Transcript
Will: [00:00:00] Knock, knock, hi! Knock,
knock, hi!
Hello and welcome to Knock, Knock, Hi! with the Glockenfleckens. I am Dr. Glockenflecken.
Kristin: I am Lady Glockenflecken. Will
Will: and Kristen Flannery, thank you for joining us today. Knock, knock, hi! Oh,
Kristin: you did it! Knock, knock. Hi!
Will: I was, I promised people I would do that.
Kristin: Yeah, a lot of people, uh, you made a joke about it and they said they actually did want that.
Will: So, we, we recently moved, uh, to a new YouTube channel for the video version of the podcast.
Kristin: Yes.
Will: So, uh, all the knock knock hi’s, all the knock knock guys, clips, everything. Clock
Kristin: talks. Yeah.
Will: And the reason we did that was because we were confusing YouTube.
Singers: Mm hmm. [00:01:00]
Will: And, and we, we had, uh, some advice given to us by someone at YouTube that says, Hey, yeah, maybe, maybe separate them out, you know?
And, uh
Kristin: Because it was getting hard for people to find your skits because
Will: Yeah. The
Kristin: YouTube algorithm was starting to think that the, um, that the podcasts were the ones that should be pushed out and the skits should be suppressed.
Will: Right. Because
Kristin: of that. I think it was just,
Will: I think YouTube had, the algorithm had a headache, everyone.
Yeah. It didn’t know what to do with you, it didn’t know what
Kristin: category to put you in and who to share you with.
Will: Exactly. So, so we moved it over to our new channel, um, at Glockum Fleckens. And that’s going to be, uh, the new home for everything. And I announced this a few weeks back and hopefully everybody’s found their way over there by now.
Uh, we’ve talked about it, uh, a little bit, uh, before. Uh, and so if you’re, if you’re, if you haven’t yet, go over there. Subscribe. Yes. All right, at Glockenfleckens or
Kristin: youtube. com slash Glockenfleckens. That’s
Will: it. Yep. [00:02:00] Uh, everything, I’m still going to be making skits on my normal channel that, that if you’re, you know, if you’re watching this and you’re a fan of YouTube, you can still find all my normal stuff over there, but the podcast episodes are at the new channel and, uh, I got a lot of good feedback so far.
Like, a lot of people were like, yeah, that makes sense. Let’s do it. You know, just separate the two out.
Kristin: They’re different things. One’s short format. One’s long format. One’s more entertaining. One’s a little more educational. And I, I
Will: have stopped trying to understand algorithms, you guys. Like, I feel like it’s, it’s so hard to predict.
Kristin: Well, they change and no one actually knows except for the people writing them.
Will: Yeah, except unless you’re like Mr. Beast and he like studies it.
Kristin: Yeah.
Will: And should to try to figure out how to best make the algorithm work for him. I don’t have
Kristin: time for that.
Will: I don’t either. I’m terrible when it comes to like trying to time my thing.
Like my skits, I’ll like post them on TikTok at like midnight.
Kristin: Yeah, because that’s when you’re doing it. Something tells me that’s
Will: not the time you’re supposed to post new content on social media is [00:03:00] midnight. On the West Coast, you guys. Right,
Kristin: so middle of the night for the rest of America.
Will: Even worse. And that’s just because that’s when I finish it.
Kristin: That’s when you’re filming and you’re done.
Will: I’m done. I’m like, okay, this is it. This is good. Let’s put it out there. I don’t know. I’m, I’m just, I don’t, this is why I need you
Kristin: and the
Will: rest of our team to like make me think about like, Oh, maybe you should like, you know,
Kristin: schedule that for later. Think about
Will: the time and how you’re posting these things.
Not just, just throw things out on the, on social media. I don’t know.
Kristin: Yeah. When do you guys want him to post? Tell us. We can do it then.
Will: Yeah, I don’t know. I mean, we’re gonna get different times for everybody, right? I mean, I guess I’m guessing though. Nobody’s gonna say 2 a. m. on a Friday morning. Only the
Kristin: insomniacs prefer that.
Will: Maybe some of you. Maybe some of you night shift folks. When do
Kristin: you look at social media?
Will: Not at 2 a. m.
Kristin: It seems like like first thing when you wake up and then like as you’re going to sleep
Will: No, I, when you
Kristin: get in [00:04:00] bed, but before you’re ready to actually go to sleep, yet be
Will: because do as I say, don’t, as don’t do it.
What is it?
Kristin: Do as I say, not as I do. That’s
Will: it. Do as I say, not as I do. Uh, we should not be looking at our phone right before bed. I
Kristin: know it’s poor sleep hygiene, but I think a lot of people do it.
Will: I know I’m guilty of it. I
Kristin: think the vast majority of people do that.
Will: Um, so now you’ve outed me as a, as a terrible sleep hygiene person.
Um,
Kristin: Was that a value that was important to you? I’ve
Will: staked my reputation on it, Kristin. Okay. Anyway, the point is, check out the new doobtube channel. That’s where all these are going. It’s been a process trying to get that done, but uh, anyway.
Kristin: Hopefully by now, as we’re recording this today, we are actively in process of transferring, so hopefully by the time people are hearing this Everything’s going smoothly.
And
Will: by the way, just you could check out our website too for like all the things we got going on. We got like a live tour coming up. Like you could buy tickets to that now. This is the time where we shamelessly promote all of our
Kristin: things. Starting next month.
Will: All of our things. But let’s [00:05:00] talk about our guest today.
We have Dr. Sayed Tabatabai. He’s a friend. Say what? Tabatabai. Tabatabai.
Kristin: Tabatabai. Dr. Sayed. Dr. Sayed
Will: Tabatabai. A friend of the pod.
Kristin: He is a friend of the pod.
Will: Friend of the Glockenfleckens. Yes. He was on our live show. He decided to have him come back for a little bit longer conversation. Clinical nephrologist and published author.
He has a, his current book is These Vital Signs, which is a series of, of. Stories and tweets and things that he has talked about on social media. He’s a very, very fantastic writer. So he came to talk about, uh, he told us some stories about his time as a nephrologist and an author and all these things. So he’s
Kristin: kind of a rare combination of very wise.
Will: He’s got my favorite type of sense of humor. Just bone dry.
Kristin: Yes.
Will: Love it. Right. It takes
Kristin: you off guard because it is so just, it sounds so serious and it takes you a second to realize it’s a joke. Dry sense of
Will: humor. Fantastic. All right, let’s get to it. Here is Dr. T.[00:06:00]
Today’s episode is brought to you by the Nuance Dragon Ambient Experience or DAX for short. To learn more about how the DAX copilot can help reduce burnout and restore the joy of practicing medicine. Stick around after the episode or visit Nuance. com slash discover DAX. That’s N U A N C E. com slash discover D A X.
All right, we are here with the one and only. Dr. Sayed Tabatabai. Dr. T, thank you again for joining us.
Kristin: How do you do on your name?
Dr. Sayed Tabatabai: That was amazing. That was really good.
Will: I’ve been I’ve been crushing the pronunciations lately Sometimes I I don’t know what it is. I just I have trouble with my words.
Kristin: Yeah,
Will: so dr T Kristen told me recently that I am a slow talker.
Kristin: Yeah, I had to break that knowledge to him He didn’t realize that
Will: and that it might be Difficult for our audience to listen to both of us
Kristin: because I’m a fast [00:07:00] talker and he’s a slow talker So if you want to put it on like 1. 5 speed or something like I’m gonna be a chipmunk But he’ll finally speak at a normal pace.
Will: I guess my point is to you Don’t worry about how fast or slow you talk because we got we got all the speeds covered over here
Dr. Sayed Tabatabai: I love it. I love it. I think it’s a relaxing speed. It’s a, you know, it’s,
Kristin: uh, it’s frustrating for me.
Will: So here’s, here’s what it is though. I, you know, actually this is great because you are practicing, you’re a nephrologist in San Antonio.
So I grew up in Texas. I, I just, everybody just talks a little slower in the South.
Kristin: However, I also grew up in Texas.
Will: That’s true. I mean, it’s not, it’s not across the board. Okay. But I do remember like moving to New Hampshire for med school and all of a sudden everybody just spoke like a mile a minute. So there’s regional differences for sure.
