Webinar | After the shift: The Pitt, unpacked

1 “Ken Heinrich” (1345757184)
00:00:04.825 –> 00:00:24.859
Well, good evening, everybody, and we appreciate all of you tuning in those who have been following our conversation on LinkedIn throughout the season and those who are joining for the very 1st time for our conversation. We’re gonna begin with just brief introductions and maybe talk a little bit about each one of us the character that.

2 “Ken Heinrich” (1345757184)
00:00:24.859 –> 00:00:48.080
Most resonated with us during the show. For those that are tuning in, if you have any questions, discussion topics you’d like us to hit, please go ahead and submit your questions through the Slido. You should be able to access that on the webinar. Anyway, my name is Ken Heinrich. I am chief medical officer for emergency Medicine for SCP health.

3 “Ken Heinrich” (1345757184)
00:00:48.080 –> 00:01:18.920
I did my training in Chicago and that’s where I continue to make my home. And character for me that actually resonated the most was nurse Dana. I think most of us who have been in emergency medicine have worked with a charge nurse or another really strong personality like that who just cared a lot, was really passionate, knew THE and could make or break a shift for each one of us. And I learned very early in my intern year.

4 “Ken Heinrich” (1345757184)
00:01:18.920 –> 00:01:37.472
That I had to embrace those people, show them genuine respect, and if I did, they’d make my life better in the. And if I didn’t, then that was my own fault and I was gonna suffer. I will then turn it over to dr. Nickels. Why don’t you introduce yourself?

5 “Stephen Nichols” (257141248)
00:01:37.472 –> 00:01:57.320
Steve Nickels, my role at the company right now is chief clinical innovation officer. I practiced in mostly rural Texas, the emergency medicine, and for me it’s, it’s an easy choice, it’s abbott. I’ve always loved nights. I loved nights before I even got into emergency medicine.

6 “Stephen Nichols” (257141248)
00:01:57.320 –> 00:02:10.752
And I I take a few wrists, I still snowboarded out in the side country and I’ve been in the deep in the trees and deep in the powder a couple times as well as a few other things, so that one’s easy for me.

7 “Ken Heinrich” (1345757184)
00:02:10.752 –> 00:02:13.676
All right, awesome. Yeah.

8 “Brian Dawson” (150787072)
00:02:13.676 –> 00:02:28.730
Good evening, so Brian Dawson, emergency medicine training in North Carolina East Carolina University and have practiced in a variety of practice environments currently practicing at an emergency department.

9 “Brian Dawson” (150787072)
00:02:28.730 –> 00:02:48.730
In Eastern tennessee. I actually have a shift on Saturday looking forward to that. And for me, like I I couldn’t much like reading different books. I found that identified with different characters at different moments in the show. And so whether it was the tough case and spending some time.

10 “Brian Dawson” (150787072)
00:02:48.730 –> 00:03:12.350
In the ambulance bay just processing or, you know, you, you got the diagnosis right and you feel great and then the very next case you totally miss it and you feel awful and you don’t understand how you missed it. Like different characters resonated at different times. Even sometimes the stress where you see the characters displacing on their teammates or their family, and you’re like, oh, that’s just not right.

11 “Brian Dawson” (150787072)
00:03:12.350 –> 00:03:29.156
Great, but you’re like I’ve been there, I’ve done that and felt bad about it, had to go like clean that up afterwards. So it wasn’t a specific character so much as identified with a lot of the situations and characters throughout the the the season.

12 “Bentley Tate” (1391579904)
00:03:29.156 –> 00:03:48.740
Yes, I’m Bentley Tate. I served as an emergency room physician out in Colorado where I’m talking to you from in rural Colorado and the eastern plains, Denver’s home for me, but did that for 29 years and I’ve had the privilege of serving as SCP health’s chief Wellness officer trying to be a dr. to doctors to help my.

13 “Bentley Tate” (1391579904)
00:03:48.740 –> 00:04:05.100
And many colleagues stay a little bit healthier and a little better out outlook on medicine. The character I think I most enjoyed was in terms of resonated with maybe aspired to be like her and in the rearview mirror would be dr. L Hashimi.

14 “Bentley Tate” (1391579904)
00:04:05.100 –> 00:04:25.100
I appreciated just that she was consistently calm despite the chaos around her. I realized how helpful that was when I did that. I hope I did that more often than not. I I appreciated how she was observant of what was going on around her with her colleagues, good behavior and bad behavior, but.

15 “Bentley Tate” (1391579904)
00:04:25.100 –> 00:04:45.100
She didn’t just follow being observant, but she just seemed to be patient and and wise to find a strategic opportunity to bring things up when she needed to as, as a leader in that emergency department. Maybe what I most appreciated was she was someone in her character that I hope.

16 “Bentley Tate” (1391579904)
00:04:45.100 –> 00:04:55.692
I was as well during my 29 years and that was someone who, who smiled more often than had a cynical look or a frown on their face.

17 “Ken Heinrich” (1345757184)
00:04:55.692 –> 00:05:15.559
Excellent. All right, so we have all spent all seasons somewhat dissecting and sharing our thoughts about the entire season and the show. So let’s talk, just spend a few minutes each one of us talking about what we thought the show really got right from our perspective, where the show might have missed a little bit.

