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The Patients We Never Forget: Healthcare Stories That Changed Us Forever · Banter At The Bedside

• 0:00
  SPEAKER_03: presentation.
• 0:01
  SPEAKER_03: That's something that is just stuck in my memory.
• 0:03
  SPEAKER_03: Yeah.
• 0:04
  SPEAKER_03: And that's changed me just from the perspective of being able to spot what that hypoxia looks like.
• 0:11
  SPEAKER_02: You didn't win her over necessarily from being like sweet and sugary and like all that.
• 0:15
  SPEAKER_02: It's just like by doing like great.
• 0:18
  SPEAKER_02: Yeah.
• 0:18
  SPEAKER_02: Yeah.
• 0:19
  SPEAKER_02: Yeah.
• 0:19
  SPEAKER_02: I love that.
• 0:26
  SPEAKER_01: Hey everyone and welcome back to Banter at the Bedside.
• 0:30
  SPEAKER_01: We are so excited to be talking to you guys today.
• 0:33
  SPEAKER_01: We are going to be telling stories about those who have touched us and changed us throughout healthcare.
• 0:39
  SPEAKER_01: Could be patients, could be other healthcare workers.
• 0:42
  SPEAKER_01: Sometimes it could be how it changes our practice or our approach to patients or just those that we carry with us and remind us why we keep doing this job and show up to work every day.
• 0:52
  SPEAKER_01: As always, this is for entertainment purposes only.
• 0:55
  SPEAKER_01: We do not represent any entity at all.
• 0:58
  SPEAKER_01: Our thoughts and opinions are our own.
• 1:00
  SPEAKER_01: This is not medical advice.
• 1:01
  SPEAKER_01: Please seek the care of your own medical professional.
• 1:04
  SPEAKER_01: I'm Abby.
• 1:05
  SPEAKER_01: I'm a nurse practitioner of eight years in the ICU, been in healthcare 17 years and I'm one of your main co-hosts.
• 1:12
  SPEAKER_01: I'm joined with Kaylee, our other main co-host, a nurse of nearly 18 years now in the ICU.
• 1:19
  SPEAKER_01: Hey everybody.
• 1:20
  SPEAKER_01: We're joined again with Mama aka Amanda, nurse an ICU nurse of nearly 20 years.
• 1:28
  SPEAKER_01: She here to share all her woo and all her love for us.
• 1:32
  SPEAKER_01: And then our resident attending today or our physician today is Dr.
• 1:38
  SPEAKER_01: Armando he is back and he is completing his long and rigorous training as a nephrocritical care fellow.
• 1:46
  SPEAKER_01: He is about to become an attendee in a couple months.
• 1:48
  SPEAKER_01: So welcome back Armando hi glad to be here.
• 1:52
  SPEAKER_01: We're so happy to have this group back I felt like the last time we all met we had a great discussion and this was kind of a topic that came up.
• 2:02
  SPEAKER_01: I saw a couple different things on social media about those who touched us and it really made me reflect about patients and other healthcare workers that have really changed me and shaped who I am as a professional.
• 2:17
  SPEAKER_01: So I thought it'd be just a nice easy storytelling thing.
• 2:21
  SPEAKER_01: So anyone have a story they want to share about how someone on their journey has changed them.
• 2:27
  SPEAKER_00: Plus here Armando have one I mean I'd probably you know it's being as you said coming out of training feels pretty exciting and makes you sort of reflect on your journey.
• 2:38
  SPEAKER_00: I will first like to start with you know I think my program director back in residency was a a great guy the type of doctor that would go bedside and you know do all the rounds bedside and kind of teach you step by step how to be a do a good physical exam, you know, good good interrogation of the patient and sort of how to give bad news, good news and explain the plan for the patient.
• 3:01
  SPEAKER_00: I think through medical school, depending on where you train or where you go to school you might get some of it or fragmented parts of it throughout your medical school but having someone that actually sort of makes it all in one package and really show you the type of doctor that you should be kind of going along with the our last talk about being human doctor right and sort of touching the patient and connecting with the patient.
• 3:26
  SPEAKER_00: I think my my program director back in residency truly truly changed the way I practice and how do I approach patients.
• 3:34
  SPEAKER_00: Frank Leon is the guy who really taught me sit down with the patient, right?
• 3:38
  SPEAKER_00: And sort of you know be humble, be another person, bring families why I give kudos now that I'm graduating to my prior program director I think it really changed my life for good as a person and also as a as a as a physician as well.
• 3:54
  SPEAKER_00: So I would like to start with that guy because I think he was phenomenal and he'll make jokes and kind of make feel like we're all in in a family meeting rather than in a very ancient doctor hierarchy you know scenario or setting so kudos to him.
• 4:10
  SPEAKER_01: And I will not say his name of course but we'll protect his privacy even though we're just singing his praises I mean that's amazing.
• 4:19
  SPEAKER_01: I mean to think it's you know teachers touch us a lot.
• 4:25
  SPEAKER_01: When you come into healthcare there's not a lot of like teaching how to teach though like so when you do get like a really amazing program director you do get like a really amazing precept or trainer like it is it can be so life changing in how you approach patients and medicine and what do you think?
• 4:45
  SPEAKER_01: Like you're about to become an attending so what do you think you're going to continue to carry forward from him?
• 4:51
  SPEAKER_01: Like how are you like you're going to be his legacy now.
• 4:56
  SPEAKER_00: Yeah I mean he he keeps you know writing me every year too you know at least close to my birthday and it's always a message or or you know kind of like at the end of the of the academy years he text like you know are you still like a fellow or like are you graduating or doing something else or whatnot.
• 5:13
  SPEAKER_00: So I I think uh for your specific question I think probably just just a very simple thing just sit in bedside with the paging.
• 5:23
  SPEAKER_00: I think that is every time I do it it reminds me of him.
• 5:28
  SPEAKER_00: I don't think he maybe he does but I I you know sometimes people you know teachers can they can go on and really not notice how much impact they they can have on learners unless a learner comes back and you know tells them about it and so on.
• 5:44
  SPEAKER_00: But really it's a simple thing from him I would say just sitting sitting bedside with it.
• 5:50
  SPEAKER_00: I I think it don't matter if they they have a big ulcer in the leg or it's it has discharge in it or not just just just just make yourself make some room in the bed and just just sit there at the bedside.
• 6:02
  SPEAKER_00: That's just a big big act of kindness and I think you know patients will will always remember kindness above all things.
• 6:09
  SPEAKER_03: So yeah I think that's one thing from him I'll remember take for me my entire life it's like you know with your with your parents and teachers it's like you can take things with you that you really like that they did you can take you cannot take things with you that you're just like you know this just does not work for me.
• 6:29
  SPEAKER_00: And I can imagine Armando that a lot of teachers especially some of the physicians were very black and white cut and dry these are the rules this is what you're doing maybe even punitive to some degree I think very very by the role by the book some attendees you know teachers they can be very good teachers don't get me wrong but does it might not create that connection right with with your learner.
• 6:56
  SPEAKER_00: And I think what once you connect really deep then learning it becomes very easy because everything sort of kind of flows in and you develop a story right a story for your learning moment that you can easily go back on your mind and connect to it and enter enter into that memory and then take care of the patient.
• 7:17
  SPEAKER_00: So yeah that guy was was awesome he was like he was taking his pilot license too in that time so yeah I never got to actually fly with him but he used to tell me once I get my license I'll get you up there.
• 7:31
  SPEAKER_00: I wasn't even thinking about proposing my wife on on an airplane with him you know so that's how much connected with me yeah it was it was pretty cool pretty cool guy pretty cool guy.