Kristin: [00:08:00] Also, when I was in grad school in New Hampshire at the same place, uh, People would like explicitly judge anyone who talked slow like they thought they were stupid. That was the assumption Yeah, the first assumption is that person’s not very smart because they’re a slow talker.
Will: Where did you grow up? Dr.
T?
Dr. Sayed Tabatabai: So I was in upstate New York Okay, so you went the opposite
Will: direction yeah,
Dr. Sayed Tabatabai: my first job was in Salisbury, Maryland Which is a rural farming Eastern Shore, you know Community And I was used to the New York style. So it was the most frustrating few months of clinic when I started, you know, listening and trying not to interrupt the patients, trying to do all the good things, you know, and by the same token, I’m like, sir, I’m sorry, you’re going to have to speak faster.
I can’t,
Will: I can’t do this. You can’t speed up.
Kristin: Yeah, there’s no 1. 5 speed for real life.
Will: So you were just telling me before we started recording, uh, what your Monday is typically [00:09:00] like. Tell us, what do you do? How much time do you spend on the dialysis unit on Mondays?
Dr. Sayed Tabatabai: So it’s, you know, time management, I think is a big part of my day.
I mean, for everybody, I guess, but in nephrology, you have to be in different places. So I have to round the dialysis units. I have to go to the hospital and I have to go to clinic and so clinic being the office, the
Will: outpatient office.
Dr. Sayed Tabatabai: So yeah, so every day it’s just kind of in the morning. Looking at my censuses, figuring out what the best way to squeeze in all those things, you know, you start again new routines So that’s good.
But Mondays are especially chaotic because I wasn’t on call on the weekend. So I don’t know quite what’s going on everywhere, so
Will: You you occasionally have trainees with you like sometimes they rotate through. Yeah, does that um, Well, how do you feel about those days? Are they does does it
Kristin: speed things up or slow things down make it more complicated?
You It
Dr. Sayed Tabatabai: definitely slows things down, um, because I’m one of those attendings where, you know, I always feel bad for the [00:10:00] trainees. I always want to be like, Are you getting, is this high yield? Is this high yield enough? I feel like you’re just watching me do stuff. That’s not high yield. Like, as you point, as
Will: you point to a whiteboard full of nephrons and calculations, is this high yield for you all?
Dr. Sayed Tabatabai: Yeah, exactly. So it does slow me down, but by the same token, I think it’s more fun too, in a way, um, you know, because, and I get a lot of good questions and they give me good feedback and it’s, it’s fun.
Will: What what’s the um, can you tell when you’re working with a trainee when you lose them like in realms?
Like can you like what what what what is it? What is it about their face their body language like that you catch on to?
Dr. Sayed Tabatabai: So so the eyes go kind of glassy The jaw gets kind of slack, the body posture starts to slouch, the slow recline back, and like the head, you start to lose neck muscle town, and just general flaccidity.
Like
Will: they’re, like they’re [00:11:00] trying to slowly get away from whatever it is they’re trying to teach them. What are the, tell us, what are the topics? That probably, uh, that, or what are the things that you’re, you talk about that, that, um, results in that kind of reaction most often?
Dr. Sayed Tabatabai: Most often it’s, it’s acid based stuff or sodium stuff.
Those are just everyone’s, you know, there’s just such a, there’s, I think there’s now such a mythology built up around them that when the topic comes up, it’s sort of larger than life. Even though I’m not just saying this as a nephrologist, it’s not that bad, but I think it’s just, it’s like math and it’s.
It’s like, you know, uh, people just sort of glaze over, it’s just numbers and formulas and people are like, ugh, that’s, that’s rough.
Will: I can’t believe, is there like a content creator that maybe like keeps making fun of that and bringing it up all the time? I don’t know. Not
Kristin: a very good one. Is that
Will: no? I don’t think, yeah.
Dude,
Dr. Sayed Tabatabai: I was so happy though, I gotta say, you used my joke, you said you were gonna use it and you used it. Nephrology lab, uh, [00:12:00] the dehydration versus volume depletion one. I was so overjoyed. I think I texted my parents. I said, I said, I shared this joke with him.
Will: Tell the audience. Tell, so, uh, set that up. What, what is
Dr. Sayed Tabatabai: it?
So, um, one of the things nephrologists are notorious about is our, is our focus on terminology. Like, you’ve got to use the right terminology. And like a classic example of that, where people will say dehydration, and nephrologists will fixate on that and say, Well, actually, dehydration refers to water. It’s not really volume.
And you know, if you’re talking about volume, it’s volume depletion. And you captured that beautifully in your skit. I did a tweet about that, responding to something you said about nephrology, that if someone says dehydration, it’s like the bat signal, and all these nephrologists will show up everywhere and just sort of lean in to see what the conversation’s about.
And you had that, you had all these other guys sipping on their Morton’s canisters coming out.
Will: Yes. It was so great. Well, I loved, I loved [00:13:00] that, that response you gave me. I was like, this is perfect. I actually, I had that, that tweet up on my computer as I was writing out the script. It was like, I gotta make sure I get this right.
Uh, because obviously, I was actually, I had several, uh, tabs open of different, different sources because Haha. Haha. You know, I gotta do a lot of research for still. I don’t know anything about nephrology. Are you kidding me? So, uh, that was really helpful and was a perfect just image of, oh yeah, it makes sense.
There should be like a salt mafia of all these
Singers: nephrologists.
Will: That descend on you whenever you say the wrong thing because we’re all so caught up in our own Terminology, that’s not just it is not just nephrology. Maybe you’re maybe you’re like top like top five Most particular when it comes to terminology, but I feel like everybody’s got a little bit of that So, I don’t know I was thinking about what it is for ophthalmology.
That’s [00:14:00] grinds our gears as far as the
Kristin: Well, by Zine, obviously.
Will: Well, yeah, but like, in terms of like what Oh, I know what it is. I know what it is. It’s when people put in the chart Perla. Perla. So, Perl, so, so, okay, let me, let me backtrack because Kristen’s looking at me like, what the, are you talking about?
Um, so it’s a, it’s an acronym. We love our acronyms in ophthalmology. I, like, just all over the place. We’ll just acronym the whole, the whole lot of the thing. Well, that’s part of it, yes. Perla is when you’re describing the pupil exam. So you say pupils are equal, round, and reactive to light. Okay.
Kristin: Okay,
Will: so Perla.
Yeah, two R’s. P E R R L. Perla.
Dr. Sayed Tabatabai: I like her version.
Will: That’s pretty good. So, but, but the, like, the classic teaching would be that you add an A to the end of it. Pupils are equal, round, and reactive to light and accommodation. [00:15:00]
Kristin: Reactive to accommodation.
Will: Yeah, because whenever you accommodate, so let’s say you’re, I’m sorry.
Kristin: I asked.
Will: Yeah. Well, thank you so much for asking Dr. T is like what the hell am I even doing here? All right, so you’re gonna learn about accommodation. Dr. T. Here we go You probably already know it but you look in the distance and then you move your focus to like up close your pupil constricts
Kristin: Yes, I was making more of a grammatical question.
Can you be reactive to accommodation? That seems like it doesn’t make sense.
Will: Your pupil is reactive.
Kristin: To accommodation? It seems like it’s reacting by Accommodating.
Will: Okay. Now this is even worse than a nephrologist here. It’s like a linguist. I
Kristin: would have been a good internal medicine doctor is all I’m saying.
Maybe rheumatology. I’m not sure
Will: about that, but rheumatology I could see. So anyway, My, my, the equivalent for us with like volume depletion dehydration is when people put perla they put the a on the end But they [00:16:00] never check nobody ever checks that the pupils react whenever the the eye accommodates So it’s like that’s like the one thing it’s like, oh really?
Oh, yeah. Tell me. How did you check accommodation, sir? You know, I’d like that kind of thing. So, uh
Kristin: Well now that we’ve lost everyone
Will: Uh, those of you who are still listening, we’re going to go into more semantics about more terminology.
Dr. Sayed Tabatabai: I like how you made per blah a thing, because it’s round by a connotation.
Per
Will: blah, per blah, that’s good. Um, alright, so we’ve established that we’re all very neurotic here. That’s good.