18 “Ken Heinrich” (1345757184)
00:05:15.559 –> 00:05:27.534
And then what made us roll our eyes at some point? And Ryan since you kicked off this journey with us on, on the 1st episode, why don’t you begin?

19 “Brian Dawson” (150787072)
00:05:27.534 –> 00:05:39.959
Yeah, thanks again. So for me, like what I really enjoyed, I did I had not watched season one and so I, I came into season two, not knowing what to expect and what I found was.

20 “Brian Dawson” (150787072)
00:05:39.959 –> 00:05:56.639
Just the humanity, like the fact that the patients, the clinicians, the environment, like it wasn’t just a case like they did a very good job of developing the characters and the stories of both the patients and the staff, and.

21 “Brian Dawson” (150787072)
00:05:56.639 –> 00:06:16.639
And what kind of what’s going on in their life? Like they’re more than just that particular case. Like there’s a lot more below the surface of that patient encounter. Much like when we work a shift and we walk in the room and they say I’m here for back pain and then you find out that actually one of their loved ones, their child passed away last week and so.

22 “Brian Dawson” (150787072)
00:06:16.639 –> 00:06:36.639
They’re there for a physical element and they’re there for an element that cuts deep to the core of their humanity and their soul, if you will. And so I thought they got that right. I, I really enjoyed seeing that. And then the other thing they got right about emergency medicine is you can go from a very impactful case like that one I just mentioned and then.

23 “Brian Dawson” (150787072)
00:06:36.639 –> 00:07:05.039
When you step in the next room and it’s a patient that just needs a work note because the fast food restaurant they’re working at required them to show up in the. And, and you, you moved to that. And then for, you know, I roll like I guess what I would say just most of the cases I’m like, Yeah I’ve seen that before, but they did pack a lot of rare cases that all of us may have seen a few times in our career into a single shift, you know, for the sake of television, I’m sure.

24 “Brian Dawson” (150787072)
00:07:05.039 –> 00:07:30.478
And we see those and did a great job of depicting them, but we don’t see all of those zebra cases, doctors would refer to them in a single shift. So we care, like they they got that right. The nurses, the doctors, everyone who shows up in the emergency department to work a shift, they genuinely care for those patients. Yeah, I agree.

25 “Ken Heinrich” (1345757184)
00:07:30.478 –> 00:07:31.592
How about you?

26 “Bentley Tate” (1391579904)
00:07:31.592 –> 00:08:00.619
Yeah, I just follow up on some things that Brian said. I I think there were some things that that they really hit the nail on the head, that one of my convictions just dealing with looking after physicians and their health, nurse practitioners and PAs as well is, is that whether you end up in a place of thriving and happiness or despair and burnout, they both have something very much in common that you tend to get to either one of those places.

27 “Bentley Tate” (1391579904)
00:08:00.619 –> 00:08:16.529
By just the accumulation of shift after shift of day after day in life. It’s it, you know, the show’s about one shift taking 15 episodes or so to to show us, but I just had a sense that the shifts.

28 “Bentley Tate” (1391579904)
00:08:16.529 –> 00:08:36.529
In the review mirror were very much the same for them and the ones ahead were gonna be very much the same. And and so the it shows just that dr. Robby and even the young physicians were, were on a path of of the accumulation of however they dealt with and the and the cards they were dealt. I think they.

29 “Bentley Tate” (1391579904)
00:08:36.529 –> 00:08:56.529
Emailed in terms of the pace that was there. One of the aspects that I think is, is so true in emergency medicine is there’s not the time to pause and reflect and process, you know, just the relentless things you’re exposed to, whether it’s just tough illnesses, you know, long term problems, death.

30 “Bentley Tate” (1391579904)
00:08:56.529 –> 00:09:25.069
Little of what I saw on the show showed people having the time, energy or the capacity to process things in the midst of the workday, however hard they were, and I think that part was kind of accurate. Maybe the eye roll for me again, I’ve got this wellness, this concern for physicians and then, you know, lasting in medicine that I just felt like was just this, this sense that was encouraged, maybe somehow portrayed that when you walk through the.

31 “Bentley Tate” (1391579904)
00:09:25.069 –> 00:09:45.069
Ambulance doors, you’re coming from home, walking into the. To begin the shift, that you just can somehow magically leave all that’s going on in your life and show up at work. Or the other, you can leave the hospital and leave all the good and the bad you’ve just experienced for 1012 longer hours and head through the.

32 “Bentley Tate” (1391579904)
00:09:45.069 –> 00:09:53.714
The same doors and just leave it all behind. That gives me an eye roll cause it’s just not consistent with how human beings live life.

33 “Ken Heinrich” (1345757184)
00:09:53.714 –> 00:10:13.129
Yeah, I I think that’s right. I I think it’s tough to put up that wall. We were all taught I I think in residency before we’re walking into a code. The 1st pulse that we have to check is our own. And so it’s important to create that separation, but as you said, we’re still bringing in some of the pressure, some of the good and the bad.

34 “Ken Heinrich” (1345757184)
00:10:13.129 –> 00:10:33.129
From our own lives. And for me, I would say the show got a lot right. I want to be clear, but one of the things that really I thought they did a great job of portraying was just the pressure of what it feels like to work in the fishbowl. And for those that don’t know who aren’t in emergency medicine, that’s what we all say. Everybody.

