Heroes of Healthcare
Heroes of Healthcare

Episode · 7 months ago

Unsung Heroes: Coordinating Emergency Services in New York City

ABOUT THIS EPISODE

Last year, a makeshift field hospital was built in Central Park. Did you know the last time that happened was during The Civil War?

The pandemic has stretched the healthcare system to its limits, but at every turn, healthcare workers across the country have met the challenge with compassion and creativity.

In this episode, I talk with Dr. Brendan Carr, who is the Professor & System Chair of Emergency Medicine at the Icahn School of Medicine in the Mount Sinai Health System, about the massive effort that went into fighting COVID in New York City and the many unsung heroes that led the way.

You were listening to heroes ofhealthcare. The podcast that highlights bold selfless professionals in thehealthcare industry focused on transforming lives in their communities.Let's get into the show, welcome to the heroes of healthcarepodcast. I'm your host Ted Wayne joining me to day is Doctor BrendanKarr Doctor Carrs, a professor and system chair of emergency medicine atthe ICON, school of Medicine, Mount Caiand I and the Mount Sini HealthSystem in New York City, Dor, carris focused on building regional systems ofcare for emergency care and developing innovative delivery solutions to createa more distributed and accessible acute care delivery system. He has a centralrole in coordinating mount cionise response to the recent epidemic effortswhere he recently was recognized by cranes, health care, doctor car earnedhis medical degree from Temple University School of Medicine andcompleted his residency in emergency medicine. At the University ofPennsylvania, Dr Carr also served as the director of Emergency CareCoordination Center and as a senior adviser within the US Department ofHealth and Human Services from two thousand and twelve to two thousand andtwenty. It's our privilege to have dtor Carr, join us here on the heroes ofhealthcare. Welcome to the show thanks so much tod, O pleasure Beger, you knowit's been fun. We've had several of the folks from Mount Syani on these calls,and I love having the team there, because your stories are so impactfuland really so inspirational, and you know, as I mentioned in theintroduction, your involvement with the emergency department and all the workthat you've done. I'd love to Gond O go back, and in our first conversation wetalked about what I call the Unsung heroes and I'd love for you to sharewith the listeners how, when the first breakout of Covid came- and you guyshad to start mobilizing what are all the logistics around behind it- thatpeople don't often think about that. You guys had to do in order to makesure you were providing the care that you needed to yeah, they're,substantial and and thanks for refreshing, my memory and sort oftaking this back to that framing all the people that are, you know Unsung,as you said, behind the scenes, but without whom you know nothing gets done.We just can't function unless all the pieces come together in the way thatthey're supposed to, then we should put a name to some of them. You know, let'sactually start broad, the inside of the healthcare system, it's easy to say,docks and nurses right, but oial boy. That is very, very ticp of the iceberg,but if we just even started it broadly than that and I think about getting towork during those months, you know I live just a twenty minute, walk awayfrom the hospital, but I live in a building that has folks that support,give thethe e doorman right and then sai an the survice guys that are makingsure that people's lives go. I stop at the grocery store in the way and grabsome things to stick in the mini fridge in my office and on the way home and inthe fridge at home. Just you know, th and their labeled, broadly as essentialworkers, and it's important just to take a minute to recognize that theynever stoppd coming to work and it'sustoundit. When you extend thatinto the hospital you know every everywhere, you turn everything youlook at, has a history behind it, so whether it is the story of the maskthat I need or or the gloves that I need or the facesield, that I need forthe medications that the patient needs or the stretcher thatit's been wipeddown and in sterilized as cleaned all those things have an amazingly complexjourney. That sort of precedes, then getting into to the moment. You knowwhere they're needed and when we put together. I know you know that you'vehad other people talk about the about the command, centor structure and Puntogether, th the experts within their disciplines. You come to realize thatthese are people who many of them, you don't have a relationship with, becausewhen things are working, wheneverything stopped and the suppliesare just the here. You go to the closet and it's magic. You know it's full ofall the things that you need right, it's not magic. You know it's people'slives, thinking about just in time,...

