Reflecting on What Matters After a Terminal Cancer Diagnosis

ALISON BEARD: Welcome to the HBR IdeaCast from Harvard Business Review. I’m Alison Beard.

From midlife on, or maybe earlier for some people, we all tend to start reflecting on the choices we’ve made in our personal lives and our careers and the legacies that we think we’re going to leave behind. I know the pandemic sparked this kind of thinking or rethinking for a lot of us; other big moments like the birth of a child, the loss of a job becoming an empty nester or retirement can do the same. But our guest today has been thinking deeply about these issues for another sadder reason.

Mark Goulston, psychiatrist, leadership coach, bestselling author, and friend of HBR reached out a few weeks ago with some terrible news. He has been diagnosed with cancer that might be terminal. A lifelong educator, he started to wake up in the middle of the night thinking about all the advice he still wants to impart. He says he’s gained a newfound clarity about what matters and what doesn’t, and he wants to share what he’s learning from this experience with us.

Mark is co-founder of the Deeper Coaching Institute and author of a number of books. Mark, I really appreciate you volunteering to come on the show to talk about this.

MARK GOULSTON: Well, thank you for having me.

ALISON BEARD: First, I am so sorry. How are you and your family doing?

MARK GOULSTON: They’re very quiet because they’re taking it in, and that’s not bad. I’m blessed to have a wonderful family, a wife that tolerates me for 45 years, and children who have all qualified to be donors because I may need a bone marrow transplant for my condition, which is heading towards acute myeloid leukemia.

ALISON BEARD: And how are you doing?

MARK GOULSTON: I can’t say happy, but I am the calmest, most content, most free of depression and anxiety that I have ever been in my life. Part of it is one of my specialties when I was a practicing psychiatrist was suicide prevention. None of my patients died by suicide in 35 years, and also doing house calls to dying patients. And a number of those dying patients, I tried to help them find peace of mind at the end of their life. And a number of them were very wealthy and powerful, and they didn’t find peace of mind because as one of them said, who had a wry sense of humor, “I have all the love that money can buy, and everything I thought was important isn’t. And everything that I thought wasn’t important is, and I’ve run out of time to fix it.”

And so I think part of why I’m content is one of my mentors, a Dr. Ed Schneiderman at UCLA, he wrote an article called The Good Death. And he had a bunch of criteria. And I am fitting all the criteria except that in this day and age, 90 is a good age to live to, and I’m 75, and there’s a very good chance I won’t make it close to that.

ALISON BEARD: How did he and you define what a good death is and what a meaningful, satisfying life should be?

MARK GOULSTON: Well, here are some of the criteria; and I check the boxes. I’m not a great fan of pain and suffering, and so I think if I had a team that I didn’t have so much confidence in, I don’t think I’d be so calm. But I have a great team, so I think the pain and suffering is going to be taken care of. I have a thing about being a burden, and I don’t want to be a burden to anyone, my family or friends, financially. My wife recently told me that… I might get a little emotional. She said, “The kids are all launched, and I’m going to be fine financially,” so this is not going to be a burden to them or her other than missing me, I guess.

The third criteria was I’m the creative lead of about seven projects, and I’m a serial creative person, and I want to make sure that I don’t leave those people hanging. I want them to go on and finish and complete what we’re working on. The next thing is I am learning things every day that this is teaching me that, again, living didn’t, and I’m sharing them. I’m sharing videos called I’m Dying to Tell You.

And I’m learning things. For instance, the initial episode was called Michelangelo Dying. And what that’s about is Michelangelo said that he saw the angel in the concrete, and he carved until he set it free. One of the first things I’ve learned is I’ve carved away everything that’s unimportant in life. And by carving away what’s unimportant, what is important literally glows.

One of the other episodes is called Visionary Dying because with a mentor of mine, Warren Bennis, we determined that there are three things that all visionaries have in common; Steve Jobs, Elon Musk. The first D is they define reality. Steve Jobs said, “We’re going to have personal computers on everyone’s desk. And we’re going to make an iPhone that’s going to change everything.” And Elon Musk said, “Well, we’re going to make an electric car and privatize space travel.” They declare a reality that’s way beyond what we have. The second D is they declare their intention. “It’s impossible, but we’re going to do it.” And the third D is they decide strategy about how to do it.

Well, I came up with this visionary dying where I’ve defined a good death by what I shared with you, little pain, not a burden, tie up loose ends, share what I know. And something else that I’ve discovered that is the most difficult is I’m letting people care about me. I have never let anyone care about me. I’m a doctor, I’m a therapist.

ALISON BEARD: You’re the caregiver.