35 “Ken Heinrich” (1345757184)
00:10:33.129 –> 00:10:52.229
Everybody sees what’s happening in the department. Everybody’s coming into the department, people medical staff are walking down. We see what’s happening with each other. It really does feel like we’re practicing in a fishbowl, and there’s a lot of pressure, a lot of stress that goes along with that. And I I thought the show just did a great job.

36 “Ken Heinrich” (1345757184)
00:10:52.229 –> 00:11:12.229
Of actually demonstrating that feeling and and really the impact that it has on everybody who’s in that. One area that I thought maybe they could have done better or at least I didn’t love, was I would say the level of autonomy that we saw in the medical students certainly and even inter.

37 “Ken Heinrich” (1345757184)
00:11:12.229 –> 00:11:32.229
I think that’s evolved as we all have gone through our careers, but in training today, I think there’s more supervision, there were a lot of bad outcomes and they needed to show those bad outcomes. But I actually think, I hope it didn’t leave the public with an impression that when they go into a teaching hospital, they’re gonna have untrained.

38 “Ken Heinrich” (1345757184)
00:11:32.229 –> 00:11:52.229
In medical students who are gonna be dictating a lot of the care. The one, the one time that I sort of rolled my eyes a bit, and we’ve all talked about this was when Landon had to do the closed blind cervical reduction. And what I mean by blind for those who don’t know is he did it without x ray or fluorroscopy or any.

39 “Ken Heinrich” (1345757184)
00:11:52.229 –> 00:12:06.594
Everything. You know, we all once in a while, have to cowboy up, so to speak, but we weigh, we weigh the risks and balances before we do something like that.

40 “Stephen Nichols” (257141248)
00:12:06.594 –> 00:12:25.909
Yeah, I think that cowboy up thing, that that is a risk and balance thing. It reminded me when we’ve talked about it in other times of an episode where I was in, I’d gone down to work in a hospital was gonna get hit by hurricane. And so I do like risk and.

41 “Stephen Nichols” (257141248)
00:12:25.909 –> 00:12:45.909
While we were there, we were still running on generators. We finally got the other generator up and we were trying to get somebody to get a cat scan. Wasn’t my patient. The patient had a little tiny IV, a 22 gauge. The other dr. came to me and said, man, I gotta try and find this IV, she was hard to get a 22 in. And I go, you know what you could do? You could just take a triple.

42 “Stephen Nichols” (257141248)
00:12:45.909 –> 00:13:06.779
Lumen, take out the guidewire, slide the guidewire in pull off the 22, slipping 18 in, and I bet it’ll work. And he goes, oh, and he leaves, then he comes back, I don’t know, 20 or 30 min later, he goes, Hey man, that that worked. That was great. How many times have you done that? And I go, I’ve never done it. I’ve ever even seen it. I’ve never even read about it. It just seemed like it might work. He was like.

43 “Stephen Nichols” (257141248)
00:13:06.779 –> 00:13:26.779
Did it work? He goes, yeah, worked great. I go, you can write it up if you want. I probably get it published. I don’t know a trick of the trade, whatever you want to do man, but i’m glad it worked because we still got a lot of people to see. So I think, you know, there was low risk and everything, but some of it is we, we liked the cowboy. We, we are used to taking care of.

44 “Stephen Nichols” (257141248)
00:13:26.779 –> 00:13:52.799
Whatever we can with whatever we have. So that part Cranny was exaggerated just like a lot of the stuff, I mean it you know, TV and movies these days is always kind of like sharknato. How much stuff can you cram in the time that you’re watching it? The thing that surprised me, but I also thought it really nailed it was the end where they were singing carriokee. Okay, two people you wouldn’t have thought would get together, but they’ve gone through.

45 “Stephen Nichols” (257141248)
00:13:52.799 –> 00:14:17.146
A very bad day in a lot of ways and hey, let’s just go get some of this out of our system. Let’s get some different energy in and release some of the negative energy, and that really did hit hit a place for me. The other thing that was an iroll was just also the amount of incredible technology, right? Not every place has all that technology.

46 “Bentley Tate” (1391579904)
00:14:17.146 –> 00:14:18.734
Sure.

47 “Stephen Nichols” (257141248)
00:14:18.734 –> 00:14:29.554
Particularly in community hospitals, a lot of things you saw, you just, you don’t have the availability. So that was it, but not a surprise I guess. Yeah.

48 “Ken Heinrich” (1345757184)
00:14:29.554 –> 00:14:45.289
I do think you’re right though we all there is unevenness in medicine. There are differences between hospitals. There are regional differences differences still in healthcare, certainly in emergency medicine. We never know what’s gonna walk through or.

49 “Ken Heinrich” (1345757184)
00:14:45.289 –> 00:15:07.375
Be driven through our front door during a shift. So, so I think they demonstrated that to your point, maybe they had more technology, but I, we got the sense that they had it because they were an academic institution. So I guess what, what else did the show surface for all of you? Again Brian, why don’t you kick us off?

50 “Brian Dawson” (150787072)
00:15:07.375 –> 00:15:22.999
Yeah, and I guess I would resonate with what you were saying, like we, the emergency department, all of us who went into this and trained many years ago, like we we knew going in that this is the front door of the hospital. This is where everyone comes for.