...supply chains and and just in time,logistics and delivering on it so frequently that it feels like magic m.We just come to expect. We just come to expredi yeah. You know, I mean peoplethink the same way about public helth. Frankly, you know neither of US woke uptoday and thought. Thank goodness I don't have a waterborn direal illness.You know we didn. We didn't wake up and think that today, and yet it turns outright very intentional right that has happened over years and years and yearsand years and years, because we are careful about our water and our food inour sanmitation. We have learned all these things anyway. So, yes, those arethe young Sun folks and when they s, when you sit around the table and areon the list and everybody points to the to the doctor or the emergency doctorstands at the entrance of the hospital. It's really easy to celebrate and don'tget me wrong. Those guys are heroes. Those women are heroes and we aregrateful. It meant a lot. A Lot. Tohav people recognize you know New York Citywas everyone has talked about it, but but you can't really understand it, anduntil it was you at seven o'clock, when people would just go on their balconiesor stick their heads out, their windows ore stop their car and start honking,just to sort of say: Hey. We see you and we know it scary in there yeah. No,that those are some of the most moving things I saw on the media, but then mydaughter lives up on a hundred and seventy fifth and Broadway and she'sright next to Presbyterian her only refuge which I've talked about anotherepisodes was up on. The roof, was a way to get out of her room and get AU. Getsome outside time during the Hay Day and she would send me the video clipsof the shift changes at Presbyterian and it was so moving you'd get chills.You know, se hearing everybody just appreciating all that work for sureyeah, I'm going to still be jol thinking about it right and thinkingabout what it meant to you know the fireahartment pulls up yeah and theNurseng go outside and and they amplaud each other. It's just I mean you know,I think, if you weren't in it, maybe it seems a little staged in a little sillyright boy. These were dark days. These were really really scary, dark days andit's nice to it's nice just to think about Tha Yegan, but again, buttirkling back right. So, but you know we're talking about one of the Loton th,one of the folks that I mentioned to when we were talking casually there'stwo people that I think about a lot. I think about and I'll name them justfirst names only as Carlos and Tom Right. You know- and I think aboutCarlos runs the supply chaing for everything that we need, that we bringinto the system and Tom runs real estate, and you know who would haveever thought that real estate has something to do with the response inNew York City Unti. You realize that these are tens of thousands ofemployees that were afraid to go home, but you got to writ it's a differentdisease. Now we understand some things about this disease that we just didn'thave ter. I remember back picking up. I think it was a newland Gounrnal, tofghmedicine, Article Tho talked about aersilized virus being alive onsurfaces for for days, houers todays, you know, and so hav ton pobatsomething that lives and is you know, as vial on the surface for days, ritingwipe down everything right. How do you wipe down your body right and we allwiped on our groceries, but we also sort of showered the second. We camehome. We all changed our clothes. You know in the garage, if you have one F,those of us who live in apartments of New York hit's not really a thing, soyou have an ante room. You know it starts to get everybody had their theirroutine around it anyway. You know it just we knew so little about it, andpeople needed a place to sleep and all of a sudden there's thousands andthousands and thousands of hotel rooms that Tom is sportating every day at thesame time that the other real estate piece Bredgium to Carlos was we allfunction with just in time supply chains right. It arrives as we'rerunning out of it until we don't trust that anymore, in which cate they say toTom. Hey, we know, is New York and no one's got space, but can you find a lotof space for Soplus to put a lot of stuff for the biggest health system inManhattan so that against stockpile? You know ourselves hoping that thesupply chains poven up beyond our internal stockile right there's justthat big warehouse is laying round open.