• 7:44
  SPEAKER_03: Anyone else any other any other experience I had some nursing instructors in school that just it's a lot like what you're saying Armando just connected with us.
• 7:55
  SPEAKER_03: It wasn't as I mean you've got to be very by the book and very policy driven but just being able to have that intentional connection with someone.
• 8:05
  SPEAKER_03: And I remember after gosh it must have been one semester she was my favorite teacher one of my favorite teachers one of my teachers but uh she had everyone at her house afterwards.
• 8:16
  SPEAKER_03: You know what instructor does that allows people into their home and cooks for them and had um just a little celebratory get together and I'll never forget that.
• 8:29
  SPEAKER_03: I thought that was very kind.
• 8:31
  SPEAKER_03: I think that's a very act a humble act you know bringing people into your oh for sure for sure you've got to really trust in people to do that.
• 8:40
  SPEAKER_03: I don't know if she did that after every semester we were probably her favorite let's be honest.
• 8:45
  SPEAKER_02: I had an instructor in nursing school that did that as well after she was like clinical instructor and at the end of the semester she had us over I was a couple years after you I wonder if it's the same person.
• 8:55
  SPEAKER_01: It was nice I do have a slightly different story.
• 8:59
  SPEAKER_01: I did have she wasn't an instructor but she was like a charge nurse preceptor on the unit and I was young and I have a lot of natural leadership skills as I've been told throughout my life and I was new on the unit but I was growing and when I was bedside nurse much to probably a lot of your surprise I was a bit of a prankster um I played a lot of pranks on my nursing unit as a bedside nurse was there was some nurses that I know that met some of the nurses that I trained and they were like oh Abby she's super funny isn't she like she's hilarious and they were like I mean you are funny.
• 9:41
  SPEAKER_01: You're hysterical by the way yeah you're still young you're hysterical we'll be texting and you say something I'm like where in the world did that come from but it was it was much more surface level like it was kind of always there it may be inappropriate at times and this charge nurse sat me down one day it was the start of my shift and I was coming on as charge and I just always believed like work should be fun like yeah we're here but we should have fun.
• 10:12
  SPEAKER_01: And she was like I would like to talk to you and she brought me into um into a the room and she basically spent like 20 minutes um telling me how I'm a leader on the unit.
• 10:27
  SPEAKER_01: I'm a natural leader and that all the silly stuff that I do is inappropriate and it's making all the other younger nurses do it and while I can do it and be silly and get my work done and my patients are taken care of.
• 10:40
  SPEAKER_01: Other patients are being harmed because the other nurses aren't doing it and that it's my fault and it like went on and on and I like left crying and I was like okay so I'm terrible um I'm just this terrible terrible person and I tell the story because for a long time like I I tend to overcorrect so I I shut it all down.
• 11:06
  SPEAKER_01: Um and I think then people were like ooh Abby's really cold and it's taken it's taken many years to kind of unmesh myself from that and find a balance but I also now with older eyes can look back on that moment and realize it could have probably been approached gentler but it was approached with such good intentions.
• 11:33
  SPEAKER_01: Like when I look back at it now and it's with older eyes I can look back and be like okay well she was trying to guide me to be a more effective leader.
• 11:42
  SPEAKER_01: Like she was trying to teach me to be a more effective leader.
• 11:45
  SPEAKER_01: Could it have again been done gentler?
• 11:47
  SPEAKER_01: Probably could it have been received from someone that I had a better relationship with.
• 11:52
  SPEAKER_01: Yeah probably but I I do reflect on that because it did change me in so many ways and for a long time I held a lot of like it changed me in a bad way and I held on to a lot of anger but now I actually look on that moment with a lot of gratefulness and a lot of respect.
• 12:12
  SPEAKER_01: I wish it had gone different but I'm still grateful for that conversation now.
• 12:18
  SPEAKER_01: And so I just wanted to highlight that like you can have amazing people and maybe sometimes in youth you might not realize what someone is doing for you in that moment.
• 12:29
  SPEAKER_02: What patients got harmed by other nurses from you being silly sounds like not a you problem because you got your work done.
• 12:38
  SPEAKER_01: I don't think patients were truly being harmed but I think your point was that's harsh yeah people were being distracted by me.
• 12:46
  SPEAKER_03: That's a stretch yeah I think so I think that the accountability needs to be with the people with the actual issues.
• 12:52
  SPEAKER_03: Now if there were issues with things that you were doing or patients were harmed or near harm or that's different but so you just went full full 180.
• 13:02
  SPEAKER_00: I guess she was more from the leadership perspective I guess she was more concerned about the work environment dynamics rather than per se your your patient direct care.
• 13:12
  SPEAKER_00: So I think she should have said that articulated that better then you know my question for you Abi is have you seen this this preceptor since that time have you come back?
• 13:22
  SPEAKER_01: We had to work together for a couple of years after this um so but I have not seen her since she unfortunately passed away.
• 13:31
  SPEAKER_02: So I have not seen her uh since I mean she has a point though because I do know that like younger nurses if they see the older nurses goofing off they think they can do it and I'm like no I've done all my work I know everything about my patient.
• 13:44
  SPEAKER_02: You don't so like I get that but also it's not my fault that you're not doing what you're supposed to be doing in my mind.
• 13:53
  SPEAKER_03: But I I get what you're saying.
• 13:54
  SPEAKER_03: Like that change pranksters I can think of like two or three pranksters between nurses and providers and I don't know maybe it just wasn't a culture that we established.
• 14:05
  SPEAKER_02: It was just a few people who did not harm anyone or patients but just like a little joke in the day it was a little a little smile brought to your face and no one was you know put down it wasn't to put down anyone else but I don't know I just hope that she like crushed your spirit for a little bit like that makes me sad.
• 14:28
  SPEAKER_02: Yeah well you know Abby she thinks she's in trouble.
• 14:37
  SPEAKER_00: So kudos for her that I think for your poems well said Abby like you know having people sometimes that can't really be doing stuff for you that you don't even realize and I think at the end of the day made the leader that you are right.
• 14:54
  SPEAKER_02: Yeah it's like looking back and being like ma'am my parents were hard on me or something and it's like but really they were right and I'm glad they were or something like that.
• 15:01
  SPEAKER_02: Like something that you hear you know things just come with like gosh they were rooms and age and life.
• 15:06
  SPEAKER_02: Yeah so I like the you know full circle moment where you're like you may not understand in that moment or you may not get it completely but five 10 years down you might say yeah.
• 15:17
  SPEAKER_02: And that makes me think of the story that I thought of as far as like a a coworker or somebody when I so I've been an intermediate nurse and then I transferred to the ICU and my preceptor was great.
• 15:27
  SPEAKER_02: She was like on it like knew all the policies but like didn't let that stop her from doing what the patient needed if that makes sense.
• 15:34
  SPEAKER_02: It's like she was so by the book she knew every policy but if something needed to happen like she would make sure it happened and just she was great so much knowledge.
• 15:42
  SPEAKER_02: But I had made a mistake where we had a patient who was there for cardiogenic shock and they had a very low EF and their blood pressure dropped and this is when we had the residents.
• 15:52
  SPEAKER_02: So it was like a first year intern or resident I'm not sure what is a first year called Armanda for resident is an intern.
• 16:00
  SPEAKER_02: Intern so I let them know and they ordered a fluid bolus which we don't typically do if the patient is there with a low EF and cardiogenic shock.
• 16:08
  SPEAKER_02: But I was new and so I started it and I told her and she went in there and she was like nope she clamped it she turned it off and then she called him back and let him know why that was not an appropriate order.
• 16:18
  SPEAKER_02: She was very professional.
