[SPEAKER_03]: Hey everybody, David here, and this is a little bit of a side track, I guess, is what Nicole and Mark would call it over on Nevermind the Music.
[SPEAKER_03]: Over the course of the season, one of our listeners on the discord has been writing in and turns out that they are an ICU nurse.
[SPEAKER_03]: And so Sarah has become our chief medical correspondent for the show and writing in on a
[SPEAKER_03]: letting us know what certain things are or how to understand certain medical procedures and whatnot.
[SPEAKER_03]: And I invited her to come on to the podcast for a little bit and she graciously accepted.
[SPEAKER_03]: And so I got to spend a good 45, 50 minutes with Sarah, learning about her work and what she does.
[SPEAKER_03]: The conversation beers a little bit into politics and
[SPEAKER_03]: you know, corporate management of healthcare.
[SPEAKER_03]: So we tried to steer it away from that a little bit, but we couldn't help but bump into those issues.
[SPEAKER_03]: So just sort of letting you know about that.
[SPEAKER_03]: Otherwise, great time talking with Sarah, really interesting in in great insights.
[SPEAKER_03]: And just just as I think a great indicator of the depth of of community that we have that has
[SPEAKER_03]: and the kind of cool people that, you know, like to listen to the shows and to then sort of share with the community their insights and their own personal life.
[SPEAKER_03]: So we really appreciate Sarah spending some time with us, you know, she herself is a bit of a nerd as well.
[SPEAKER_03]: And so we're now her nerd herd.
[SPEAKER_03]: So I love that.
[SPEAKER_03]: We talk a little bit that at the end of the show.
[SPEAKER_03]: But it's just great to be able to find people who are into the same kind of stuff as we all are All in different walks of life and different professions and stuff like that and we'll get to get to come together over a show like the pit So everyone on the discord give a shout out to Sarah on the channel and thank her for her time and her wisdom and Otherwise here is my conversation with Sarah and I will see you later this week for the next episode of the pit
[SPEAKER_03]: So, Ogilvy.
[SPEAKER_03]: What are we supposed to make of Ogilvy?
[SPEAKER_03]: Because you know John and I have far beef.
[SPEAKER_02]: Oh, I know.
[SPEAKER_02]: I mean, he's like a med student still.
[SPEAKER_02]: And a lot of times, they kind of have that like need to show off.
[SPEAKER_03]: OK, especially coming in on their first day, they want to prove themselves.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: And although I think he's a little more cocky than most of them that I've ever met, a lot of them are very scared, like other first day.
[SPEAKER_02]: They're like, walk up with their like hands up with their hands.
[SPEAKER_02]: And they're like, I'm here for my first day.
[SPEAKER_02]: Um, but the ones that are more like, I have met some that are like him and they learn.
[SPEAKER_01]: Right.
[SPEAKER_02]: It takes some time.
[SPEAKER_02]: They learn.
[SPEAKER_02]: They learn that they can't what they can and can't say how they can and can act.
[SPEAKER_02]: I, I give him a little bit of leeway because he's a first, like, a med student on a first day.
[SPEAKER_03]: Right.
[SPEAKER_02]: But he's a punchable.
[SPEAKER_03]: Some people are you at a teaching hospital as well?
[SPEAKER_02]: I am.
[SPEAKER_02]: I have pretty much always worked at a teaching hospital.
[SPEAKER_03]: Um, and those are a space out like a special designation or is that just a special arrangement with a call with a school or something or something or something.
[SPEAKER_02]: So most of the teaching hospitals are like the big university hospitals that have medical schools attached to them.
[SPEAKER_02]: So, um, I started as a baby nurse at a teaching hospital.
[SPEAKER_02]: Like Emma?
[SPEAKER_02]: Yeah, at a big university hospital and, um, I still work at a big university hospital.
[SPEAKER_02]: So I'm gonna date myself here.
[SPEAKER_02]: Yeah, yeah.
[SPEAKER_02]: I have been in our since 2001.
[SPEAKER_02]: Okay.
[SPEAKER_02]: So 25 years.
[SPEAKER_03]: Great.
[SPEAKER_03]: And did you know that this is what you wanted to do when you were studying?
[SPEAKER_02]: Or when I graduated from high school, I initially went into like a biochem major as a pre-med and then after my first semester.
[SPEAKER_02]: and a half of college.
[SPEAKER_02]: I was like, I don't want to do this for 10 years in my life before I actually get into the workforce.
[SPEAKER_02]: So I had friends that were nurses, like friends of my parents that were nurses and I spoke with a few of them and they're like, if you want to be in it now, this is do this.
[SPEAKER_02]: Yeah.
[SPEAKER_03]: So I went to nursing school instead and did you did it feel like you're calling when you
[SPEAKER_02]: I did.
[SPEAKER_02]: I think I brought up in like one of the discourse that I was like er, the show er was the reason I went into healthcare.
[SPEAKER_02]: So now the pit is like exactly.
[SPEAKER_02]: Yeah, so like I watched er's a you know teen.
[SPEAKER_02]: Yeah.
[SPEAKER_03]: I was like, I watched too much wild kingdom when I was here.
[SPEAKER_02]: So I was like, I want to do that.
[SPEAKER_02]: Yeah, um, and yeah, as soon as I was actually in it, I was like, yeah, this is what I was supposed to do.
[SPEAKER_03]: Got it.
[SPEAKER_03]: It felt normal.
[SPEAKER_03]: It felt like putting on the glove.
[SPEAKER_02]: Yeah.
[SPEAKER_03]: Yeah, this is it.
[SPEAKER_03]: Did you know your specialty was going to be an emergency medicine, or did I actually worked in the ICU and to trauma ICU?
[SPEAKER_03]: Okay, oh, whoa, that's even more intense, right?
[SPEAKER_03]: But they're stable by that point, right?
[SPEAKER_02]: And so you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, you really, really, you really, you really, really, you really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really
[SPEAKER_03]: We were before, just to let everybody know before Mike, we were, you know, getting settled and we were joking about our cats making an eruption, so.
[SPEAKER_03]: Yeah.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: And I was like, it's the emergency department is like pure chaos.
[SPEAKER_02]: And so I actually started out, I was supposed to actually work in transplant and the first day I showed up on the unit for my first orientation shift, the charge nurse, what like ran out crying and people were like it was like, it was a horrible, it was a shit show.
[SPEAKER_01]: Yeah, you can swear on your point.
[SPEAKER_02]: And, uh,
[SPEAKER_02]: They were like, we're going to send you across the whole to Orient because we're having some issues over here and that was like, oh, this is not a good surprise to me.
[SPEAKER_01]: Yeah.
[SPEAKER_02]: And across the whole was trauma surgery.
[SPEAKER_02]: So I oriented with them.
[SPEAKER_03]: That's like Garcia.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: Yep.
[SPEAKER_02]: So, but the time I was like halfway through my orientation, I was like, can I just stay here and not go back across all of them?
[SPEAKER_02]: Absolutely.
[SPEAKER_02]: So, that was how I ended up in trauma.
[SPEAKER_02]: So I did four years on the like a floor regular med surge floor, which was trauma and then I went to the ICU and I've been a nice unit since then so trauma ICU is controlled chaos is what we like to call it and our trauma surgeons would always like to get their patients out of the emergency department as soon as possible.
[SPEAKER_03]: They would have gone into a street level medicine.
[SPEAKER_02]: Exactly.
[SPEAKER_02]: They'd be calling us, and they'd be like, how fast can we get the station up there?
[SPEAKER_02]: So if they didn't have to go to directly to the operating room, they would come directly up to us within an hour, usually.
[SPEAKER_02]: So they were still pretty unstable.
