about 35 hours a week. They have universal healthcare. They have education. They have lots of maternity and paternity leave. And then many of them live in communes, so 8 families living together. One mother has to cook once in 8 days. That's a formula for happiness, right? The others help. The kids, if they're 2 kids per family, think they have 14 cousins. And some of the families have grandparents who regale them with stories. It's all storytelling. The social fabric, connectedness, but they also have a very interesting phenomenon. That's called hygge And huggah is informal gathering of friends. You don't call a friend and say we're in the vicinity. Maybe we drop in. You simply ring the bell and they welcome you. You sit down by the fireside. Have a chat. You're only allowed to discuss positive things. Have hot chocolate or a drink. And this is called hygge. It also occurs in Norway. In a setting that is cozy, comfortable, and convivial. Let's move on and finish with living with purpose. Montaigne, the French philosopher, once said the great and glorious masterpiece of man is to live with purpose. Defining your purpose can come to you. Some of you have already found it. You're living it. Others are looking for it. And I'll come to you. You reflect on it. One of the things you could do is take 30 3 by 5 index cards, and every day at the end of the day, write down two or three things you did and give it a rating from 1 to 10, where one, you were miserable and 10 maybe you were in bliss. At the end of the month, strike off everything below 6. Look at 6789. This is bringing me more joy. This resonates for me. Maybe my purpose is intricately linked to this. But it can also come from watching something starkly negative. And it becomes a momentous and magical moment. Where the person witnessing it has the courage and fortitude and grit to say this is unacceptable. I'm going to try and make a dent here. I'm going to try and make a difference here. Most of us will experience sorrow. When you experience the abyss of sorrow and emerge stronger and with a clear purpose. You will have triumphed Viktor Frankl again. He said, we who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man, but one thing. The last of the human freedoms to choose one's attitude in any given given set of circumstances. To choose one's own way. The Buddha once said, every life has a measure of sorrow. Sometimes it is this. That awakens us now. I'm very privileged and honored to call this individual you see on the screen. A friend and a mentor. I met him at a leadership course at the Kellogg School some 9 years ago. He's from the country Colombia. His name is Jaime Aramillo, but he's a national hero, hence the term Papa Jaime. He's about 68 years of age. 40 years ago, at age 28, he's standing at a street corner in Bogota, Colombia, and across the street, there's a sewer, and there are orphans who live. There's an underground city there. And he's feeling sorry for their plight. There's a 7-year-old beautiful girl smiling at him. As they're having this interaction, a car comes around the corner, stops in the middle of the street, a window rolls down, and somebody tosses a toy. It's a yellow school bus, Fisher Price toy. The car recedes. Seven year old girl comes running to the middle of the street. She's never possessed a toy. She picks it up. She's looking at Jaime Aramillo, beaming with joy. And as they're having this interaction, a speeding truck comes around the corner. smashes her into oblivion. And he says to himself, This is it. This is my calling in life. I'm going to adopt these kids. He has adopted, house, school, and fed 52,000 children. 52,000 children. He's been doing it for 40 years. You can see the bliss in his eyes. He found his purpose in life 40 years ago by witnessing the tragic death of this beautiful girl. So I said to him, I said, Papa, how do you pay for all of this? He says, Sanjeev, I have a staff of 150. We have a bakery. The only thing we make is cookies. I've convinced all the restaurants in Medellin, Bogota to have a cookie jar next to the cash register as people are leaving. They grab a cookie. I have a shoebox. They drop change. I get 50% of my needs. I said, what about the other 50%? He said, I'm a motivational speaker. Speak all over Latin America. I plow my own rarium into the foundation. I said, come on, Papa, that doesn't cut it. I know what motivational speakers get. So he looked at me, he smiled. He said, Sanjay, it's uncanny. Every time I need money out of the blue, somebody helps me. I said, give me an example. He said, I'll tell you, 3 weeks ago I needed $41,000 US dollars. To pay my bills, I go to 3 banks. They turn me down. Papa, we love the work you do. You already got loans with us at the lowest rate. Don't even tell anyone the rate. So