Kristin: We have.
Will: Uh, so, uh, Dr. T, you shared with us some wonderful stories. Um, and one thing I, I just love is this. I would think. That there aren’t a lot of Syed Tabatabais out there. Like, you got, like, they can’t, it seems like a fairly unique name.
Dr. Sayed Tabatabai: Yeah, does it have a meaning? It’s a very unique name, and, um, [00:17:00] it doesn’t really It doesn’t really, you know, it doesn’t really have a specific meaning. I think the Tabatabai part is just a reference to, it’s like a Iranian last name, a Persian last name. So some ancestry, um, my family’s mostly from, from Pakistan.
Some ancestry, somewhere along the line is where that came from. But you’re right. It’s not common at all.
Will: So, um, it was, I’m sure it was very surprising to you to find out that there’s another. Say it Tabitabi. This was
Dr. Sayed Tabatabai: this was such a funny thing because when you know when the first time you get your license and you go to like the medical board thing and you google yourself and Your license is active and you’re like, yes, this is so cool.
Or maybe only I did that But
Will: I don’t think I ever did that.
Dr. Sayed Tabatabai: No, I think I might have been the only Tabitabi A second name popped up and I’m like, who’s this Tabitha Bai? And then I was like, OK, whatever. And then I didn’t pay attention. And then I moved to another state for my job. So I was in [00:18:00] upstate New York.
I moved to Maryland. And in Maryland, it’s the same guy. It’s the same Tabitha Bai, the same name. And I’m like, OK, he’s licensed here, too. All right. And then I moved down to Texas and I’m like, no way I get the license. There’s one other Tabitha Bai in the state. It’s the same dude, and he’s in my city, and I’m like, who is this guy?
You know, I’ve got a, but you know, then I sort of put it out of my mind, but in the back of my mind, I’m like, somewhere in San Antonio is this other Tabitha body who’s haunted me my whole medical career. And he must be
Will: destroyed. Exactly. And
Dr. Sayed Tabatabai: then one day, I get in this elevator at this local hospital I go to, and there’s another guy and they’re older gentlemen, and he’s just looking at my name tag.
I’m like, what? It doesn’t say anything, and then I look at his name tag. I’m like, what? And there’s total silence for a moment, and then he just says, it was so perfect, he just says really quietly, he’s got a bushy mustache, he’s like, It’s you.
And I looked at him and I was like, what do we, do we draw swords? We’re in an elevator, it’s like a closed, you know, Only one [00:19:00] of us is getting off this elevator, you know, that’s what I felt like. So he knew as well. Yeah, yeah, you know, and he told me afterwards that he would get like wrong orders all the time
Singers: Nurses would
Dr. Sayed Tabatabai: verbally put in under his name.
Will: It’s like who’s ordering all these urine electrolytes Going on here.
Dr. Sayed Tabatabai: That was really funny.
Will: What kind of doctor is he?
Dr. Sayed Tabatabai: He’s an anesthesiologist
Will: Okay. All right. That’s correct. Are your friends now or I probably just you know Acquaintances
Dr. Sayed Tabatabai: I had to kill him
Will: Would
Dr. Sayed Tabatabai: you? You didn’t get off that elevator
Will: No,
Dr. Sayed Tabatabai: we’re friends we’re well, I guess we’re queens as we
Will: cross you would you would not each other in the hallway Yeah, yeah, you would say hello.
And yeah, we just sort of look at each other We’re like hello tab.
Kristin: So he was also moving. He was following you Moving to all the same places who
Dr. Sayed Tabatabai: I think we just our paths ended up crossing in multiple places We both started in the north and ended up in texas.
Kristin: Yeah,
Will: who’s got the better facial hair?[00:20:00]
Kristin: Sounds like the other guy. Yeah. I gotta
Dr. Sayed Tabatabai: give it to him. He just had, it was majestic.
Will: Um, okay. I got, uh, one, another, you, you, you were great with these stories. Um, how many times, let me actually preface it with this question. How many times would you say you have responded to a code blue in the hospital?
Dr. Sayed Tabatabai: As an attending, not very often because they’re ICU teams and respiratory therapy.
But when I was a resident, that was like one of the exciting things, right? That was like, You would run to the code holding your white coat to make sure stuff didn’t fly out of your pockets.
Will: But, but, but in the dialysis unit, I mean, there’s people sick there, right? Yeah, no,
Dr. Sayed Tabatabai: there’s a fair number of codes.
That’s true. That’s true. We do see, we have a fair number of six people.
Will: Okay, and so, um, tell us about what’s the strangest place you had a, you responded to a code blue.
Dr. Sayed Tabatabai: So this was, this was funny. This was during residency. And um, there’s a beep that happens before the code when they called it in my [00:21:00] residency.
It was kind of this different tone beep to like give you a heads up that it’s about to be a code. It’s like beep and then say adult code 99 or whatever the thing was.
Will: It’s like so everybody can like pay attention? Yeah, exactly. The beep
Dr. Sayed Tabatabai: is like the starter’s mark and the, you know, the one you’re about to run the 100 meter dash.
It’s like take your mark. So I heard the beep and everybody stops what they’re doing and it’s internal medicine round. So we got another eight hours of it anyway. So we, we all stopped. And then, uh, it’s Code Blue Medical Genetics Building. And we’re like, what? There’s a Medical Genetics Building? Like, what do we do?
And then, um, our senior resident is like, Yeah, I know where it is. It’s this way. We gotta go this way. And like, we all take off running. And after about 20 minutes of running, it’s pretty clear that he doesn’t know where it is.
Kristin: Oh no.
Dr. Sayed Tabatabai: We’re, we all kind of split up, and we’re trying to find the Medical Genetics Building, because obviously a code’s happening, gotta get there.
And finally, me and another intern stumbled upon it, and it was like off campus, and this like side, you had to go through these tunnels to get [00:22:00] there, and it’s a tower, and the elevator’s not working, and it’s like the 12th floor where this office is, where they call this thing, so, um, we finally get up there, and, to cut a long story short, it was a false alarm, but both me and this intern Good, because I was thinking the
Kristin: person was dead by now.
Yeah,
Dr. Sayed Tabatabai: yeah, we’re like, there’s no way they’ve survived this long, you know, but, you We get up there and it was just someone who is a little hypoglycemic and they were fine. And, uh, but me and the intern were not. Cause by that point we had run about, we’d run like six miles and climb 12 flights of stairs.
And literally I still remember we were just lying on the ground at the medical genetics building in our full, like just lying and gasping for air. And it was about to be two more codes. So
Will: two, two thoughts on this first. Actually, this, this could be a good like quality improvement project. They need to, I think there are some places that they need to, in addition to telling you where the code is, they need to give explicit directions on where to find the code.
Correct. Like, I [00:23:00] feel like Molecular Genetics Lab, they’re like, Code Blue, Molecular Genetics. North, uh, walk, you know, East.
Kristin: Yeah, give some very well known landmark. East of
Will: the cafeteria. What is it relative to that? Like a quarter mile. I don’t know, something like that.
Dr. Sayed Tabatabai: Like a quarter mile? I don’t
Will: know. Um, and then also I’ve, you know, I feel like I’ve, I’ve heard people talk about this on social media is that you usually don’t see a lot of doctors like sprinting in the hospital.
Like, there’s not a lot of running and that’s like something you see a lot in like TV shows and movies. And obviously when Dr. T is responding to an emergency, like maybe he’s, he just wanted to get some exercise too. I don’t know. Maybe that’s the case. But um, I feel like there’s not a lot of running because you don’t want to be out of breath by the time you get To the code, right?
Yeah, and so it’s like you need to like be but under control Because it was like to I mean, [00:24:00] could you have done effective chest compressions like maybe for like 10 seconds?
Dr. Sayed Tabatabai: I needed chest compressions I was not doing them
Will: That’s great It’s been a long time since I’ve responded to what was the last time you responded to a code blue
Kristin: Uh, what’s a code blue?
Will: A cardiac, uh, uh,
Kristin: Oh, that’s a, I’m not even mad at you, I don’t know
Will: your colors. You’ve been sitting there this whole time being like, what the hell are they talking about? I knew, I knew a code
Kristin: is something that is specific based on the color and it means you need to hurry.