51 “Brian Dawson” (150787072)
00:15:22.999 –> 00:15:43.799
Anything from the hangnail to the heart attack, the car crash, whatever it is, we’re there to see them in that moment and take care of them. But I think the show did do a good job of demonstrating and maybe kind of compressing for us in the, in the one shift is.

52 “Brian Dawson” (150787072)
00:15:43.799 –> 00:16:03.799
I think emergency medicine today versus ten or 20 years ago like it it keeps getting more complex. The volume and complexity keep going up. The societal expectations of, we don’t know what to do with that, so why don’t we just have the do that? They should ask that question. They should enroll the patient in this. They should take care of that problem.

53 “Brian Dawson” (150787072)
00:16:03.799 –> 00:16:23.799
And so stuff that used to find itself in other places in the society safety net are now in the emergency department, and I think the show did a good job of, of surfacing that throughout the season for us. And it didn’t feel invented like we we’ve all on this probably many of those watching or partici.

54 “Brian Dawson” (150787072)
00:16:23.799 –> 00:16:43.709
Participating tonight we’ve experienced workplace violence. We either have experienced it personally or we’ve seen it occur to our partners at work or our teammates while they’re working. We certainly have seen the unhoused patients, the social crisis, the opioid epidemic, drug addiction, like we’ve all taken care of that. I think.

55 “Brian Dawson” (150787072)
00:16:43.709 –> 00:17:03.709
Because the show got to got that right for us as well. And certainly while it’s NO place that we, our patients would want to be, we’re always open 2047 and we we always have our lights on and we’re always there ready to welcome them and take care of them. And I think that’s something that we should all be proud of and I think the show did a great job of demonstration.

56 “Brian Dawson” (150787072)
00:17:03.709 –> 00:17:08.012
Trading that to society.

57 “Bentley Tate” (1391579904)
00:17:08.012 –> 00:17:25.399
Yeah Brian, I would add to that. I I think the show did a pretty good job of showing that it’s hard, we get asked to handle a lot of hard things, things we don’t feel ready to handle. Most I think people would think outside of medicine, of course, you know, you’re gonna have seen every.

58 “Bentley Tate” (1391579904)
00:17:25.399 –> 00:17:45.399
Every disease or, you know, maybe you haven’t done a procedure for a while and and true, you know, that that’s part of hard is diagnosing something that’s infrequent or you’ve never seen before. But you know part of what’s hard is a lot of the other stuff that I think many of us would say I don’t know if I had mentored or really shown.

59 “Bentley Tate” (1391579904)
00:17:45.399 –> 00:18:10.829
On how to do that. I’m thinking of things like telling people really bad news. That never gets easy. I don’t care how long your career goes. Dealing with problems dealing with someone who has problems that really are, their problem list is a marass of decades long of of social and, and physical and psychological problems. You know, some of it.

60 “Bentley Tate” (1391579904)
00:18:10.829 –> 00:18:28.109
Maybe their issues, bad decisions over years neglecting their health, but a lot of it just being dealt, you know, some tough cards in life and things that were outside of their control. I mean, I, I even after all the years I did it, I never felt like I was just really good.

61 “Bentley Tate” (1391579904)
00:18:28.109 –> 00:18:48.109
And trying to deal with unfixable problems quickly but this never gets easy and how, how you deal with that when you know the next patient is waiting and has been waiting for a while. I mean one little ancidote would be a lot of times in emergency you could ask by law enforcement to sign a serious bodily injury form.

62 “Bentley Tate” (1391579904)
00:18:48.109 –> 00:19:08.109
You know, and and sometimes even nicely, you know, hey, Doc, can you sign this so you can get on with the other patients and now you’re behind. I think it took me years to even realize how significant me signing that basically legal form or not signing it meant in a court of law. And.

63 “Bentley Tate” (1391579904)
00:19:08.109 –> 00:19:28.109
And I guess as I look back, I, I never took it unseriously. I wouldn’t want anybody thinking I didn’t take it seriously, but but I have to say it just felt like I was being asked to do that with about the same amount of bandwidth of time and energy that I would respond when we were ordering doordash, and I was asked to add some fries to my order.

64 “Bentley Tate” (1391579904)
00:19:28.109 –> 00:19:44.274
You know, it just is, it’s just tough, it surfaced just the fact that our our wellness and aspects of being handling the tough things, sometimes can we can feel pretty lacking in that despite the years of training we get. Yeah, I.

65 “Ken Heinrich” (1345757184)
00:19:44.274 –> 00:20:03.019
You know, I think that’s a really good point. The fact that there are going to be some things that are really tough for us and others that are easier because we’ve seen a bunch and during our training, that we’re not gonna see everything. I actually remember during one of my interviews for residency, one of the.

66 “Ken Heinrich” (1345757184)
00:20:03.019 –> 00:20:23.174
One of the interview is one of the interviewers, one of the docs asked me, what are you looking to get out of residency? And I made the naive statement, well, I want to see everything I need to see so that I’m comfortable when I get out as an attending and you guys are all up because we all know, but he said, well, that’s impossible. You.

67 “Stephen Nichols” (257141248)
00:20:23.174 –> 00:20:26.995
You will never see everything in your residency.

