Life in the ICU with Critical Care Pulmonologist Dr. Wes Ely

KKH Trailer Wide


Will: [00:00:00] Knock,


hi! Knock, knock, hi!

Hello, welcome to Knock, Knock, Hi! with the Glockenfleckens. I am Will Flannery, also known as Dr. Glockenflecken. I am 

Kristin: Kristen Flannery, also known as Lady Glockenflecken. Thank you for 

Will: being here today. We’re always happy to have you. It’s great welcoming you into our lives, into our studio, uh, which is just a spare room in our house.

It’s we need a better studio. I know. I mean it works. It’s fine 

Kristin: does but it’s supposed to be a guest room Is what this is 

Will: supposed to be that’s true And I also have to record all my videos in here and it’s it’s a little crowded at times. It’s true. That’s okay That’s working. Yeah working out You guys aren’t having any problems with it.

Uh, I guess that we’re the only [00:01:00] ones that do so we are excited for you to be here today Listening we are interviewing. Dr. Wes 

Kristin: Ely. Yes. He’s someone whose work I really admire I’ve been following on social media for a while now. He’s got some Really great stories about, um, working in the ICU and what’s, what that’s like and, and just humanity 

Will: in general.

He is a critical care pulmonologist, uh, and a professor of medicine at Vanderbilt and also a, a just a fantastic author. Uh, so we talk about his book, Every Deep Drawn Breath, uh, a little bit and, uh, yeah, just, uh, which is a, is a kind of a storytelling. Adventure. Yes. In ICU medicine. So we talk a lot about critical care and patient care and uh, it’s just really a wonderful conversation.

He’s, he’s, he grew up in the South. 

Kristin: He did. As did we. Very close to where we grew up. Yes. Closer to where you grew up, but more similar, I think, to where I 

Will: grew up. Yeah, he grew up in uh, uh, in Louisiana. Louisiana. Louisiana, [00:02:00] as he would say. And um, and we were next door in Texas. You were in Central Texas.

Very small town. Small town. 

Kristin: Have we talked about it before? Dublin? Oh, yes. I it up quite a lot. I don’t know what your fascination with it 

Will: is, but… I asked Kristen the other day, uh, if she would ever want to go visit her old high school. Right, 

Kristin: because we went and toured yours. Yeah, I went back… You got like a VIP tour.

I did. It was the most bizarre thing to me, because… Who wants 

Will: to go back to high school? You make it sound very sad. This is what being a comedian internet ophthalmologist gets you. You get private tours of your old 

Kristin: high school. Where you used to spend every day, like. Yes, I did. There was a purpose. We were there for a purpose.

But you have 

Will: no desire to go visit your old high school. 

Kristin: No. My high school was one hallway, one long hallway, with doors on either side [00:03:00] into the classrooms. And then. Connected to that was a cafetorium. 

Will: Oh, which is a cafeteria in your auditorium. 

Kristin: Yeah, so it’s big it’s a cafeteria with a stage in it. And then, uh, and that’s where we would have, like, you know, anything that required a stage.

And, uh, then connected to that was a gigantic gym and athletic facilities, because it is Central Texas. It was very Friday Night Lights. Yeah. You 

Will: know. And, uh, later on in this episode, we’re gonna play a game, uh, that involves, like, TVs and movies and stuff. Um, and it reminded, uh, Kristen of a story that I actually forgot.

I don’t know what she’s about to say. 

Kristin: Well, it’s not so much a story as an explanation. Like, I was very nervous about this game because… It required some knowledge about, uh, TV and movies, you know, over time. And I don’t know, I, I have never been much of a TV watcher to begin with because growing up, you know, my parents kind of controlled the TV and it was back [00:04:00] when you had one family TV.

With three channels. Yeah, well maybe five or six, but yeah, we didn’t have cable. I mean people had cable, but we didn’t have cable So it just wasn’t anything and then now you control the TV all the time I don’t watch that much TV Between you and the kids I’ve just kind of given, it just doesn’t even occur to me to turn on the TV because somebody else is usually in control of it.

So anyway, all that to say, I’m not a big TV watcher to begin with. But then also, when I was growing up, probably from about junior high on, I don’t know, my timeline a little bit off, but about that. Um, so we lived out in the country, right? And One time, it is rural Texas, so, or central Texas, so, uh, storms, big storms would come through, big thunderstorms, windstorms.

And so one of these days, we had one of those storms, and it, again, we didn’t have cable, we didn’t have a satellite dish, all we had was [00:05:00] an antenna. And the storm blew the antenna off the roof. And my parents, In a decision that was baffling to me at the time, but makes complete sense now as a busy working parent, they decided, we’re just not gonna mess there’s too much to deal with.

We just don’t have TV now. Sorry. That was it? That was it. Really? You know, it’s a whole ordeal to get somebody to come all the way out there. We’re talking, we had to lay down the broadband lines. So that our house could get internet. Like we had to hire people to come do that. We’re out in the middle of nowhere.

Right. And so they just gave up on it. And I don’t know, maybe they made a phone call or two, who knows, but they did, they decided not to, not to pursue fixing it. And so then from then on, we could only watch, um, movies, you know, like with the VCR. And then later the DVD player, so yeah, that was all that the TV was any good for, so, so I just, you know, have a big black hole [00:06:00] in my TV and movie watching history.

Yeah, I did, I spent a lot of time outside and doing things, gymnastics. 

Will: Probably better for you in the long run. I guess. But it 

Kristin: is funny. But I was very nervous about the game, because I was like, I’m not gonna know any of 

Will: these. You did a good job with it. But I thought! You’ll have to, you guys may definitely stick around for that, uh, toward the end of the episode.

Yeah! Um, and so with that, let’s get to Dr. Wes Ely. Here he is.

Today’s episode is brought to you by the Nuance Dragon Ambient Experience, or DAX for short. This is AI powered ambient technology that helps physicians be more efficient and to reduce the clinical documentation that leads to so much burnout in medicine these days. To learn more about how DAX 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 dot com slash discover D A X. [00:07:00] All right, we are here with Dr. Wes Ely. Wes, thank you for coming on. We’re so excited to see you. 

Dr Wes Ely: Well, and Kristen, it’s great to be 

Will: here. It looks like you’re at work. Is that, are you in your office? Uh, I’m saying that because you are wearing a scrub shirt and you’re surrounded by books.

Dr Wes Ely: Yeah, I’m in my office. I was in the ICU earlier this morning. I took care of veterans at our VA hospital and I made sure I was here on time to be with you. 

Kristin: Your book stacks look about like mine. 

Will: Yes, very different from mine though. I’ve, you know, I, I think it’s been like, I don’t know, six years since I’ve read a book.

Not that long. I don’t want anybody to sound like I don’t know how to read. But, um, Wes, I, I, I’m telling you, I, I’m looking over your history here. All right. Let me just, I’m going to go through a couple of things here. All right. So master of public health degree at Tulane. Uh, med school at Tulane. Internal medicine residency.

Pulmonary and Critical Care Fellowship, Geriatric Neuropsychology [00:08:00] Fellowship, Lung Transplantation Fellowship. Oh my. Are you done training or are you, are you still going? Like, how many years are you in at this point? My goodness. I think I’m 

Dr Wes Ely: just getting started, but all that really matters. Is that my patients are the ones teaching me all the time.

I’m just on my knees begging to learn from them. That’s it, Will. 

Will: That’s right. 

Kristin: You forgot to add author to that list. I 

Will: mean, it goes on and on. But I just wanted to, you know, I feel like every time I talk to somebody, like in medicine, I learn about a different fellowship that exists that I didn’t know existed.

existed. So, yeah, you know, 

Dr Wes Ely: if I do any more, Will, it’ll be, it’ll be what I call divorceogenic, meaning my wife is going to divorce me rapidly. 

Kristin: I know that feeling. Yep. 

Will: Well, I guess where I want to start is just How are people doing in the ICU these days? How are, how, how’s the, how are the staff? How’s the, what’s the, uh, the, [00:09:00] the, the burnout level that we’re talking about these days?

Dr Wes Ely: I asked Brad this morning. This actually happened this morning. Brad is one of our senior nurses. I said, Brad, how long have you been in our ICU? He said, He said, three and a half years. And I said, Oh my gosh, you came in right at COVID then. Yeah. Yeah. He said, yes. He goes, you know, Wes, and I was up there with them in the COVID ICU.