Will: Yes, so code blue is when there’s like a cardiac arrest, a Decompensation, heart stops, no breathing.
Kristin: Yeah. Okay. Well, I did that on May 11th, 2020. Thank you very much
Will: What are the other codes? It can you think? Yeah, what
Kristin: is there a code? How many
Will: codes can you name? Oh my goodness. I’m more interested
Kristin: in why the colors were chosen because that’s the kind of person I am Some
Will: of them are different for different hospitals, too Code red is usually [00:25:00] fire.
Dr. Sayed Tabatabai: Fire. Yeah Code Pink is usually like a missing baby or baby alert. Yeah. Someone,
Will: someone stole a baby. Uh oh. Um, there’s usually like a, there’s a code for like, uh, an agitated, angry patient Yeah. Who might be physically threatening other people purple if you’re really angry. Couple of, there’s like shooter code.
Dr. Sayed Tabatabai: Yeah. Um, there’s a bomb threat code. Oh yeah, yeah, yeah. There’s a, uh, fall code if someone has a fall.
Will: Um, there’s, um, there’s a, so do
Kristin: you all know. The colors when they’re called, or are you like, hold on a second, and
Will: you have to reference. Yeah, I mean everybody knows code blue. There’s also a Ophthalmologist in the ICU code.
Singers: Hmm.
Will: I don’t know that’s that’s a code royal blue. Yeah, um, but no, we don’t know we don’t know Usually they’re on the badge, right?
Kristin: Emergency. Okay. So there it [00:26:00] is somewhere that you can see it very quickly.
Will: Yeah, you just turn around Look through it real quick figure out what these all
Kristin: sound really time sensitive.
Dr. Sayed Tabatabai: I Just look at everybody else’s faces and judge the level of panic.
Kristin: Yeah, I’m
Dr. Sayed Tabatabai: like, are we good? Okay,
Kristin: right Is there a code brown? Black.
Will: Uh, well, code code Joe, code Brown or real code Brown.
Kristin: No. Real
Will: because real joke, code brown is when somebody poops their pants.
Kristin: Well, sure,
Will: but real code brown. I think there’s probably, I don’t know.
You gotta have, like I say, everybody’s got different code. Yeah. Combinations. Um, all right, well we can talk about somebody else today. Code teal. Let’s coat teal. I dunno. Chart
Kristin: truths. What else could we have codes about? We could come up
Will: with all kinds of codes. Um, I wanna talk about, let’s, let’s talk a little bit about, uh.
Your, your decision. I love hearing origin stories, your decision to pursue nephrology. Um, because I feel like it takes an analytical mind. It takes a Someone who likes math. [00:27:00]
Dr. Sayed Tabatabai: You know, it’s interesting because all of the things you would think you would need to like nephrology, like I hated all of them. You know, I was um, I actually went to med school originally thinking I would do a surgical specialty.
All my mentors were surgeons and by the time I was entering, you know, my tail end where I had to like make choices, At that point I was like, I just don’t have the passion for surgery. I’m not sure what I want to do. And I was leaning towards medicine, you know, I like pediatrics, and I was kind of in that general medical student kind of lost period where I wasn’t sure what the hell I wanted to do.
Um, and then I had a rotation in nephrology. Which I tried desperately hard to get out of. It was kind of, um, I, I tried swapping with other people. I was like, hey, I’ve got a medicine rotation. I’ll swap you your, and they’re like, what medicine rotation? I’m like, well, it’s just kind of internal medicine and nephrology.
And, uh, and it just never worked. I could never get out of it. So I was like, fine. I gritted my teeth. And like most things in life, I think I [00:28:00] just had, I was lucky. To have a really, really good mentor. And, and, um, I had a couple of really good mentors who taught nephrology just really, really well. And it was something I had done very poorly on initially in med school and the exams, and then they explained it in such a way that suddenly these concepts I’d never really understood were clicking for me and I’ll never forget the date.
My last day on the rotation, they let me go do a consult by myself. And it was like a complicated consult with multiple things going on. And I went back and I presented it to the attending and he was like, yeah, okay, sounds good. And I was like, holy crap. This is amazing. It’s like I just handled all this stuff and and then I was just turned on to it and yeah, I loved it.
Will: Kind of clicked. It clicked, yeah. It was like
Dr. Sayed Tabatabai: I could literally feel like something in my head go click in a position and then I was a nephrologist, that was it. Just
Kristin: like that.
Dr. Sayed Tabatabai: Yeah, the nephrologist switch somewhere in there. Yeah.
Will: And then the, the, uh, the surgery switch just was immediately turned off.
Right. Nothing, [00:29:00] like not, not anything there. Let’s take a quick break. We’ll come right back.
Hey, Kristen. We got to talk about infectious disease.
Kristin: Why? What’s wrong with you?
Will: Well, not me. Oh, I want to tell you about Precision.
Kristin: Oh,
Will: this is great. It’s the first ever EHR integrated infectious disease AI platform.
Kristin: Very cool. For
Will: any specific patient, it automatically highlights better antibiotic regimens.
Kristin: So helpful.
Will: Helps with burnout. It just helps you save lives. It’s great. To see a demo, go to precision. com slash KKH. That’s precision spelled with an X instead of an E. So P R X C I S I O N dot com slash KKH.
All right, we are back with Dr. T. All right, Dr. T, uh, we mentioned, we already went over what What led you into nephrology as a field, which I think is, is a fairly. Unique field. Um, it’s, I think a lot of people find it very challenging. I know I did, and [00:30:00] I had also a couple really strong educators. I feel like maybe people who love to teach do gravitate toward that field because there’s
Kristin: Just a lot to explain.
Will: Yeah. I just love explaining things to people.
Kristin: What is so complicated about nephrology? I, because I know that people say that, but I don’t know why.
Will: I
Kristin: never think about the kidneys, personally. I apologize.
Will: Teach us why it’s so hard to teach the kidneys, Dr. T.
Dr. Sayed Tabatabai: Teach us why it’s hard to teach. Um, I, you know, I think it’s a confluence of a couple of different things.
Uh, there’s a lot of memorization in med school, and I think the nephrology chunk of it has a lot of like pathways and transporters and loop mechanisms and all kinds of stuff that it gets really convoluted, and I think it’s hard for people to keep that straight. Um, and then the problems themselves, a lot of them deal with, uh, kind of mathematical principles, too, and people hate math, too.
It’s like a [00:31:00] combination of dense memorization, um, lots of different mechanisms, and, uh, one of the things I actually like about nephrology is one of the things that makes it difficult is that you can’t have tunnel vision as a nephrologist. It’s not possible to be a bad general doctor and a good nephrologist.
You have to be able to, um, You know, obviously it’s cliche, but you have to see the whole patient. You have to be appreciating everything that’s going on. The antibiotics are getting for their infection. You know, the pulmonary process that’s driving their, you know, they’re, you can’t just focus on one thing.
So I think that adds some complexity to it. Um, also.
Will: Well, I, there’s no way I could do it. That’s, I mean, cause you just mentioned, like, it’s, it’s cliche to say you have to see the whole patient. I literally, I do not have to see the whole patient. If I’m seeing the whole patient.
Kristin: You have to see almost none of the patient like you could Very easily walk around in a in a room full of your patients and not recognize a single one of them Because [00:32:00] you’re just looking inside of their eyeballs.
Will: I do look at their faces. By the time
Kristin: you come in They’ve got the thing on their face I
Will: sometimes think about that. I was like, when I walk into a, most of my, my patient encounters, like, the room’s already dark.
Kristin: Yep, it’s dark in there, and they’ve got stuff covering their face. Their
Will: eyes are dilated, and, and a lot of them, a lot of people have poor vision, or, you know, moderate vision, not, not great vision without any correction, or certainly when they’re dilated.
Kristin: Right.
Will: And so, most of them probably haven’t, like, seen my face real clearly. Yeah, they
Kristin: probably just recognize you by smell.
Will: Very good.
Kristin: So you should consider that when you get ready for work every morning.
Will: Maybe I will. One of the things that, that I’ve been learning about a little bit recently, uh, some conversations we’ve had on the podcast is about these, uh, GLP 1 medications, uh, and because it seems like everything affects the kidneys these days.