MARK GOULSTON: I’m the caregiver. And I had a moment where apparently discovering that there’s a number of people who care about me. And I remember there was a breakthrough about six weeks ago, and he said, “Oh, hi Mark. How are you doing?” And instead of my usual, “I’m fine. Let’s focus on you.” I said, “Well, I’m dealing with an issue.” And then I shared with him. And I got emotional and I got embarrassed. And I apologized. And he said to me, “Don’t apologize.” And I’m saying this because there’s a lot of caretakers, a lot of executives, they have trouble letting people care about them. It’s uncomfortable. That’s helping defining a good death.

ALISON BEARD: Yeah. That’s one thing you’ve learned through this experience. I want to dig into a lot of the other things that maybe you’ve either learned or begun to rethink. You are best known for your expertise in communication. You have books, Just Listen and Talking to Crazy. As you reflect on the lessons you tried to impart in those books, what are some of your most important takeaways?

MARK GOULSTON: Here are a couple that are bookends. It really surprised me how unaware people are of talking too much. In fact, I had a blog at HBR in 2015 called “How to Know if You’re Talking Too Much.” And what I talked about is a friend of mine who’s a career coach, Marty Nemko. He said, “You know, Mark, for a guy who wrote a book on listening, you really stink.”

And he told me about the traffic light rule. And the traffic light rule is that unless you’re invited to give a monologue, if you’re in conversation with people, you have 20 seconds before the green light turns to yellow, 20 seconds before the yellow light turns to red. That’s 40 seconds before you start wearing out your welcome. And those 40 seconds feel like three seconds because it feels oh so good, and you don’t take a hint. People are fidgeting, they’re looking around you, and you don’t even notice it.

And then the other thing that I found fascinating is I have a podcast called My Wakeup Call. And I would say about 1/3rd of the people who really seem to have it together, I point out to them, “You’re really impressive. Is there anything you could get better at?” And one of the most common things they say is, “I could be a better listener.” And so people are aware, especially in their marriages and with their children, that the way they listen, listening to solve problems and give advice when people don’t want that, it’s not going well. But they’re not committed to changing it.

ALISON BEARD: And did your diagnosis or any other major life changes that you had before this affect how and why you communicate to others?

MARK GOULSTON: Well, my diagnosis has certainly helped. About 10 years ago, I decided to stop trying to convince or persuade anyone to do anything right out of the gate until I’ve earned the right to their attention. I replaced it by first compelling to open people’s minds, which earned me the right to convince them to take action. And what I’ve discovered is most compelling that you can do is to realize that whoever you’re talking with, from one to 1,000 to one to one, as we’re talking, everybody is listening for something underneath their listening to you.

For instance, I’m guessing that you’re listening for something to give your listeners where they think, now, that was a great use of my time. And you’re also listening for a way to prevent your listeners from thinking, now, that was a real waste of my time. And by the way, wouldn’t you agree that would be the best use of these busy people’s time is for us to cover things that are relevant to their role in their life that’s clear, concise, and immediately doable by them? That’s what you’re listening for, eh?

ALISON BEARD: That is. You talked about the ability to strip away everything that’s unimportant. Your diagnosis has obviously given you more clarity on which elements of your life to put in what category, but how do you make those decisions? Or how did you decide what to strip away and what to keep?

MARK GOULSTON: Warren Bennis and I came up with a quote; I’ll try and remember. There are none so blind as those who won’t see, there are none so deaf as those who won’t hear, there are none so ignorant as those who won’t listen, and there are none so foolish who think you can change someone who won’t see, hear or listen.

I’ve switched from being a therapist to being a coach and a mentor. And I’m selective about being a mentor. Because when I mentor someone, and I’m mentoring more than 40 people, I want to wholeheartedly and enthusiastically look forward to seeing them and rooting for them.

And when that happens, and here’s the key for me to being a great mentor, I offer them unwavering, non-judgmental, positive regard and safety. And this forms what we do with the Deeper Coaching Institute, is that when you can create safety positive regard not being judgmental, what’s happening is my mentees and my coaching clients, they start to say, “I got a lot of hangups.” And what happens is you make it safe for them to talk about their hangups that they’ve never talked to anyone else. And it’s so freeing to them.

ALISON BEARD: You have developed this sense of urgency to remove people who won’t see, hear or listen from your life. How do people who aren’t faced with an existential threat or a big life change, how do they develop that urgency?

MARK GOULSTON: One of the ways to create urgency is to cause people to have a flashback of something that really costs them. When I used to do presentations about listening, I’d say, “I’d like you to think of someone in your mind’s eye who cares about you, roots for you, has your back. And I’d like you to think about asking them, “What would be the positive impact on my success, my happiness, and our relationship if I was a better listener?” Small, moderate, large.” And nearly all these people would say, “Oh yeah, moderate.” Yeah. And then here’s the pincer effect. Keep that person in your mind’s eye and now ask them, “What has already been the negative effect on my success, happiness in our relationship when I have been at my absolute worst as a listener?