He said, we had, remember five patients died one day. And, uh, it was, it was a whole different world. You know, last week I said to somebody. During COVID, as if it was over, of course, the pandemic’s not over, we’re, in fact, we’re having a surge of a new, of a new variant right now, but, but what we experienced in the unit, that is not happening, you know, it is not like our whole unit is full up with COVID people on ventilators and ECMO, but there’s still a, there’s still a sadness.

You know, people are still in recovery from this and the grief. And I, I know you have both experienced an immense amount of grief and hardship in your lives. And I’m sure we might get to some of this later, but, uh, that grief never [00:10:00] really goes away. We just learn how to work our way toward acceptance. And then my hope is that we can find meaning in it in some way so I can at least, like in my book, on my bookshelf, you mentioned books.

It’s like there’s a book there, from what we went through, of the grief of it all, and that book is always going to be there with me. It’s just that other books will come and accompany it. Does that make any sense? Right. 

Kristin: Yeah, completely. Definitely. 

Will: Well, I want, I want to, um, I, I, we asked you to bring some stories.

Uh, because what I want to do is give people an idea of what it’s like in, uh, uh, in, in an ICU, uh, because I feel like that’s an area of medicine. That’s, you know, hopefully people don’t have, uh, a lot of firsthand knowledge with, with being in an ICU, but I think it’s also an important, uh, to put into perspective what life is like for people working in the ICU.

What, type of patients that you’re, what are people coming in with? What are the, some of the, [00:11:00] the struggles, the challenges that you’re facing, you and the rest of the staff there are facing on a day to day basis. And so, so we asked, we asked you to bring some stories and I love what you did. You didn’t, you didn’t tell us what the stories are.

You just gave us some prompts. Teasers. And they’re, they’re teasers. Yeah. It’s like, oh man, I really got to know about the blue guy. Or the leopard skin bra. It’s like, it’s perfect, uh, teaser material here. And so, um, but before we, we get into your, your, um, your stories, uh, I just want everyone to know you did get permission to talk about these things from the patients themselves and everything.

And so, um, uh, I’m sure they’re going to be very informative and interesting. 

Dr Wes Ely: You know, when I, when I. I write down people’s stories. I record them, you know, much like you do. I, I use devices. I transcribe their stories. So when I use direct quotes and when I, in my writing, it’s, it’s not me making it up from memory.

I have it all actually what they said and, and I have all their permissions signed. I don’t want to break anybody’s privacy, but these [00:12:00] are people who want me to share their stories because they, they find meaning in that. You know, so this blue guy you brought up, for example, uh, on the way to the ICU, people have problems that might land them in the ICU.

So one day I was in clinic. I had just done my transplant training and come back to the hospital where they were getting me to start this new lung transplant program. And in the clinic walks in this guy. whose name is Marcus Cobb, a real person. His picture is on our website. His story is in Every Deep Drawn Breath.

And anyway, Marcus walks in with Danita, his wife, and, and right off the bat, I could see, I mean, he, he looked like a Smurf. He was that blue, like just a dark, dense, intense blue. And when we see that, we know that oxygen levels are very low. So I figured his oxygen levels have got to be, instead of in the 95 percent range, probably in the 60s.

And When a guy comes to me for a transplant and his skin is blue, usually he has a hole in his heart. I start talking, taking his history. He’s, he’s very challenging to [00:13:00] me. He’s, he says, doctor, you know, all these other doctors have said I was going to die. Why do you think I need a new heart and lung now?

And how do you know? And as I’m Processing that this man who’s 30 years old has been told he was going to be dead when he was five, and he’s still going, and his kid, Ariel, is playing at his feet, and I’m thinking, God, there’s a lot at stake here. And I started thinking about, what if I make the big mistakes and I start getting nervous?

Now, you both are so young, you didn’t ever see the movie Broadcast News, probably. But there’s this famous movie called Broadcast News, and this guy is delivering the news. And if you, if you, if anybody wants to Google this, you can just Google sweating scene in broadcast news. This guy starts sweating.

Well, as I’m looking at Marcus and Danita, I began to be self conscious and doubting myself. And I’d had all this training, but I started sweating a little bit. And then the more I thought about. Oh my gosh, do I really know what I’m doing? I’d sweat, I’d sweat more. And that, what if I pick wrong for the time when he needs [00:14:00] disease organs and I’m starting to sweat more?

And before long Will and Kristen, I was soaking wet. It was insane. I mean, I’m sitting in this room and I am pouring sweat. I had on a light blue Oxford shirt. It was turning dark blue and I’m thinking, Oh my God, how do I get out of this situation? I’m in this clinic. With this, with this sweating phenomenon, I can’t stop it.

And I started trying to take deep breaths and slow my cadence. And it was just getting worse and worse. And finally I said, I’ve got to get out of here. So I went into the bathroom. I said, excuse me. I went in the bathroom. I looked at myself. I’d used all the paper towels I could to sop up all the sweat. I looked at my shirt and it was pouring in with water.

And I thought, Oh my God, what am I going to do? And, and the lesson is. When we make, as a servant, because I’m really a servant of him and his wife, but I made it about me. I made myself the center of that story, and if I had just kept my attention on him, and what am I going to do for him, and how will I improve and help reduce his suffering, then I’ve [00:15:00] never had it happen since.

But the lesson Marcus taught me was, was to not be so D A M N, conceited and self centered, to put myself at the center of the story. So I went back in the room, I told him, look, I was just sheepish, put my head down, look here, you know, go get some more fluid pills. I’m not sure what’ll happen with you and, but you know, come back and see me in a few months.

And my wife and I, uh, she got a job at Vanderbilt. So we moved from North Carolina to Nashville, Tennessee. We’ve been here at Vanderbilt for now for 25 years. And a few years later. I walked in the clinic here where I was running the lung transplant program as a medical director and Danita and Marcus were sitting in the room waiting for me.

And I said, what in the world? Why are y’all here? They said, when you started sweating like that, I didn’t bring it up, they did. When you started sweating that much, we knew That you knew you didn’t know. And we, we want a doctor who knows he doesn’t know. So he got his transplant. He jumped out of airplanes.

[00:16:00] He went parachuting. He, he led an amazing life. A few years later, I was delivering a lecture at San Diego and Danita called me and said, Wes. Marcus is dying and he wants you and I flew back, I left immediately, flew back across the country, got there in time, it was with him and, uh, I’ll never forget the blue guy and the lessons he taught me.


Kristin: Oh, 

Will: that’s beautiful. Man, I can relate to that, uh, so much. Just the mindset of being a brand new, you know, an early career physician, maybe right out of training and you just, you feel like you have to have all the answers, right? You’re, you do, you’re, you’re, you’re an attending now. Like it’s, it’s all on you.

Uh, and, and I would, I would be like in the clinic, uh, you know, sitting there with a patient and like not know what’s going on and it’d be like, I, I really need to like look something up, but I’m afraid of, of conveying that to the patient. Um, and then I e eventually, you know, learned after it was like beaten into me time and time again.

Like, it’s okay. [00:17:00] Like look it up right there with the patient. Yeah. They love it. Exactly. They’re like, oh, you care about finding the right answer. And, and, and that’s, that’s the takeaway that the patient will have. And so, you know, it’s, um, because we’re not going to have all the right answers, right? I still don’t know what the right answer is sometimes.

Dr Wes Ely: But, um… I know you’re asking the questions, but Kristen, I’m dying to know from your experience, would you have been mad or frustrated if the doctor had said they didn’t know and we’re going to have to go get more information? How would you respond? I 

Kristin: would love it because same as what they said, you know, you don’t, I know that a doctor is just a human, right?

And all of this like culture around med school and everything that makes you feel like you have to know everything and just be a walking encyclopedia, I don’t know, maybe that served doctors well at one point in time, but it’s certainly not serving you well now in the age of Google, right? So, I think that by you doing that, it shows that you’re not going to be doing anything You know, you’re not gonna be, like, overstepping your ability in any way, so [00:18:00] that makes me trust more that I’m in good hands.

And, if you’re looking the information up right there with the patient, or you’re explaining your process of looking it up to the patient, like, you’re modeling good behavior. In the age of Google, right? You’re modeling how to find good information. And moreover, I’m not coming to you for your what you’ve memorized, I’m coming to you for how what you’ve memorized allows you to think about my case and this information.