There's just not big warehouse, that'sexactly right! Yeah! It's a little bit of a thin Manhattan. You know peoplemay have noticed for that so anyway, so you know the. I meanthese guys, I think about them all the time and I think about what theyovercame and I think about how stressful it was. You know, in order for them to do theirjobs, you know they needed, they need a mathematic modeler. They needed peopleto tell us what are these words on' of these e words people think about, butwhat our burn rain was yeah right, so that you can tell us how many days outwe are for everything right t how many days we have loves. How many days do wehave left of masks how many gowons etc everything Medicatea the moment?There's UM certainty there, there's panic, yeah and the you know theclinical facing even the nonclinical facing leadership have to be able tosay to their folks were three weeks three weeks solid of masks right and wehave a million worders out there and we're sourcing it from all over theplace. It's okay right, we're, okay, don't panic and you need- and it needsto be true, because if tit's not true number one, most people don't want tosay it and get false reah assurance. But in anyway, so you know added themathematic modelers onto the list of heroes, thelogistic exbergs, whosenames most of us don't know and probably didn't hear that seven PMapplause as for them as much, even though they were also working twentytwo out days, yeah. So and let's talk about I tom a little bit- and youtalked about the th n, the room so just to make sure the listeners understand.So he was having to coordinate places for the medical staff and other staffto stay. Is that correct, yeah? That's right! People were afraid to go home.We didn't really know much about the disease and it wasn't clear how it wasspread. We knew that there was a symptom matof, the ability to carry itand being some damatic, and during those days you know if you'recontamnating, your your kids or your partner, your grandparents,whoever it might be, that introduces a sort of a level of stress beyond thenormal level of stress, is one thing watching. People get critically ill andDi during the day and then working the extra shift or stayed for a couplehours to help out and then being able to go home. Take a shower, see yourfamily and re charge a little bit. It's an otherful thing to go home andyoulock yourself in a room and be afraid you're going to contaminate yourfamily or go home and interact with them normally and worrying that you'rethat you're going to contaminate them. So a lot of people chose to stay inhotel rooms by the way the hotel industry was pretty extraordinary andwhat they gave us for free or this counteenf. I don't actually know thedetails, but lots of lots of people sort of rose to the ocasion yeal. Ieven heard there were some pools where you could call if you were evacuatingthe city, because you didn't want to be in the city and your apartment had beenleft empty for a period of time where you felt it was safe. There was a poolto volunteer your apartment, you could say to the health systems, here's anapartment and such and such a street, and we let the doctors, use it andwe'll figure way to let them in and everything so yeah well extraordinarytimes. Everybody had to rally in an extraorrdinary way, but I do love that,because we talk about this, that there's the frontline workers areclearly heroes, but there's no small players on the team everybody's got toplay their role in order for it to work. As you mentioned, the supply chains gotto be able to provide them with the necessary equipment for them to be safe.One of the thing that I want to I'd love for you to explain to which you'vegot a lot of you heard about in the media and stuff, was your guy's abilityto mobilize and set things up using central park. How did that come about alittle bit and what were some of the logistical challenges to you know totake over part of central park and set it up as a makeshift hospital as amobile hospital yeah? There's! No! Some here, there's a bunch on some here, O'sbehind this one too, but one of them, the one of them from Asinis. His nameis Dan and he's so unsongin behind the Rador all times that I know you dinner,if you can get them on the podcast, but I highly dowbn it I will. I will sellthim out and give you his email, an his phone number but heis the guy behindthe scenes. All the time you run a mergency management for our healthsystem, which is the biggest health...