[SPEAKER_02]: And then we had more controlled chaos in the ICU.
[SPEAKER_02]: But we saw all the same things they see in the ED.
[SPEAKER_02]: We saw tons of gunshot wounds and car accidents and stabings.
[SPEAKER_03]: Given the size of PTSD is Dr. Hal Hashimi correct in that they really need to have two attendings on staff on duty at all times.
[SPEAKER_02]: Yeah, they probably need more than two.
[SPEAKER_03]: At least on a busy holiday weekend, you would want more.
[SPEAKER_02]: Yeah, even like the little community hospitals, usually have at least two.
[SPEAKER_02]: So the big university hospitals, I don't think we ever had less than four attendings on.
[SPEAKER_03]: Wow.
[SPEAKER_03]: Oh wow, so this is a real anomaly then.
[SPEAKER_02]: Yeah, this is, this is the one.
[SPEAKER_03]: This is the one.
[SPEAKER_02]: I think this is so they don't have to introduce you to so many people.
[SPEAKER_03]: I don't know exactly.
[SPEAKER_02]: It's purely for traumatic purposes, but... Got it.
[SPEAKER_03]: Got it.
[SPEAKER_03]: And would there be a lot of jacking and hierarchy among the attendings on a shift like that?
[SPEAKER_02]: I feel like most of the emergency room attendings get along pretty well together.
[SPEAKER_02]: They work together all the time.
[SPEAKER_02]: I mean, I'm sure there are some personality issues that are always right with doctors.
[SPEAKER_02]: But I did see some between the trauma surgeons, when the trauma surgeons would come down, and the emergency department attendings, like sometimes they get in a little tiff so things.
[SPEAKER_03]: Right, right.
[SPEAKER_03]: the way that they're depicting the flow of patients, that kind of pace, and that sort of chaos, does that feel like, I don't know how you could watch the show, if that's your reality, and then you come, like, I know most people, they would want to watch something that is far from their professional, so that they can disassociate and dissipate all of that energy and intensity.
[SPEAKER_02]: I mean, I just really watch other things to do that, but the pit, I don't know.
[SPEAKER_02]: I feel like it's like, what's the magic then?
[SPEAKER_02]: I don't know.
[SPEAKER_02]: I don't.
[SPEAKER_02]: It has the same feel as ER hit me when I was, you know, a teenager watching it.
[SPEAKER_02]: Like, it has a lot of the same qualities.
[SPEAKER_02]: I feel like, and I know why Lee is probably part of that.
[UNKNOWN]: Right.
[SPEAKER_02]: But the flow is definitely very much realistic.
[SPEAKER_02]: Like it's made, emergency departments are chaotic, always.
[SPEAKER_02]: And I, but I feel like sometimes when I'm watching it, it actually gives me an outlet to like let go of some of my feelings that I've pushed down at work because it,
[SPEAKER_03]: Interesting when you're at work.
[SPEAKER_03]: Yeah.
[SPEAKER_02]: In that position like you're around family members and other patients like you can't let all that out or you would be in a corner somewhere rocking.
[SPEAKER_03]: So we've seen we saw Javadi process in that, you know, we don't say oops in front of patients.
[SPEAKER_02]: Robby's panic attack and season one like if we let that stuff bubble to the surface at work that would be how all of us would be so I kind of feel a little bit like watching this like I can get some of those feelings out when I'm sitting at my couch safe at home Right in a controlled environment like like in the case said she's like I don't know if I remember how to turn on my emotions Maybe she should sit down and watch a bit
[SPEAKER_03]: Because Mohan, the way that the advice he gave to Mohan was like four field walls.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: Like he takes a lot of psychological strength to be able to set those boundaries while you're there.
[SPEAKER_03]: I can imagine.
[SPEAKER_01]: I can't imagine.
[SPEAKER_03]: That's the thing.
[SPEAKER_03]: Without violating any sort of patient confidentialities, what's something funny that is at the
[SPEAKER_02]: I mean, we had one patient who she was a prostitute, a sex worker, and she had been shot outside like a drug house.
[SPEAKER_01]: Oh my God.
[SPEAKER_02]: And she was there for a very long time.
[SPEAKER_02]: She was very ill when she first came in.
[SPEAKER_02]: We got her through all of it.
[SPEAKER_02]: But she was a little confused by like a lot of patients end up confused if once they've been in the ICU for a long period of time.
[SPEAKER_02]: But what she was starting to come around and get better and she was restrained because she kept like trying to pull out or lines and stuff.
[SPEAKER_02]: Right.
[SPEAKER_03]: Is that a common thing?
[SPEAKER_02]: Yes, that's very common.
[SPEAKER_02]: Right.
[SPEAKER_02]: She was offering everyone sexual favors on tire.
[SPEAKER_02]: Everyone.
[SPEAKER_02]: Male female didn't matter.
[SPEAKER_03]: That's pretty funny.
[SPEAKER_03]: But that's the, I thought that was really interesting with McKay taking oval view across the park, the other episode was this idea like meeting patients where they are.
[SPEAKER_03]: I mean, obviously you're dealing with them as they're coming in, but the people are really dealing with some of the worst days of their lives.
[SPEAKER_02]: Yeah, and it's pretty, it's got to be pretty intense.
[SPEAKER_02]: not easy.
[SPEAKER_02]: And I worked in a hospital.
[SPEAKER_02]: I moved since then.
[SPEAKER_02]: I still work in a university hospital.
[SPEAKER_02]: But the hospital I worked at was like the big hospital for the region that I lived in.
[SPEAKER_02]: And I every day was worried that someone I would know would come in and show.
[SPEAKER_03]: Wow.
[SPEAKER_03]: Yeah.
[SPEAKER_02]: And so that was like one other level of stress.
[SPEAKER_03]: Right.
[SPEAKER_03]: Yeah, because you never know who's coming in through the wheel.
[SPEAKER_03]: Yeah, coming in on the on the gurneys.
[SPEAKER_03]: Yeah, so on the shifts.
[SPEAKER_03]: Do you work?
[SPEAKER_03]: How what it seems like you know John and I have been talking about this on the on the show The amazing outcomes that we can achieve, but the malappropriation of you know how health care is distributed
[SPEAKER_03]: And a lot of it just seems like it's structural in terms of shifts and overlap and staff and and all of these kinds of stuff is that is that the case is do you guys, you know, like, yeah, what's what's that, what's the average shift length do you work so most nurses work 12 hour shifts and how we're yeah, so I have breaks.
[SPEAKER_02]: Technically.
[SPEAKER_02]: I think you guys were actually talking about it on the podcast this week about like someone like not taking their break and setting the culture that like and nurses are like that all the time like yeah we usually work seven to seven which ends up being seven to seven 30 because they factor in the 30 minute lunch that you get
[SPEAKER_03]: God, that's so being free.
[SPEAKER_02]: Yes, it is very much.
[SPEAKER_02]: And I've worked nights since the second year that I was a nurse.
[SPEAKER_02]: So I work 7 p.m. to 7 30 a.m.
[UNKNOWN]: Okay.
[SPEAKER_02]: Um, technically, you're supposed to get to 15s in a 30 minute lunch, um, you're lucky.
[SPEAKER_02]: If you get your 30 minute lunch, just at most the time that's at your desk, well, you're doing charting or something, which is technically not a non-interrupted break, but then there's to do it all the time.
[SPEAKER_02]: And I think that part of the, like, nurses have been,
[SPEAKER_02]: victimized a little bit by corporate culture, I think, like, hostels prey on her empathy and are, you know, it's a mostly female dominated profession.
[SPEAKER_01]: Yeah.