And it’s more the critical thinking and the expertise, you know, that I’m that I’m there for, I don’t, I don’t really care what you can memorize. I love it. Thank you. Yeah, so I would, I would like 

Will: it. And I know, I know that like if, if Wes walked in to the room, I know like, well, if he didn’t know the answer, he has every book imaginable in his office.

Exactly! Yes! So he could go figure it out. 

Kristin: He can figure it out. And I’m a person that likes to know why, even as a patient, especially as a patient, you know, it’s my body. I want to know why things are happening. I want to know everything I can know about what’s… going wrong [00:19:00] or, or different or whatever, so, you know, by you walking through that with me, you know, I think sometimes, and people are all sorts of ways, some people don’t want this, but a lot of people I think do want to know more about their bodies and they want to learn what’s going on and so by you walking through it instead of just telling me here’s what you gotta do, you know, then I’m, I’m learning how to take care of myself better as well.

Dr Wes Ely: And you guys, there’s so many people, millions of people who follow you and I, and, and they, they adore you and you’re And I’ll just say that one of the things that I teach our students, and I’m not Buddhist, but this is a Buddhist thing, it’s called Tao Te Ching 65. It’s that the ancient masters used to teach their students to not know, because if the students think they know, they can’t be taught.

But when you know you don’t know, then you have room in your cup. Sort of thing. 

Kristin: Yeah. Yeah, I’m all for that. I think that it’s nothing good comes when you get arrogant about things So, 

Will: all right, I’m dying to know about the leopard skin [00:20:00] bra Please 

Dr Wes Ely: enlighten me. All right. So so this guy’s this is a true story.

Of course, all these stories are true this guy’s name is Danny West and Danny came to me for, he had already had a transplant, so one of his lungs was normal and one of them was trashed. And it would sound like H E double hockey sticks if you were to listen to it. And a few years earlier, I was teaching the med students in physical diagnosis about the lung sounds.

And I would always get a volunteer. Well, on this particular day, before I knew Danny, I asked for a volunteer. And usually it would be some testosterone laden guy who would want to show off his muscles. And I would tell them, you’re going to have to take your shirt off and come down in front of the class.

And I’m going to examine you. And on this day, this Uh, very buxom woman decided to take off her shirt and come down in front of the class. And before I could do anything, she was standing right in front of me in a leopard skin bra. And, uh, I was like, Oh my God, you know, this is making me a bit nervous. And, uh, I dealt with it.

And you [00:21:00] started pouring 

Kristin: buckets 

Dr Wes Ely: of sweat. Yes, exactly. Common theme here. I was trying to do, you know, when I got through it, I fumbled through it. I said, I said, well, I’m never asking for volunteers again. But then there was Danny West. So I said, Danny. Uh, would you be the person? Can you come in there and come down to the room and it’ll be great because I can listen to one side and they all have these stethoscopes in their ears so they can hear what I’m hearing.

And so we got him, we brought him down and the students are sitting there and I told them that story. And I reached around to get my stethoscope and as I turned around the whole room burst out in laughter. And I turned around and Danny was sitting there. with a leopard skin bra on. And, and so I examined him in front of the room with that leopard skin bra on.

They took our pictures and then some resident swapped our heads and sent the picture all over the medical center. So the next week I got called into the principal’s office, which is the Department of Medicine chairman, like, Eli, why is [00:22:00] there a picture of you with a leopard skin bra on going all over?

And, uh, the thing about this story and what Danny taught me, if you build on Marcus Cobb’s story to Danny, is that I learned how to be vulnerable because what Danny started doing every time he wrote to me, he said, uh, love your favorite patient, Danny. And at first it made me a bit uncomfortable. Can I have a favorite patient?

Is that, is that allowable? Uh, of course, I, I love all my patients, but he always wrote that. And over time, I, I, I let him in and I let my, my guard down and we created this relationship that was just so great. And I’ve learned to do that with many, many of my patients. And, uh, I’m, I’m learning about vulnerability, Kristen, because guys think that they’re on top of everything, but I’m, I’m not.

You know, so Danny and the leopard skin bra story kind of helped me get over myself. Well, 

Kristin: how do you… That sounds like something you would do, by the way. 

Will: I think that’s, [00:23:00] that’s an interesting topic of, of learning to be more vulnerable. Cause I mean, a lot of people in medicine put up walls and I think that might be in part because of how grave some of these situations are that you’re dealing with.

And so do you, how does that… affect you emotionally and, and, and your ability to, you know, go from, you know, patient to patient. And, and when you’re letting people in and showing that vulnerability, that seems like a hard thing to try to, cause you want to also need to protect yourself and to be able to, you know, have that emotional.

You know, reservoir to be able to continue working and doing 

Dr Wes Ely: the things you’re doing. Absolutely. And you asked at the very beginning to kind of give a picture of what it’s like in the ICU. Uh, when I was, uh, I grew up in, in Louisiana, we say Louisiana, we don’t pronounce. 

Kristin: I was going to say the way you’re spelling your four letter words tells me that you’re from the South.

Dr Wes Ely: Yeah. I grew up in Louisiana and my mom, when I was a second year medicine, gave me this book of [00:24:00] Osler’s famous speech. It’s called Equanimitas. I know you know of this equanimity, like even keeledness. And I read that book and I, you know, uh, my dad left us, we were little, so my mom raised us in a little bitty house.

I was a farmer growing up, uh, we had like 6, 000 tomato plants and everything to scale and we had no money. But, um, I kind of learned to overdo everything. I, I, I, if I worked hard enough, if I, if I swam far enough, if I studied long enough, I, I could get by. Well, I took that equanimitous idea. And I grossly over applied it and, and Will, this gets at what your question is.

So I was like, I will not make myself vulnerable. I will, I will make a wall and I will not allow myself to be sucked in to this situation and that way I’ll protect myself. What I’ve learned. You can see how much gray hair I’ve got now. I’m, I’m 59. I’m, I’m old now. I’ve been doing this 30 years. Um, I’ve learned that that was not doing anybody any favors.

Not only was it removing the patient from having a [00:25:00] healer because I wasn’t truly diving into their chaos, I was not helping myself because there’s a real burnout that can occur when I don’t really get the sweetness. And the sweetness for me comes from learning who they are. Like, I like to, now I ask everybody four questions.

What are your favorite hobbies? What’s your favorite music? Your favorite food? And what are your pet’s names? And that’s just my way of getting started. And then usually we end up laughing. If, if I can find out about music, food, hobbies, and pet’s names, something in there is going to make us laugh. And, um, and I think Kristen, you said, uh, laughter is like fertilizer.

You know, and I love that, you know, does that make sense? Yeah. 

Kristin: Yes, completely. And you know, so I’m going to get on a soapbox here if you’ll allow it, but so I have a psychology background and specifically… It’s your podcast. You can. That’s true. I allow it. No. Um, so I was in social psychology and my, you know, particular area of specialty, if you [00:26:00] will, was emotions.

Emotions. And so… I think, I don’t, I hate, it’s one of my pet peeves, when people deal with difficult situations by compartmentalizing, because, like, in, you know, there are cases, there are times when that might be a good strategy to use, like in acute trauma, for, you know, a temporary time, um, but it’s not the way to live life, right?

It’s not the way to have a career that deals in difficult situations. And wouldn’t it be so much better if we taught everyone emotion regulation skills so that you don’t have to make those walls, you don’t have to make those little boxes and just cram things in there and then, you know, have the top fly off at unpredictable times?

What if you could just go through your career feeling your feelings but knowing how to Deal with them and understanding them better and, you know, knowing that they’re just signals that are telling you something about what’s going on in your life and how, [00:27:00] how you want to deal with it or not deal with it.

You know, I mean, they’re all they’re useful information and we teach doctors to just lock them 

Dr Wes Ely: away. We do. You know, I was with the med students recently and they said to me, Dr, Dr. West, how do you deal with grief? And they said, I said, well, what have you been taught? Cause I want to know, what are they learning?

And he said, Oh, I’m a neurosurgeon came in and taught us that he deals with grief by, and he said, I have a little box. I put it in there. I’ve turned the key and I put the box in a field and I throw the key away. I’m like, what? Why would you? Why would you teach a med student that? This is horrible. Instead, my guru wife, like, Will, you and I both have guru wives.

My guru wife has been saying to me for years, Wes, you’ve got to deal with this. The pain has got to come out somewhere. 