I'm coming back to my office and there's a street woman. She says, Papa Jaime crosses the street and gives him a hug, and he turns to her and he says, Are you hungry? She said, Yeah. He says, Come, come, come to the office. You can have coffee and cookies. So she's sitting in his office having coffee and cookies. He's on the phone calling 3 other bankers, and she can tell that he's being turned down. So after a while she looks at him, she says, Papa, how much money do you need? He says, Sanjeev, I told her I need $41,000 US dollars. She looks at me, smiles, and says, I'll give it to you, he says. I said to myself, she's cuckoo. She opened her purse. She had $60,000. Son had sent her the money to get off the street. And move into a home. She had to go to a bank, sign a piece of paper, and move, and she says to him, I'm OK on the street. You need it. Your children need it. I've saved some other money. I can move. You take this money now, no questions asked. You can return it if you want. When you want, Sajit, that kind of thing happens to me all the time. He showed me the photograph of a young lady with 3rd degree burns on the entire left side of her body. She was one of the orphans. She crept outside. She was new, didn't know the rules, and was begging outside a fancy restaurant. The restaurant owner called the police. It was not the police that showed up, but a death squad, took her back to the gutter and torched her. And he rescued her 17 reconstructive surgeries, schooled, she then comes to our country on a scholarship, computer sciences, is back home, is married, has a kid, says, Sanjeev, that's my grandchild. Plays with my biological grandchildren. But the next moment he showed me the photograph of a young man dressed in impeccable white with a tennis racket flanked by Pete Sampras and Agassi. He's the national junior champion of tennis from Colombia, one of his orphans. They've grown up to become nurses, doctors, surgeons, teachers, accountants, professional athletes. And many of them are giving back to his foundation, but he found his purpose in life 40 years ago witnessing the tragic death of that one beautiful 7-year-old girl. You know, Jim Collins said the good to great leaders never wanted to become larger than life heroes. They never aspired to be put on a pedestal or become unreachable icons. They were seemingly ordinary people quietly producing extraordinary results. And Joseph Campbell once said, follow your bliss. And doors will open where there were no doors before. I don't know if you've heard Joseph Campbell. There's a wonderful series on PBS with Bill Moyers. He wrote about. The power of mythology, a hero's journey, amazingly, Brilliant and wise individual. Now some of you may have heard of this remarkable individual. His name is Abru. He's an economist from the country Venezuela. A couple of years ago, two people received an honorary doctorate at Harvard at the commencement. It was Abru and Oprah Winfrey. And some 33 years ago, he takes 9 kids off the street. And he teaches them classical music. This program is called El Systema. And There are now 400,000 kids. I may need, Chris. OK. Last year at the Proms, here in the Royal Albert Hall, something amazing happened. Chris, double click to get the full screen. A huge orchestra of kids from the shanty towns of Venezuela came to play Shostakovich's 10th Symphony. One critic called it the performance of the season so far. It was an astonishing prom's debut for one of the most remarkable orchestras in the world. I would say in my experience that there is no more important work being done in music now than is being done in Venezuela. The second half of the concert went off like a rocket. The Proms had never seen anything like it. OK, good. But that's only half the story. Let's go to the next slide. So this is called El Sistema. There are now 400,000 children in Venezuela playing classical music. 90% come from poor families. They would be in gangs, on drugs, maybe dead. It also to me settles the debate about nature versus nurture. Nature's important, the genes we inherit, but nurture is so much more important. These kids are performing in Vienna at the Philharmonic, and the critics are calling it the performance of the year. This gentleman you see on the screen is Gustavo Dudermel, one of his kids. He at age 26 became the conductor of the LA Philharmonic. He's considered one of the most celebrated conductors in the world. He has started a similar program in LA. We have a similar program in Boston, in Scotland, in Sweden. It's Greece. It's. Becoming very international, the story of El Sistema. So one of my favorite quotes and the title of my new book, The Two Most Important Days in Your Life. At the day you're born And the day you find out why. So each one of us has a singular purpose