[SPEAKER_02]: And they prey on her empathy and they're like, well, we're all the family.
[SPEAKER_02]: We're all like, it's for the patients.
[SPEAKER_02]: And so this week was a family.
[SPEAKER_03]: If we were a family, you couldn't fire me.
[SPEAKER_02]: So like traditionally like nurses have put up with a lot and kind of kicked down the road where like we don't get paid for that 30 minutes even though we're technically working during that 30 minutes because we're charting because if we don't chart during that 30 minutes we don't get out on time and we don't get home to our beds or families or whatever.
[SPEAKER_03]: and get the rest you need to be able to come back to do it again.
[SPEAKER_02]: Correct.
[SPEAKER_02]: The nice thing is most nurses only work 36 hours a week, so we work 3, 12 hours just a week, but everybody's like, oh, you only work 3 days a week.
[SPEAKER_02]: That much to be so nice.
[SPEAKER_02]: But you need two days to recover from work in those 3 days.
[SPEAKER_03]: Great, just literally being on your feet that amount of time.
[SPEAKER_03]: And whenever you're sitting down, I'm sure it's not to rest as much as it is like using a terminal or something.
[SPEAKER_02]: Correct.
[SPEAKER_02]: Yeah, if you're sitting, you're charting.
[SPEAKER_02]: There's a call it going off.
[SPEAKER_02]: There's a vent to learn going off.
[SPEAKER_02]: There's an IV pump going off.
[SPEAKER_02]: Like you don't sit for long before you're getting up, back down.
[SPEAKER_03]: Right.
[SPEAKER_03]: And then you're trying to eat and bathroom break.
[SPEAKER_03]: Like we saw that in season one where and Robbie was trying to get to the bathroom, like most of the episode.
[SPEAKER_02]: Yeah, if you have a very sick patient, you might not get a bathroom break, or you have to find someone who's going to come in and sit with your patient while you go to the bathroom
[SPEAKER_02]: Sometimes you're like, I've had patients that are so sick that you can't leave the bedside really.
[SPEAKER_03]: It's just too precarious.
[SPEAKER_03]: Are you a fan of Devil Wars Prada, the movie?
[SPEAKER_02]: I said the first one.
[SPEAKER_02]: Yeah, the first one.
[SPEAKER_03]: There's a very funny line.
[SPEAKER_03]: Emily Blunt, she has to go to the bathroom, and she makes quotes her name, man, the phones, and it's a funny thing, but not at all related to her, or just a little bit.
[SPEAKER_02]: I was like, I saw the first one when it came out of so long ago.
[SPEAKER_02]: I'm bad at movie quotes.
[SPEAKER_03]: that's fine.
[SPEAKER_03]: Well, that's tough, too, and then the number of nurses that are available let alone whether we have enough paid to go around for all of them.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: Do you what's the overlap between shifts?
[SPEAKER_02]: So, like, I work night, so I work 7pm to 7.30 a.m.
[SPEAKER_02]: So, day shift comes in at 7 a.m.
[SPEAKER_02]: So, there's at 30 minutes.
[SPEAKER_03]: 30 minutes to hand over.
[SPEAKER_02]: It depends on the day, it's not uncommon for it's not uncommon and luckily in the ICU usually only have one or two patients so it's easier to get out the poor med search nurses have four or five six patients to hand off and that takes a lot longer so I think it's more common for them to get out late than it is for the ICU nurses but like if you have a patient,
[SPEAKER_02]: like circling the drain, it changes shift, then.
[SPEAKER_02]: Sometimes you're there till 9 o'clock.
[SPEAKER_03]: Right, in John and I were talking about this on the last pod, sometimes that's just the way it goes, and that's fine.
[SPEAKER_03]: In an end adult, and as a professional, and somebody who's committed to your profession,
[SPEAKER_03]: Yeah, you know, you go the extra mile every once in a while, but that's the exception, not the rule.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: Right.
[SPEAKER_03]: That's in a free and fair society.
[SPEAKER_03]: That's what the idea is.
[SPEAKER_02]: That is.
[SPEAKER_02]: I do have to say, like, when they put joy in this last week where she was like, it's, I'm not getting paid to do this.
[SPEAKER_02]: I'm leaving.
[SPEAKER_03]: Yeah.
[SPEAKER_02]: It there has been a little bit just the start of a cultural shift towards like more quality of life, more balance of work life.
[SPEAKER_02]: Because the generation that's coming into the work for us now is much more keen on work life balance and my generation.
[SPEAKER_03]: Right.
[SPEAKER_03]: Well, and we had that great conversation with what's your name?
[SPEAKER_03]: The nurse, the clerk nurse who came in,
[SPEAKER_02]: I'm blanking, I have to look at the... Melanie, I know what it's like.
[SPEAKER_03]: Have you looked at the sugar?
[SPEAKER_02]: I guess I have.
[SPEAKER_02]: Okay.
[SPEAKER_03]: Where is I'm scrolling?
[SPEAKER_03]: I'm scrolling, I'm scrolling.
[SPEAKER_03]: It's here somewhere, Monica.
[SPEAKER_03]: Monica.
[SPEAKER_02]: Yeah, it's like it's personal to nap, my notes.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: Yeah, and the, that sort of weird flex that she does like, well, I had to like, you know.
[SPEAKER_03]: Yeah, sure.
[SPEAKER_03]: Give me, I was like, wow, okay, in Javadi's like, whoa, yeah.
[SPEAKER_03]: I don't know what you'd pros, I don't know how to deal with this.
[SPEAKER_02]: Yeah, but it is kind of good like that that this coming up generation that's entering the workforce is definitely I think going to help shift the culture.
[SPEAKER_02]: Okay.
[SPEAKER_02]: To more work life balance than it has traditionally been.
[SPEAKER_03]: And this is going to be interesting because you're going to have that culture clash coming in with administration with the way that hospitals are administered and not just
[SPEAKER_03]: parts of much bigger conglomerates of hospitals.
[SPEAKER_03]: And so it's not even necessarily your administrator in your facility that you might be dealing with.
[SPEAKER_03]: There's a corporate structural well above up in the way up in the cloud somewhere where somebody else is setting these policies.
[SPEAKER_02]: Yeah, and I think that that's why recently we've seen a lot more nurses striking that are the ones that are unionized, which is not most nurses I don't think.
[SPEAKER_02]: But the ones that are unionized, you've started to see them striking for safe patient nurse ratios and health care workplace violence protocols and fair pay.
[SPEAKER_03]: My local hospital, they just voted for a strike.
[SPEAKER_03]: So we'll see if it actually happens and then see what we do.
[SPEAKER_03]: And that's like, it's a hard one.
[SPEAKER_03]: It's not like UPS drivers going on strike or something like that.
[SPEAKER_03]: Oh, no, I'm not going to get my pet food delivery or my weird rubber thing that I bought from wherever.
[SPEAKER_03]: This is literally life and death for people.
[SPEAKER_02]: Yeah, and hospitals have, you know, they have strike insurance and then they pay for a bunch of travelers to come in and work the strike and they pay them exorbitant amounts of money.
[SPEAKER_02]: And instead of just giving you a fair contract to like exactly.
[SPEAKER_02]: And like the pay for safety is horrible during those events.
[SPEAKER_01]: Yeah.
[SPEAKER_02]: If you're also striking, I don't recommend you going there.
[SPEAKER_02]: And let you absolutely have to go.
[SPEAKER_03]: Yeah, we had a bus driver strike happening because our local bus company got taken over by one of these private equity firms and then
[SPEAKER_03]: It was a family company that operated for years and years and years and then they sold the nobody, nobody in their family wanted to take the business anymore, so they sold this private equity firm who obviously came in and started changing the HR policies and stuff.