...system in New York City. It's a big job,F, emergency management for those who sort of don't know what that is. So I'min TA works physician were Jus, seen, medicine S, re know what that is.mergency management is the operational lojestic side of taking care of thehealth care systems needs during sort of any sort of threat, whether that beAF flood in the basement to obviously sort of a global pandemic. It is you,you know what ar thinking it, mostly as tmo te Ceteamergency management right,Yep, so John runs that and don head and worked in the federal governmentprevacy and worked in Boston, GRC and worked in New York in this spacepreviously, and I will embarrass mem m even more and say you know, in additionto being an experimens mentiment he's a lawyer and you know, sort of uses amultiplie different skill sets to approach those problems, but he hadexperienced with a couple different relief organizations and these relieforganizations are generally deployed in places whether its not a sophisticaandhealth care system, which is to say, tycnically and globally and developingthe world, and in fact this is the first time that wasn't til a hospitalin central parks into the civil war. Now so you know, I called the CMO oneof these rele fortizations. He called his contact. I think the COO had one ofthese realief organizations. We asked you could come help and it was a wholebunch more on some Eros showed up, which is to say the next day, theSecurity Guy, the engineering guy, the guy. That sort of you know Tho theMedical League. You know e central o, the administrator for this or of thinga Nurseleyad, a very small number of people showed up and they flew thatafternoon met us the next morning we looked at a bunch of sites and theysaid we're ready to go. If you ready to go and they picked a site and then theymade a phone call and the truck started ball and with the field, hospitals andit. So that was the partnership with an extral organization that was not sortof sign. I driven the sign I receptor, for it was to plug into everything thatwe do, whether that be our laboratory, our pharmacy, our electronic medicalrecord, because we treated them as a virtual unit inside of our hospital.But you know be want to. This is Addo The list, the pharmacy folks, the youknow, e the Mor frankly needed to sort of. We became an extension of that theinformation technology people that every six hours we would say we justbuilt a whole new suite of rooms in the hospital lobby, where they're settingup a field hospital in central park across the street. Can you guild avirtual unit that didn't used to exist inside of our electronic medical recordso that we can track everybody and they just they were just grinding andcrinding from the time you said? Yes, we will take your help and they saidwe'll make get the trucks rolling to the time they were fully kind of up andrunning. How long was that period of time? That's a good et. How quick werethey able to mobilize? I think it's seventy two hours. It might be Mye justa little bit more. I think they opened o April one. I just can't rememberexactly what Saturday it was I mean yeah Saturday morning we calld themFriday night. Think I'm the planing Menm O Sevenaham Saturday morning andthe truck started rolling by doer, so o North Carolina got up here and theyjust started building and how big was the. So what was the kind of thecapacity once they kind of got up and set up? How many patients were you guysable to serve in there? You know so. In there ther was sixty eight beds wow andthey treated almost two hundred patients. We think of this asLNONTRITIOAL Space Alternative Care Space, a field hospital certainlycounts, but our engineeris did the amazing things they built inside of ourlot of the pictures extraordinariy built inside of our lobby with you knowtwo by fours and tenting material canvas material. They built hospitalrooms all the way down. You know the hallway between the the fancy lobby,where there's usually like a starbucks in a reception area all the way down tothe Holli Te least medical school. You know the engineeris silently all night,long converting empty space in the rooms to put people at in another. Idon't know sixty mets, just in the hallway or just in the in the Atriam,so you know between all these different spaces that we created we searched. Youknow we search probably several hundred...

...percent above our normal capascit wow.You know, N, when you talk about all the things that you' mentioned so manythings that as the listeners are hearing you don't think about right isit is behind the scenes. I think you mentioned that even the strain on theoxygen system was a challenge. Australia, I mean anybody who took careof a Lord Vimo copedations pra any time, especially during that time knows thatthe line start to freeze up if your oxygen demand is too high. You knowthese are things you know. I've worked at the intersection of Berns son,medicine and and prepare mess aversency management. I have no no expertise inthat area compared to the people to do this for a living and when people callwith a problem like that, I watch them solve that problem right. I watch youknow they just do the math and they start thinking all right. Well, this iswhat we're going to need right and they turn in and make a phone call right andand that's extraordinary, and that happens very quietly, and you know theyhave these H and we create portable otching and capacity that all immensethe system. Yep Yeah is Perfutur, so grateful for the depth of expertisethat people have that you never need ans about yeah. You know- and I thinkou even talked about the getting power into the park- was a logistical issue,and how do you deal with a public utility, the size of Kon Edison in NewYork City and say to them hey? We need a little bit of power over in thislittle section of the park yeah. So you know not just power, but water, and youknow seage. If we can have it and you know ps what if we need Toland ahelicopter, would that be okay? Hey? How about security? It's a park in themiddle of New York, right, we're, Goingno, write or all of a sudden goingto have all kinds of computers around and technology around, and patientsaround and families around yeah was one after another, so that was thatafternoon. Actually the morning of was was the meeting, and then we went to acouple different sites and the once te Gotifid the site that afternoon- andthere was a long call with ith city and state between Mansidiamericans purse,which was the the Relliy fagency that supported and in the city o state totalk through the several dozen different commining things andlogistics challenges that are pretty incomprehensibe yeah. I think I lovethe last time we talked, I loved your expression. You said I think you saidyour guys would have had said in the past that would have taken us a year toget a no and in twenty four forty eight hours we EALTO get a yes and boy was ata sign that the times were different. We were facing something very different,extraordinary, yeah yeah people knew, I mean life was on the line. You knowgive it I'll, tell you you now, so we think about the field hospital out infront of our primary hospital n, the uppereast side, so Peopleokno New York,but we have hospitals all over the city in the uppereat side, Hospipalis thebiggest by far the biggest, and so the other hospitals across the city alsohad to surge, and we transferred a lot of Patiente a lot of patients infectmost of the patients. I would venture to say I don't have this in fun. On themost of the patiens treated in the field, hospital came from hospitalsother than the upper east side hospital. Okay, we balance the load across acrossour system across the city by moving patients to where there is an open bed,because you know the front or ar still open, and there are more people comingin so extraordinary on Sung HeroesEverywhere, love that- and here we ard, let's fast forward, we come to theholidays, we got a holiday searge, we had the fall Serghe that came back andthen Thanksgiving added another component to it and Christmas addedanother component to it or those. The December holidays for sure what did yousee lessons learned from Spring and summerthat you guys were able to apply now that has made this easier? Alwaysalways the known is easier than the unknown, and certainly you guys weredealing with a lot of unknown. Like you talked about not even knowing theairborne capability of this and how long does it keep on surfaces and allthose things that we didn't know and clearly, our ability to treat this isnow better than it was. But what were some of the big things that, as thishas come back to stress the system...