68 “Ken Heinrich” (1345757184)
00:20:26.995 –> 00:20:51.849
But hopefully, by the time you’re done here, you’ll feel comfortable handling whatever comes in. And that’s what it’s all about. It’s learning to feel comfortable with it. And certainly I I was blessed actually because my residency program, we had three different ERs, very, very different practice environments. So I got exposed to a lot. Bandly I was I mean I had law enforcement in all the time because.

69 “Ken Heinrich” (1345757184)
00:20:51.849 –> 00:21:09.932
There’s a couple of them were inter city, so I probably got a little bit more used to that. That goes back to the some of the unevenness I guess of distribution. But again, I think we all see enough hopefully during our training that we can handle what comes, what, what comes through our door.

70 “Stephen Nichols” (257141248)
00:21:09.932 –> 00:21:42.319
Yeah, yeah, you never see it all. I practiced in southern California for about ten years before I moved to rural Texas and and it was a different set of stuff, but some of the things were the same like delivering bad news and things like that. The unevenness can sometimes be the other way. We, we at one point had to accept kidney stones from larger cities to ours because we were the only ones that had a eurologist. I had a patient in a trauma center, who came.

71 “Stephen Nichols” (257141248)
00:21:42.319 –> 00:22:03.959
To us, he had a trauma. We had just gotten a new slice, 64 slice CT scanner. My Cta’s neck, everything seems fine. My general surgeon wanted me to call the trauma team up in Dallas. So I call him, he’s looking at the scan, and he goes, so we need to get vascular clearance, I go, that’s what they want. He goes.

72 “Stephen Nichols” (257141248)
00:22:03.959 –> 00:22:23.959
That looks like it’s a brand new ct scanner. I go, it is, we got it two weeks ago. He goes, can you do a vascular reconstruction? And I go, me? No, I can’t, but the guy here next to me, the tech, I hope he knows now. And he goes, Yeah I learned last week. So literally takes 2 min and they put up a nice three D representation of the vasculature.

73 “Stephen Nichols” (257141248)
00:22:23.959 –> 00:22:42.727
Could spin it around, it looked like special effects to me. It was incredible, and the vascular guy over in Dallas goes, that’s it. We’re done. You don’t need to send him here. I don’t even have that capability here. You’ll actually be sending him like we’re supposed to get ours, but it’s not in yet. So keep the patient. You’re done.

74 “Bentley Tate” (1391579904)
00:22:42.727 –> 00:22:43.752
And that was.

75 “Stephen Nichols” (257141248)
00:22:43.752 –> 00:23:00.299
Incredible and the surgeon was like really? I’m like, look, he gave me his name his cell phone. He says call him if there’s any problem. So it isn’t spread evenly everywhere. I think the best thing they did, again, they compressed it all together, but they showed what a mess.

76 “Stephen Nichols” (257141248)
00:23:00.299 –> 00:23:20.299
Things are in US Healthcare right now. I mean all the stuff that’s come together, this isn’t the system we built by a plan or anything. It’s just grown together and unfortunately it’s reached the stage where enough is enough. I think many many people feel that way. Not just the clinicians.

77 “Stephen Nichols” (257141248)
00:23:20.299 –> 00:23:38.591
But patience, people, it’s just something the technology can’t fix, and we we have to figure out something better because it’s not gonna get better on its own. Yeah, I think that’s what they hit hardest for me. Yeah, I I.

78 “Ken Heinrich” (1345757184)
00:23:38.591 –> 00:23:57.049
I could not agree more. You know, we, we know about burnout. We all see it unfortunately, throughout our careers and colleagues and friends sometimes in ourselves. And I don’t even like to use the word burnout. I really do think it’s, it’s moral injury it’s the healthcare system. It’s not any individual.

79 “Ken Heinrich” (1345757184)
00:23:57.049 –> 00:24:21.559
Fault it’s this, it’s this big complex system that does it but it it’s tough. So on that point I guess what, you know, we’re done with the pit, it was a TV show and yet we all know that hundreds of thousands of health care workers are showing up to work and will continue to show up to work in ERs across the globe.

80 “Ken Heinrich” (1345757184)
00:24:21.559 –> 00:24:35.475
Country, so what does it take for all of our colleagues and for us? Ryan, you’re going in on Saturday. What does it take to keep showing up despite that system?

81 “Brian Dawson” (150787072)
00:24:35.475 –> 00:25:02.099
I think for me at least like you know, I think I guess we could say it could be hard to keep your humanity with the chaos that the healthcare systems become and that an shift has become, I think we have to kind of hold all of that and not drown in it and for me, it’s thinking about that one patient or that one encounter that I’m looking for on each shift, Sometimes it’s more than one, but.

82 “Brian Dawson” (150787072)
00:25:02.099 –> 00:25:22.099
I kind of approached the shift like I I’m certain that there’s somebody here today that I’m meant to see and then I can have add value to their experience to their life. And sometimes I know who that is after the shift, sometimes I don’t. I certainly pray about that and think about that going into the shift. Like I have a parking lot ratual where I stop and.

83 “Brian Dawson” (150787072)
00:25:22.099 –> 00:25:45.509
Just sort of take a moment, like Bentley said you can’t leave your whole life behind you, and I think I wrote about this on one of my posts, like I’m carrying my humanity and myself into the emergency department, that makes me better than if I just shut it all off and compress it down and don’t experience my own humanity. But stopping for a moment, pausing, thinking about what I’m about to enter.