[SPEAKER_03]: And they brought in these drivers.
[SPEAKER_03]: On the first day of school, people were like two, three hours like yours, my kid, you know, because in the poor, you know, the workers that they brought in,
[SPEAKER_03]: They don't know this place, they don't know a lot of them, you know, a lot of English isn't their first language and so they're trying to read instruction seeds or understand what's going on is really horrible.
[SPEAKER_03]: So when we, when we mix profit, this, I'm sorry, this is getting way up to the loudspeaker, but yeah, but mixing profit in terms of health outcomes and, you know, human well-being and these kinds of things it gets really messy.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: Absolutely.
[SPEAKER_03]: So, um, how is this, uh, do you have any idea of, are you going to stay as an ICU nurse?
[SPEAKER_03]: Are you looking to do a little bit more, or are you, are you pretty much in your groove and you're just cruising on the road?
[SPEAKER_02]: It's actually just recently transitioned into the pack you, which is post-analysis a carer, which is a recovery room.
[SPEAKER_03]: Okay.
[SPEAKER_02]: Um, not very long ago, so it was a nice unit or something until like this last year.
[SPEAKER_02]: Okay.
[SPEAKER_02]: So recovery room, much less stressful.
[SPEAKER_02]: Do you still have to be critical care certified?
[SPEAKER_02]: Because some of those patients come out sick, but, um, so much less stressful.
[SPEAKER_02]: And I was like, I tell everybody I retired to the vacuum.
[SPEAKER_02]: because it's so much less stress than the ICU was.
[SPEAKER_02]: Right.
[SPEAKER_02]: But after, you know, it was 21 years of ICU.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: Does it are the hospitals providing enough professional mental health support?
[SPEAKER_02]: I mean, they tried it like...
[SPEAKER_03]: They talked a good deal.
[SPEAKER_02]: They did.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: I just didn't think it's like a lot of...
[SPEAKER_02]: corporate places where they're like, oh, we keep steering over into the ditch.
[SPEAKER_02]: I know.
[SPEAKER_02]: Sorry, this is health care.
[SPEAKER_02]: Right, exactly.
[SPEAKER_02]: Fortunately, there's a little the corporate speak of like, oh, we have EAP, you know, and we have meditation room and we have still got.
[SPEAKER_03]: That a daisy in room is like where you go sleep between ships.
[SPEAKER_02]: You can download the calm app on your phone for free.
[SPEAKER_03]: Oh my gosh.
[SPEAKER_02]: So like, that's the kind of stuff they give us.
[SPEAKER_03]: Right.
[SPEAKER_03]: That's crazy.
[SPEAKER_03]: Let's talk about the emergency department a little bit more.
[SPEAKER_03]: We got this season a couple of fun extra characters given that electronic systems way down.
[SPEAKER_03]: We got the clinical pharmacologist.
[SPEAKER_03]: the internet like freaked out, Dr. Megan Nort, everybody on the internet, all the pharmacists were like, we're seeing, they were like super excited.
[SPEAKER_03]: And yeah, yeah, and I talked about this on the podcast, I'm like this whole idea with the beers list and with that couple, with the medication interactions, like how important talk a little bit about the importance of clinical pharmacology in your workplace.
[SPEAKER_02]: I think they're so important and when I was in the ICU, we actually had a pharmacist, a clinical pharmacist that rounded with us every day.
[SPEAKER_02]: So when the team rounded, it was the attending and the residents and the nurses and the clinical pharmacists would round with us every day.
[SPEAKER_02]: And so the pharmacists would go through their medists and say,
[SPEAKER_02]: Hey, you know, we should change these antibiotics because their blood cultures came back and these are not appropriate or they've been on these for 12 days and they don't need them anymore.
[SPEAKER_02]: This med can interact with that med and it's so important, especially in our big like trauma patients that also have like brain injuries because we've got a lot of brain injuries.
[SPEAKER_02]: So it's really important to get their med lists correct.
[SPEAKER_02]: So they were minimizing the amount of confusion that meds were causing.
[SPEAKER_02]: compared to what their head injury was already causing, or just being in the ICU sedated for so long.
[SPEAKER_02]: And also antibiotic stewardship is a big thing.
[SPEAKER_02]: How are you're getting resistant?
[SPEAKER_03]: Yeah, Merso has touched my life.
[SPEAKER_03]: Yeah, directly.
[SPEAKER_03]: Yeah, Merso.
[SPEAKER_02]: Yeah, Merso.
[SPEAKER_02]: Yeah,
[SPEAKER_03]: What's Ferry?
[SPEAKER_02]: Um, it's Van Gogh.
[SPEAKER_02]: We should talk.
[SPEAKER_03]: We should act weird.
[SPEAKER_02]: We're throwing some action.
[SPEAKER_02]: It's Van Gogh, Van Gogh, by us, and Resistant.
[SPEAKER_02]: Entero Caucus.
[SPEAKER_02]: It's another bug.
[SPEAKER_02]: It's Resistant to a nanobiotic.
[SPEAKER_02]: Um.
[SPEAKER_02]: Necrotizing fasciitis is often caused by antibiotic resistance.
[SPEAKER_03]: No way, really.
[SPEAKER_02]: Yeah.
[SPEAKER_03]: I thought it was just some sort of weird exotic bug that lived in a pond or something like you.
[SPEAKER_02]: No, actually.
[SPEAKER_02]: No.
[SPEAKER_02]: No, and Necrotizing Peshadis is usually common bacteria, but it gets in done, like, all been wounds.
[SPEAKER_02]: And so you have to, like, be very...
[SPEAKER_03]: So Robby, do the right thing when he did the heist.
[SPEAKER_02]: Absolutely.
[SPEAKER_02]: Like, that Necrotizing Peshadis can kill you so fast.
[SPEAKER_02]: Like, it...
[SPEAKER_02]: So when he did that and was like, get somebody down here that knows what they're doing right now because you need to go to the operating room.
[SPEAKER_02]: I've seen advertising fashion go from like the size of a pencil eraser to entirely across someone's Chested up their neck in a matter of hours.
[SPEAKER_02]: Wow.
[SPEAKER_02]: So it's it's terrifying.
[SPEAKER_02]: But like this is why.
[SPEAKER_02]: pharmacists are so important because they will pick up on that like this is the wrong antibiotic for the specteria or this is they've been on this too long they not been on this long enough helps to prevent those drug resistant bugs from getting worse because we just were just literally applying in a bit back Sorry, what am I brain just
[SPEAKER_03]: like anti-bacterial, no, antibiotics.
[SPEAKER_03]: Yeah, we were just kind of like, and a biotics for you, and for you, and for you.
[SPEAKER_03]: And so yeah, we sort of a victim of our own problems there.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: What about the Dr. Nick, the, or I don't know if he's a doctor, the radiologist.
[SPEAKER_02]: Radiologists are usually doctors.
[SPEAKER_02]: Yeah, okay.
[SPEAKER_03]: But that little mobile radio or radiology x-ray cart that looked really cool.
[SPEAKER_03]: Is that something that you guys have?
[SPEAKER_02]: Yeah, so there's just like a portable extra machine.
[SPEAKER_02]: OK.
[SPEAKER_02]: So we do portable chest X-rays all the time with them.
[SPEAKER_02]: You can do other portable X-rays with them, most commonly we do chest X-rays with them.
[SPEAKER_02]: And then you can pull the X-ray up on the screen.
[SPEAKER_03]: And so, well, I mean, yeah, I mean, you can read that result.
[SPEAKER_03]: And you have less time of transporting the patient somewhere and back.