...again? Have you lessons learned if youguys have helped you to be more prepared yeah? So maybe it we'll justsort of say real quickly and then push aside the clinical stuff. You knoweverything from plasma a sterons to Monicotal anibodies to you know whatdifferent medicines that we should or shouldn't use all of that, whether ornot toing to bet but beverbing than youvpen to people early versus to a lapto allow for some relatively low oxygen levels for a while blood tinters. Youknow it's extraordinary. What we've learned clinically Yep moving mad aside,I think your sort of question a little bit is only logistics, an operationside which is which is where many you know I mean not for notthing. We shouldprobably say a loud there's, a whole lot of people that spent their lives,understanding, vaccines, right and RNA at yeah. W deserve a little bit of ashot hot for the Om son, major yeah, absolately yeah, but on the logisticside, some of what I was just talking about in the way that we sort ofbalance across the system. Let's, let's say some of these names, Abe and Carleyand Kevin. You know, look an Helen. The people that just their whole day, theirwhole life, is balancing across the enterprise and ustounding to make surethat nobody gives those streks that carragets compromised. So that's a bigpiece of what we learned. We learned how to leverage staffing in ways thatyou know you might not otherwise had to during the remember duing the initialsurge people ere willing to come from other parts of the country right yeahduring this Surgh everybody Servin, you know, there's not all of a sudden apool of people yep thinking about you know how to sort of leverage the skillset of some the people by creating teams wis an important Blesson, andthen I guess I would say you know some. Some of the other things that reallycome to mind for me are focused around some of the other podcast that you'vedone, which is how to take care of a staff and how to keep Tak it so thatthey can come to work so t they are able to. You know not just get out ofbed and put their shoes on and come to work, but show up at work with enoughgas in the tank to be able to take care of people yeah it one more just whichis the the communication with with families. It's so hard. It's so so hardthat the families are never in the room, never at the bedside, and that we can't,you know, depend on Themto, take care of their loved ones. Small activitiesof daily Living D needs more to help us with a history. The patient doesn'tdoesn't know it. That really has changed things that need to Theno tocommunicate only by thone and all the intervittanly with families whootherwise would be there to help yeah. You know we just panic. It's ciof oneof the episodes that's going to be coming out. We talk with Adventishospital at and Seeme Valley. What are the locations in Smi Valley? California,that's dealing with the hall La Surgon. You know one of the things that they'vebeen having a lot of success with is what they call hospital at home, wherethey're having the people go home and through Tella and through nursing on onsite and stuff they're able to treat certain classifications better. Butwhat they're seeing is faster recovery times because of the home because ofthe family because of the connectedness that they have. They believe thatthat's a big contributing factor to the recovery times of somebody who normallymight have been in the hospital for two weeks, theyre recovering at home,faster in the week or ten days, because h just that connectedness, which nowwith he, as you said bit the virus family members aren't up there. So youdon't even have the visitor? You don't even have, as you know, the person whocan come and bring you the flowers or bring you something or bring you aParis, your favorite pair of socks, or something that you know it's going tothose creature comforts that just make us feel that there's some semblance ofnormalcy to it. Yea. I don't know the data on that, but but I'm a buyer, I'ma believer that is th. The power of hope is nobodyextraordinary and when you have famili surrounding you and when you believethat you can continue trangle improve, I believe yeah well, and you eventouched upon it earlier to the information right, just the access tothe information that may be, somebody...