84 “Brian Dawson” (150787072)
00:25:45.509 –> 00:26:05.509
And trying to be present for those patients and say a little prayer for who’s that one that I’m here to see today. And it’s kinda, it’s it’s a really cool gig that we get to do. Like I still find joy in going to the emergence department even on the busy chaotic day. Like we get to be a pastor, we get to be a scientist. We get to be an attorney.

85 “Brian Dawson” (150787072)
00:26:05.509 –> 00:26:26.959
For our patients like and our work matters, like we get to see lives saved and even though it’s extraordinarily difficult and takes something from us, we also get to hold the hands of the dying and give the bad news and try to do that in the most respectful and humane way. So I, I think it just it it matters and it feels impact.

86 “Brian Dawson” (150787072)
00:26:26.959 –> 00:26:36.992
Important and sacred almost. So for me like that’s, I still keep showing up and I think if I quit feeling that, like that’s when I need to quit showing up.

87 “Stephen Nichols” (257141248)
00:26:39.393 –> 00:26:51.209
Yeah, it’s, there’s give and take to it. It’s interesting that the the ending with dr. Robbie, I read somebodycizing the way he swaddled the baby. Okay, well.

88 “Stephen Nichols” (257141248)
00:26:51.209 –> 00:27:14.987
He’s unmarried, he doesn’t have kids. Like, how does he know how to swallow a baby I didn’t learn how to swallow a baby in my training than anybody, I don’t think so, but I do remember, I didn’t get married until later and I had my kids much later than that. So I did have to handle kids though, and when I would go to my friends who had young children, they were like, Oh, you’re really good with kids? I’m like, really? I don’t mind hanging them up by their feet.

89 “Brian Dawson” (150787072)
00:27:14.987 –> 00:27:17.353
It’s fine. You know I’m comfortable. You can’t really.

90 “Stephen Nichols” (257141248)
00:27:17.353 –> 00:27:19.651
Pull their arms and legs off, they stick. It’s good.

91 “Brian Dawson” (150787072)
00:27:19.651 –> 00:27:21.254
So.

92 “Stephen Nichols” (257141248)
00:27:21.254 –> 00:27:34.799
But then when I had kids I I hoped that helped me. Like I, I I was comfortable around children, and then I did learn how to swaddle babies cause I had some and I think I did a better job of that in the year, right? It, it.

93 “Stephen Nichols” (257141248)
00:27:34.799 –> 00:27:54.799
It is a give and take situation for us, and you have to give both parts of your life, right? You have to have balance, you have to have some break between the two, but it’s not completely perfect ever. But it should be getting better. I mean like you should have more good days than bad days.

94 “Stephen Nichols” (257141248)
00:27:54.799 –> 00:27:59.788
And that’s true for whatever you do, right? Yeah.

95 “Bentley Tate” (1391579904)
00:27:59.788 –> 00:28:24.229
It won’t surprise you guys. I I find I wanna answer that question more expansively. What does it take to keep showing up? I wanna say, well what does it take to keep showing up well? You know, what does it take to keep showing up or wanting to show up? What does it take to keep showing up and the patient actually wants to see you rather than wait for another talk to come into the room.

96 “Brian Dawson” (150787072)
00:28:24.229 –> 00:28:27.872
Because I’m concerned that, that.

97 “Bentley Tate” (1391579904)
00:28:27.872 –> 00:28:41.519
Docs are or need to not just show up but do it in a way that is good for them and good for, for patients. You know, as we were prepping for this and I was thinking about it, I thought, you know, I, there’s.

98 “Bentley Tate” (1391579904)
00:28:41.519 –> 00:28:59.699
Hospital closest to me. If I would be willing to see, I think almost anybody that I saw in terms of providers on the pit, if I was a patient and I had to go there because my heart was about this had stopped or, you know, my shoulder was out of place or I needed some stitches.

99 “Bentley Tate” (1391579904)
00:28:59.699 –> 00:29:19.699
But I think I would drive somewhere else if I needed a dose of compassion, not knowing whether I was gonna get it from, you know, some of those docs that we saw on that, on this season or or someone who could give a little bit more uninterrupted listening to my issues or.

100 “Bentley Tate” (1391579904)
00:29:19.699 –> 00:29:49.489
Someone who could provide a little extra effort to help me navigate after I’m discharged the health care system and its complexities, which I just feel like extra effort is much more likely to happen as an outflow of a heart that’s not jaded and totally cynical. So I, those are the kinds of things I think about. What does it take to keep showing up? One of it I think is addressing the challenges from our earliest days in our training. I I I think this might surprise not just.

101 “Bentley Tate” (1391579904)
00:29:49.489 –> 00:30:14.009
There’s a lot of of non medical people, but I think you’d probably surprised a lot of people within, you know, the, the, the hallowed halls of medicine to realize when they did a study in 20 1412 years ago, they they assessed whether students who were about to start medical school, how well do they stack up in terms of how well they’re doing? You know, mental health, you know, quality of life.

102 “Bentley Tate” (1391579904)
00:30:14.009 –> 00:30:34.009
Well, would you believe that these medical students before day one scored 25 to 35 % better than their peers who weren’t going into medicine in terms of burnout scores, in terms of depression, in terms of even quality of life, more general scores. But that all changed.