Or maybe that’s always been the my day,
Kristin: nothing affected the [00:33:00] kidneys.
Dr. Sayed Tabatabai: When I was in training.
Will: It’s just everything. Everything affects the kidneys in some way or one or the other. Um, how, how has this, uh, these, how have these medications impacted your specialty? Or is, is there any impact to them? There’s been a
Dr. Sayed Tabatabai: massive, massive impact, you know, in these medications.
Um, you know, all the, all the weight loss that we see, impacts the diabetes that we see, impacts the blood pressure. And then there’s also this, uh, study that was, I think just last week, um, showing a CKD, um, improvement or benefit with, uh, just a direct benefit with, with those medications also. Chronic
Will: kidney disease.
Kristin: Oh.
Dr. Sayed Tabatabai: Sorry.
Kristin: In my mind I was going cytokine. Let’s start. Death?
Will: I like that whenever you hear an acronym on this podcast, you just to yourself. I
Kristin: do, I try to figure it out.
Will: Just come up with whatever that
Kristin: is. Because I figure that everyone else knows what it, I mean, obviously you too. And then most of our audience is doctors.
There’s no
Will: stupid questions. You can [00:34:00] always ask to clarify an acronym. Anyway, go ahead. What is, what’s happening with CKD? It’s,
Dr. Sayed Tabatabai: I think it’s been, I think there’s. It’s an exciting time in nephrology because for a long time we didn’t have many options for many things. It’d be like, oh, this is what you have, uh, watch your blood sugars, you know, do this lifestyle stuff, do this stuff, and we’ll see you later.
And we didn’t really have much beyond that. I mean, not that those weren’t powerful. I mean, obviously, lifestyle interventions can be extremely powerful, but now with the GLP1s, the SGLT2 inhibitors like Farsiga and Jardians, and then, uh, You know, all these other meds that are coming down the pipeline. It’s an exciting time to have actually options.
Um, so when I was in training, we didn’t have a lot of this stuff.
Will: Are any of these nephrotoxic in any way?
Dr. Sayed Tabatabai: Um, I mean, any, any, you know, there’s always a potential for nephrotoxicity. Yeah. So I mean, and, and they can affect impact your kidneys. It’s just one of those things on a case by case basis, but overall their benefits as classes of [00:35:00] drugs, vastly overweigh the risks to the kidneys.
Or outweigh, I should say.
Will: Do you have any kidney questions for him?
Kristin: Well, ibuprofen is kidneys, right? I always think of ibuprofen is bad for your kidneys.
Will: Ibuprofen is kidneys, right?
Kristin: Tylenol is bad for your liver. Yeah, that’s
Will: great So
Kristin: that’s why you have to alternate
Will: And
Kristin: then there’s you that just pops ibuprofen.
Oh, I do not pop
Will: ibuprofen. I I take a reasonable amount of ibuprofen The recommended daily amount. Yeah Dr. T, my my kidneys are fine.
Kristin: Crushes it up and puts it in his coffee in the morning
Dr. Sayed Tabatabai: As long as you’re not eating blueberries, I’m okay with that. That’s right. I know. Yes, horrible for
Kristin: your kidneys. I’m still getting
Dr. Sayed Tabatabai: flack about that one.
Kristin: I know, people were really upset. So if you, if you don’t know, we’re referencing a live show that we did at the Hollywood Improv and Dr. T here was our, one of our guests.
Will: Yes.
Kristin: And I think, did you ask him what foods were bad for the kidneys? I
Will: did. I said, what, give us, [00:36:00] uh, something. What’s, What’s something that’s, yeah, I guess it was food.
I think that’s food. What food is, is there anything that we eat or consume that’s bad for the kidneys? Yeah. And without, without even thinking, he just, just blueberries.
Kristin: And the room audibly gasps. There was this huge
Will: gasp. Blueberry, don’t take my, don’t pry my blueberries away from me. And it’s a room,
Kristin: again, it’s a room full of medical professionals, like intelligent people that know the body and everyone just like immediately believed it and was horrified.
So
Will: funny because it’s just like, wow, this is, this is what misinformation is like.
Kristin: Yes. Thank you.
Will: This is amazing. This is
Kristin: how it happens.
Will: Of course you told everybody. So yeah, what was the Did you get any reaction from the people you work with?
Dr. Sayed Tabatabai: No, it’s like random people. People I don’t even know. Like the other day this uh, this surgeon that I barely interacted with Yell down the hallways like, hey, blueberries!
Kristin: I’m
Singers: like,
Dr. Sayed Tabatabai: what?
Kristin: That’s your name now?
Dr. Sayed Tabatabai: Yeah, that’s what they call me. [00:37:00] But it’s, no, I had a lot of people tag me on, on social media and be like, is this true? And I was like, no, it’s not true. I was just thinking at the time when you were, as you were asking me that question, I was thinking what can I choose that would mortify a California audience the most.
It was either avocado or blueberry. Yeah, I was about
Will: to say, avocado would have been a good one.
Kristin: It worked. It was very successful. Yes. Yep. But no, blueberries are good everyone. Eat your blueberries. Yeah, no,
Singers: they’re
Will: good. And since then, you’ve launched your comedy career. Is that right?
Dr. Sayed Tabatabai: Uh, yeah, no. Big Blueberry has been after me.
I have a meeting with their lawyers.
Kristin: Is their mascot just like the Kool Aid guy? But blue?
Will: No idea.
Kristin: Okay, sorry.
Will: Um, Big Blueberry. We have another story you gave us, and these are also some of our favorite types of stories, coming of age stories. [00:38:00] You know, the things we go through in medicine that make us grow up.
I mean, we are grown. We’re fully grown people, but, you know, grow up in the sense of, yeah, of, of learning something, some valuable lesson. Uh, and so tell me about the time that you were alone in the ICU as, uh, during a blizzard.
Dr. Sayed Tabatabai: So this happened in, um, This happened in early 2000s, and this was in the town of Brockton, Massachusetts.
And Brockton is famous for, um, two things. One is, um, producing championship boxers. Um, a lot of famous boxers came out of that small town. Um, of course, now that I said that, I’m blanking on who, I, I, I want to say Rocky Marciano, I, I could be wrong, but there were a couple of like famous boxers that came out of Brockton.
And then the other thing that it’s famous for is terrifying internal medicine residents because there’s a community hospital there that’s part of the rotation that we had to do. where for a couple [00:39:00] of months we would do ICU there and we would staff that ICU. It’s a small community ICU so it’s like, you know, six beds or something like that.
How close
Will: is this to Boston? It’s about
Dr. Sayed Tabatabai: 40 minutes out.
Will: Okay,
Dr. Sayed Tabatabai: all right, gotcha. And uh, so you were there on call by yourself with an anesthesiologist who is a critical care covering person and this was during a horrible blizzard and the blizzard had shut down all traffic. going to Boston. We were basically isolated.
It was kind of like The Shining, um, but scarier. And, uh, there was a patient with pancreatitis. And pancreatitis is one of those conditions that, um, there are two conditions that you can deal with in the ICU that go south, like, really fast. And one is pancreatitis, where if there’s inflammation of the pancreas, if that starts to explode, Someone can go from talking to you and feeling fine to being on death’s doorstep in less than 24 hours.
And the other one is a gastrointestinal bleed. If someone has a GI bleed, they can go from normal to just exsanguinating in, you know, minutes. [00:40:00] So this was a young patient with pancreatitis. We all rounded, all my co residents left before the snow really started coming down, so I was by myself. The anesthesiologist had these emergency surgeries, so he was out of commission.
He was sort of talking to me on the phone when he could, And I’m watching this pancreatitis patient, it’s a young guy, and the poor guy is just decompensating and decompensating. And it occurs to me about halfway through my shift, and this is nighttime now, that he’s gonna die. I have to get him out of this hospital.
I don’t have enough, you know, support and all the ICU stuff. He needs to go to a big center. And it’s a blizzard. And so what do I do? And I’m trying to call the anesthesiologist. I’m like, sorry, he scrubbed in. There’s another thing going on. He said, you know, just figure it out.