in life. Sir Ken Robinson, wonderful book, Finding Your Element, Having a Purpose in Life is the wellspring of sustained happiness. So I mentioned the four traits of the happy people friends, forgiveness for others, and gratitude. They'll make you happy. But happiness is more than the sum total of happy moments. Happiness is more than the sum total of happy moments, and if you want to have sustained happiness and joy and bliss, you have to find your purpose and live it. And you do that and anything else you do, if it does not align to your purpose, is a distraction. It's a detour. And we have to learn to say no to that. Now, here are 5 things. I should have said I love you more often. I should have had the courage to pursue my dreams and aspirations. I should have traveled more. I should have been the bigger person and said, I'm sorry. I should have spent more time with my friends. Who says these five things? You know it. Say it. People in hospice. What are your greatest regrets in life? Nobody says I should have worked harder. I should have lived in a bigger, fancier house. I should have owned a new Tesla every 3 years. So what's the point of this? The point of this is we should make sure we're doing this now. All right, very simple things that you can do that'll bring you so much joy and happiness. Young people can find their purpose. This is Jennifer Stapel. I've met her. She's an amazing inspirational person. At age 19, as a pre-med student, she does an ophthalmology rotation. It's saddened to see people who've grown blind from treatable, preventable causes of blindness. Who are these people? Poor people, New Heaven. So she goes back to Yale with 29 other students, forms an organization called Unite for Sight. They have now seen more than 1.2 million patients. They have 4000 fellows. She has 4000 volunteers, including professors of ophthalmology and web designers. They have done 52,000 site restoring surgeries. She got admission to Stanford, and she said, I want to defer admission. I have to work 80 hours on my organization, Unite for Sight, and the dean of admissions said, Jennifer, take your time. When you're ready, we'll be ready for you. Really amazing inspirational leader, but again, Happened with that one ophthalmology elective. And I'm going to conclude by telling you about Adam Braun, a very inspirational young man. He was studying at Brown. He does a semester at sea. And on a lark, every country he visits in Africa and Asia through an interpreter, he picks an 8 year old kid on the street and says, if you could have one wish in the world, what would it be? So this 8-year-old girl in an African country says to dance. He says, Come on, she didn't get the question. Ask it again, and she repeats it. Another 8-year-old girl in a different country, she says, for my mother to be well, walk me to school and hold my hand. And he goes to India and he's mesmerized. And he meets an eight year old beggar, boy. And through an interpreter says, if you could have one wish in the world, what would it be? And the boy says, a pencil. He says, What? You can have any wish in the world. A pencil? Ask him again. So he repeats it. It turns out the beggar. begs outside a school and these kids come out of school. They sit on a wall next to him. They're opening their notebooks, they're laughing, they're smiling, they're writing, they're drawing with a pencil. He thinks his ticket to happiness is a pencil. So Adam Braun buys a whole bunch of pencils, and every country he visits after that, he doles out pencils to kids on the street. Comes back to New York. And he's haunted By the image of this 8-year-old beggar, all he wanted was a pencil, so he decides, I'm going to create a school. He starts a foundation called Promise of a Pencil. He does a fundraiser in New York. Social media helps him, his friends. They raised $6000. He goes around the country in a van. Meets college students. Sometimes a dorm. One student will show up, sometimes 41 young lady in a small college in California says, Adam, I'm going to ride a bike across America. I'll raise $10,000 for you. She raises 10,000. Somebody matches it, 20,000. Adam has now built. 