Kristin: Yes, and it will. You cannot stop it from coming. No one can. So you can, you can learn how to deal with it in the moment and have skills around dealing with it in productive ways. Or you can just wait for the volcano to erupt.

You and make a giant mess of your life. So I don’t know, it doesn’t make any 

Dr Wes Ely: sense to [00:28:00] me. I’ll be vulnerable with you right now, and I haven’t said this publicly, but I, I um, I go to Al a nan. So Al a nan is for people who have addiction, addiction in their life. Like in my sister or my, I’m not saying specifically who they are, but So I, I didn’t do that for so long, Will and Kristen, that I kept just putting all this and pretending everything was okay.

And I have some very serious qualifications to go to Al Anon, let’s put it that way. Um, and I’ve just now in the past four years started processing all this and learning how, and I am so much happier now that I go, I live by the 12 steps and I have a sponsor and I go to these meetings and all we do, we never give anybody advice.

We just share. our experience, strength, and hope with one another and learn from other people’s experience, strength, and hope. It’s pretty amazing. 

Kristin: And there is so much power in that, in people’s stories. You know, it’s another reason that we like to share stories on this podcast and that we encourage people to tell [00:29:00] their stories and we tell our story because that’s I think one of the best ways for human beings to learn from each other.

Dr Wes Ely: Thank you for doing that. I’ve listened to plenty of times where you’ve shared your story and it’s it’s helped me a lot and and Do you mind if I just share one thing that I observed? Sure I I don’t know what you went through. I can’t possibly understand it, but something happened in me When I was listening to the 911 call and, um, I’m not sure if it’s okay to bring this up or anything, but, uh, but when I heard the noises of what you were doing, and by the way, it was amazing to me how you listened to that woman teach you how to do what you needed to do with the CPR, and then when you were doing it, and Will, I could hear your exhalations, and I thought to myself, how connected the beauty of marriage and how connected the two of you were and how nothing could come between you.

And that this, this was an auditory example of something that I [00:30:00] can’t really put into words, but you saved his life and you’ve probably been saving each other’s lives all throughout your marriage in more ways than that. And for me, I just want you to know that I’m carrying that with me. And when I see my wife, even I think about the audio that I heard there and I, I’m going to try and use it to be a better husband.

Kristin: That’s so nice. Thank you for sharing that. And 

Will: I do think it’s, it’s, it’s, uh, not completely one sided, but, uh, but I’d say she’s probably saved my life a little bit more, I would say, than the other way around, but that’s okay. We’ll take it, right? We’ll take it. Yeah, exactly. Um, so I want to, uh, move on to some of these other, uh, prompts here that you’ve given us.

So, um, the next one on the list is Shonda. 

Dr Wes Ely: Yeah, Shonda was an amazing person. I met this young woman and, uh, she had a bad disease. Uh, it’s a disease where your, your bone marrow starts [00:31:00] fighting itself. Um, it’s called, it’s called HLH for the listener, if they want to look it up. Hemagophagocytic lymphohistiocytosis.

Don’t say that after a couple of beers. But she said, Dr. Ely, I’ve got a big personality and everybody knows it. And I couldn’t believe she said it because when I was in college at Tulane, the priest told me that he believed in people with big personalities, like personalities you could feel like in the next room.

You know, I’m talking with two people who have big personalities. She, she told me about this and I, and I. Having learned from Marcus and Danny, I was now in a place where I could let those barriers down, dive into her chaos, and be present for her as her disease kind of swirled into things. And I, um, we started taking her outside to see her nieces and nephews, and I watched as her family Interacted, um, so much with one another and I, I was actually just going to read to you the closing of her story.

Is it okay if I do that? Yeah. Uh, this is just the end of her [00:32:00] story, but moment by moment, I tried to approach the sorrow of her dying with an appreciation for spending time with her. In the past, I would have retreated, but this time I plunged in. Her bravery gave me the courage to be vulnerable, to shed my doctor’s skin.

As her death grew closer, her loved ones sat beside her, still telling stories, threading their lives to hers. There was love and hope. Their sadness bravely held at bay for her. Two hours after she’d taken her last breath, I was walking by Shonda’s room on my way through the busy ICU, where so many lives still hung in the balance.

I felt drawn inside, and padding across the floor, I was struck by the silence. The machines were quiet. I peered behind the dividing curtain, expecting the room to be empty. Instead, her figure still lay there on the bed beneath a sheet. I placed a hand on her arm and looked out the large window into the waning light.

We had not been doctor and patient, but two people, [00:33:00] two humans, small in the big picture. Tears of grief ran down my face and gratitude too for the way she taught me to hold on to the now. I thank Shonda for the privilege of accompanying her through illness into the beautiful forever. And I chose that story to share with you because there is not only sadness in losing a patient in the ICU.

And Will, you asked me at the beginning, what’s it like to be up there? And I’ve learned that about half of my job is helping people find their way into survival. And the other half of my way of my job is to, is to help them find their way into their dying. And there’s such a beauty. Not that I want anybody to ever die, of course, but when somebody like Shonda can share her experience with me and when I can dive into her life and be present with her, I have been able to find meaning there alongside the grief.

And I don’t really know [00:34:00] what that looks like, and I’m sure it’s different for anyone. But, uh, it’s like when you go through Kubler Ross’s stages and you grant to acceptance, I think for me, I can get to acceptance personally, but I want to go a little bit further than that, and, and for my own self, it’s, it will keep me coming back to the Shondas and the Marcuses just because I know it’s an unearned privilege to be with them during that time.

I don’t know if that makes any sense. 

Kristin: Yes. And, you know, it speaks to kind of the fertilizer analogy that you were referencing earlier, which is, you know, when bad things happen, you can either… Just let it be a bad thing that happened, right? And it’s just this big stinking pile of crap. Or, you know, you can plant a seed in there and give it a little water and a little light and a little time and something really beautiful grows out of it.

But, you know, beautiful things, in order to grow, do require some fertilizer. And fertilizer is just poop, you know, a lot [00:35:00] of the time. So, you know, it’s, it’s, I don’t know, I don’t like these dichotomy, dichotomies and binary thinking of just good and bad. And, you know, it’s all messy and complicated, and it’s all both all mixed in together.

And you can find the good and the bad in just about every situation. And you don’t need to be scared away from certain situations just because, you know, they’re heavy or something. I mean, there, there are good. Things to be gained in them as well. Well, let’s say I feel like I’m just like on all my soapboxes 

Dr Wes Ely: today.

No, let’s stay on poop. Will, can we stay on poop for a second, ? Please do. Okay. Okay. So we’ll, we’ll have a comeback to this one, but you know, I, I, I watched Ted Lasso. Is it okay to mention another show? Sure. 

Will: Yes, that’s fine. Yeah. Okay. Exactly. Ted, we’re not in direct competition, but Ted Lasso, 

Dr Wes Ely: I don. Okay, there’s Ted Lasso, there’s this character named Jamie.

I think he’s up for an Emmy or whatever it is they give him. Um, he said at one point there was this terrible thing going on with his dad and with the team and all this stuff and You know, you said that fertilizer is just poop, but you’re right It’s just all this crap, but we can use it. And [00:36:00] anyway, Jamie says It’s poop ay, let it flow.

They’re down in the sewers, and he says, It’s poop ay, it’s poop ay, let it flow. And so, whenever my wife calls me now, she says, Hey poop ay, how are you? And I just kind of realized, let’s just laugh about the poop ay. Yeah. 

Kristin: What else can you do? Let it flow. 

Will: Hey, I’m all about laughing when you have nothing else that you know how to do.

Um, that’s why, you know, whenever I woke up in the ICU after my cardiac arrest, one of the first things I… Did after after talking with you was start tweeting and then and telling jokes about You know this this Uncontrollable situation I found myself in and and you 

Kristin: were even making videos in the ICU. I think That was 

Will: when I went back in for my defibrillator surgery.

It was a wild time, man. How did 

Dr Wes Ely: you find the wherewithal to do that? Seriously, come on, take us into your mind. That’s [00:37:00] just his, 

Kristin: like, he can’t not. Yeah, 

Will: I, so, I don’t know. 

Kristin: That’s his little box that he puts things in. This is how 

Will: I’ve always dealt with… With trauma and things in my life with the cancer diagnosis, I, you know, I, I started, I was just writing jokes, writing material.