Kristin: I’m like,
Dr. Sayed Tabatabai: what do I do? So I’m calling, I start just looking in the phone book and calling hospitals in Boston.
So I’m calling
Singers: Mass General
Dr. Sayed Tabatabai: Hospital. I’m like, can I speak to your ICU? And you know, then the ICU attendings there are like, no, we don’t have any beds. And finally, I get to, um, this one hospital, I [00:41:00] think it was Brigham, and they were like, we have one bed, and we have seven people waiting for that bed, but yours sounds the sickest.
And then they grove me on a bunch of formulas. They’re like, what the Ransom’s criteria, what are all these things? And I was like, I just happened to have them, because I’d been freaking out this whole time. And they said, okay, fine, we’ll accept them. And I’m like, yes! And I hang up, and I’m like, wait a minute.
How do I get there? Like, what do I do? So I call, and they’re like, sorry, our ambulances can’t make it. And I remember I looked up online this like helicopter. I was like medical helicopter search and there was like this medevac thing and a 1 800 number.
Singers: I called it
Dr. Sayed Tabatabai: up. I was like talking to my charge nurse.
She’s like, just call. What’s the, I was like, do we, do we have a heliport or thing? And she’s like, no. I was like, alright, well, so I call them up and I’m like, look, we don’t have a heliport, but I need to get this guy out of here, and the guy was so calm, I’ll never forget, you know how these pilots always have these Chuck Yeager voices, they’re super calm, and he’s like, we got you on the screen right now, and uh, there is a baseball field, [00:42:00] uh, at the school across from you guys, we’ll land there, and I was like, oh my god.
I was
Singers: like, oh my
Dr. Sayed Tabatabai: god. And so they come and they land, and these guys show up, and in my eyes I’m like crying, they’re moving in slow motion, they’ve got the whole thing, they have their, the med flight nurses are super professional, they take him, he’s intubated, he’s on drips, and they’re like, we’ll take care of it.
And then, as they’re rolling out, the last thing he says to me, he like, grabs my shoulder and he says, Brigham, right? And I’m like, yeah, Brigham. And I’m like, in my mind I’m like, or was it? Boston University.
Kristin: Oh no. Or
Dr. Sayed Tabatabai: was it? I was like, nope, they’re gone now.
Will: That’s
Dr. Sayed Tabatabai: it. But,
Will: yeah. Was it the right, did you tell them the right place?
Dr. Sayed Tabatabai: It was the right place.
Will: It was the right
Dr. Sayed Tabatabai: place.
Will: He got there. Why did they all
Kristin: start with a B? Yeah, I was like, yeah.
Dr. Sayed Tabatabai: Yeah, Brigham, Beth Israel, Boston, you know? And so, yeah, the guy survived, he made it out, but that was like my, my moment where I lost imposter, imposter syndrome after that. I was like, there’s nothing that I can’t handle.
Kristin: Right.
Will: Yeah. Wow. [00:43:00] Was this, so this was, how big was this ICU? Cause I’m trying to, I’m comparing it to the ICU that I had to work in in my intern year because it was a small community hospital. And I had a similar experience where I was all alone at night.
Dr. Sayed Tabatabai: Yeah, yeah, it was like, I can’t remember if it was six beds or ten beds, but it,
Will: yeah,
Dr. Sayed Tabatabai: it was like one little, like, U shape with all the beds there.
And, uh, it was just absolutely terrifying just being on call.
Will: Yes, I think nighttime in the ICU is one of the most, is one of the scariest places. Yeah, I don’t think you
Kristin: had the same experience of getting rid of your imposter syndrome. I think it just deepened it.
Will: More like reinforced my desire to be an optimist.
I am not cut out for critical care medicine, that’s not, that’s not for me. Um, and I, I just, I remember the, did you have a, in this place, did they have the remote monitoring system?
Dr. Sayed Tabatabai: Uh, they did, but we couldn’t, I mean, no, they didn’t have it where we could monitor it remotely and not be in the room, we had to be around.
They had a [00:44:00] central monitoring that was doing telemetry, but we weren’t able to see that.
Will: So you didn’t have like the voice of God thing? Oh
Dr. Sayed Tabatabai: no, no, we did. We had this little, uh, emergency pager system that was like World War II walkie talkie kind of thing. Where there would be a loud burst of static that would wake you up to evacuate your bowels and pee at the same time because it was so terrifying and then you would have to like take it and talk into it.
Kristin: I’m learning some things about our health care system in this conversation. First of all, who cares how sick you are? We don’t have beds. That’s what determines whether you get care. And then, Our technology are fax machines and World War II intercoms.
Will: Now might be a good time to remind, to reassure the people, good people of Brockton, Massachusetts.
You’ll be fine. There’s good people working there. You’ll be all right.
Dr. Sayed Tabatabai: Yeah, that, that hospital, it’s a lot, you know, this, this was, this was a blizzard in extreme circumstances. And the patients are fine. So everyone’s going to be fine. It’s a great hospital.
Will: But Kristen, you do bring [00:45:00] up a good point. Like, I feel like, Available beds are, are like a huge
Kristin: Can’t we just get some more beds?
Will: Well, I mean, you make beds. Like that’s why you have people that board in the emergency department for, you know, three days sometimes. Do we
Kristin: need more
Will: hospitals? I think Are
Kristin: we going to solve healthcare today? Yeah, let’s
Will: do it. How much time do you got, Dr. T? Can we All right, let me
Dr. Sayed Tabatabai: cancel my schedule here.
Will: No, I, I, you know, I think there’s a, there’s a lot that goes into, uh
Kristin: Yeah,
Will: available, uh, you know, beds and hospitals and, and which types of, which patients get admitted. And this is
Kristin: one of those things though, that as a patient, right? Like when you don’t know all the nuance behind this issue, it just looks like we’ll get some more beds then.
Like what’s, come on guys, you know,
Will: I will say
Kristin: seems like a solvable problem
Will: that they, thank goodness we have an, uh, a thing called MTALA, which [00:46:00] requires that. People who need medical care, like in an emergency setting, receive it. Like if you come into the emergency department, you have to be seen. Now, now that also is probably is why we have so much burnout in emergency medicine, because, uh, a lot of, a lot of things fall to them because you have certain hospitals, certain places that will refuse to see patients or that don’t want to see certain types of patients that have a certain level of illness.
And, and so there’s cherry picking that does happen out there. So fortunately we have this emergency system in our country, but that’s, it shouldn’t all fall on them.
Kristin: Yeah.
Will: So I don’t know. It’s, it’s a lot, we’re opening up a whole thing here, but, um, anyway, I’m glad that you survived, you personally got through that experience and it’s probably, probably made you a better doctor, Dr.
T.
Dr. Sayed Tabatabai: Yeah, I think, uh, it was one of those, you know, you get forged in the crucible moments, you know, where you figure out what you’re made of kind of thing. [00:47:00]
Will: And, uh, do, uh, do, um, uh, do blizzards still scare you? Did you have any, like, residual, like, PTSD?
Kristin: That’s why he lives in San Antonio, man. Yeah, is that why you live in San Antonio?
Why do you think
Dr. Sayed Tabatabai: I’m in San Antonio? No, uh, the, you know, the one PTSD thing I did have, it was pretty funny, The tone for the code pager, that beep, and the tone for the shopper’s alert at ShopRite are the exact same perc’s frequency. And so I stopped going there because every time there was a, there was a teet, I would stop and just like stare up.
Like, I’d wait for like the voice of God to come down.
Will: No, wait, because in our, at the hospital I was at, at Resurrection, you know, in our ICU, there was, there was somebody monitoring the ICU. And so when I was there alone, they would come over the speaker system and be like, what’s Winter’s formula? I don’t know.
Like, whatever. I don’t know. I don’t remember what they would say, but they were like, like, as I was standing there, they would like, And you can look around [00:48:00] like, what the hell is that? And it’s a
Kristin: voice that exists just to pimp you?
Will: No. In my mind, that’s what was happening, but, but they were like there to just help out remotely.
Yeah. They could, they could like talk to you though.
Kristin: Yeah.
Will: And it was like a real person. I don’t know where they were. So someone just like
Kristin: working from home, keeping an eye on this ICU. I
Will: don’t know. I, most of my terrible experiences from the ICU is. Fortunately, there weren’t a lot of like, you know, I let a patient die or something, but it was a lot of just angry attendings grilling me about different things.