When I’ve cut you off, when I’ve ridiculed you, when I’ve been sarcastic.” And they all respond huge because they get a flashback of what it costs them. You get people to self-discover an opportunity that they failed to seize or a crisis that they could have avoided but didn’t.

ALISON BEARD: You know, that’s a calculation we should be making all the time. Rather than just blindly going along through life, trying to succeed in the career or walk up the corporate ladder or impress certain people, we need to be making those decisions based on what is the positive impact that this is having on my life and what is the negative impact?

MARK GOULSTON: Absolutely. And I think it’s also important to know what your values are and if you’ve been aligned with them during your life. My values, the top two, are kindness and personal sacrifice.

I dropped out of medical school twice, and they wanted to kick me out the second time because they were losing money. And the dean of students saw something in me that I didn’t see. And then he did something that changed my life. He said, “You have something that the world needs that you can’t see. And you won’t see it until you’re 35. But you need to make it till you’re 35, and you deserve to be on this planet. And you’re going to let me help you.” He stood up to the entire medical school. And he was just a PhD standing up to all these MDs, and he said, “We’re giving this one a second chance.”

And I just paid that forward. The trifecta of hope is an unconditional seeing the goodness in people and their value when they can’t. And they don’t have to perform to do it. The second thing is seeing a future for them that they can’t see. The third thing is going to bat for them at your own sacrifice.

ALISON BEARD: So you mentor students, clients, other coaches. And you have had great mentors, some of which you’ve mentioned. What did they do for you that you try to do for others in that paying it forward way?

MARK GOULSTON: Well, what they did for me, all the way back to that dean of students, is they bathed me an unwavering non-judgmental, positive regard so that I could open up fully to them. And what I’ve discovered is by being empathic, by being caring, and by joining people in the dark night of the soul and keeping them company there when they’ve only been alone there, people start to cry with relief. And it’s utterly transformational. I’m going to live this out trying to bring human kindness to humankind. And when I teach people to be empathic, especially in conflict resolution, it changes everything.

ALISON BEARD: Yeah. Talking about conflict resolution, you wrote the book on dealing with irrational and impossible people, Talking to Crazy. Have you in the past months sometimes felt that you want to have a word with this irrational, impossible thing that is cancer?

MARK GOULSTON: Well, here’s the weird thing. I realize that cancer is not happening to me, it’s happening for me. I think I’ve spent my whole life wanting to feel whole. And there was always something missing. And the prospect of dying has caused me to feel whole because I’m living my values; nothing to prove, nothing to show, and nothing to hide or fear.

And I’m trying to teach people these things before I go, because for me, they’re so monumental, and they’re within reach.

ALISON BEARD: Well, it does sound like you have tremendous support from family and friends. And I think part of the reason perhaps that you are at peace is because that you manage to find the right balance between personal success and professional success. All of us, when our time comes, want to feel like we’ve done a good job on both those fronts. What advice do you have for people about getting that balance right?

MARK GOULSTON: You need to realize that everybody in your life, including you, compete for time, they don’t compete for importance. In the well-lived life, everything including you is important. And the way you demonstrate importance to everyone, including yourself, you put it on your calendar. And when it’s on your calendar, you focus on being totally present, undistracted, undivided attention. Doctors and lawyers do a good job of that when they have to go from one patient or one client, one file to the next. When you drag one role into the next, everybody loses. And you can build this muscle, you can build this muscle that whoever you’re with gets your undivided attention.

ALISON BEARD: I talked to Dan Pink last year about his research on regrets. his takeaway was that the biggest regrets people have are inaction regrets, I didn’t do the thing I wanted to do, and connection regrets, I didn’t reach out to that person. I didn’t maintain or build my relationship with that person. Does that resonate with you?

MARK GOULSTON: Oh, yeah. And I’m going to give you something that is the steroid of connection and regrets. I think being forgiving and asking forgiveness, especially the second I think the keys to happiness. There’s a quote from a friend of mine, Dr. Shawne Duperon. And she has a program called Project Forgive with Desmond Tutu. It was nominated for a Nobel Prize. And she has a quote, “Forgiveness is accepting the apology you will never receive.” And when I heard that 25 years after my dad had died, I accept his apology for being overly critical, I think, of my creative crazy ideas. And the apology he gave me that I never received was, “You know, Mark, I was good with numbers. I hid behind numbers. I wasn’t good with a lot of creative ideas. And when I used to put you down for them, it’s because you made me nervous because I was good with numbers and I wasn’t that good with emotionally connecting to your brothers and especially your mom. And what you’ve been able to do with your life, the people you have touched, the lives you’ve saved, I don’t deserve you as my son. And I’m sorry.”