...who is older or a little moreincapacitated or God forbid, intibated right. They can't communicate with youabout other past. You know problems that they've had or allergies or youknow, or any of those other how you feeling right, those sorts of thingsand and when you don't have the family members around to help or communicatewith it. It just compounds the challenge yeah. So let's talk a littlebit about what are you seeing today? What are you seeing kind of coming downthe road and tell me a little bit more about your passion, which is the the Erand why you love those people so much Youav Fenc, you know I mean so comingdown the road we're all watching and I don't know I won't pretend to haveanything terribly intelligent to say about the mutations right in thevariangs that we're all watching we're all hoping. You know the vaccinescontinue to be effective, we're hoping that enough people get vaccinated thatthese themucations don't become widespread, though you know the race.This plant seems like the virusis go away and not of vaccinations. So thenit's really going to be about what Yeu take, whether not something thatmoutates that changes? The vaccine response significantly or not, so therewas a lot of hope. You know a couple weeks ago, when health careworkersallstart to get vaccinated, there has been a little bit more caution, fearthat has reemerged, as we've been listening to all the different variantsthat are showing up across the globe and what that might mean. There was alot of talk just a couple weeks ago about this notion that this summer,this summer, is what we anchor on. You know the winter's gone, the springisgoing to be gone ish, but in the summer we can be outside again, so it's easierto socialize, even distance. So in Massoon it's been very col en thenortheast the last couple weeks- and you know you don't take a walk- an thepark with a friend for you know more than twenty minutes or half an hourbefore you ready to. You, know befere you're ready to find some the warm spotagain. So we have been anchored on that and I'd like to believe that we canstill think that that's true and it's going to depend a lot on on thevariance that are showing up an this sbeed with which we can getvaccinations into arms. The emergency medicine PIECEC that you touched on andthings were, bringing that back up. You know, as I think, about Unsun heroes. Idon't mean to be too hypobolic here, but you know most people'sunderstanding of what theer is sort of a place that they don't want to be it'sa layover on the way to wherever they want to be. You know we think of it asthis extraordinary place where you get yo, you know an outpatient, dianostic,workup and or stabilization or treatment in several hours. Instead ofstretching out over weeks, you go get your yo go ee, your doctor, then Youlget your lab work and then you go get your xa or your cat scann. Then you goback and see the specialist and then they you know they sort of want to do acouple more things. You do those things and then you come back and this timewhen you talk about a strategy, you know we think that it's prettytaordinary. We do that over the course of you know six hours most people atthe six hour marks say I can't take it anymore. Get me out of here, and Ireally understand both both sides of it anyway. But you know the merdencydepartment is it's a complicated place? It looks a lot like chaos to theuninitiated, and yet, if you spend your life there right, you see the rhythmsthat are happening. You understand the wordflow and we need to do a better jobof explaining the patience what's happening to demystify it o communicatewith the better to help them to understand the process. But it is thisplace that doesn't close the front door. Doesn't lot, doesn't lock the frontdoor, doesn't can't close the front door right? The most of them don't havea lock on them. You can walk in twnt, four, seven and we hand off to eachother, not stop. There's stocks, there's nurses, there's texthere's,always people to receive you and, on the one hand, that's a hugeresponsibility. Wo needs a lot of MIS dinners and kids ball games andweekends and nights of sleep you know were ship workers like every othershipworker that you know sort of quietly is staffing the thing in themiddle of the night. That knew happened to me that night, that you're up at onenight out of the month and you're driving home late, then you STOPP andget gas, and we know that those folks...