[SPEAKER_03]: That just seems like a really great medical device.
[SPEAKER_02]: Yeah, I would say most of the time when we're using it for chest X-rays, we're looking for like an pneumonia, because we would overload or the position of like an endotracheal tube, which is, you know, helping them breathe or we put in NG tubes, which are tubes that go through your nose and your stomach to feed you.
[SPEAKER_03]: So we're just forming right now.
[SPEAKER_02]: recently looking for one of those things and the doctors that are on the unit with us can usually look at them on the screen and be like, okay, this is fine.
[SPEAKER_02]: This is where it's supposed to be or this is bone-yard.
[SPEAKER_02]: This is fluid overload.
[SPEAKER_02]: Um, but in the case where like their whole system was down, you couldn't pull anything up on the computer, it was pretty smart of them to get a radiologist up there out of the basement to read them on the fly for them.
[SPEAKER_03]: Are they often in the basement because that's like the power and weight like you don't have to move it up to the upper floor because some of those machines are pretty big C. T's and MRI.
[SPEAKER_02]: Yeah, those are usually I mean pretty much every hospital I've ever worked in they've been on like the ground floor.
[SPEAKER_03]: Right.
[SPEAKER_03]: Makes it easier.
[SPEAKER_03]: Now is the.
[SPEAKER_03]: I know cyber attack is a big thing just across.
[SPEAKER_03]: industry in general and hospitals and are particularly at risk.
[SPEAKER_03]: The way that they handle this in the show, how do you feel did it break your versatility or did it seem okay?
[SPEAKER_03]: To me, it seemed a little bit dopey.
[SPEAKER_03]: Computers going off now.
[SPEAKER_03]: You can't even shut the network down, but leave the computers on.
[SPEAKER_03]: I don't know.
[SPEAKER_02]: I just seemed to me like a little bit.
[SPEAKER_03]: We could would it cause you to come to a halt like that, like I mean, it would probably if it all got shut down.
[SPEAKER_02]: Yeah, I would, um, I was, we do do like down planned down times where they update things in the system.
[SPEAKER_02]: Right.
[SPEAKER_02]: And, but we always have like a read-only version of the chart available to us, so that at least we can see like what meds they're getting or what they're last updated.
[SPEAKER_02]: Right.
[SPEAKER_02]: The correct.
[SPEAKER_02]: We can't do anything
[SPEAKER_02]: If we had to go full on paper with no charts at all, that would be hard.
[SPEAKER_03]: Because they rolled out those whiteboards, like they were waiting, they didn't some environmental staff or some other hospital administrator, like, what are these doing here?
[SPEAKER_03]: Get them down to the basement or whatever.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: They had those, like, that didn't mean, like, pretty far-fetched.
[SPEAKER_02]: Yeah, I think they probably have to go search for them in some closet.
[SPEAKER_02]: So exactly.
[SPEAKER_02]: I mean, we have like a tote of paperwork that we pull out and like pull out all the papers.
[SPEAKER_03]: Now, in fact, machine, do you have a tote full of toner cartridges?
[SPEAKER_02]: We actually still use a fax machine.
[SPEAKER_03]: Yeah, I know actually.
[SPEAKER_03]: I know that that's true, right?
[SPEAKER_03]: Because moving medical records around, they're like, well, you could fax into us.
[SPEAKER_03]: I'm like, I don't have a fax.
[SPEAKER_02]: I know.
[SPEAKER_02]: Yeah, I know we like, when we request blood from the blood bank, we have to fax the request stone of the blood bank.
[SPEAKER_02]: And I'm like, why are we using a fax machine?
[SPEAKER_03]: To hip a thing, isn't it?
[SPEAKER_02]: I think part of it, but like the blood releases in their system and prints down in their labs.
[SPEAKER_03]: So I don't know why we have to fix it, but I go to my pharmacy, you know, my local whatever pharmacy, and they know everything.
[SPEAKER_03]: They're like, let me look, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run, run
[SPEAKER_02]: It does occasionally cause problems with like family members cause like they'll be like, how come their labs are not drawing your like their labs were drawn?
[SPEAKER_02]: What are you doing?
[SPEAKER_02]: I'm like, well they're not in their my chart yet.
[SPEAKER_02]: And I'm like, you did draw them.
[SPEAKER_03]: Just hasn't cycling, you haven't waited yet.
[SPEAKER_03]: We're just long enough for them to come through.
[SPEAKER_03]: Oh man, okay, well, so what do you, what's your hot takes on the season so far?
[SPEAKER_02]: I really like it.
[SPEAKER_02]: I think that it's, it's been interesting.
[SPEAKER_02]: It's definitely like less dramatic than less less season because there's not like the big, you know, mass casualty event that was at the end of the lesson, at least I hope they didn't know they didn't know, you know, what the season, you know, if they were going to get green litter, whatever.
[SPEAKER_03]: So I think they would big a little bit.
[SPEAKER_03]: I think bigger, yeah everybody.
[SPEAKER_02]: So from that point of view, it's like a little Congress more of like an average.
[SPEAKER_02]: day in the emergency department rather than a mass casual due day.
[SPEAKER_03]: That was John's point in the last part, too.
[SPEAKER_03]: Like if that's what it is, that's what it is, is yeah, this is good.
[SPEAKER_02]: But I think they bring up so many good like point, like points to like make people think about like all the things that we have already talked about, like the corporateization of health care and
[SPEAKER_02]: staffing and workplace violence.
[SPEAKER_02]: And so I think that it's doing a really good job of putting them those things out there for you to see and talk about without like shoving them down your throat.
[SPEAKER_02]: Because I think there are some shows that kind of shove their point of view down your throat.
[SPEAKER_02]: But I think they're doing a good job of that.
[SPEAKER_03]: It's kind of weird, it's kind of meta because if PTMC is a teaching hospital, this is a teaching television show.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: This show is literally teaching us about the American health care.
[SPEAKER_03]: And one aspect of the American health care industry and health care space.
[SPEAKER_03]: Do you have any, what's your, what's your hot take on Dr. Alashibi?
[SPEAKER_03]: Wait, okay, so there you go.
[SPEAKER_03]: You want to work for Robby or you want to work for Dr. Alashibi?
[SPEAKER_03]: Ooh, that's a tough one, that is tough one.
[SPEAKER_02]: Like, Dr. Robbie definitely has his issues.
[SPEAKER_02]: And he seems like he could be hard to get along with it times, but I think he's a really good mentor also at other times.
[SPEAKER_02]: Where's Dr. Huff, I have a hard time reading her.
[SPEAKER_02]: And I think that might be harder to work for.
[SPEAKER_03]: right.
[SPEAKER_03]: Yeah, because she's not the way that she dropped it on Dr. Bikai.
[SPEAKER_03]: She was like, I don't know if motherhood is made me more empathetic or more judgmental.
[SPEAKER_03]: I'm like, whoa, that was a real hard brace.
[SPEAKER_03]: Like, because she was basically telling me, okay.
[SPEAKER_03]: Stop gossiping about that one.
[SPEAKER_03]: Stop thinking those thoughts, but like stop it.
[SPEAKER_01]: Yeah.
[SPEAKER_03]: But she did it in such a weird way that it was like, how do I read you?
[SPEAKER_02]: And also like, do we know she had kids?
[SPEAKER_03]: Like we do.
[SPEAKER_03]: She mentioned it once before.
[SPEAKER_02]: I don't remember that.
[SPEAKER_02]: So it's like,
[SPEAKER_03]: It was, um, she said it, I think it was to Robbie and that she was defending AI.
[SPEAKER_03]: She said if it will, if my, you know, if my AI app will let me get home to my kid faster than the other.