But what was revealing to me is I owed him an apology. I said, “I accept your apology.” And I believe he would give that to me from the grave. And I said, “I’m the psychiatrist in the family. I had a chip on my shoulder about you. I had a grudge I was holding against you. And I know that everything you did was based on fear. When people tried to drag you out of numbers, you got uncomfortable. And I know that underneath, you really loved us even though you couldn’t relate to us. And I’m finally able to say six words that I haven’t been able to say, and feel them. I love you and I miss you.”

ALISON BEARD: Yeah. And when you were young, you didn’t have the language to say, “Dad, what’s making you frustrated? What’s making you upset? What’s making you disappointed?” And he probably wasn’t living in an era when he was comfortable being vulnerable in that way. That’s a really touching story. Let’s talk about legacy. What do you want yours to be?

MARK GOULSTON: As I said, I’d like to bring a little human kindness to humankind. You know, Freud said, “Where it is, let ego be. Where impulses are, let ego be,” ego meaning reality, not the way ego is. And my adage is where competitiveness is, let compassion be.

ALISON BEARD: I like that. I like that a lot. And so my next question was advice for other people out there listening who might be early or mid-career. What is your advice for them on how to build a good successful life when they’re greeted with terrible news to accept it, fight but accept it with peace and to have a lasting legacy? What advice do you give young people today?

MARK GOULSTON: Here’s my advice to younger people in mid-career. Be the go-to person who does the jobs that nobody else wants to do and become excellent at them without complaining. People are more impressed by excellence such as that of Serena Williams or Tiger Woods than what you’re excellent at. You don’t have to like tennis or golf to be impressed with excellence. And also, when you’re doing something that nobody wants to do without complaining, that’s going to make you a unicorn.

Also, something that I’m teaching people, and I probably won’t write the book, but it’d be a good book title, Take the Hit: How to deal with anything that life throws at you with poise, courage, and calm. Every time something happens to you, see it as an opportunity. I’ll share this exercise that I do with many groups. I’ll say, “Raise your hand if you’ve had a breakthrough in life.” And many of them do. “Raise your hand if you’ve had five breakthroughs.” And many of them do. And I say, “Raise your hand if prior to the breakthrough you had a breakdown that wasn’t pleasant, invited and was sometimes scary.” And the majority of them keep their hands up. And I’ll say, “Here’s the best advice I given myself about breakdowns.” And I borrowed it from being a psychiatrist in training. I put myself on a 72-hour hold, which is what we used to do in the emergency room. And I say to myself whenever something doesn’t work out well, I say, “Don’t do anything to make it worse for 72 hours,” because we often miss the breakthrough because we will do things to make it worse. We will get drunk, we’ll eat, we’ll get angry. But if you can not do anything to make a breakdown worse for 72 hours… Now, some people you might need to do it for a lot longer than that, but the breakthrough will reveal itself to you.

A very quick anecdote. A good friend of mine, it was the CEO of Abbott Medical Optics. And their top product was herding corneas. And my friend, Jim Mazo, took their top product off the shelves without checking with the board, without checking with anyone. He didn’t want to hurt customers. And I called him and I said, “Jim, I just want to tell you how much I admire you for doing that.” And he said to me, “Mark, I’m giddy with excitement.” I said, “You better close your door. What do you mean you’re giddy with excitement?” He said, “Every time I’ve hit adversity in my career or my life, every time it made me smarter and stronger. And I’m giddy because I know this is going to do the same and I don’t know what it’s going to show up like.

ALISON BEARD: That’s amazing. Well, first, Mark, I think you should definitely write that book, Take the Hit. And secondly, I’m really inspired by the fact that you are using this adversity in your life to find new breakthroughs.

MARK GOULSTON: Thank you. Thank you for having me.

ALISON BEARD: That’s Mark Goulston, husband, dad, leadership coach, consultant, speaker, and author of Just Listen, Talking to Crazy, and Getting Out of Your Own Way.

We have more episodes and more podcasts to help you manage your team, your organization, and your career. Find them at hbr.org/podcasts or search HBR on Apple Podcast, Spotify, or wherever you listen.

This episode was produced by Mary Dooe. We get technical help from Rob Eckhardt. Our audio product manager is Ian Fox. And Hannah Bates is our audio production assistant. Thanks for listening to the HBR IdeaCast. We’ll be back with a new episode on Tuesday. I’m Alison Beard.