What are, what are a couple of your favorite pimping questions, Dr. T? What do you, what do you like to ask about?
Dr. Sayed Tabatabai: What do I like to ask? Um, I really don’t, you know, honestly, I’m not just saying this, uh, I really don’t like pimping style questions. I feel like I know there’s some people who think the yield is really high when people are uncomfortable, and you know, that kind of thing, and a certain amount of stress is good for learning, but I try to make things as low key as possible.
So my [00:49:00] questions are often, um, pretty mild. I don’t ask students to calculate free water. There you go. Uh, ask, you know, what’s the delta delta here, or you know, what kind of acid, you know. I do ask generally, kind of. Kind of more bigger picture questions like what do you think the fluid status is here or like if you had a choice of What to do with this patient?
What what kind of pathway would you go down or you know that kind of or why do you think this patient’s kidneys are low? So kind of more broad general questions just to get them thinking and engaged and then we can drill down on details together But nephrology is hard enough. It all comes
Will: back to free water deficit.
It all comes back to free
Dr. Sayed Tabatabai: water. It’s coming up sooner or later. It’s gonna, it’s gonna get mentioned. Um, but no, it, nephrology is hard enough that, you know, I, I, it’s too easy to kill someone’s spirit.
Singers: You know? Yeah.
Dr. Sayed Tabatabai: So I want them to be happy and engaged and getting questions right and not being like, you know, God, I gotta get a calculator out.
Will: You have, um, 30 seconds to convince a med [00:50:00] student to, to choose, um, Nephrology as a career.
Dr. Sayed Tabatabai: Don’t do it. No, I’m kidding. Um, 30 seconds. Uh, so things about nephrology. Why you should you do it? Uh, it’s intellectually challenging. It’s, uh, stimulating. You get to practice a broad spectrum of medicine in a wide variety of settings.
You get to deal with acute critically ill patients. You get stable chronic patients. You get to form relationships over years. There’s transplant patients. And just a huge variety of pathology and, uh, clinical skills and you’ll never be bored.
Will: Dang, that’s good. You did it. Ooh, that was good. Yeah. And then last question I have for you, what’s your favorite, uh, uh, IV fluid?
Dr. Sayed Tabatabai: Well, at the end of a long, stressful day, I just like lactated ringers. It’s like, pour out a Pour out a glass of good old LR and just
Will: Wade, you’re an internal medicine physician. You don’t use lactated ringers.
Dr. Sayed Tabatabai: You know
Will: Or is that, or is that a, is that a myth? [00:51:00]
Dr. Sayed Tabatabai: Oh, there’s been a big push back towards LR just because we’re tired of causing acidosis with normal saline.
So we’re just like, just use LR. It’s, it’s, uh The surgeons are happy. And the surgeons are happy. It’s just, everyone’s holding hands.
Will: Well, let’s, uh, also before we go, uh, mention your book, These Vital Signs. Tell us a little bit about it. We have it right here. We’ll show it to you if you’re watching on YouTube.
These Vital Signs, wonderful cover.
Dr. Sayed Tabatabai: I chose that color just for your bookshelf. Thank you, I really
Kristin: appreciate that.
Will: A Doctor’s Notes on Life and Loss in Tweets.
Dr. Sayed Tabatabai: So
Kristin: yeah, tell us about your approach to this book because it’s a really creative like way to do a book.
Dr. Sayed Tabatabai: So, um, my, my, I would say probably my second passion after medicine has always been writing.
I love writing. I’ve written ever since I was young. I’ve always kept a journal. And, uh, on Twitter, in particular, I guess that’s what got me engaged with MedTwitter was I wrote threads, [00:52:00] and my favorite topic to write about is humanism and medicine, and, you know, connecting with patients, and all those kind of things are whys in medicine, and different issues in medicine, and so over the years, I wrote literally more than a hundred stories on Twitter.
And that’s where my following kind of grew and people would, would message all the time and be like, Hey, do you have a place where these are all kind of compiled where I can just, you know, go and read? And I kept saying no to that question enough times that I was like, you know what? I really got to write this down as a, as a book.
And that’s where that book came from. And, uh, it’s a bunch of, of Twitter threads. I think there’s like 29 or something stories. And then there are a bunch of essays, uh, personal essays and their autobiographical stuff. And I had the manuscript for about five years. I got rejected by everybody, pretty much, uh, literary agents, publishers.
And then finally one, one day I w I was going to just publish it myself. And one day I was looking through the likes on one of my stories and I saw someone in it [00:53:00] and on their bio, it said VP Harper Collins, and I was like, no way. And I like immediately, immediately DM them. I said, I noticed you liked one of my treads.
There’s plenty more where that came from. And then she got in touch with me and I, it was just, uh, it was a, it was a miracle. I, you know, it was the intersection of luck and opportunity.
Will: You know, all those people that rejected you, cardiologists.
Dr. Sayed Tabatabai: That’s what, in my mind, I was like, cardio.
Will: Absolutely. That’s the only explanation.
Well, check it out. It’s really, it’s wonderful to read your writing and it’s, it’s, I’ve been following you for and reading your stuff on social media for quite some time. And so, um, uh, definitely check it out. These vital signs. Uh, and, uh, thank you so much for joining us. It’s always, always a pleasure. We had so much fun talking to you during our live show, uh, a few months back that we had to get you on and, and talk some more.
So, uh, [00:54:00] Always a pleasure.
Dr. Sayed Tabatabai: Thanks so much for having me, and thank you guys for everything you do. I mean, you really do a massive amount for medicine, for people, for patients, for survivors, for the caregivers, everybody. It means a lot. I talk about humanism, you guys live it. So, you know, it’s a privilege to be here.
Will: Appreciate it.
Kristin: Thanks.
Will: Take care. Dr. T. Take care.
Hey, Kristen. Yeah. You know what I have
Kristin: What?
Will: A box full of eyelid mites. .
Kristin: Oh, you shouldn’t have, look at these little
Will: guys. Look at their cute little, their cute little, uh, legs and their, and the ripping. Yeah. Look at this. This what
Kristin: is, I want you to just be able to doing this
Will: experience. All of them. Look at that.
We got so many. We got so many, you know what these guys will do? They cause a disease called demodex
Kristin: blepharitis. That doesn’t sound fun.
Will: So if you’ve ever had red, itchy, irritated eyelids, it could be because of this.
Kristin: You know, like
Will: crusty, flaky buildup on your eyelashes.
Kristin: Yeah, that sounds uncomfortable. No,
Will: [00:55:00] it’s, it’s, I mean, look, but I mean, they are really cute though.
Look at the little beady eyes.
Kristin: Okay.
Will: Well, don’t get freaked out by this. Why
Kristin: not? It’s. It sounds awful. Just get checked out. Oh, that does make more sense. You
Will: gotta, you gotta, yeah, you gotta get checked out for this. To find out more about Demodex Blufferitis, you go to EyelidCheck. com. That’s E Y E L I D Check.
com to get more information about these little things. These little guys and Demodex Blepharitis.
Love talking to Dr. T.
Kristin: Yes, he’s always so funny and he’s so quick witted. He’s very, he’s
Will: got a quick wit. Very
Kristin: unassuming and calm. Which makes sense. He’s so,
Will: he’s smart. He’s a nephrologist. I mean, you know, they gotta be, they gotta be quick. They gotta come up with those calculations real fast. So anyway, um, always fun to talk with them.
Um, and should we do a fan story?
Kristin: Yeah, it’s been a while. Let’s do one.
Will: Okay. This comes from Dove. Dov, Dov says, Dov, [00:56:00] Dov, D O V, that’s all we got, um, said love your content. About 10 years ago, the professor at Sydney Eye Hospital and I created the Rules of the House of Ophthalmology with a large dose of poetic license from Sam Shams The Rules of the House of Gods.
Uh, there’s a little take on that. I’ll, there’s, there’s like 13 of them, I’ll, I’ll read a few of these, I’ll read a few. Okay. All right, first one. Patient satisfaction post cataract surgery is inversely proportional to income.