I was doing standups. I was going to like open mics and stuff. And, um, and once at that point when the cardiac arrest happened, you know, I, I was well entrenched in Twitter. I was hopelessly obsessed with, you know, My building the social media, you know, thing and, and basically using social media, yeah, using social media as a surrogate for like going on stage and telling jokes in person.

And so, um, uh, you know, I, I woke up and I, I don’t really remember my thought process at the time, but, uh, you know, it was probably just 

Kristin: habit. You were just so, yeah, 

Will: it was like, oh man, wait till people hear about this kind of thing. And uh, cause what is, what a story. And, um, uh, in its. You know, anything uncomfortable in my [00:38:00] life, my, my, uh, my go to is, is to, to find some humor in it and, and tell a joke and share a laugh with people and, and, um, I don’t know, that’s, that’s, that’s why humor is a, is a, is a famous coping mechanism, right?

Because it allows you to, to, to reassert control over uncontrollable situations. Yeah, to 

Kristin: deal with hard truths in a softer 

Dr Wes Ely: way. No, honestly, I mean, all through the pandemic, there’ll be times I’ll be sitting right at this desk just feeling so down and low and I’d open up, and I was never on any social media before COVID, but then I got on Twitter during COVID.

And um, and your videos would lift me up and be like, Oh my God, that’s exactly what I needed. I just needed that exhalation, that, that laughter, whether, whether it was you doing a neurologist or orthopedic surgeon or whatever. Oh, and some of my favorite ones are the pathologists. Cause I send those to my wife, Kim, who’s a pathologist and she gets such a kick out of that.

So thank you. How did 

Kristin: you feel about the critical care ophthalmologist? Did you think that you’d have to have one of those? 

Dr Wes Ely: I need one of [00:39:00] those in my back pocket there. That was beautiful. 

Will: Well, it’s like, what I joke about is like, you know, I’m, I’m somewhat, um, I’m somewhat of limited use during a respiratory pandemic as an ophthalmologist, and so any way I can help I’m happy to if that’s just by, you know, making a silly video That’s like 90 seconds long for people to watch then happy to do it Well, let 

Dr Wes Ely: me give you another story because I think it fits in with your with your latest gig Which I think my view of your latest gig is this whole let’s get these insurance companies to quit jacking everybody around every five seconds.

Uh, so that’s, that falls into social justice. Um, you know, Kristen, you said that you were let in as an end of life case, uh, Lieutenant Greg or whatever let you in. When, when we were locked down and there was nobody allowed in, I had a young woman come into the ICU and she had meningitis. She was, she had lupus cerebritis, but she had a fungus in her head and they weren’t letting her family in and she didn’t even [00:40:00] have COVID.

And I thought to myself, this is incredibly wrong. I’m letting her family in. So the, I, the hospital’s like, no, no, you can’t, you can’t. I was like, well, they’re coming in. So I went downstairs, got the wife and the, the, the mother and the husband and brought them in. And when we took off our stuff, Once inside the room and she took off her stuff because she was going to stay, I knew the lady.

She was the checkout lady at our Kroger and we knew each other personally. I said, this is, I’m Dr. Wes and it was, I mean, I would have never known that that was her daughter. So she was the first family to come in. Then we started, of course, opening up visitation and allowing people in. But on one day, another non COVID patient was let in.

And when I walked in this room, he had this huge red shackle. on his leg. And I do not take credit for this. This is not my genius, but the med students said, why does he have a red shackle? And we’ve got to get it off. And so the, the young people are so beautifully social justice oriented now, you know, and they are teaching me and I’m, I’m, well, I’m ready to learn [00:41:00] from them.

Cause how many years have I just allowed the rules to last and stay? So anyway, the way the story ends and the point of it is that we got those shackles off of him and he lifted his knees up in the bed and he looked at me. And nodded, gave me that, that nod of you see me and I see you. And, you know, we thought that he was dying actively.

We thought he was actively dying. He is still alive. His, I got his, we got his daughter in there. We got his sister in there. They told jokes. They laughed. He went from a dying man. And he was a prisoner and he still is in jail, but he’s alive and he’s found a purpose again. He’s found his why again. And I just realized social justice has got to be a part of my life.

And we’ve actually created a website called Scopes and Shields, where we’re going to teach doctors how to, how, what their rights are to fight for people who have in prison situation, that sort of thing. So I think all of us, what you’re doing with insurance, [00:42:00] what I’m doing in the ICU, if we can all just try and do our part.

What are you thinking? 

Will: I, I agree. I, I, you know, just, you know, for a long time I struggled whenever I was making a lot of these health insurance videos or U. S. healthcare system videos, I was like, okay, I’m, I’m just showing, I’m showing all the problems, but what am I actually doing? You know, to, to help make it better, 

Kristin: uh, I’m not, I’m not, 

Will: I’m not producing any solutions.

And what I realized is like, I don’t necessarily have to have a solution to the problem by, by just making it people aware of what’s happening because we take it for granted, especially with the U. S. healthcare system that like we, those of us in the healthcare system working in it, we kind of just know some of these things because we see them every day.

But there’s a whole lot of people that have no idea about things like prior authorizations or automated claim denials and all these things. And so, [00:43:00] um, and so for things like, you know, your patient and, uh, and social justice surrounding, you know, uh, uh, uh, care of, of inmates and, and, um, uh, health insurance issues.

You know, I think just getting the word out, spreading awareness of those things. is is powerful and needed. 

Dr Wes Ely: I mean, I didn’t, I didn’t know when I was a young non gray haired doctor that I could call the warden and say, I’m the doctor and I’m prescribing you to remove. And I don’t mean that every inmate has to have no shackles.

I mean, some of them actually pose a risk threat, but this man did not. So there was no reason. So Let’s just do our part and keep waking ourselves up to the idea that we can do better for other people if we put them at the center of our service 

Kristin: goal. Exactly. Yeah, and what you said about he looked at you and just, you know, the implication is you see me and I see you, right?

Like, that is one of the, another one of my little soapboxes that I get on all the [00:44:00] time is to say that for some people, like the co survivors of critical illness and medical trauma, sometimes that is what. is healing about the situation. It’s just to know that the people who are able to help see you for what you are and what you need and, and, you know, what you bring to the table and what you need from them.

And I don’t, I don’t know if you even did this on purpose, but you said, you know, I see you. And he works 

Will: in an 

Kristin: ICU. Yes, but, but, oh no, that’s not what you’re saying. Wouldn’t that be… Wonderful. If that is, you know, in the intensive care unit, it is this philosophy of I C U. Yes. 

Dr Wes Ely: I S S I S E E U. Yes. And I, I believe in that.

I teach that, um, I actually say that we have to convert ourselves from a depersonalization chamber. into a re personalization chamber so that it becomes an ICU, right? And we’re working on this. You know, we, we [00:45:00] have a program now, I’ll tell you during COVID, we developed all these long COVID support groups.

People need a community, you know, and the ICU survivors get something called PICS, post intensive care syndrome, where they acquire a dementia. and PTSD and depression and muscle and nerve disease. That’s what they live with afterwards, which is their new normal. But the, but a lot of the patients who get this rapidly acquired brain dysfunction now are long COVID patients who never got sick.

They were mildly sick with COVID and then three to six months later, they have this, this massive onset. of cognitive impairment that looks a lot like a dementia. And so we have hired, uh, the money from this book, Every Deep Drawn Breath, and through donors, we’ve hired social workers. We’ve got free support groups that they come into from all over the country and the world.

And what we’re trying to do is create a community where we can say, I see you. And, um, and it’s all free. And we want to template this out so that I think that [00:46:00] eventually, I think every major city should have a, a, a, an academic center like a Vanderbilt or a Ohio State or a Harvard or a UCSF, whatever. And they should all have one of these survivorship centers for people with rapidly acquired brain and body dysfunction.

And then we can do a, you know, have little tentacles out to, to make people able to find their, their people. They can cry with, scream with. What do you think? Does it seem reasonable? 

Kristin: Oh yeah. Yeah, I think there’s a lot of power in community and knowing you’re not alone and what you have 

Will: been through.

Let’s take a quick break, all right, and we’ll come back with Dr. Wes.

Uh, hey Kristen, what do you got 

Kristin: there? Oh, this? Oh, well, you may not know this as an ophthalmologist, but uh, this is called a stethoscope. 