• 16:19
  SPEAKER_02: They said thank you so much for catching that and then she sat me down and told me why and I was like oh my God like I could have you know caused him to go into like distress or whatever.
• 16:28
  SPEAKER_02: But the way she was telling me like she didn't make me feel bad.
• 16:30
  SPEAKER_02: She was like this is why you learn nothing happened.
• 16:33
  SPEAKER_02: And it also helped me like internalize the fact that these physicians don't know everything and I really have to be like on my game working here because that order was put in you know approved everything and it could have been carried out all the way if she hadn't shown up.
• 16:49
  SPEAKER_02: So it's just like one of those things that was like thank God that happened and nothing bad happened from it.
• 16:53
  SPEAKER_02: Like a little lesson but like that was very early on in my orientation it was like no I have to know exactly what's going on.
• 16:59
  SPEAKER_02: I have to be the second line of defense or whatever it is.
• 17:02
  SPEAKER_03: So that teaches you that confidence too you know like being able to be able to confidently talk to someone and say like hey let's talk about this order.
• 17:12
  SPEAKER_03: I'm uh there's some confusion can you help me understand?
• 17:15
  SPEAKER_03: I mean you can do it in a very professional kind way exactly who you are talking about.
• 17:22
  SPEAKER_03: And she was a great nurse.
• 17:24
  SPEAKER_03: Yeah she was great.
• 17:26
  SPEAKER_03: And um she had a way to be able to speak to people and she's very convincing too stuff.
• 17:34
  SPEAKER_02: So that was helpful.
• 17:35
  SPEAKER_02: Yeah but I mean I just remember that doctor came up they were like thank you so much like yeah I'm so glad you caught that I was like okay I I can see sort of how this needs to be like transitioning from an intermediate to an interest yeah yeah she was great preceptor I miss her.
• 17:50
  SPEAKER_03: I miss her too she doesn't even know we miss her.
• 17:52
  SPEAKER_01: Hopefully she's watching this and she'll know exactly who she is what about I mean we've talked about teachers and charge nurses and preceptors.
• 18:01
  SPEAKER_01: Are there any like patient situations that you carry forward um or I can go ahead.
• 18:08
  SPEAKER_03: I have I have one that I can think of um it's not a warm and fuzzy story but I will never ever ever ever forget how a hypoxic patient looks before they die.
• 18:24
  SPEAKER_03: I will never I will never get that out of my head the the distress this person was in and she was pleading for help and assistance and not being able to breathe and wanting to get out of the bed and just fidgeting and it went from zero to a billion in less than 10 seconds and we tried for a very long time and never got her back.
• 18:47
  SPEAKER_03: And it's like one of those things that once you see a patient who is acting like that, you know exactly what's about to happen.
• 18:54
  SPEAKER_03: You know, that hypoxic presentation that's something that is just stuck in my memory.
• 19:00
  SPEAKER_03: Yeah.
• 19:00
  SPEAKER_03: And that's changed me just from the perspective of being able to spot what that hypoxia looks like when the patients are in distress.
• 19:09
  SPEAKER_00: I'm gonna piggyback with that hypoxia because during COVID I was a resident I was a COVID resident just finishing year becoming a second year on night in Florida.
• 19:20
  SPEAKER_00: You know as you can know COVID started in January trickled down to the south all the way you know summer into autumn and so just going above what you were telling Amanda or talking about I had this I mean we had this floor full of COVID patients maybe like I don't know like 80 patients in that floor full ICU no ventilators you know you're doing what you can PPEs and all that all that madness that was going there.
• 19:45
  SPEAKER_00: But I had this couple of the husband was 71 and the wife was 75 if I'm not mistaken.
• 19:53
  SPEAKER_00: And they were both there admitted uh and the husband died one night and you know I the wife was like a couple of rooms down down the down the hallway and I remember being called soon after when I pronounced the the husband to see her because she was also in short you know having shortness of breath and when I got there I did have a very conflicting moment because you know seeing someone hypoxic I agree there's a very particular phenotype to it.
• 20:23
  SPEAKER_00: And you know I could see that she was she was also gonna die potentially that same night and and you know I had a very conflicting moment that I didn't know what to do at that moment in regards to telling her about her husband.
• 20:38
  SPEAKER_00: You know I was so so confronted by the idea of she's at her worst she might be thinking that she's gonna die and then I'm I'm gonna drop the you know the news that her husband didn't die and pass.
• 20:51
  SPEAKER_00: And I didn't do it.
• 20:52
  SPEAKER_00: And you know looking back I wonder if I and she ended up dying that night actually as well and and you know it's something a patient experience that I really don't know even now how I think some days I think it it really shaped me for for being a more more conscious about giving these bad news to people kind of trying to think are patients really you know ready to receive this news or not.
• 21:20
  SPEAKER_00: The other time on the other side was what you know she died and she didn't even knew her husband died or or or maybe maybe she should have I really don't know what what was the answer that the daughter that was uh over the phone and you know gave them two bad news in one night.
• 21:39
  SPEAKER_00: But you know looking at that hypoxic way right it does yeah I agree.
• 21:47
  SPEAKER_00: I think I have that same experience as you I will never forget her look and she ended up dying as well.
• 21:53
  SPEAKER_00: So I don't know you ever have to do something or have some experience like that like giving you know relative Dying very quick, very close to each other in the same floor as well, same day, within six hours.
• 22:06
  SPEAKER_00: I don't know if there's any any cues about how to really take that experience.
• 22:10
  SPEAKER_00: I I'm embracing it though.
• 22:12
  SPEAKER_00: I I think I think it's more gentle when I'm I'm thinking more through when I'm giving this end-of-life news to people than actually stopping and pausing and saying, Well, how am I gonna say this?
• 22:23
  SPEAKER_03: Yeah.
• 22:25
  SPEAKER_03: It's hard.
• 22:25
  SPEAKER_03: It's hard.
• 22:26
  SPEAKER_03: You know, you you do the best you can with the information that you have and the moments that you have them.
• 22:31
  SPEAKER_03: Um, and I, you know, to piggyback off of what you just said, Armando, I remember taking care of a COVID patient.
• 22:38
  SPEAKER_03: This was on a different floor, and I remember, um, I don't know, something just told me like he needs to see his family, he needs to see his family.
• 22:46
  SPEAKER_03: Well, of course, he can't see his family physically because he's in the COVID unit and there's no families allowed.
• 22:53
  SPEAKER_03: And there were iPads accessible for patients.
• 22:56
  SPEAKER_03: And I remember taking care of this guy, and he was so sweet, and we could not get him off by path.
• 23:02
  SPEAKER_03: And I remember it had been like four days.
• 23:04
  SPEAKER_03: He had been in the hospital for four days, and I said, Have you seen your family?
• 23:08
  SPEAKER_03: And he said, No, I haven't.
• 23:09
  SPEAKER_03: And I just had a granddaughter that was born a few months ago.
• 23:15
  SPEAKER_03: And something kept saying, He is a T's family, he's a T's family.
• 23:18
  SPEAKER_03: So I call his wife and say, Hey, can we make this work where we can FaceTime your family?
• 23:24
  SPEAKER_03: She was like, Oh my gosh, yes.
• 23:26
  SPEAKER_03: I have this family member, this family member, I'm gonna ask them to come over.
• 23:29
  SPEAKER_03: Could this time work?
• 23:31
  SPEAKER_03: I said, Yes, I will make it happen.
• 23:33
  SPEAKER_03: And I try to, you know, plan my day where everything was done.
• 23:36
  SPEAKER_03: So I knew for this time period, and you know, you have to get all garbed up and you can barely hear what each other are saying.