...are largely not visible to people thatare just on the way of their invasion ben or just had that one time thingthat they need to get seen for or wreck their car or had a heart attack and arunconscious. So I do do have a warm spot in my heart for this sort ofalways present quiet safety net that exists so that we know that if our lifeor our lives are threatened there, someone will grab Iu sowill, be there ointo the call yeah. I think you know. I agree. It's a special calling. You knowin terms of wanting to and willing to do that, the emergency room. Obviouslyit is the front lines you know, th the trauma that comes in the things thatthey see is different and I think, as any doctor who's getting ready todeclare their specialty and move into an area that they want to. You know,live the rest of their life working and has to find that passion. The peoplewho say I'm ready to go work on those front lines in the emergency room. It'sa special calling to have that passion and special treatment of care. I thinkI mentioned to you when I saw that when my dad was sitting in the covidemergency room locally at the hospital and just watching those healthcareworkers selflessly go to AU patient who might be getting sick or go to apatient who is clearly in pulmonary distress and not think anything oftheir own safety and go and to help that person selflessly that's e. onlyother word I can keep coming up with, so they are a special breed. Thosepeople and certainly are the frontline heroes, and I'm glad we get to spendsome time talking about the backline heroes or the unsung heroes. As we say,yeah thanks, you know S. it's interesting. I mean I work at a giantReferral Center, Dian Academic Medical Center, and I can't help but wonderwhat our medical students are thinking. I don't know which way this pushes them.I don't know if this push is them to run into the fire or sort of try tofind a place to run away from I'm worried about our bibeblines fornursesbecause they're, the nursing shortages, even if it was youre callingor is Youre calling it's exhausting yeah, you know and sand. So I don't Imean I worry and wonder what this is going to do to the workforce of thefuture yeah. I did see one article I can't remembeer his newsweekor who, butsomebody said that there was a surge of medical school applications as a resultof this, and so I'm wondering whether it is having that typical. That'sinteresting call to action, which is it's a it's bringing some of thatpurpose. You know this, this generation for sure is pursuing purpose andpassion and everything that they want to do, and you know millennials andgenerations. Ze Sometimes get a bad knock, but they certainly arepassionate. I think I was Time magazine had an article and I talked aboutmillennials hit, says their selfcentered there. This they're thisall these negative things and they said they just mightch save the world because yeah, you know, because that you knowthat's the subtect, if some of your other some eother podcast I' talkingabout this a lot, but this is really sort of exposed, some deep inequities that exist inhealthcare delivery and far beyond right. I mean the disparant outcomesbetween the halvs and the have knots, even with the disease that you knowshouldn't impact everybody on the biologic side. It doesn't it doesn't.You know Pickor Choes, but if you live in a multi generational house in thesprall space, if you are at a central worker and you have to be onl thesubway, if you are, you know if you are exposed in a million different otherways, if you have cronic medical conditions that are out of controlbecause healthcare is complicated and expensive, you don't have healthinsurance. You know, there's for all the reasons that you know they don'tneed to be articulated here, but thener that need to be articulated. It hasreally increased our awareness around the inequity and, frankly, some of theracism that exists in the country and in t healthcare system anyway, and thatyou know- and you are right- we spend a lot of time with tha that thegeneration that is not going to take it anymore. You know it is both. It is anis extraordinarily inspirational and...

...refreshing, but sometimes it also istoo much to take on. You know for those of us you're just trying to keep yourlips above the water. You know and they're doing the right thing andtheyre forceing you to recognize. There's this other deeper layer. Wehave to fix that too. An O bless them. You know, because they're, tenaciousand and they are forcing us to ask questions that are really hard andreally really essential that we get right. We have a moment. I think wereally have a moment, but we can pivot and we can say the words out loud andaddress out loud the importance of framing everything that we do in thecountry in the world, but in healthcare delivery through a lens of race andequity. You know and we're trying to get there but we're all human. We allsee it the way we have been trained to see it and we have to learn new waysand we have to evolve and it is interesting, but you know but the sthey are every time you work in the Mest, Tudienyou work with a residentand- and they ask questions that you long ago, stop asking because you gotblind to it. Yeah Yeah, you reminded you know that that in you know he inevery opportunity right. If you see with fresh eyes you get to see. Youknow you gou can see it a new and you get to think about it. crititally yeahwell, and I love that you call that out, because it is a time for us to tochallenge ourselves because these things in the past we either had grownblind to or we had chosen, not to or socially we. You know just w know if wewere allowed to. I that's a great way to put it didn't know if we wereallowed to yeah and now we can and that's the moment of opportunity that Ithink we have to seize, which is okay. We can talk about it. We can talk aboutthat. The racism is going on and we can talk about these things and we have to,and we have to continue to push each other not to just crawl back into ourhold wore pretend it doesn't exist or say: it'll all be okay and, as you know,as we do move towards some level of whatever we call normal cy back intoour world and our times in our routine. We just have to remember not to wecan't we can't forget. We have to continue to get better. You know it'snot something atwill be fixed overnight in my view, but we have to continue toget better and we have to continue to address it and try to be better. Iagree with you, but you know, but I also I mean as you thinking over thelast. I guess it's been. It's been almost a year, yeah, Congo Januarytwenty six were recording this and you know we diagnosed our first case March,one yeah, so he were almost in a year and certainly at this point actuallyimin. I think probably Washington sate was already on fire year ago, not onfive. There were wildfixs last summer, ther last year, two, but I actuallymeant very, very hot with Covid, but you know sort of thinking about thepeople that were asking to sort of to take on this challenge. It does alsochange the way that you think about leading. You know this idea that thereis a commanden control, talk on structures going to follow, ordersroyal boy. That is that you know that is not what we found was effective overthe last year. What was effective was a lot of authenticity, a lot of empathy,a lot of transparency, a lot of dialogue around what it is like to beHart of this team than Isais trying to get through this, and so you know Imean those are the pieces that I will be forever grateful for the you know,the late night early morning, middle of the night conversations with colleagueswhere we sort of all recognize that Aur shared humanity I share humanity isreally the only way that we can get through this. We have to len on eachother and trust each other and and try to grow together, because otherwise,it's just too lonely and sort of thinking back to what he said aboutpeople dying alone. Those are the images that will haunt people for yearsand years and years to come as they sort out how to manage their Bost,traumatic stress from being a covid responder yeah. It's about watchingpeople die alone. We Watch plannpe, T bi. Sadly, and it's always...