Will: Yeah, I know what a stethoscope is. I also know it’s supposed to go in your ears and not sitting on top of your 

Kristin: headphones. No, I like it better this way. Besides, this is not just any stethoscope.

This is the EchoCore 500 digital stethoscope [00:47:00] with three lead ECG. I’ve 

Will: heard about these things. Yeah. 40 times noise amplification. That’s right. Noise cancellation. Three audio filter modes. I know it. Full color display. Yeah, buddy. 60 hours of battery life too. That’s right. Everybody loves a good battery life and it’s durable.

That’s right. Awesome. We have a special offer for our audience here in the us. Learn slash kh. That’s EK and use code knock 50 for a 75 day risk-free trial and a free case. And free shipping to the continental U. S. to get your CORE 500 stethoscope. Hey Kristen, can I interest you in a Demodex mite?

No, you may not. You know what these little guys do? What? They cause Demodex Blepharitis, which makes your eyelids like red, irritated, itchy. That’s gross. Well you can get checked out, you know, your eye doctor can look and see if you have them. My eye doctor 

Kristin: is currently covered in them. [00:48:00] 

Will: And I can find out for you.

Oh, good. To find out more about Demodex, go to EyelidCheck. com. Again, that’s E Y E L I D Check. com to get more information about Demodex blepharitis. Don’t get freaked out, get checked out.

All right, we are back with Dr. Wes Ely. Uh, so… Dr. Wes, uh, we’ve come up with a little game that we could play. I think this will be a lot of fun. Um, it’s called Cold Cold Heart. Cold Cold Heart. Okay, I’ll, I’ll 

Dr Wes Ely: game. 

Will: Alright, so, um, Wes, you spend, you know, your career, your job is, you know, you bring a lot of compassion to healthcare, and we all appreciate that.

But let’s, uh, I want to test this knowledge, uh, that you have on, um, using, uh, fictional characters who are… Compassion challenged. Okay. Compassion challenge. So I’m going to read the clues and, uh, and then you’re going to [00:49:00] try to guess and both of you, Wes, you and Kristen will both try to just, okay. Well, we could do a competition, but you know, whoever.

Comes up with the answer first would be great, but we can keep a little tally, but You’re gonna have to to guess which compassion challenged character Fictional character I am talking about so this could be from I think they’re all from movies or TV shows, okay? Okay, 

Dr Wes Ely: Kristen’s gonna win this 

Will: Wide range of things they’re all pretty famous though All right, here’s the first one.

First character. Elderly and miserly, he owns most of the businesses in town, including the bank. He is always scheming to force people to lose their homes and rent his run down properties. Can I 

Dr Wes Ely: guess? Yes. 

Will: Potterville. Mr. Potter from It’s a Wonderful Life. You’re right. 

Dr Wes Ely: Oh, 

Will: yeah. Very good. Nicely done. Mr.

Potter. What a 

Dr Wes Ely: horrible man. 

Will: Yes. Potter. Top, top ten probably [00:50:00] most, uh, compassion challenged individuals. Maybe 

Kristin: your health insurance. You know, administrator should be Mr. Potter 

Will: maybe? Yeah. My, uh, Bartholomew Bank, or no, 

Kristin: the, uh, that’s private equity, but yeah, the health insurance, I’m 

Will: losing track of all, like the, the terrible characters that I portray.

And, um, okay, here’s the next one. She’s seeking revenge for her sister’s death and doesn’t care that it was an accident. She has a distinctive laugh, and is obsessed with rubies. 

Dr Wes Ely: This is Cinderella’s mom. No? Ruby slippers? No? What is 

Will: ruby slippers? Oh, Dorothy. 

Kristin: Oh, Dorothy! So, so the Wicked Witch? Wicked Witch of 

Dr Wes Ely: the West!

That’s good. Go, Kristen. 

Will: Nicely done. Okay, 

Dr Wes Ely: okay. Alright. But I mean, clearly, I got PTSD from her. That was the scariest individual as of growing up. That 

Will: was a scary one. 

Kristin: My dad says the same thing, like that movie just terrified him. They couldn’t watch 

Will: it [00:51:00] anymore. I remember being scared of the, the flying monkeys.

Yeah. Like that was always kind of terrifying to me as like a 

Dr Wes Ely: little kid. But her cat, her cackle was not to be messed with. 

Will: Right. Oh yeah. Yeah. Yeah. That was too serious. Okay. Here’s another elderly and miserly fellow. Despite having considerable personal wealth, he lives cheaply and joylessly in the home of his business partner who has passed away.

Scrooge. Ebeneezer. Ebeneezer Scrooge. You got it. Okay. Um, she is very fashionable, with a one of a kind winter coat at the top of her wish list. She’s a little too interested in puppies with 

Dr Wes Ely: spots. 101 Dalmatians. Yeah, Cruella de 

Will: Vil. Cruella de Vil, that’s right. Alright, I got a couple more. Um. Let’s see, let’s go…

He compulsively nibbles on his pinky while hatching inept schemes to terrorize and take over the world. 

Kristin: Austin. Yeah, Dr. Evil. [00:52:00] 

Will: Dr. Evil and Austin 

Dr Wes Ely: Flynn. You got it. I’ll let you in on the fact that I dressed up like Austin Powers for Halloween. Oh, funny. Equipped with, uh, chest hair, fake chest hair. And I went to the urologist and got a penis pump.

Oh my god. 


Kristin: did not see that coming. I 

Will: love it. They got those lying around at the urologist’s office. Love it. Alright, here’s one more. This might be kind of tough. He’s a short man. On a tall mission to rid his kingdom of fairy tale creatures, he is looking for a princess to marry so that he can become king, but he’s not willing to rescue said princess.

Is this Lord Farquaad? Yes! You are so good. You got it! Shrek, Lord Farquaad. Wow, I’m impressed. Well 

Kristin: done. That’s funny. I’m impressed, too. I wasn’t expecting to know 

Dr Wes Ely: any of those. You have all the wells of knowledge, Kristen. 

Will: [00:53:00] See, Dr. West, I feel like you could teach all of these people a thing or two about compassion.

That’s what I’m saying. Yeah. 

Dr Wes Ely: I have my moments of need, and I’ve learned from all of them. So I just want to do my, just keep getting better, Will. I want to keep changing and getting better, because I’ve got a long way to 

Will: go. Well, I mean, we all, we all kind of do. But, you know, it’s some of the… Um, you know, going through our, our own, you know, health issues, we’ve certainly learned a lot about, um, about medicine and humanity.

And, uh, I tell you, just being a patient and being a co survivor, and it really does, it just gives you a whole different perspective on the healthcare system, on, on so many things in medicine that we just don’t think 

Dr Wes Ely: about. And isn’t it easy, if you kind of view yourself before the events, before the cancer, before the cardiac arrest, it’s so easy to go through life and not have a connection enough to be aware of how personal this is.[00:54:00] 

But I think as all of us go through life, one factoid for the listeners is that the average American will have one and a half ICU stays in their lifetime. So most people are going to have an experience like what you went through. And I think that… Those patients who go through it and then the Christens of the world who have to help lift them up and get them through it.

That’s who’s going to drive medicine society to do a better job of fixing things. It’s just, Kristen, you keep talking about a light. You know, my motto is it’s better to light a candle than to curse the darkness. And, uh, maybe there’s a way that, you know, your podcast is lighting candles big time. Thank you for doing that.

And, uh, I hope so. It is. It’s lighting candles and, and we can, we can light these candles to, uh, to do a better job. Yeah, 

Kristin: I agree. And I think, you know, you mentioned I was let into the, the ICU as an end of life case and, and I, I, well, I wasn’t let into the ICU, I was let into the hospital, uh, but I was still separated from him.

And then, um, long story short, but eventually I got kicked out of [00:55:00] the hospital and I didn’t ever… Get to see him, um, or be with him during his hospital stay. And I just bring that up because there are so many people, um, throughout the pandemic that were in the same situation, um, and had to say goodbye even to loved ones over FaceTime or not at all.

And, and so, you know, I would implore all the physicians out there to keep that in mind over these. Next year’s, you know, that that’s kind of what people are, are dealing with and, and recovering from. And hopefully we can all learn from, from that experience too and do it better the next 

Dr Wes Ely: time around. We, it was, it was wrong.