• 23:42
  SPEAKER_03: But I remember him getting to see his wife and his other family members and that baby, and they were all in tears crying.
• 23:51
  SPEAKER_03: And this guy was relatively young.
• 23:53
  SPEAKER_03: And I remember being so happy that they were able to see each other and also so sad that no one had FaceTimed his family in four days.
• 24:00
  SPEAKER_03: And I came back to work and I have some friends on that unit and I was asking about him, and he died.
• 24:07
  SPEAKER_03: I don't know if it was the next day or the day after, but it was soon thereafter he died.
• 24:12
  SPEAKER_03: And I remember thinking to myself, I am so glad that whatever that gnawing, nagging feeling was within me that I listened to because his family got to see him and they got to talk to each other and see each other one last time.
• 24:25
  SPEAKER_03: I will never forget that.
• 24:27
  SPEAKER_03: I will never forget the look of those family members, and I will never forget how happy he was in that moment.
• 24:33
  SPEAKER_00: I just got chills.
• 24:34
  SPEAKER_00: I think that, right?
• 24:35
  SPEAKER_00: That in itself does really, really pushes yourself, transforms yourself to a I think for most of us in the healthcare industry, probably for a better person.
• 24:45
  SPEAKER_00: I I I had a great friend as a teenager.
• 24:48
  SPEAKER_00: His name was Armando, actually.
• 24:51
  SPEAKER_00: Yeah, uh the Armandos.
• 24:53
  SPEAKER_00: We were playing on a quartet.
• 24:54
  SPEAKER_00: I do play classical guitar, and we were, you know, we grew up doing that.
• 24:59
  SPEAKER_03: When you can't love them anymore, guys.
• 25:04
  SPEAKER_00: He was a year older than me, and I think one of my earliest experiences that I think shaped the doctor and I is learning how life can be very fragile.
• 25:15
  SPEAKER_00: And I think in healthcare that you have experienced that before becoming or before getting into healthcare, I think that helps you to sort of conceptualize all these, you know, conversations about death and end of life.
• 25:29
  SPEAKER_00: But my friend, uh, he was 17, he died drowned.
• 25:32
  SPEAKER_00: He drowned in Puerto Rico.
• 25:34
  SPEAKER_00: He he was a surfer.
• 25:36
  SPEAKER_00: And you know, one of the things that really kind of hit me and and early when I was 16 years old, I was like, wow, life is very fragile.
• 25:44
  SPEAKER_00: Was going to his funeral and see him all beat up because of you know the currents who smash you to the rocks and whatnot, and the and the family kept his casket open and and then he looked a whole different person, you know, Paul and Bruce and all these things.
• 25:59
  SPEAKER_00: So and you know, I I know we were, I don't want to make this a sad podcast, but you know, being it being it being it being a podcast about you know things that sort of you know touch us, at least for me as a teenager, that didn't really show me how fragile life is.
• 26:15
  SPEAKER_00: And now being a doctor where we get to see or you know, healthcare providers, we get to see people at their worst.
• 26:22
  SPEAKER_00: I think being humble about that, about how fragile things can be, physically, mentally, spiritually, uh it's an important thing that we all should have, and we hope everyone in healthcare has.
• 26:34
  SPEAKER_00: But you know, sometimes I question myself, does everyone really know how fragile life is, at least within themselves?
• 26:42
  SPEAKER_00: Uh not not rationalizing, yeah, sure, you know, life can be fragile, but feeling it.
• 26:48
  SPEAKER_00: I don't know.
• 26:49
  SPEAKER_00: Uh I don't know y'all have any experiences like that, but that definitely always stuck with me after 20 plus years.
• 26:56
  SPEAKER_03: Well, I think to follow up with what you were saying, Armando, I think that there are moments in our lives that are highlighted that much more how fragile life is.
• 27:06
  SPEAKER_03: And I think we become, I don't want to say immune, because I don't believe that I'm immune to it, but I think it's more highlighted to us as healthcare professionals because we deal with this often.
• 27:16
  SPEAKER_03: But, you know, we're human and we take for granted so many things.
• 27:20
  SPEAKER_03: Even the people who try to be so intentional with their words and actions, you know, we're gonna mess up and we're gonna um, like I said, take life for granted.
• 27:30
  SPEAKER_03: And it's something that you've carried with ever since you were 16.
• 27:34
  SPEAKER_03: But I'm sure it feels heavier sometimes than other times, just like with everything that we go through, you know, it kind of hits you in waves.
• 27:43
  SPEAKER_00: Yeah, I can I can tell you did sort of help me deal with my mom loss.
• 27:47
  SPEAKER_00: I lost my mom when I was 19.
• 27:49
  SPEAKER_00: Like going from dad to dad does did help when I'm looking back and looking at how my dad, you know, processed this, my family and so on, you know, being the youngest of five.
• 27:58
  SPEAKER_00: I I think I did pretty well for being a teenager at that point.
• 28:03
  SPEAKER_00: But yeah, life is fragile.
• 28:05
  SPEAKER_00: And I mean, we have healthcare healthcare personnel, we're there to help people navigate those moments.
• 28:11
  SPEAKER_00: I mean, that's that's what we do.
• 28:12
  SPEAKER_00: And we're proud of ourselves, matter of fact.
• 28:15
  SPEAKER_00: But you know, I don't want to keep these sort of ongoing, you know, it's kind of sad positive stories.
• 28:21
  SPEAKER_00: They're sad positive.
• 28:23
  SPEAKER_00: I have positive, positive.
• 28:24
  SPEAKER_00: But but I wanted to ask is there any stories that you feel like he empowered you even more or or kind of reiterated that you are good at what you're doing and sort of make you keep going in in your life?
• 28:37
  SPEAKER_01: I do.
• 28:38
  SPEAKER_01: Uh and I this is one that I reflect on, and I had a relationship with this family after, and I do have some pictures that I'll that I use to reflect on.
• 28:49
  SPEAKER_01: So I had a young patient had a car accident and had a very bad brain injury, very, very bad, was never supposed to wake up ever again.
• 29:00
  SPEAKER_01: And they, as they do, they trached, you know, a breathing tube in his throat, a peg tube, a feeding tube into his stomach, and came down to my step-down unit.
• 29:11
  SPEAKER_01: And the first day that I had him, I I I'll admit, I'll I freely admit, you know, as you continue to see these patients, you get a little compassion fatigue.
• 29:22
  SPEAKER_01: And I went into the room and I was just kind of like, oh, another really sad case of the family making a decision that you know I wouldn't make for my own family member.
• 29:34
  SPEAKER_01: But I was like, all right, well, if they want to do it, we're doing it.
• 29:37
  SPEAKER_01: Like we're doing it.
• 29:39
  SPEAKER_01: And I was like, if this is what they want, then I'm I'm giving it my all here.
• 29:44
  SPEAKER_01: And so I got this patient up the first day I got them, I got them the first day I got them up to the chair right away in the morning, got them back into bed.
• 29:55
  SPEAKER_01: I got them up, I got them up to the chair three times that day.
• 29:59
  SPEAKER_01: And every two hours, range of motion, bath, oral care, did all the things that you're supposed to do.
• 30:05
  SPEAKER_01: And the mom that first day, me and her butted heads.
• 30:09
  SPEAKER_01: She was like, they're not strong enough for this, they can't do this.
• 30:13
  SPEAKER_01: What are you doing?
• 30:14
  SPEAKER_01: Don't you know how bad their brain is?
• 30:16
  SPEAKER_01: And I'm like, this is what they need.
• 30:17
  SPEAKER_01: If we have a fighting chance chance, this is what we need to do.
• 30:22
  SPEAKER_01: And the second day I came, did the same thing.