Kristin: Hmm, this seems correct based on what I’ve
Will: seen. I, uh, I do think that’s, I do think that’s pretty much correct.
It’s, it’s so interesting too, you know, being in the northwest.
Kristin: Yeah.
Will: You know, they’re, I don’t know what it is, maybe it’s regional though. It might be more regional. I mean, there’s
Kristin: I mean, how do you tease all that apart? I don’t know how to tease that out, right?
Will: You’re not going to do a study.
Kristin: Well, you’re not, that’s for sure.
Will: But yeah, I do, I sometimes miss treating those Iowa farmers [00:57:00] who are just happy to leave surgery with eyeballs and they don’t like, if they see, they can see their field, they can see their equipment. I mean, they’re just happy to
Kristin: leave, period. They’re getting back to work. Yeah,
Will: they just want to, exactly, they just want to go back to work.
Uh, it’s, it’s a little bit higher expectations out where we are now.
Singers: Mm hmm. Mm hmm.
Will: Probably whether that’s income based. I don’t know. Probably. There’s something to it. Anyway, I like that one. All right, this is number two. One eyed patients always injure the only good eye. This just comes, this is like, uh, objects just tend to find your eyes, period.
Like it’s, there’s some, it’s like, I mean, it makes sense. Cause you’re always looking at the things that you’re doing. Right. And so things like bungee cords, uh, uh, metal grinding, little flecks of metal. They’ll find your eye. I don’t know. Right. It’s like this, they always find your eyes. So we should always be wearing safety goggles everywhere we go at all times.
Kristin: Hey, where’s our safety goggles?
Will: We should be wearing them right now.
Kristin: No, but do we have any? Yeah, we have some. Where?
Will: They’re in our, uh, they moved all the [00:58:00] stuff over the new house. We got the things. You’ve never seen them?
Kristin: No, I think we need to do a family safety meeting about, about eyewear.
Will: All right.
Number three, when things go wrong, take a deep breath and reach for the viscoelastic. That’s a very specific, uh, surgery, ophthalmology surgery thing. And it’s absolutely true. So we’ll, I’m not going to go into details on that one. Number four, if you’re not sure what to do, start steroids. That’s, that’s something you can do.
As an ophthalmologist Inflammation, right? If you’re a non ophthalmologist, don’t just indiscriminately start steroids. Yeah,
Kristin: like inject yourself to get big. That’s what people will think of when you say steroids.
Will: I do sometimes will start steroids if I’m not sure what to do to try to get a patient feeling better.
And you can always stop them later.
Kristin: But you didn’t, so that’s for inflammation?
Will: Yeah.
Kristin: So, like, generally speaking, if you don’t know what’s happening, try reducing inflammation. As
Will: long as you know there’s not, like, an infection going on, then, yeah, start some steroids, try to reduce the inflammation. We’ll do one more.
If you have started [00:59:00] steroids and still don’t know what to do, double the steroid dose.
Kristin: This is not inspiring confidence. I take a little bit of issue in
Will: that one. Oh, well, it’s, you know, it’s all tongue in cheek. Yeah. Um. Alright, one more. If you still don’t know what to do, take a photo. I, I do love, we love our photos in ophthalmology.
It’s a very visual specialty. No pun intended. Yeah,
Kristin: seriously. Also, the photos, I don’t love the photos. I hate the photos. As a patient I know
Will: you do. It’s very bright.
Kristin: Yeah, so, you know, maybe consider not doing the photos if you don’t have to.
Will: Oh, this is a good one, actually. If you don’t test for syphilis, you will not make the diagnosis of syphilis.
That’s actually true because it’s not something you think about, but syphilis for the eye. It can look like all different types of things. Like it doesn’t have a very specific thing. Like it can be a number of different manifestations. How many times
Kristin: have you diagnosed syphilis? Like, like many, few, rare?
Will: Few, like twice.
Kristin: Yeah.
Will: In like seven years.
Kristin: How many times have you tested for syphilis?
Will: More than that.
Kristin: OK.
Will: [01:00:00] Many more than that. All right. Thank you for that. I’ll maybe I’ll save the rest of them for another time. Send us your stories or anything you want to send us. Knock, knock. Hi. At human content. com. I shouldn’t say anything.
Let’s, let’s, you know. Within reason. Within reason. Yeah. There’s lots of ways you can hit us up. Uh, you can email us, dognetguyathuman content. com. Visit us on our social media platforms. Hang out with us in our human content podcast family on Instagram and Tik Tok at humancontentpods. Thanks to all the great listeners leaving feedback and reviews.
If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out. Like today, at existentialguy21 on YouTube said about our Dr. Reuben episode, We need the immunologist slash allergist as a character now.
Kristin: That would be a good character. Yes, we
Will: do. Absolutely, we do. I did a first day of Allergy.
First day of allergy. I gotta do it. I’m gonna get on it. Full video episodes are up [01:01:00] every week on our YouTube channel at Glockenfleckens. We also have a Patreon. Lots of cool perks, bonus episodes, or react to shows and movies. Hang out with other members of the community. The Knock Knock High, and our little subset, our little enclave of Knock Knock High people, too.
We do overlap, we interact with each other, we have get togethers, we have cookouts, whatever. We’re active in early ad free episode access, interactive Q& A livestream events, and much more! Patreon. com slash Glockenflaken, or go to Glockenflaken. com! Speaking of Patreon community perks, we have a new member shoutout!
Woo! Alright, Joyce C., Gary M., Amelia B., Crystal T., and Sardi! Sorry, I love the one name. I’ve got
Kristin: questions.
Will: Sardi. What?
Kristin: About Sardi. Sardi?
Will: Sarti. Sarti. Sardi. Yeah, I like it. Shout out to all the Jonathans, as always. Well, first, welcome all the new members. All right, we’ll find jobs for you eventually. Shout out to all the Jonathans, as always.
Patrick, Lucia C, Sharon S, Omer, Edward K, Steven G, Jonathan F. Mary and [01:02:00] W, Mr. Grandaddy. Kaitlyn C, Brianna L, Kay L, Keith G, JJ H, Derek M, Mary H, Susanna F, Jenny J, Muhammad K, Avika, Parker Ryan, Muhammad L, David H, Jack K, David H, Gabe, Gary M, Medical Meg, Bubbly Salt, and
Kristin: Pink Macho!
Will: Patreon roulette time! Random shoutout to someone on the emergency medicine tier, Jennifer B!
Thank you for being a patron. And thank you all for listening. We are your hosts, Will and Kristen Flanagan, also known as the Glockenplekens. Special thanks to our guest today, Dr. Sayed Tabatabai. Our executive producers are Will under Crypto player and Cory Rob Goldman and Shanti Brooke. Our editor engineer is Jason Portis.
Our music is by OER . To learn about our knock-knock highs program, disclaim ethics, policy submission, and verification, and licensing terms and, and our HIPAA release terms, all of them go to our website, clock and plugin.com or reach out to us at Human debt. Uh, reach out to us at Knock Knock high@humancontent.com with any questions, concerns, or recommendations to help me talk faster.[01:03:00]
Knock knock high is a human content.
Hey, Kristen. Yeah. Weren’t you just talking about how much you hate admin work? Yes, it’s the worst. Yeah, we don’t like it much in medicine either.
Kristin: Yeah, no one does.
Will: Fortunately, we have DAX, though.
Kristin: I know, you lucky ducks. Yes,
Will: the Nuance Dragon Ambient Experience, or DAX for short. This is AI powered ambient technology.
That is incredible at reducing admin burden.
Kristin: Yeah. It helps with your documentation, which is the worst part.
Will: Yeah. It improves the physician patient relationship. We can get back to what we love to do, which is just taking care of patients.
Kristin: Yeah. Kind of ironic. It’s AI putting the human back into medicine.
Will: Exactly. And, uh, DAX is so great. You should ask for it from your company. Uh, in fact, 80 percent of patients say that their physician is more focused with the DAX copilot. [01:04:00] 85 percent of patients. say their physician is more personable and conversational with Dax Copilot. Do
Kristin: they make a home version?
Will: To learn more about the Nuance Dragon Ambient Experience or Dax Copilot, visit Nuance.
com slash Discover Dax. That’s N U A N C E dot com slash Discover D A X.