Uh, it was, it was anti medicine, but I was part of it and we, we were scared. We didn’t have a vaccine. We didn’t have PPE. So we were doing the best we could with this dim light that we had. Right. But I agree with what you just said. We doubt, we now know, and we know the PPE works, and we know what we made a mistake of, and we can’t do it again.

We cannot allow that to happen again. Yeah, no 

Will: way but Kristen, uh, you [00:56:00] know did something very smart though Despite I mean she knew that she wasn’t gonna be able to or I don’t know if you knew at the time that you wouldn’t It wouldn’t be able to be in the hospital. I did But she uh, you know, she sent my phone with me 

Kristin: once he 

Will: woke up.

Yeah to the hospital Yeah, she sent my phone in but deleted my social media apps 

Kristin: from the phone. And banking and email and anything he might get himself into some trouble. 

Will: She knew, she knew right away. I was like, I was going to start documenting my uh, ICU stay from, from the 

Dr Wes Ely: ICU. That is, that is a genius idea because then he’s got to remember his own passwords to get back in.


Kristin: That is what my thinking was. This is a good cognitive test. If he can remember how to download an app, remember the password to log in, then he’s fine to use it. That’s right. 

Will: I have to assume that was also something that was probably said whenever my team did rounds on me. They’re like, Well, I mean, he’s tweeting.

I, you know, I guess he’s fine. Time to go 

Dr Wes Ely: home. There’s actually a thing called the, the crossed leg [00:57:00] sign in the ICU. This is a real thing. If you’re, if this has actually been studied and published, people have a higher survival rate if they have a crossed leg in the ICU, because it means they’re sitting there with their legs crossed like, Oh, hum de dum, it’s better.

I’m good. It’s okay. So you were exhibiting the crossed leg sign by your tweeting. Oh, that’s 

Will: great. The crossed legs. Wow, that’s such a cool thing to, like, publish about. 

Dr Wes Ely: Yeah. You know? There’s all kinds of cool things like that. Like, we have a thing called quitter’s nails. Do you know what that is? No.

Quitter’s nails is for the smoker who comes in, has his big heart attack, and quits. And then about two months later, half of his nail is yellow and the other half is pink. So that, that line marks his teachable moment. Yeah. I love 

Kristin: it. How about that? That’s incredibly, I bet there’s so many little, I don’t know, I would think of them as hacks like that for the ICU.

Yeah. That’s so fun. Little clinical 

Will: signs. Yeah. Um. How are you, how do you, um, how are you with the check in for [00:58:00] contact lenses on all the patients that come in? I always ask the ICU folks 

Dr Wes Ely: this. We have to check for contacts because people can, I’ve had patients in there for days and they’ll develop corneal ulcers and stuff.

Yeah. Yeah, so I always check Will. I’m in. I’m in. I 

Will: love it. Good. 

Kristin: And the lubrication, that was the other thing that I reluctantly asked about while you were in the ICU. 

Will: She could, she could just knew, uh, yeah, you know, keeping those, keeping those eyeballs lubricated. It’s always a good thing whenever people are intubated and sedated.


Dr Wes Ely: a, it’s incredible. The first fancy word that I learned in the ICU was called chemosis because the sclera gets all edematous and we would just call it scleral edema, but that’s called chemosis, right? You, you guys are lucky. You’ve got all these fancy words that nobody else in medicine knows. So you come in, you automatically sound smart.


Will: that’s, that’s right. Yeah. Just throw, I just start saying, because I mean, we’re, you know, we’re already nervous to be in the ICU in the first place. We don’t like to go there generally as ophthalmologists. And so we just start throwing out [00:59:00] fancy words to make us seem like we belong. So that’s, that’s exactly.

Yeah. The 

Kristin: only reason he goes to the hospital is to. Go find the snacks in the Physicians Lounge. 

Dr Wes Ely: Well, if you just walk in the ICU and start saying things like, Have you guys checked for Roth spots lately? Because I, you know, you’re gonna make everybody, you know, nervous. 

Will: Oh, I, you know, right, I could go in and be like, Hey, kid, what’s winter’s formula on this patient?

Have you checked that? That’s still, that’s still something I want to do someday and just see what the reaction is and and they give me an answer that I have no idea what they’re talking about. 

Dr Wes Ely: Well it’s true because Kristen, some of the stuff that he does on his videos I’m sitting here thinking, how does he know that?

Oh, I know. How does he possibly know that? Because that was, that was third year stuff, and he hadn’t done that since. So it’s good. Yeah, 

Will: I spent a lot of time on social, on Google, and looking 

Kristin: it up. He’s faking. 

Will: All right, well, let’s take one more break here, and we’ll come back and we’ll wrap up with Dr. Wes.

All [01:00:00] right, Dr. Wes Ely. Uh, we are going to, uh, finish up here with a, a fan story. So we have our listeners send in their own medical stories. And so this is an anonymous story. It goes, as an MD PhD student, I had just finished my family medicine rotation that I needed to do during my PhD training to celebrate.

I decided to take six games. Um, I decided to take six games on the weekend right, oh, six soccer games, sorry, uh, over the weekend right after my shelf exam. I’m a soccer referee. That’s, okay, it’s refereeing soccer games. I was a, I’m a soccer referee and these games were premier youth and adult games. After refereeing over eight hours Hold on, hold on, 

Kristin: hold on.

So this person, this MD PhD student, they are celebrating being done with their shelf exam by working, yes. 

Dr Wes Ely: What is wrong with you people? It’s crazy. Let’s find a better way to 

Will: relax. We got problems. Alright, he’s a soccer referee. Uh, and uh, these games were [01:01:00] premier youth and adult games. After refereeing for over eight hours, I realized I had a bump on my Achilles tendon.

On Monday, when I returned to lab limping, I diagnosed myself with Achilles tendonitis. I’ve never had Achilles tendonitis. After going to the doctor and getting PT, I heard your podcast that chatted about soccer and being old. That’s right, because I just recently I decided to just try my hand at indoor soccer and it was extremely 

Kristin: difficult.

It’s like a community league, but all the old people have found each other and formed a team. Did you find 

Dr Wes Ely: out that you were way more sore the next day than you thought you’d be? 

Will: Oh yeah. Oh yeah. I could like barely move. 

Dr Wes Ely: Yeah, it was terrible. Cause I remember a few years ago, I, I, I let the residents talk me into playing football with them and I had a great time, but the next day I couldn’t get out of the bed.

Will: Uh, he says, uh, I am only 27 years old, but I learned that I cannot just do a condensed four week family medicine rotation, referee six [01:02:00] games, and accept to expect to have a functional human body for research with only 24 hours of recovery. Thank you both for reminding me that I am a human too, as a.

Training physician scientist. Oh, 

Kristin: good. Yes. 

Will: I’m glad we could help. I’m glad. I’m just reminding people of their own mortality and their difficulty with exercise . 

Kristin: It starts earlier than you would think, though. You know? It does. When I was a kid, I envisioned getting old as like at least 40 before you start having any sort of feeling like you’re slowing down or anything.

And, hmm. When I was probably about that same age, about 27, I started noticing, like, oh, you know, I’m kind of a little bit sore. My ankles, when I first get out of bed or, you know, just little things start and they just never stop. 

Will: And now, if I turn my head the wrong way, my week is ruined. Exactly. 

Dr Wes Ely: That’s what’s so depressing is you get hurt.

You’re like, I didn’t even do anything. 

Kristin: Exactly. Yes. I just was sleeping in my own bed, and 

Will: now I can’t [01:03:00] walk. We are turning this into an old person podcast here. Hey, but 

Dr Wes Ely: listen, Kim and I raise a boy who has Down syndrome, and he’s, he’s 58. His name is Greg, and he is teaching me so much about life, because he, even though he, you know, he’s 58, so it’s like a 75 year old, because they age prematurely.

But he still finds a way, Kristen, to, despite his little quirks and agingness, to just be happy. And he just, he takes life. The beauty of Greg is he accepts life on life’s terms. Which means if I’m getting older, I’m getting older. It’s happening. Let’s just accept that this is what’s happening. That’s what Greg is teaching me.


Kristin: wonderful. Like you can’t find it. May as well just enjoy. It’s very Buddhist, right? Of, of, uh, what is that principle that the, the happiness is just, I’m butchering it, but, but yeah, it’s like, it’s. It’s just, you stop fighting things and then you’re happy. That was horrible. That was completely butchered.

Somebody please put the real thing in the comments or something. 