• 30:26
  SPEAKER_01: And then slowly over time, I became their favorite nurse.
• 30:31
  SPEAKER_01: And then they developed the Abbey schedule and they wrote out my schedule on the wall, and it was the Abbey schedule.
• 30:38
  SPEAKER_03: I bet the other nurses were like, oh my god.
• 30:41
  SPEAKER_02: They hated me.
• 30:42
  SPEAKER_01: Oh, they hated me.
• 30:42
  SPEAKER_02: Three times.
• 30:43
  SPEAKER_02: They're like, three times?
• 30:44
  SPEAKER_02: Three times.
• 30:45
  SPEAKER_01: They hated me.
• 30:46
  SPEAKER_01: They hated me so much.
• 30:47
  SPEAKER_01: Oh my god, they were pretty high too, right?
• 30:51
  SPEAKER_01: Yeah.
• 30:51
  SPEAKER_01: And like, I mean, literally range of motion every two hours.
• 30:55
  SPEAKER_01: I was going in, it's range of motion time.
• 30:57
  SPEAKER_01: Every two hours, we're switching the boots, we're switching the splints, oral care twice a day.
• 31:02
  SPEAKER_01: Like all the things, favorite TV show on.
• 31:05
  SPEAKER_01: And this is where it starts to get good.
• 31:07
  SPEAKER_01: They were on our unit a long time.
• 31:09
  SPEAKER_01: After a couple months, this patient that was never supposed to ever interact again started to give a thumbs up on command.
• 31:15
  SPEAKER_01: After a few more months, he was able to wiggle their toes on command.
• 31:21
  SPEAKER_01: The patient eventually was able to walk and talk.
• 31:25
  SPEAKER_01: Now not going to be the the function fully functioning member of society that they were before, but a person that can function, that can do things, that can be with their child, that can be with their mother.
• 31:39
  SPEAKER_01: And I got a voicemail from them that I keep and I will listen.
• 31:45
  SPEAKER_01: And it is from the mom.
• 31:48
  SPEAKER_01: The mom sent it to me.
• 31:49
  SPEAKER_01: And rehab, the patient, the physical therapist came in, and these were the first words that he really truly spoke.
• 31:58
  SPEAKER_01: Physical therapy came in and they said, Okay, do you wanna do more?
• 32:02
  SPEAKER_01: And he goes, Clear as day, got in on recording.
• 32:06
  SPEAKER_01: No, I'm tired.
• 32:10
  SPEAKER_01: Oh and the mom was recording, sent it to me, and it is I use it to reflect on.
• 32:19
  SPEAKER_01: And what what it really did is those times when my coworkers hated me for the Abby schedule on the wall, the times that I doubted the medicine, the times that I doubted the mom's initial decision.
• 32:32
  SPEAKER_01: When I have those moments, I reflect on that case.
• 32:36
  SPEAKER_01: Do I acknowledge that there's a level of miracle to that?
• 32:39
  SPEAKER_01: Yeah, I do.
• 32:40
  SPEAKER_01: But I can also acknowledge that there is a lot of medicine and science that helped that outcome.
• 32:46
  SPEAKER_01: And it's so beautiful to know that.
• 32:49
  SPEAKER_01: We kept contact for many years.
• 32:51
  SPEAKER_01: And this is not what I say.
• 32:54
  SPEAKER_01: This is just what the mom has said that they truly believe that without the Abbey schedule, he would not, they the patient would not have functioned as well.
• 33:03
  SPEAKER_01: I mean on the unit, bedbound months, not a pressure ulcer on him, not a contracted hand, foot, nothing because of that the Abbey schedule that everyone hated.
• 33:16
  SPEAKER_01: So I do use that to to motivate me.
• 33:19
  SPEAKER_03: That's why you can't convince me that God doesn't work through people because that's you truly doing your work that you need to do.
• 33:27
  SPEAKER_03: Now, were there other disciplines that helped increase the likelihood of him being able to walk with PTOT?
• 33:33
  SPEAKER_03: Obviously.
• 33:35
  SPEAKER_03: It's not just one single person when we take care of a patient.
• 33:37
  SPEAKER_03: It's a whole team approach.
• 33:39
  SPEAKER_03: But I imagine that you started a standard and a raised the bar to another level that maybe he wouldn't have done so well without the Abbey schedule, you know?
• 33:50
  SPEAKER_03: Good job, Abby.
• 33:51
  SPEAKER_03: That's awesome.
• 33:52
  SPEAKER_00: Well, the s the science backs it up, right?
• 33:54
  SPEAKER_00: You need to have real stimuli so those nerves connections can rewire some way, somehow.
• 34:00
  SPEAKER_00: So I wish we have a lot of Abbey schedules even today.
• 34:06
  SPEAKER_00: You know, it'll be it'll be it'll be fun to to make it like a like a curriculum part of physical therapy schools.
• 34:12
  SPEAKER_00: Yeah.
• 34:12
  SPEAKER_00: And they they they they go and work for a week and do the abbey schedule for a week.
• 34:16
  SPEAKER_02: Yeah.
• 34:17
  SPEAKER_02: I don't think the abbey schedule is like I feel like we do that for certain patients, not for all of them.
• 34:24
  SPEAKER_02: But I think that would be great if we had the staff and the resources and the equipment to make that happen.
• 34:29
  SPEAKER_01: It was it was a lot, it was a fight, but if there were more staff, it would have been been easier.
• 34:36
  SPEAKER_01: If there was more resources, it would have been easier.
• 34:40
  SPEAKER_00: We could say like ABI, Abby, ambulation, ambulation break intervention.
• 34:47
  SPEAKER_00: Ambulation break intervention.
• 34:50
  SPEAKER_00: No, that's that's that's a great story.
• 34:52
  SPEAKER_00: That's an actually successful story, to be frankly honest.
• 34:55
  SPEAKER_00: After seeing so many people with you know potential brain dead and and you know prolonged comatose, I think we we uh sometimes we don't get to see those stories, actually.
• 35:05
  SPEAKER_00: I I have colleagues that have never seen a successful story like that, and and can already frame them to say, well, here comes another one, as you said, the compassion and fatigue, and just just throw the towel from the echo.
• 35:18
  SPEAKER_00: Hopefully we still have good neurologists that will come in and kind of reel those back in into hey, this could be recoverable in a couple of weeks and months, especially young folks.
• 35:29
  SPEAKER_00: But yeah, that's a great story, actually.
• 35:34
  SPEAKER_03: I like that you kept the I like that you kept the voicemail so that you can refer back to that.
• 35:39
  SPEAKER_03: Because there are times where we say, in the whole world, do we do what we do?
• 35:45
  SPEAKER_03: And then there's some days where we say, My gun, this is why we do what we do.
• 35:51
  SPEAKER_03: You know, I remember being, gosh, this was probably seven years ago.
• 35:54
  SPEAKER_03: Now, this is me being very vulnerable.
• 35:56
  SPEAKER_03: This is a lot of woo-woo.
• 35:58
  SPEAKER_03: So I need a very open mind for everyone as I tell this story.
• 36:02
  SPEAKER_03: But I remember having a really hard time about seven years ago and thinking, gosh, like I just feel this like change inside of me.
• 36:09
  SPEAKER_03: I don't know what it is.
• 36:10
  SPEAKER_03: I feel like maybe there's an okay, maybe I need I'm better served in another job.
• 36:14
  SPEAKER_03: And I remember I was struggling in that aspect and or well, what I thought was that aspect.
• 36:21
  SPEAKER_03: But I remember having this dream.
• 36:23
  SPEAKER_03: And you know how you guys have a dream, and it's like, oh, that was kind of weird.