200 schools Across Africa, Asia, and Latin America, 15 million educational hours delivered to children. Forbes magazine rates him as one of the most influential people in the world under the age of 30 years. His grandmother, this is a few years ago. Holocaust survivor, she's 5 ft tall. Her name ironically is Eva Braun, and Adam had a job at Bain Capital here in town, and he quit it. And she says to him, Adam, I was so proud of you. You were working for Bain. What is this pencil thing you're doing? And he calls her Grandma. He says, Grandma, come and sit with me. He calls her Ma, and they sit and he goes to his computer. He shows 3 slides, these poor kids playing in the dirt, spanking new school. And the 3rd slide, the first school he built. As you walk into the foyer, there's a plaque, and it says this school is dedicated to Ma Eva Braun. And then the two of them sob. He's at a rooftop in Manhattan, and he's feeling like a fish out of water, all these elderly, mostly male, rich, rich people, and one rich older gentleman walks up to him and says, Young man, what do you do? He says, I have a nonprofit. Before he can finish the sentence, the guy walks off. So as he's walking off, he says, Sir, can I have your card? And then he reflects on it. And he meets with the guy. He says, Can you spare 10 minutes and have a cup of coffee with me? And the guy says, OK, so they meet for coffee and when they sit down, Adam turns to him and says, I don't have a nonprofit. I have a for-purpose organization. We build schools for poor people all over the world, right? The word nonprofit has a negative connotation. How much of the money is going into overhead? How many million dollars is the CEO making? How many golf junkets for purpose, much more powerful. And the guy takes out his checkbook and writes him a check there on the spot for $20,000. So I'm going to conclude by telling you in the next 2 minutes, the story of the starfish. I've told you about Adam Braun and Papa Jaime and Jennifer Staple. These are very amazing stories and inspirational, but we can all. Do things that are very meaningful. There's a young lady walking on a beach where there are 10,000 starfish stranded, and she picks one, twirls it, throws it into the ocean, picks another one, twirls it, throws it into the ocean. There's an older gentleman sitting in a chair smoking a pipe, reading a book. He says, Young lady, young lady, come here. What are you doing? Do you think you can make a difference? There are 10,000 staff are stranded here. You see the beach across? Another. 10,000. So she smiles, picks up a starfish, twirls it, and throws it into the ocean. And says it made a difference to that one. Right, so we can all make a meaningful difference in small and big ways. I think it's in the Talmud that says if you save one life, you save. The world you save humanity. So I'm going to conclude by sharing with you my purpose in life is to fulfill my d Dharma to teach medicine, to teach leadership, happiness. To do it grounded in humility with an ardent desire to learn every single day, to celebrate with gratitude my family, friends, colleagues, students, patients who inspire me in countless ways. And in some small measure inspire everyone I meet. I invite you to reflect on what gives you the greatest joy. And resonates for you Take a few minutes now, later, probably later, reflect on your purpose, if you haven't found it, and write it down. You may wish to share it with your closest family and friends. It is my ardent desire and fervent hope that each one of you will find lasting happiness. Live your purpose. To its fullest, and that it will light up every single day of your life. Thank you very much. Well, Doctor Chopra. Awe inspiring to hear your presentation today and hopefully we'll all. Leave with more happiness and joy than we came in this uh. This morning. I find the study that you, you mentioned from Harvard remarkable where they followed the people and, and that those who had joy and happiness lived longer. I would have thought that it would have been manifest in their blood pressure or other factors that you said were perfectly normal. Yeah, isn't that remarkable. That was an amazing cohort of people. It, you know, of that group, some became doctors, some became teachers, accountants, some committed suicide, some became skid row derelicts. One of them became our president. John F. Kennedy was in that study. So it's a remarkable study that's almost 80 years old, 4 principal investigators, and that's the major conclusion, and I think we know it. Loneliness is toxic, but that your satisfaction with your relationships with friends at age 50 is a better predictor of health, happiness, and longevity three decades later. That's remarkable, really remarkable. So the social fabric, connectedness. And I think we need to encourage that, and we need to ask our patients when they're leaving in the visit, you know, maybe even in a questionnaire. Tell me a little bit about your friends. How much time do you spend? What brings you joy when you're with your friends? Just plant the seed. Additional questions for Doctor Chopra. So I wrote a book with a friend and colleague, Gina Weil. It's called The Two Most Important Days, and I've gifted it to the surgical residents. Faculty are allowed to borrow. Well, I guess you have everybody, uh, Dharmed and ready to go out with you. Thank you so much for sharing. Thank you. Thank you for the honor.