[SPEAKER_02]: Because I was like, I don't remember her saying she had kids before.
[SPEAKER_02]: So I was like, I'm just dealing with that.
[SPEAKER_02]: And where is like, okay, did I miss that?
[SPEAKER_03]: And Dr. Santos, do we call or do we call when do we call somebody doctor or not?
[SPEAKER_02]: Yeah, Sanctus would be called a doctor.
[SPEAKER_02]: So first year residency, which is also an intern, they get called doctor.
[SPEAKER_03]: It's like technically a doctor right if you if you are a lieutenant commander, but you take charge of a ship by custom.
[SPEAKER_03]: They call you captain Because you're the person in charge.
[SPEAKER_03]: You're the person in charge of that.
[SPEAKER_02]: You don't have the rank, but you have the responsibility Yeah, so like the hospital ranking like you have med students usually you don't get med students to like their third or fourth year usually Okay, they have a short coat usually if they're wearing a coat and then you get interns or first year residents
[SPEAKER_02]: their doctors, they graduate in May and in July, who they become doctors.
[SPEAKER_02]: And then you have R2s, which are second year residents, R3s, third year residents, R4s are usually chief residents.
[SPEAKER_02]: So like each service will have a chief resident, which is kind of like the person that looks down on everybody underneath them.
[SPEAKER_03]: Okay, and they're kind of a senior class in the door person and then the attending is above everybody.
[SPEAKER_03]: Okay.
[SPEAKER_03]: So, so then Mohan and Langdon and McKay, Ellis, even Mal, I guess, are there what are their residents?
[SPEAKER_03]: They're residents and residents.
[SPEAKER_02]: I think that they're like our threes.
[SPEAKER_03]: Okay.
[SPEAKER_03]: So they're not that much farther ahead than with occurred in Santos.
[SPEAKER_02]: Yeah.
[SPEAKER_03]: a year or two.
[SPEAKER_02]: Yeah.
[SPEAKER_03]: Okay, that's a lot of experience in a short period of time.
[SPEAKER_02]: Yeah, doctors get a lot of experience.
[SPEAKER_03]: What do you what do you make of Dr. Santas and Dr. Whitaker are they you enjoy them as characters?
[SPEAKER_02]: I love them together.
[SPEAKER_02]: I think there's such great foils for each other.
[SPEAKER_02]: Like Whitaker's just kind of like
[SPEAKER_02]: a little naive and very country-bumped guinea and then Santa's is kind of harder to sharp and I think a little more worldly.
[SPEAKER_02]: Right.
[SPEAKER_03]: So I think that together is gooey inside though, too.
[SPEAKER_02]: Yeah, I think she hides it very well, but there she's she's gooey, but yeah, I think them together they're like great foils for each other.
[SPEAKER_02]: I just think she's sweet.
[SPEAKER_03]: Yeah, she's really great.
[SPEAKER_03]: We talked, I think McCay is coming out to be my MVP for the senior residents, for that resident level.
[SPEAKER_03]: Joy-Quan is obviously just bringing a lot of joy to it.
[SPEAKER_03]: What do we do with Langdon?
[SPEAKER_03]: Because this whole dilemma, he actually stole controlled subs.
[SPEAKER_02]: I know.
[SPEAKER_03]: But he's a great doctor and now that he's not in jerk, he's kind of a cool guy.
[SPEAKER_02]: Yeah, I, it's laying down as tough because unfortunately, this is not on common situation, especially in emergency medicine and I think in anesthesia a lot, there's a lot of drug problems.
[SPEAKER_03]: Wow, okay.
[SPEAKER_02]: But, and I think that it's not uncommon for them to brush things under the rug with doctors.
[SPEAKER_02]: Okay.
[SPEAKER_02]: I think if it was a nurse that they caught stealing drugs,
[SPEAKER_03]: boom.
[SPEAKER_02]: She would have been gone immediately gone.
[SPEAKER_03]: Right.
[SPEAKER_03]: But I had not even ownership now gone.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: She would be walked out with security.
[SPEAKER_03]: Right.
[SPEAKER_02]: Out of the hospital.
[SPEAKER_02]: And they're reported to the board of nursing to lose her license and reported to the police probably to be arrested.
[SPEAKER_02]: Right.
[SPEAKER_02]: But unfortunately, unfortunately, I've seen this in real life where a physician was having some substance abuse issues and right.
[SPEAKER_02]: I didn't personally see this person steal drugs, but I can't imagine they weren't taking drugs from the hospital.
[SPEAKER_02]: And I think that part of it was brush, brush straight under the rug, and they went to rehab, and they came back, and they were, you know.
[SPEAKER_03]: So the rehab journey is not uncommon, like it's that you wouldn't, it's not surprising.
[SPEAKER_03]: Okay, that's interesting.
[SPEAKER_03]: Did you watch the rehearsal?
[SPEAKER_03]: I did not.
[SPEAKER_03]: Okay, season two is really interesting, because it's all about airline pilots.
[SPEAKER_03]: It's a weird show.
[SPEAKER_03]: I don't know how what your tastes are, and diluting.
[SPEAKER_02]: I've heard about that show, and it was on my watch list, and then they got lost somewhere.
[SPEAKER_03]: But you know what I'm talking about?
[SPEAKER_03]: It's professional, how professions are encapsulated and dealt with.
[SPEAKER_03]: I don't think there's any drug issues in there, but it's about airline pilots, right?
[SPEAKER_03]: It's like people entrusted with the safety and welfare
[SPEAKER_03]: so many other people, like how do we approach them and how do we as society and allow them to be themselves but at the same time when you're on duty, you could your three, four, five hundred people are in your hands at the one given go.
[SPEAKER_03]: So I think it's an interesting conundrum.
[SPEAKER_03]: Do you have any opinions about the nursing staff?
[SPEAKER_03]: Do you have a,
[SPEAKER_02]: So I think this is a one very unrealistic thing about the show is you would have many more nurses in that emergency department got it.
[SPEAKER_03]: I think there's plenty around like if you watch the background acts, there's lot there's nurses everywhere.
[SPEAKER_03]: We're only me.
[SPEAKER_02]: But you would see them doing much more of the things than they were doing.
[SPEAKER_02]: So okay.
[SPEAKER_02]: All the IV placements, all the blood draws, all the vital signs.
[SPEAKER_01]: Right.
[SPEAKER_02]: all the men giving all of that is done by nurses like there's no way like that lady that had the retinal artery occlusion that they gave TPA or TPA to that she would not have been monitored by a doctor she would have been monitored by a nurse only they would have done hourly well there's a protocol
[SPEAKER_03]: Do you have any timers you have running on your phone?
[SPEAKER_03]: Do you talk to your wife?
[SPEAKER_02]: I'm pretty funny.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: That's crazy.
[SPEAKER_03]: I mean, like, great British bake-off or anything like that.
[SPEAKER_03]: They got nothing on you guys.
[SPEAKER_01]: Yeah, I know.
[SPEAKER_03]: You keep in track of everything.
[SPEAKER_03]: If you got to hang out with a nurse or two after shift, would you hang out with Princess or Perla or Jesse or Mateo, like who's your people?
[SPEAKER_02]: Um, I mean, I, I love Dana.
[SPEAKER_03]: I'm a big Jane Dow.
[SPEAKER_03]: I don't know if people have called in on that.
[SPEAKER_03]: I'm, I'm upset at our listeners.
[SPEAKER_03]: I want to more baby Jane Dow.
[SPEAKER_02]: Um, I think she reminds me a little bit of myself.
[SPEAKER_03]: Oh, okay.
[SPEAKER_03]: You keep four milligrams of her said in your pocket.