• 36:27
  SPEAKER_03: And then there's some dreams where you wake up, and I remember my mom would describe this as a hard dream.
• 36:33
  SPEAKER_03: Like it was just thick.
• 36:34
  SPEAKER_03: It I mean, it just was laid on you.
• 36:36
  SPEAKER_03: It just felt so real.
• 36:38
  SPEAKER_03: And I remember waking up, feeling that way.
• 36:41
  SPEAKER_03: But basically, what it was, this old lady was leading me to her husband.
• 36:47
  SPEAKER_03: And she said, Come here, I need to show you something.
• 36:49
  SPEAKER_03: She said, You took care of my husband.
• 36:51
  SPEAKER_03: And her, the husband was in the bed and he was intubated and sedated.
• 36:57
  SPEAKER_03: Like I guess it was like before he died, because then she said, He passed away, but you took care of him.
• 37:02
  SPEAKER_03: And I just wanted to thank you for taking care of taking care of him.
• 37:05
  SPEAKER_03: And I remember in a dream, she was dead too, but she was showing me her husband, who had also passed.
• 37:12
  SPEAKER_03: But in that moment when I was really struggling with like, okay, what's going on?
• 37:15
  SPEAKER_03: What's going on?
• 37:16
  SPEAKER_03: And I remember waking up and like writing this dream down because it just felt so real.
• 37:22
  SPEAKER_03: And it was like what I needed in that moment to say, okay, stick with what you're doing.
• 37:27
  SPEAKER_03: You're doing okay, you're making a difference.
• 37:30
  SPEAKER_03: But I remember I've never had a dream like, like that.
• 37:33
  SPEAKER_03: And I just, I could have chose to blow it off, but I didn't.
• 37:37
  SPEAKER_03: And I still refer back to that where I wrote it down and say, okay, let me remind myself, I am making a difference.
• 37:45
  SPEAKER_01: And I think that that's what I was hoping with this, is that people will listen and take that moment to reflect on some of these wins or redirections or just signs from whatever power that be, whether it's our own signs, a higher power signs, that we are we are doing what we're supposed to be doing, that we are all in medicine for a reason.
• 38:12
  SPEAKER_01: It it's hard sometimes, like it's hard sometimes on those days.
• 38:17
  SPEAKER_01: Like we all struggle, we all have moments of crisis of like, oh goodness, what am I doing in work and out of work.
• 38:25
  SPEAKER_01: And I think it's just so important to have these stories that we remember.
• 38:31
  SPEAKER_01: And I think you did a good job writing it down.
• 38:33
  SPEAKER_01: Like, yes, it's a dream, but writing it down to just remind you, or like, you know, I know Armando has stuff that he has shared from his program director that he keeps as a reminder, and my voicemail that I keep as my reminder.
• 38:48
  SPEAKER_01: We all have these reminders, and I think it's just so important that we acknowledge that and that we all need that too.
• 38:56
  SPEAKER_01: Like we all need that.
• 38:57
  SPEAKER_03: And it might come across different for different people, you know.
• 39:00
  SPEAKER_03: Yeah.
• 39:01
  SPEAKER_03: And you have to know how to look for it.
• 39:03
  SPEAKER_03: You know, sometimes it might be in your face and might be a call from your professor on your around your birthday to remind you.
• 39:12
  SPEAKER_03: And sometimes it's something that, you know, there I remember one day some I was pulled to another unit and this family said, You're like the Chick-fil-A nurse.
• 39:23
  SPEAKER_03: And I thought, what?
• 39:24
  SPEAKER_03: She was like, You just go above and beyond.
• 39:26
  SPEAKER_03: And I thought that was kind.
• 39:28
  SPEAKER_03: I was like, huh?
• 39:30
  SPEAKER_03: Because I was thinking to myself, did I use that verbiage like my pleasure?
• 39:34
  SPEAKER_03: No, I don't use that.
• 39:35
  SPEAKER_02: You know how they should pull to a unit where they're all And nothing about nothing.
• 39:39
  SPEAKER_03: But what I didn't say is that that was very kind.
• 39:42
  SPEAKER_03: You know, just it might be in your face, it might be something very quiet.
• 39:47
  SPEAKER_03: But just look for it because it's there.
• 39:49
  SPEAKER_03: It they are there.
• 39:50
  SPEAKER_01: I like Go ahead.
• 39:52
  SPEAKER_01: Sorry.
• 39:52
  SPEAKER_02: I was gonna say I liked in Abby's story how at the beginning the the the patient's mom didn't like her and then she became the favorite nurse.
• 40:00
  SPEAKER_02: Yeah.
• 40:01
  SPEAKER_02: Yeah.
• 40:02
  SPEAKER_00: From villain to hero.
• 40:03
  SPEAKER_02: I love that.
• 40:04
  SPEAKER_02: Where it's like, God, why she she's making him do all this stuff.
• 40:07
  SPEAKER_02: He shouldn't be doing that.
• 40:08
  SPEAKER_02: He's he's not he's too weak for that.
• 40:10
  SPEAKER_02: And then it's like you now you see like she did all of this, she's doing all of this.
• 40:15
  SPEAKER_02: These other nurses probably need to be why are they doing that?
• 40:19
  SPEAKER_02: And so I I like that because you didn't win her over necessarily from being like sweet and sugary and like all that.
• 40:26
  SPEAKER_02: It's just like by doing like great.
• 40:27
  SPEAKER_02: This is what we have to do.
• 40:29
  SPEAKER_02: Yeah, yeah, yeah.
• 40:30
  SPEAKER_02: I love that.
• 40:30
  SPEAKER_02: And I think it's awesome with the dream for Amanda because it's like there are certain things in life that you just can't explain, and it's no one can, to my knowledge, like we still don't know how we dream, why we dream what we dream.
• 40:43
  SPEAKER_02: And just like with medicine, sometimes treating people, there's just things we can't explain.
• 40:47
  SPEAKER_02: So I think it's cool, show the connection.
• 40:50
  SPEAKER_00: The uncertainty, going back to my program director, he told me also the uncertainty in medicine can really drive you crazy or empower you.
• 40:59
  SPEAKER_01: Oh, yeah.
• 41:00
  SPEAKER_00: We all have to deal with that every day.
• 41:02
  SPEAKER_01: Yeah.
• 41:03
  SPEAKER_00: Yeah.
• 41:04
  SPEAKER_01: Yes, the uncertainty in medicine, it can drive you crazy.
• 41:07
  SPEAKER_01: I choose to let it empower me.
• 41:09
  SPEAKER_01: I was uncertain getting that patient up three times a day, every day for a long time, if it would work and I trusted it, and it did.
• 41:21
  SPEAKER_02: And if it hadn't worked, it still would have been a job well done.
• 41:24
  SPEAKER_01: It wouldn't.
• 41:25
  SPEAKER_01: And it I still could have had pride in the fact that when that patient left our unit for like oh my like six months, I think.
• 41:34
  SPEAKER_01: It was a long time.
• 41:35
  SPEAKER_01: No pressure ulcers.
• 41:37
  SPEAKER_01: Yeah.
• 41:37
  SPEAKER_02: Like not the fact that he wasn't like super atrophy, no foot drop, no, like you said, like that's a win.
• 41:44
  SPEAKER_01: I think it is still a win.
• 41:47
  SPEAKER_01: Even if he didn't have the big recovery, that is still a win.
• 41:51
  SPEAKER_01: And we have to find those wins too, even in the sadder stories.
• 41:55
  SPEAKER_01: There are still there's always a win or a lesson that we can carry forward.