103 “Bentley Tate” (1391579904)
00:30:34.009 –> 00:30:55.039
Changes the evidence is as soon as we start medical school and start our training. So we gotta pay attention to the challenges in medicine, you know, on our overall well being and our souls from the earliest days. And I know that is getting increasing attention, but that really does need to continue.

104 “Ken Heinrich” (1345757184)
00:30:56.073 –> 00:31:15.229
Yeah, I I think that’s right, and I think that’s something that we all as attendings and as leaders really need to to commit to, to being there to support not just our colleagues, the people that the teammates that we work with, but our profession and our industry and all the people.

105 “Ken Heinrich” (1345757184)
00:31:15.229 –> 00:31:40.279
Who are in it. I actually think as maybe as jadeded and or burnt out or morally injured as a lot of the people were on the show. One thing I liked is we saw that they were there for each other. They, they allowed each other to get whatever support they needed. And I think we saw it in dr. Robby. He kept showing up for his.

106 “Ken Heinrich” (1345757184)
00:31:40.279 –> 00:32:00.279
His colleagues for his team. And you know, II1 of my, actually my 1st medical director as when I was out of residency and he’s a good friend of mine now. Remember him sitting me down and one of my shifts it was late at night and I was arguing with an attending who needed to come into the. And I was frustrated.

107 “Ken Heinrich” (1345757184)
00:32:00.279 –> 00:32:17.429
Did, and he actually said, you know what, Ken? We are the one profession where what we do not only matters, but we advocate for our patients every single day, every single shift. And that’s a privilege.

108 “Ken Heinrich” (1345757184)
00:32:17.429 –> 00:32:36.239
And I think, I think what we need to do is carry that advocacy outside of the four walls of the. Brian, you talked about workplace violence. It’s, it’s sad to me that 75 % of all workplace violence in this country happens in a hospital.

109 “Ken Heinrich” (1345757184)
00:32:36.239 –> 00:32:56.239
Or in the health care system and we aren’t doing enough as a country and we need to advocate. We need our legislators to do more, to avoid Medicare cuts to clinicians. We need to continue to fight for clinicians like with the Lauren Abrinact, lots and lots of stuff.

110 “Ken Heinrich” (1345757184)
00:32:56.239 –> 00:33:16.909
I’ll share with you guys actually I got a text from another friend of mine, An old friend I’ve known for many many many years. And he said, you know, I I watched the pit all season and I never realized what you all go through. Thank you for what you do. And I was really moved by that. It meant a lot to me and what occurred.

111 “Ken Heinrich” (1345757184)
00:33:16.909 –> 00:33:55.049
To me, and what occurs to me now listening to all of you talk is we need all of those people as well who were moving the show to call up their representatives, their senators, whoever it maybe, so that we can all advocate for our frontline workers and for our patients. I think that’s something that everybody can do so that our colleagues can keep showing up every shift. All right, any questions from the audience? I’m just checking right now.

112 “Brian Dawson” (150787072)
00:33:55.049 –> 00:34:03.449
While you while you look at that can I’ll just say something that resonated as I was listening to you all speak, I think another way that we.

113 “Brian Dawson” (150787072)
00:34:03.449 –> 00:34:19.979
Keep our humanity and it was something in attending early on told me they say you know you go in as a medical student and you want to get the whole history right, and you want to come out with the perfect HPI, you don’t want to miss that they had X Y and Z done and so you’re like all stressed about that. And this attending said, you know.

114 “Brian Dawson” (150787072)
00:34:19.979 –> 00:34:39.979
It’s a privilege to take care of humans, like these are humans and they have stories and they have families and he said, I want you to come out with your presentation and tell me something non medical that you learned about the individual that you’re treating. Like it can be that they have six grandkids or that they’ve been married for 50 years and that they think the key to a successful marriage is this.

115 “Brian Dawson” (150787072)
00:34:39.979 –> 00:35:10.789
He said I don’t care what it is, but learn something non medical about your patient and make a human connection and I don’t know I’ve carried that through my whole career and I actually have found that it’s one of the most enjoyable aspects of the history and physical is learning that little tidbit about them and, you know, could be asking them about the tattoo on their arm or about the family member in the room or what they did before they retired, you know, and I’ve had fascinating stories as a result. And that brings me joy. Like I go home and I’m like, hey, I met a retired four star general.

116 “Brian Dawson” (150787072)
00:35:10.789 –> 00:35:26.834
Or someone who worked on the space shuttle and like it’s just cool. Like, where else do you get to have that kind of encounter? So I think that helps us connect our our humanity into those individuals as well. Do we get any questions? We.

117 “Ken Heinrich” (1345757184)
00:35:26.834 –> 00:35:56.999
We didn’t get any questions, by the way, I agree with you completely about the connection. I I think that’s so critical to all of us feeling what valuable in what we do. So, if you all in closing had to share one takeaway that you hope everybody walks away with from the show or understanding about our profession of emergency medicine, what would that be?

118 “Ken Heinrich” (1345757184)
00:35:56.999 –> 00:36:01.471
Yeah Ryan will start with you again.

119 “Brian Dawson” (150787072)
00:36:01.471 –> 00:36:19.429
Yeah, for me, I would just say that the nurses, the NPs, the PAs, the doctors, the techs, like we even saw the pharmacists helping like we’re all people too, and we hurt as well and we care like and and the caregivers that are there are gen.