[SPEAKER_02]: I do not.
[SPEAKER_03]: That's a range in your bucket or you're not happy to see me.
[SPEAKER_02]: Um, but I don't know.
[SPEAKER_02]: I think potatoes pretty cool.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: Hang out with Mateo.
[SPEAKER_02]: I like Jesse.
[SPEAKER_02]: I don't know.
[SPEAKER_02]: Princess and Pearlwood are a little too gossipy for me.
[SPEAKER_02]: I try to stay away from the gossip a little bit.
[SPEAKER_03]: Got it.
[SPEAKER_02]: I like them.
[SPEAKER_02]: But I think they're a little too gossipy.
[SPEAKER_03]: Donnie's pretty cool.
[SPEAKER_03]: I mean, he's an LPN right now.
[SPEAKER_03]: That's another level.
[SPEAKER_02]: Donnie's a nurse practitioner.
[SPEAKER_03]: No, it's for sorry, sorry, sorry, sorry, sorry.
[SPEAKER_03]: I'm sorry, mixing my acronyms, right?
[SPEAKER_03]: It's in your expectation.
[SPEAKER_03]: What's the difference between it just for the folks at home?
[SPEAKER_03]: What's the difference between a nurse practitioner and a nurse?
[SPEAKER_02]: So there are LPNs, there are RNs, there are nurse practitioners.
[SPEAKER_02]: So an LPN is a licensed practical nurse.
[SPEAKER_03]: And that's, I kind of called Tony an LPN.
[SPEAKER_02]: That's that was the wrong thing to call.
[SPEAKER_02]: They're kind of everybody.
[SPEAKER_02]: Fading out LPNs a little bit.
[SPEAKER_02]: Interesting.
[SPEAKER_02]: Mostly we'll find LPNs in nursing homes.
[SPEAKER_02]: Oh, OK.
[SPEAKER_02]: So LPNs have like vocational training.
[SPEAKER_02]: They can't, they technically can't assess a patient.
[SPEAKER_02]: Um, they can't give IV push medications.
[SPEAKER_02]: They can't hang the first dose of any IV medication.
[SPEAKER_03]: There's, was there an ocean and a paramedic B, what, what level to each other?
[SPEAKER_03]: Because a paramedic can administer certain drugs.
[SPEAKER_02]: Yeah, a paramedic is closer to like on level with an RN.
[SPEAKER_02]: RN.
[SPEAKER_02]: Okay.
[SPEAKER_02]: So then an RN is, um, more schooling, more clinical time.
[SPEAKER_02]: We can assess the patient.
[SPEAKER_02]: We can give IV push medications.
[SPEAKER_02]: We can hang IV.
[SPEAKER_02]: First doses of IV medications, we can access central lines.
[SPEAKER_03]: Right.
[SPEAKER_02]: Um, you're going to find us in hospitals mostly, you are.
[SPEAKER_02]: Uh, at nurse practitioners have an extra-
[SPEAKER_02]: Some states are a master's degree.
[SPEAKER_02]: You're a lot of states are not moving towards doctorate degrees.
[SPEAKER_02]: So, a lot of np's are not doctorates.
[SPEAKER_02]: So, they have extra schooling where they are allowed to practice medicine in a specified lane basically.
[SPEAKER_02]: So, okay.
[SPEAKER_02]: So, they can do acute care.
[SPEAKER_02]: They can do geriatric.
[SPEAKER_02]: So, they can do psych.
[SPEAKER_02]: things like that.
[SPEAKER_03]: And where you don't have to have a doctor, that frees up the doctor.
[SPEAKER_03]: Right.
[SPEAKER_02]: So there's practices, can write prescriptions.
[SPEAKER_02]: They can do full assessments, HMPs, and stuff on patients.
[SPEAKER_02]: So got it.
[SPEAKER_02]: You'll find them in the hospital.
[SPEAKER_02]: You'll find them in clinics, urgent cares.
[SPEAKER_02]: They work a lot of urgent cares.
[SPEAKER_02]: Nurse practitioners don't need a doctor to co-sign their orders.
[SPEAKER_02]: Whereas, you also have physician assistants as well.
[SPEAKER_03]: Right, yeah, yeah, I've had about that.
[SPEAKER_02]: So physicians assistants are usually a master's program, I believe, at this point.
[SPEAKER_02]: They may be heading towards a doctorate for them, too, but an EPA and an NPR pretty close to the same level.
[SPEAKER_01]: Gotcha.
[SPEAKER_02]: PAs can also write scripts and do assessments and stuff like that, but PAs have to be work under a physician, whereas an NP doesn't have to technically work under a physician in most states.
[SPEAKER_02]: There are some states where that differs, but got it.
[SPEAKER_03]: Right.
[SPEAKER_03]: Yeah, and then we have state to state things as well.
[SPEAKER_03]: Yeah, there's that that gets all kind of crazy.
[SPEAKER_03]: What's your, what's your kind of go to?
[SPEAKER_03]: TV watching when you come home, besides the pits, like, what would be find you watching on the big hot dee game of thrones?
[SPEAKER_03]: Nice, okay.
[SPEAKER_02]: How I found you guys?
[SPEAKER_03]: Yeah, I was gonna ask you, how did you assemble the process?
[SPEAKER_02]: I actually think it was the, like, Laura Hounds, like, the actual, like, Tolkien stuff.
[SPEAKER_02]: Oh, they're talking stuff, yeah.
[SPEAKER_02]: Yeah, I'm one of the people that I was even before rings the power.
[SPEAKER_02]: Like I'm one of the people that have read the similar similar.
[SPEAKER_02]: Right, so I think it was like that book stuff that I Okay, mostly how I found you guys and then the message to John is to hurry up and finish with the silver
[SPEAKER_03]: There's a sort of, it's gifted away.
[SPEAKER_02]: It gives me something to come back to.
[SPEAKER_03]: But we have Marilyn kicking around.
[SPEAKER_02]: Yeah, I know I love listening to Marilyn, she's so interesting.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: So I watched those shows.
[SPEAKER_02]: I'm also a big outlander fan, so last season about lander.
[SPEAKER_02]: I'm so sad.
[SPEAKER_03]: And then... Did you paradise this year?
[SPEAKER_02]: and did not.
[SPEAKER_03]: Okay, that's a wacky show.
[SPEAKER_03]: Are you more of the fantasy stuff, the fantasy stuff, I like the period drama, so like get the gilded age, just another thing that I watch.
[SPEAKER_03]: Kind of yeah, Alicia and Lisa and Lisa just put out some stuff on that.
[SPEAKER_03]: Yeah, I think you're weathering high to one.
[SPEAKER_03]: They did a gilded age one while.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: So I like a lot of those things.
[SPEAKER_03]: Cool.
[SPEAKER_02]: I did an interview with Vampire.
[SPEAKER_03]: Okay.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: I died John and, and Alicia excited for that.
[SPEAKER_03]: That's coming back to see you.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: That the first couple of seasons were really good at.
[SPEAKER_02]: So I'm excited for the next season of that.
[SPEAKER_03]: Cool.
[SPEAKER_02]: I have, I mean, I watch a little bit of everything.
[SPEAKER_02]: I try to stay away from reality TV.
[SPEAKER_02]: I'm not a big reality TV person.
[SPEAKER_03]: Are you are you looking forward to anything in particular this year coming back to you anything that's exciting?
[SPEAKER_02]: I don't I like I have so many things on a list and then I feel like forget to watch Right, I mean how's the dragon we we're assuming sometime in June so we're yeah, I am sure yeah I watched I loved night as a seven kingdoms.