• 42:01
  SPEAKER_03: And when we get to see those wins, especially because you know, with us being in the ICU, whether we discharge, um, excuse me, transfer someone to intermediate or go if they go straight to rehab because there's not intermediate beds, it's like we don't get to see them.
• 42:14
  SPEAKER_03: We don't get to see how well they're doing.
• 42:16
  SPEAKER_03: And so when they come back, if they have a doctor's visit, you know, and they say, well, we just want to stop by.
• 42:21
  SPEAKER_03: And, you know, I remember folks coming back.
• 42:23
  SPEAKER_03: It doesn't happen regularly, but it does happen sometimes where they come back and say, Look, I'm better.
• 42:29
  SPEAKER_03: You know, we had someone come back who was a cardiac arrest and she came back with her family and just thanked everyone and how it's changed her life and what she now chooses to be a part of and volunteer with, and allowing people to learn more about women and cardiac health is just, you know, so many things that happen to you are just for you and you just don't realize it in the moment.
• 42:54
  SPEAKER_01: For any patients out there listening, I think it's also important to highlight that we do carry things forward.
• 43:01
  SPEAKER_01: We carry these lessons and these patients with us for years, years on end.
• 43:08
  SPEAKER_01: I took care of that patient ten years ago now, at least.
• 43:12
  SPEAKER_01: It was a long time.
• 43:14
  SPEAKER_01: So there's so many lives that we touch in healthcare, and so many lives that touch us in healthcare, and it's just important to highlight that and remember it and use it to continue to come to work.
• 43:25
  SPEAKER_01: Yeah, do what we do.
• 43:28
  SPEAKER_01: Yeah.
• 43:29
  SPEAKER_01: Do what we do.
• 43:30
  SPEAKER_00: I had a similar story like that.
• 43:33
  SPEAKER_00: Just gonna summarize, I don't wanna linger too much on this story, but this lady she had bipolarism and she didn't she didn't have much education in her background, never completed high school.
• 43:45
  SPEAKER_00: And you know, probably you have seen someone with a psych disorder that gets labeled, right?
• 43:50
  SPEAKER_00: And sort of frame in a certain way every time they come to the hospital.
• 43:55
  SPEAKER_00: And you know, being a double advocate, sure, sure, you know, half of it might be real.
• 44:00
  SPEAKER_00: Half more halfway might not.
• 44:02
  SPEAKER_00: But I had this lady that really touched me in the sense of listening to patients.
• 44:06
  SPEAKER_00: She came in many times to my to my hospital for headaches.
• 44:10
  SPEAKER_00: And you know, she has some migraine disorder.
• 44:12
  SPEAKER_00: She has some pseudocerebral tumor disorder.
• 44:15
  SPEAKER_00: She she had all the things that could cause headaches.
• 44:17
  SPEAKER_00: So everyone and the anxiety and the bipolarism and how she was all crazy about it.
• 44:22
  SPEAKER_00: No, my pain doesn't get better, doesn't get better.
• 44:25
  SPEAKER_00: You know, she'll get snozed with medicine and you know, pain will get better a little bit and then sent home with opiates or whatnot.
• 44:32
  SPEAKER_00: But, you know, for many weeks this lady came back and came back and came back and came back.
• 44:39
  SPEAKER_00: And I think she really touched me in the sense that no one really sat down and listened to her complaints and ended up being a toothache.
• 44:48
  SPEAKER_00: All she needed was someone to really tell her you gotta go to the dentist.
• 44:53
  SPEAKER_00: And she didn't have my family support.
• 44:55
  SPEAKER_00: So I think the loneliness of not having someone to really help you once you leave the hospital, that also was a teaching moment for me.
• 45:03
  SPEAKER_00: Because, you know, as soon as we figure like this might just be the wisdom thief or something back there, and you know, no dentist usually goes to the hospital unless it's a big, big, big issue.
• 45:14
  SPEAKER_00: So if she will, you know, get lost to follow up every time she left home and left the hospital.
• 45:19
  SPEAKER_00: So at one point she came back and she said, like, dude, I haven't been able to get to a dentist.
• 45:23
  SPEAKER_00: You know, we don't have I don't have money here and there.
• 45:26
  SPEAKER_00: You know, bottom line, you know, we managed to get one of our my junior residents, I was a senior by then, one of our social workers to kind of help her out, you know, find her right, coordinate the whole appointment to the dentist and whatnot.
• 45:38
  SPEAKER_00: Um and I feel that story might align with with you, that's probably not as as huge as as your win, of course.
• 45:45
  SPEAKER_00: But again, every win in a patient care is probably a decent win.
• 45:49
  SPEAKER_01: Oh yeah, every win.
• 45:50
  SPEAKER_00: But it really touched me in the sense of reminds me now, even today, that you know, if things are not matching, right?
• 45:57
  SPEAKER_00: You're doing interridge thing and things are not lining up, you you might need to listen a little bit more longer or ask the hard questions to really try to help people.
• 46:06
  SPEAKER_00: So I think that moment really kind of is a win-win for me and kind of empowered me.
• 46:10
  SPEAKER_00: You know, I got got back to my home.
• 46:12
  SPEAKER_00: I was like, man, it was this simple thing, and you know, I can do this.
• 46:16
  SPEAKER_00: I'm a doctor, I can really impact people in a positive way.
• 46:19
  SPEAKER_00: So I think that lady, that lady, I mean, she kept coming back to the office not to say hi to see you.
• 46:26
  SPEAKER_00: Yeah, I mean, see me, see the other ones, and you can did a lot of the damage.
• 46:30
  SPEAKER_03: She trusted y'all and felt comfortable with y'all, I'm sure, and felt so grateful.
• 46:34
  SPEAKER_03: But then it goes back to what we talked about when we were all four together the last time.
• 46:38
  SPEAKER_03: Although some of those things that she was complaining about aren't little things, but you just being there and being a social support.
• 46:43
  SPEAKER_03: And you know, we all have to draw the line somewhere when it comes to certain things when folks come in through the ED or whatever, but um it's just the little things, it's just the little things that can make such a huge difference that we don't learn in a textbook, just being kind and being human.
• 47:00
  SPEAKER_03: Yeah.
• 47:00
  SPEAKER_00: That in medicine is called the hidden curriculum.
• 47:04
  SPEAKER_01: The hidden curriculum, yes.
• 47:05
  SPEAKER_00: The things that we learn that are not in a textbook, right?
• 47:08
  SPEAKER_00: Or in a couple of yeah, yes.
• 47:11
  SPEAKER_01: But I still love that story.
• 47:13
  SPEAKER_01: It doesn't have to be like they don't have to be these big, like miraculous ones either.
• 47:18
  SPEAKER_01: They can be small ones.
• 47:19
  SPEAKER_01: And I'm sure that's the teeth, actually.
• 47:22
  SPEAKER_01: Yeah.
• 47:23
  SPEAKER_00: Next time she came, she had a whole new, you know, she was a whole new mouth, and her promise got so much better, she was up.
• 47:32
  SPEAKER_00: I mean, a simple thing, but again, she got labeled by her anxiety disorder, her bipology disorder, her migraine disorder.
• 47:40
  SPEAKER_00: I mean, they throw they threw the toilet on her in regards to analgesia, and the pain wasn't there.
• 47:45
  SPEAKER_00: Like pen C T scang after and an MRI after, and I was like, what the hell?
• 47:50
  SPEAKER_00: Gracious.
• 47:51
  SPEAKER_00: Yeah, so it was a toothache all all that time.
• 47:54
  SPEAKER_03: I'm telling you, tooth pain is awful.
• 47:58
  SPEAKER_03: Have you all had tooth pain?
• 47:59
  SPEAKER_03: An ear pain, tooth pain?