120 “Brian Dawson” (150787072)
00:36:19.429 –> 00:36:45.294
Annually doing their best. And so if as a result of folks watching the show, they understand that a little better and they give our colleagues who are working shifts right now, and later tonight a little more grace because they’re like, you know, they do have it kind of hard sometimes, then I think that’s a good thing. If the show brought that awareness to society, that’s helpful.

121 “Bentley Tate” (1391579904)
00:36:45.294 –> 00:37:16.819
Brian I think I could add to that because I think my takeaway and hope for people listening in a medicine or outside of medicine really resonates with that. And that is I hope people just take away from the show the accurate fact that that there’s a personal cost to practicing emergency medicine. You know physician dog, good nursey practitioner, whatever it is in the emergency. There’s a there’s a cost that the season two really brought out that the emergency department can be a sole crushing.

122 “Bentley Tate” (1391579904)
00:37:16.819 –> 00:37:35.549
Being health crushing place, you know, this for some, from people over the years. So I found myself in over the years saying to people, you know, when, when you see your dr., you, you you you your dr. needs compassion and they start nodding their head and then I say from you.

123 “Bentley Tate” (1391579904)
00:37:35.549 –> 00:37:55.549
You know, it it needs to be a two way street. I think the show hopefully did some things where people next time they show up, particularly in the acute care hectic setting, are not just expecting compassion to come towards them. And absolutely, I know the four of us all want that and want to be those kinds of physicians.

124 “Bentley Tate” (1391579904)
00:37:55.549 –> 00:38:15.549
But there’s a place for it also being reciprocated. And I also hope maybe for something for the just the families and and friends of people who work in the emergency department, I I hope you might feel a taste of the support I felt a little bit analogous, can to your friend.

125 “Bentley Tate” (1391579904)
00:38:15.549 –> 00:38:40.173
And that after watching one of the episodes mid season and my my son was home, my youngest who’s in his last year of college and, and my wife was with me. And as the credit started rolling at the end of the show, they literally both turned to me and said, Thanks for doing that for so many years for me. And that meant a lot.

126 “Stephen Nichols” (257141248)
00:38:40.173 –> 00:38:55.290
Yeah, I would say the, all the high tech stuff, the systems and the processes and all the things they have wrong, you know, they’re real people who are the clinicians there and and they’re doing the best they can with what they have. It’s it’s.

127 “Stephen Nichols” (257141248)
00:38:55.290 –> 00:39:15.290
It is true, NO matter how bad it gets or whatever, they’re they’re there to do what they can. The one thing that I realized as you were talking about it that really hit me about the carrioke was when I was a PGY two, a medical student came back to see me in May, and she had been on my service in the fall.

128 “Stephen Nichols” (257141248)
00:39:15.290 –> 00:39:31.650
And she just came up to thank me and tell me she was graduating. Well, I was a little rushed because I was still PGY two and I’m like, what are you doing here? And she goes NO, I really wanted to thank you. I’m like, ok, whatever, you know, like do you need a lot of recommendation? Like, what does it, what does he mean? What does he?

129 “Stephen Nichols” (257141248)
00:39:31.650 –> 00:39:51.650
And she’s like, No I just want to thank you because, you made it clear that we needed to have some life outside of this. When we would get off shift, you’d say I’m going to the beach room, I’m going to do this or whatever it is, and what are you gonna go do? You need to go do something. And, and that’s what she wanted to think before. It sounded like she had come from a family that pressured her to.

130 “Stephen Nichols” (257141248)
00:39:51.650 –> 00:40:09.132
To perform and Excel and exceed and all those things which we push our kids to do. And she just wanted to know we should be people and I think we can all do that for each other, whether you’re an emergency medicine or or not, right? Modern life is not getting simpler.

131 “Ken Heinrich” (1345757184)
00:40:09.132 –> 00:40:27.930
You know, I, I think that’s so true. That’s what I hope everybody watching this season understands is that in all of medicine and certainly in emergency medicine, we’re people, we’re humans. We’re going to make mistakes. Bad things happen and we don’t like it. It hurts us.

132 “Ken Heinrich” (1345757184)
00:40:27.930 –> 00:40:44.190
When bad things happen. But we’re there and Brian, you said it to start us off on this section. We’re there because we care, because we care about making sure that patients feel better, that they get the treatment that they need.

133 “Ken Heinrich” (1345757184)
00:40:44.190 –> 00:41:04.190
We care about our colleagues. We care about the system. We’re showing up, not because of a paycheck. We’re showing up because this is the best job for us. And I hope everybody walks away understanding that in a pre having hopefully a little bit.

134 “Ken Heinrich” (1345757184)
00:41:04.190 –> 00:41:26.240
Get more appreciation for that nurse or dr. or NP or PA or whomever it is the next time they have to visit AN. So I think on that note, we’ll thank everybody who tuned in or those of you who are gonna watch the recording later. It was a lot of fun for me this season. I appreciate all of you guys, day in and day out. So.

135 “Ken Heinrich” (1345757184)
00:41:26.240 –> 00:41:29.873
So thank you to everybody and have a great night. Thank you.

136 “Stephen Nichols” (257141248)
00:41:29.873 –> 00:41:30.634
Spokes.

137 “Brian Dawson” (150787072)
00:41:30.634 –> 00:41:36.416
Thank you.