[SPEAKER_02]: Yeah, that was that was so fun So that like got me back into like right looking forward to hot D coming back right are you as Star Wars person at all
[SPEAKER_02]: I do like Star Wars.
[SPEAKER_02]: I haven't watched a lot of the news stuff.
[SPEAKER_03]: Okay.
[SPEAKER_03]: I'm really excited for the new mall shadow lord animated starts in about a week or so.
[SPEAKER_03]: We're going to do some coverage on that.
[SPEAKER_02]: Nice.
[SPEAKER_02]: Oh, and I watched Aliens Earth.
[SPEAKER_02]: Oh, yeah.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: That was good.
[SPEAKER_03]: Yeah.
[SPEAKER_02]: Like what else have I watched?
[SPEAKER_03]: Yeah, it's hard to keep track of everything.
[SPEAKER_02]: I know, I know.
[SPEAKER_03]: That's when we have the show tracker.
[SPEAKER_02]: I know.
[SPEAKER_02]: I think that's a good show tracker.
[SPEAKER_02]: Part of the, I was like, oh, what are they talking about this?
[SPEAKER_02]: All right, I'll start watching that.
[SPEAKER_03]: That was nice.
[SPEAKER_03]: Perfect, awesome.
[SPEAKER_03]: Cool.
[SPEAKER_03]: This is fun.
[SPEAKER_03]: I really appreciate you have been super diligent about sending us in emails and answering our questions.
[SPEAKER_03]: So like, I can't thank you enough for taking the time to write in and give like your really good writer.
[SPEAKER_03]: Like all of your emails are very clear.
[SPEAKER_03]: It's very complex stuff and you lay it out like really well.
[SPEAKER_03]: And I feel like we, yeah, it's just been a valuable
[SPEAKER_03]: connect with us.
[SPEAKER_02]: I've always like teaching like when I pre-sept do nurses like my whole thing is like tell me why we do this like if you tell me why then you know like so like I've always really like teaching people so when you guys started asking medical questions and I was like oh nobody's actually answering that.
[SPEAKER_02]: I guess I can answer that.
[SPEAKER_03]: No, that's good too, because if you think to why, then all the technical stuff can come after that, but if you understand the why about something, then you have a greater understanding as a whole.
[SPEAKER_02]: Yeah, yeah, I've never been like, all right, just do this test.
[SPEAKER_02]: Do this test.
[SPEAKER_02]: No, tell me why we're doing this for this.
[SPEAKER_03]: Right.
[SPEAKER_03]: And yeah, and widen your viewpoint as a practitioner, right?
[SPEAKER_03]: Is that professional?
[SPEAKER_03]: Yeah.
[SPEAKER_03]: Cool.
[SPEAKER_02]: I don't know.
[SPEAKER_03]: He needs to old will be half compassion for old will be.
[SPEAKER_02]: I mean, cutting a little bit of slacks just because he's like, I know I can hear John in my head right now.
[SPEAKER_02]: He's like, I know I know I know I don't need so good will be.
[SPEAKER_02]: I can see where he's coming from, I really can't.
[SPEAKER_02]: And it is hard to remember that it's his first day as a medical student.
[SPEAKER_02]: If you can remember that, it's a little easier to cut him a little slack, but he has a lot of learning to do what I have to.
[SPEAKER_03]: Absolutely.
[SPEAKER_03]: Yeah.
[SPEAKER_02]: Absolutely.
[SPEAKER_03]: I'm humbled today quite quite.
[SPEAKER_02]: Yes, there's a last episode.
[SPEAKER_03]: Yeah, for sure.
[SPEAKER_03]: Cool.
[SPEAKER_03]: Well, Sarah, thanks so much.
[SPEAKER_03]: We really appreciate it.
[SPEAKER_03]: This is going to be a show that's going to, I mean, I think, are they already?
[SPEAKER_03]: I already writing season three and I probably start filming it pretty soon, so look forward to wrapping up the season and then we'll look to next year.
[SPEAKER_03]: Oh, and I'm hopefully, I kind of tucked into coal.
[SPEAKER_03]: We traded some messages, but I really went into coal that you really won't stop for the show.
[SPEAKER_03]: So we're hoping to get her on for the season.
[SPEAKER_02]: I love those guys, too.
[SPEAKER_03]: Yeah, and then music.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: So basically fans of cool, right on.
[SPEAKER_03]: you should write into them as well, whatever, but like if you want, at the end of the season, if you want, if you have any hot takes or you want to wrap anything up, let me know, maybe we could record a short little segment, we could tack in there, or you could send us an advice mail, or email is fine as well, if that's your preferred medium, whatever.
[SPEAKER_03]: But I really do want to hear what you think about the season at the end, so I'm not one way.
[SPEAKER_02]: I'm interested to see how they're going to wrap this season like what's going to happen in the next couple of episodes because we're technically we're at the end of the shift so.
[SPEAKER_03]: Yeah, and we know we've got two more to go.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: A little more episodes to go.
[SPEAKER_03]: So what is it going to be?
[SPEAKER_03]: Yeah.
[SPEAKER_03]: I hopefully they didn't jump the shark.
[SPEAKER_03]: And I know.
[SPEAKER_03]: It was something ridiculous.
[SPEAKER_03]: It could just be like everybody's charting for the next hour.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: Well, like Robbie was like, every's got to load all their stuff in it.
[SPEAKER_02]: I was like, I had sent that in that one email.
[SPEAKER_02]: Right.
[SPEAKER_02]: So it was going to suck when they come back up.
[SPEAKER_02]: Because everybody has to hand put everything back in the computer.
[SPEAKER_03]: Exactly.
[SPEAKER_03]: Yeah.
[SPEAKER_03]: That's a lot of work.
[SPEAKER_03]: All right, well, Sarah, thanks so much again.
[SPEAKER_03]: I really appreciate you taking some time out of your personal life.
[SPEAKER_03]: And again, thank you for writing in.
[SPEAKER_03]: And yeah, I want to hear what you think at the end of the season.
[SPEAKER_02]: Absolutely.
[SPEAKER_02]: Now, I love listening to you guys and like all your deep dives on things and hot takes.
[SPEAKER_02]: So it's, I used to have like, we used to call ourselves the nerd herd, like,
[SPEAKER_02]: a group of friends.
[SPEAKER_03]: Oh, I love that.
[SPEAKER_03]: I've never heard that one before.
[SPEAKER_03]: That's perfect.
[SPEAKER_02]: I love that.
[SPEAKER_02]: We would like go to like the Marvel movies together.
[SPEAKER_02]: Nice.
[SPEAKER_02]: The Lord of the Rings.
[SPEAKER_02]: Oh, yeah.
[SPEAKER_03]: Well, we hear people.
[SPEAKER_02]: Yeah.
[SPEAKER_02]: And so.
[SPEAKER_02]: And then I moved away and like everybody moved in other places.
[SPEAKER_02]: And so like this.
[SPEAKER_03]: Yeah.
[SPEAKER_02]: You guys are my new nerd hurt.
[SPEAKER_03]: Awesome.
[SPEAKER_03]: No, that's great.
[SPEAKER_03]: I'm so glad.
[SPEAKER_03]: Yeah, it's gonna be how's the dragon's gonna be good I've been doing my rewatch right now and I know anything and Steve are gonna be, you know, covering it as well and yeah, it should be good Well anyway, I'm glad that you're heard you're with your heart Yeah, thank you so much.
[SPEAKER_03]: Okay, we'll talk to you again soon.
[SPEAKER_02]: All right.
[UNKNOWN]: Bye
[SPEAKER_00]: The lower-hounds podcast is produced and published by the lower-hounds.
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[SPEAKER_00]: Thanks for listening.