Will: Well, uh, Dr. [01:04:00] Ely, uh, it’s been such a pleasure. I want to make sure we, we mentioned a couple of things here. So, um, this website, icudelirium. org. Can you tell people about 

Dr Wes Ely: this? Sure. This is a 20 year old website. There’s nothing there to sell you per se payment wise.

This is for you to go and get information about. What does it mean to be in the ICU? What does it mean to be a patient and family member? How do I survive after the ICU? And there is just so much information there to help patients and families get through critical illness. And there’s a very informative page on Long COVID because we are now doing a lot of research in Long COVID to help people find answers and to pick up the pieces of their life.

Will: That’s ICUDelirium. org. Also, your book, Every Deep Drawn Breath, which we have right here, and it’s just a wonderful 

Dr Wes Ely: book. And all it is, it’s a book of real people, real stories. Everybody in there has vetted their story to be told, but it tells, it’s about life and people. It’s about how do I get through hard [01:05:00] times and find meaning on the other side of that.

And every penny… goes back to COVID survivors and survivors of critical illness. So it’s a project to build that endowment I spoke about earlier. Yeah. And you 

Kristin: have a model for physicians to use in here too, right? The A to F model or bundle 

Dr Wes Ely: you call it. Yeah. The A to F model is basically a, a 400 scientific papers proven way of more safely caring for people.

The short of that would be if your loved one is in the ICU, um, go to that website, ICUdealing. org and read about the A2F bundle. This is waking people up, getting them out of bed, bringing their family there. And I like to now flip it over and call it the F2A bundle because that means we’re starting with family.

Because family is where everything revolves around family. But in the ICU too often, we find people sedated, immobilized, and without family, and we’re fighting that as 

Kristin: unsaved. It all boils down to treating people like a human, that, that bundle. 

Will: Every deep drawn breath. And also people can find you on, [01:06:00] um, on Twitter.

Twitter. com. On Twitter. 

Dr Wes Ely: I can’t do 

Will: it. Can’t can’t call it that. Just Twitter, you knows. Know what I mean? What we’re talking about at, uh, Wess Ely, W e s e l y m D. Uh, so check that out. And again, Wess, thank you so much. It’s been a pleasure. 

Dr Wes Ely: It’s been my privilege. You guys are amazing. And I’m, uh, you’re my heroes.

Ah, oh, thank you, . 

Will: Thank you. All right. We’ll see you next time.

I feel like we have like a little. Love hate relationship with the ICU, don’t we? Yeah, 

Kristin: you could say that. Yeah, I think that’s fair. Yes, very appreciative. Yes for the work that goes on in there, but you certainly never want to find yourself needing it. 

Will: But it was it’s fascinating to hear Dr. Ely really talk about the human side of it.

Yeah Versus this the straight medicine because that’s that’s all my brain, you know [01:07:00] thinks about and so That’s what I 

Kristin: have learned in our experiences You know you physicians and and probably nurses and other kinds of clinicians as well Like that is what you are trained to think and to you know from the patient side.

It feels like wait. Why is this so? Dehumanized, you know this whole healthcare experience in this country. And so I love what he does because that’s so in line with, with what I’m trying to do of re humanizing medicine. 

Will: Some people are just like meant to be a doctor. He’s just like one of these people.

It’s like. This is what he 

Kristin: was born to do. Yes, he’s very good at it. Specifically, 

Will: in the ICU, all this stuff. Uh, yeah, check out the book, really. Every Deep Drawn 

Kristin: Breath. I mean, I think you can tell just from his storytelling. He’s a fantastic writer. The book is really interesting. What’d you think of the game?

I thought it was fun! I did better than I thought I was gonna do, cause I didn’t see TV growing 

Will: up. I didn’t know if you guys [01:08:00] would pick up any of those. But, and then he came out, you know, with 

Kristin: Mr. Potter. Yeah, Mr. Potter. 

Will: Which, I was like, no one’s gonna get this, but anyway, they did. 

Kristin: It’s a 

Will: beloved film. Well, let us know what you guys think.

Do you have any game ideas? Like, we’re always happy to hear those. Or any other thoughts? You can reach out to us in a lot of different ways. Email us knockknockhai at human content. com. We’re on all the social media platforms. Uh, you can also hang out with us and our human content podcast family on Instagram and TikTok at humancontentpods.

Thank you to everybody listening! We love that you’re here. We love that you’re still listening at this point. That’s always very exciting. 

Kristin: Who’s out there? Tell us if you listen all the way to this 

Will: part. If you are still listening to this point, then you’re probably more likely to give wonderful feedback and awesome reviews of this podcast.

Please do. We love those. It helps other 

Kristin: people find the podcast. Absolutely. 

Will: If you subscribe, and it makes us feel [01:09:00] real good. If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out like… Um, Sonakshi, Sonakshi on YouTube said, As a med student, I love listening to these convos so much.

Thank you. That’s very kind. That’s what we’re going for. That’s what we’re going for. Hopefully give you a little chuckle too. Uh, full episodes of this podcast are up every week on my YouTube channel at DGlockenflecken. I also have a Patreon. Lots of fun perks, bonus episodes, where we react to medical shows and movies.

Hang out with other members of this community. Uh, we are there. We’re active in it. Got a little town hall every so often, uh, like, uh, like, like Pawnee on Parks and Rec. 

Kristin: Uh, I think you’re Ron Swanson, and I am Leslie Knope. I 

Will: think so, yes. Um, and… Well, 

Kristin: I, I think I alternate between Leslie Knope and April. Uh, Like, if they had a love child, that’d be me.

Will: I think that’s fair. Yeah. Um, who’s Jerry? 

Kristin: Who’s Jerry? Rob Goblin. 

Will: [01:10:00] Rob, one of our producers is Jerry from the… They’re, we need them to be happy with us. Okay, uh, anyway, Patreon, uh, going back, early ad free episode access, interactive Q& A live stream events, and much more. We tend to get a little bit off track just late in the day.

Patreon. com slash glockenflecken or go to glockenflecken. com. Speaking of Patreon community perks, shout out to all the Jonathans as always, Patrick, Lucia C, Sharon S, Omer, Edward K, Steven G, Rossbox, Jonathan F. Marion W. Mr. Grand Eddy, Caitlin C. Brianne L. Dr. J. Chaver W. Jonathan A. Leah D. K. L. Rachel L. and Anne P.

A virtual head nod to you all. Patreon Roulette, a random shoutout to an emergency medicine tier patron. Shoutout to… Sarah D. For being a patron. Thank you, Sarah D. And thank you all for listening. We are your hosts, Will and Kristen Flannery, also known as the Glockenfleckens. Special thanks to our guest today, Dr.

Wes Ely. Our Executive [01:11:00] Producers are Will Fennery, Kristen Flannery, Aron Korney, Rob Goldman, and Shahnti Brooke. Rob, I don’t know why I have any problem with, I have so much problem with your name. Editor and Portizzo. Our music is by Omer Ben Zvi. To learn about Knock Knock High’s program, disclaimer, and ethics, policy, submission, verification, licensing, terms, and HIPAA released terms, you can go to Glockenflecken.

com or reach out to us at knockknockhigh at human content. com. With any burning questions about submission verification terms… Concerns about HIPAA release terms. Or fun medical puns about program disclaimer and ethics policy. Or other nicknames for Rob. Yes, Knock Knock High is a human content production.

Hey Kristen, do you know what I love about ophthalmology? Nobody tickles you! [01:12:00] That, that’s really nice, but also eyeballs. Of course. And Work Life Balance. Yeah, because you 

Kristin: have Jonathan to help do all your clinical documentation and stuff. 

Will: I’m also not willing to share my Jonathan though. 

Kristin: Well, no. People ask.

That’s too 

Will: much to ask. I can’t. That’s too much. But I need Jonathan because I’ve got all this other stuff going on, right? That’s right. Social media, I’ve got the podcast, family life. Yeah. Ophthalmology, it’s just, there’s so much to do. Exactly. But if you don’t have a Jonathan? There’s DAX. Yes. Yeah. Nuance Dragon Ambient Experience, or DAX.

It helps reduce administrative tasks with clinical documentation that writes itself. 79 percent of physicians say their work life balance improved with DAX. That’s better than your med school grades. Oh, yep. You may be right there. To learn more about the Nuance Dragon Ambient Experience, or DAX, visit nuance.

com slash discover DAX.[01:13:00]