...it's usually a misioable thing. Thereare times you know where it looks like peace, but there's a lot of times.Especiall Lernsin apartment most times where it's miserable. This wasdifferent yeah, it's time to resurrect our humanity, ope that so ut stillintactin yeah, no yeah there's a little bit of a left. Well, so, as we wrap uphere hey. Thank you very much for your time. I know it's a busy time for you,no shortage of work to be done, even in the midst of, as we continue to battlethrough this thing. So thanks for peeling off a little bit of time tospend and share your stories with us and our listeners, I know they'llappreciate it very much as well, and thanks for your transparency and yourheart, and thank you for everything you do as well, because you're a big partof it as well. I want to give a special thanks to Carlos Tom Habe Carley Kevinand don those ware. The names that you threw out as some of the unsung heroeshat was taking notes with, and hopefully, they'll, listen in and knowthat we gave them a big shoutout and you did to you did and thanks for doingthat. As we end EAD show I'd be remiss if I don't ask you growing up orcurrently, who is your hero that when you think back to it in your life who,as one of your big role, models or heroes, you know I want to deconstructit a little bit, and I know it's cheating but I'll. Do it. An a you knowtop of mind is top of mind. Is a guy who trained me and fellashit residencyand fellowship who was a trauma Surginmat University of Pennsylvania,who was an army reserv ast? She was killed in Iraq, lite morer came over ththe wall on Christmas Day wow, you know, so this is a guy that ran into the fireand easily could easily could have lived a very nice. You know casual lifein the Philadelphia suburbs who Workin Hart as a surgeon, not o mean to takeaway from that yeah, but instead put on a uniform and was ultimately killed. Soit's hard to not think about him for his selflessness, but I have to balancewith two other people. I went to a Jesuit University and Father Tim Brownhas a sa He's a lawyer and a priest, and he just deeply believes in justiceand aquity and kindness at all times, and I always think about how he see theworld and then the last one is to is tesalid rock the steadiness that no onecould ever ever match, which is the he lovely woman at home that I call mywife she's extraordinary through all this. So sorry, I know I took a threefor H R, but you know now that Tak yeah the selflessmits there's no rightanswer. It's your right. You got to own it and ther's two Berry Vesus, yeah! No,and and that's it you know it doesn't have to be one person, there's a lot ofpeople who influence us as we go through our lives and so lots of heroes.So that's that's great. I love you shared that with us again thanks foryour time, thanks for your candor and your heart, and we just continue towish you best of luck and continue to fight the good fight and we hope tocircle back with you in some time in the future and get some good updatesand hear about how things are changing for the better. I look forward to thosedays very, very, very much thanks fack to Kar. Thank you. Sir. You've beenlistening to heroes of healthcare for more subscribe to the show in yourfavorite podcast player, or visit us at heroes of healthcare. Podcastcom.

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