• 48:01
  SPEAKER_02: Yep.
• 48:02
  SPEAKER_02: No, it's bad.
• 48:03
  SPEAKER_02: Well, I was gonna say, I have a I quick story about a patient, but it made me think about that because it's involving pain.
• 48:10
  SPEAKER_02: You know, like when you they say in school, like pain's a fifth idol sign?
• 48:14
  SPEAKER_02: Yeah.
• 48:14
  SPEAKER_02: Yeah.
• 48:15
  SPEAKER_02: And you're like, okay, okay, okay, okay.
• 48:17
  SPEAKER_02: But we had a patient, so this is like a while ago, and Amanda probably remembers this.
• 48:22
  SPEAKER_02: We would get a lot of thoracic patients, and they would get this procedure or surgery, esophagogastrectomy.
• 48:30
  SPEAKER_02: And they would come out, they would have an NG tube, chest tubes, JPs, a big back then it was so like a big incision, midline abdominal, like an incision on their side, tube general.
• 48:41
  SPEAKER_02: Yes, a G tube, a J tube, a epidural, a PCA, a foliage.
• 48:44
  SPEAKER_02: I mean, there's so many lines and tubes, and they would normally be in the ICU, but this woman um was in an intermediate pod for me.
• 48:52
  SPEAKER_02: So she was, I think had had surgery maybe that day or the day before.
• 48:57
  SPEAKER_02: She was in the intermediate pod that we had had on the floor.
• 49:00
  SPEAKER_02: And I was working a night shift.
• 49:02
  SPEAKER_02: And long story short, she was in this unrelieved pain all night, and nothing I could do would help her.
• 49:10
  SPEAKER_02: I had reached out to the anesthesiologist, the resident, the fellow, eventually the attending, the surgeon himself, the thoracic surgeon called to ask what was going on.
• 49:20
  SPEAKER_02: And this is a very particular man.
• 49:22
  SPEAKER_02: Um, I'll just say that.
• 49:24
  SPEAKER_02: And she was just writhing in the bed and nothing we could do would help.
• 49:28
  SPEAKER_02: And I was like telling my charge nurse, and they were like, I mean, I don't know what you want me to do.
• 49:31
  SPEAKER_02: Like, that's what they said.
• 49:32
  SPEAKER_02: And I was like, something's wrong.
• 49:34
  SPEAKER_02: I'm still a newer ICU nurse at this point, but I'm like, something is wrong.
• 49:38
  SPEAKER_02: Like, I know she had surgery.
• 49:40
  SPEAKER_02: I've had surgery, but she's on, she has all of these pain medications and it's not helping.
• 49:45
  SPEAKER_02: And she cannot sit still in this bed.
• 49:47
  SPEAKER_02: And the next morning, they had to intubate her, give her like all these medications to get her still, take her to CT.
• 49:52
  SPEAKER_02: And she ended up having to go to the OR.
• 49:54
  SPEAKER_02: Something had leaked or ruptured, and she was in a bad way.
• 49:56
  SPEAKER_02: And she ended up being on our unit for I think three or four months, multiple trips to the OR.
• 50:02
  SPEAKER_02: She ended up getting trached, pegged, but she did end up walking out.
• 50:06
  SPEAKER_02: She was there for so long.
• 50:07
  SPEAKER_02: We had to have a hairdresser come and like cut her hair because it was all like matted and dirty, and she got her haircut.
• 50:12
  SPEAKER_02: She was like up walking around the unit, had her little like downsized trait, but she was able to talk and she got out of there.
• 50:18
  SPEAKER_02: But I always remember that because I knew something wasn't right, and I couldn't, I mean, like, I was like, Well, she's had all this stuff, but I was like, it's not just pain, like you're not just in pain like that, that's unrelieved for that long for no reason.
• 50:33
  SPEAKER_02: So if you're in school or you're a new nurse or something, or you know, you're turning your nose up at pain's the fifth vital sign.
• 50:39
  SPEAKER_02: Well, I think it is, and that was like a very clear thing that I have never forgotten.
• 50:44
  SPEAKER_02: I was like, No, that's not right.
• 50:47
  SPEAKER_02: You shouldn't be like that.
• 50:49
  SPEAKER_02: Yeah.
• 50:49
  SPEAKER_02: But that was just one of the ones I thought of.
• 50:51
  SPEAKER_02: I was scared to death.
• 50:51
  SPEAKER_02: I was like, I'm gonna get in trouble.
• 50:52
  SPEAKER_02: I I'm in so much trouble.
• 50:54
  SPEAKER_02: You're always wearing it in trouble.
• 50:56
  SPEAKER_02: Because we had this really intense epidural and like PCA policy, and it was like, you can't give any other narcotics if they have an epidural.
• 51:03
  SPEAKER_02: Yeah, yeah, yeah.
• 51:04
  SPEAKER_02: And that's what they were ordering.
• 51:05
  SPEAKER_02: And that's what the surgeon was like, you probably need to go ahead and um tell somebody that you're gonna be in trouble because you shouldn't have done that.
• 51:10
  SPEAKER_02: And I'm like, okay, well, that's what the anesthesia all just told me to do, and she's not okay.
• 51:15
  SPEAKER_02: But anyways, I didn't get you didn't do anything wrong except let her be miserable.
• 51:19
  SPEAKER_02: I tried my best, but also as a charge nurse, I think that when I became a charge nurse, it's like, you've got to step in and help.
• 51:25
  SPEAKER_03: Maybe I'm go up the chain.
• 51:27
  SPEAKER_03: It's okay.
• 51:28
  SPEAKER_03: You're not getting what you need from this person, go up.
• 51:30
  SPEAKER_03: There's always someone higher.
• 51:31
  SPEAKER_00: Yeah.
• 51:32
  SPEAKER_00: There's always somewhere higher, yes.
• 51:34
  SPEAKER_00: Mm-hmm.
• 51:35
  SPEAKER_01: Well, any final thoughts?
• 51:37
  SPEAKER_01: Any final stories?
• 51:38
  SPEAKER_03: You know, we could probably yap about this for hours, but no, I thought this was good.
• 51:42
  SPEAKER_03: I think we touched on a lot.
• 51:44
  SPEAKER_03: Yeah.
• 51:44
  SPEAKER_00: So I I hope hopefully this podcast, right, can kind of help other trainees as well, and the patients and other people kind of immerse in the life of healthcare providers.
• 51:55
  SPEAKER_00: Is is is it's it's a good profession, people.
• 51:58
  SPEAKER_00: I think we should all feel proud about it.
• 52:00
  SPEAKER_00: And I do believe we are making a difference in this world.
• 52:04
  SPEAKER_00: Not just in the payment because and Abby, thank you for having these great podcasts.
• 52:10
  SPEAKER_00: It's always fun.
• 52:11
  SPEAKER_01: Yeah, thanks for coming.
• 52:13
  SPEAKER_01: So I hope you all listening, take a pause, whether you're in healthcare or not in healthcare, and think about those who have affected your life for good, for bad.
• 52:24
  SPEAKER_01: Maybe you'll have a self-reflection moment like I have that maybe something in your youth that you thought was bad is actually someone being really helpful and really helping shape you for the better.
• 52:34
  SPEAKER_01: From all of us shift talkers here, until next time.
• 52:37
  SPEAKER_01: Bye.
• 52:38
  SPEAKER_01: Bye.
• 52:45
  SPEAKER_01: Good job.
• 52:46
  SPEAKER_01: If this felt your kind of conversation, make sure you're following, leave us a review, and we'll see you back here soon.
• 52:52
  SPEAKER_01: Bye.
• 52:54
  SPEAKER_04: Step into the light where the stories come.