Transcript
Will: [00:00:00] Knock,
knock, knock. Hi, welcome to Knock-Knock. Hi, with the Glock fls. I am your host, Dr. Glock Flecking. I I’m
Kristin: also your host, lady Glock fl, Dr.
Will: Lady Glock Fln. Uh, and we are talking today to a hospitalist mm-hmm. And an author Yes. Named Dr. Ricardo Nola. That’s right. And he’s also from Houston. Uh, yes. Lots of Houstonians lately.
Yeah. We’ve done, uh, uh, we’ve done another, uh, show with a Houston. Uh, and so it maybe, should we just turn it into an All Houston podcast here? No,
Kristin: I think it, probably not. Probably other people
Will: wanna hear our options here. Mm-hmm. So today is may, I mean it’s, today is like an a. It is in May. It is in May. But it’s May.
Yeah, it is. What is, what is May to you, [00:01:00] may do you enjoy May?
Kristin: Um, April showers, spring May Flowers. It’s very pretty. Yeah. Here I like the flowers. There’s a lot of flowers. There are, we’re, I feel like Portland and Spring is very similar to like October in Vermont. You know, it’s like spring’s answer to a
Will: New England fall.
We’re gonna have to start paying attention to our garden. Yeah. I say we as if I’m gonna be doing any of that. Yeah. Isn’t that the truth? I. You know what, you’ve, you’ve come a long way in your ability to grow things. I have,
Kristin: yes. I, I have had the blackest thumb for most of my life. I would kill even the easiest plants.
But, you know, everybody had like a pandemic project. Yeah. And some people were like baking sourdough and stuff. Well, for some reason, I mean, my first project was you had a cardiac arrest right at the beginning. And so that was like a, a, a big thing to deal with for a little while. But then once you were okay, it was like, what else can I keep alive?
And so I just started gardening for some reason, like some sort of mental crisis in the middle of the pandemic. And I, I [00:02:00] don’t know, I’m sure there’s something I could unpack in therapy underneath all of that, but, uh, yeah, now I, now I can grow things. Not
Will: to diminish your progress as a gardener, but, uh, we are in Oregon
Kristin: and it makes it much easier.
True.
Will: It’s like a cheat. Throw things outside and and they’ll grow. It will grow. Right. And, and you’ll, it’s temperate
Kristin: climate. It rains a lot. There’s. Good. You know, it’s not that
Will: hard, but you’ve done great. You’ve really come a long way because you did kill a lot of things for a long time.
Kristin: Yes. I mean, even house plants that are supposed to be
Dr. Ricardo Nulia: super easy, so Yeah.
Will: I don’t know what it is. Yeah. Um, you just, you just look at the plant funny. And it would, it would croak
Kristin: right on us. Yep. So, so yeah, I have, I have come a long way and now we have beautiful flowers every spring and that,
Will: that’s really nice. I hope all of you have beautiful flowers this spring
Kristin: too. But you know what else May is what?
May is mental health awareness month. It
Will: is yes. Mental health awareness month. And so this is a good month to, uh, check in on the people around you. And especially in [00:03:00] healthcare, you know, this is, uh, um, burnout is such a huge problem. Uh, and it, it continues to be even before the pandemic and it’s just gotten worse over the last few years.
Uh, and so, you know, and the, the times in my life when I’ve felt burnout, when I’ve, I’ve. Just this, the stress of life has really gotten to me. Mm-hmm. Uh, I do think talking to the people around you, you know, can really be helpful.
Kristin: Yeah. Don’t, don’t just keep it all to yourself. I don’t think that ever helps anybody,
Will: whether it’s, you know, a therapist, a, a family member, a loved one, whatever, just, um, dog, you know, be there with each other.
You’re dog if, if it helps, do it. And so, uh, yep. Take care of each other. Take care of yourself and let’s, um, yeah. And
Kristin: there’s no shame in, in getting a little help with your mental health. I mean, you would take your car to the mechanic if it was needing an oil change or something. Right. Like it’s just routine maintenance for That’s good for everybody.
Yep. You don’t have to be, you know, really struggling with something to take care of your
Will: mental health. And let’s, um, let’s talk about our guests today. All right. Should we, [00:04:00] so we have, uh, Dr. Ricardo Nola, um, and he is a hospitalist at Binta Hospital in Houston. Also the director of the Humanities expression and Arts Lab.
Heal at Baylor College of Medicine, uh, which brings all the arts and humanities into medical education. And he’s also the author of a fantastic book called The People’s Hospital, hope and Peril in American Medicine, which was released recently on March 14th. Uh, and so we’re gonna talk about that. The book we’re talk, talk about Binta Hospital and gonna talk about a lot about internal medicine.
Um,
Kristin: yeah, it was a body medicine heavy episode. It’s something episode
Will: you made me do later. Mm-hmm. So, uh,
Kristin: dust off your, your body medicine
Will: knowledge. I dusted my brain off a bit in this episode. Gonna clean
Kristin: it up. Little spring cleaning
Will: in your head. All right, here we go. Here is Dr. Noah.
All right, welcome. We have, uh, [00:05:00] Dr. Ricardo Nola. Uh, sorry, I should have asked you that before we started.
Dr. Ricardo Nulia: Is that No, but you got it. You nailed it. Oh, I get, look at there. You know what, you know, I’m not
Will: even gonna edit that out. I, I should have just gone with it and just, it just, you know, trusted
Dr. Ricardo Nulia: myself. You, you, you, you went with it and, and it’s, it’s uncommon.
People butcher it all the time, so
Will: congrats. Well, I, I feel pretty good about that. I mean, people butcher Glock Flecking all the time too, but that’s, that’s a fake name
Dr. Ricardo Nulia: that I gave myself.
Kristin: But we also butcher flannery, believe it or not. Yeah, that’s true.
Will: Yeah. Well, thank you so much for, for being here. It’s, uh, it’s really a pleasure.
Dr. Ricardo Nulia: Oh, no. Pleasure’s mine. Thanks for, I mean, y’all do such a wonderful work. Well, are you good beer.
Will: So what are you taking, uh, time off from work to be doing this? Like what, what, what, what would you normally be doing today?
Dr. Ricardo Nulia: If you weren’t doing this, um, right now I’d be probably on a bike ride with my kids, which is why I feel kind of guilty about.
No, that’s, that’s way more important. I mean, I mean, normally work-wise, I would probably either be on an off on week at the hospital, hospitalist [00:06:00] work, probably getting outta work right now at this time. Or I would be off and writing and figuring this stuff out or, you know, um, you know, just, I have some other responsibilities at the medical school.
Might be doing some of that.
Will: Can you, can you go and just tell your kids that you’re talking with a, a social media, internet comedian, ophthalmologist? I, I
Dr. Ricardo Nulia: can, and, and the thing is, is that my daughter would just get on YouTube and I’m just like, you know, that, that’s like the, that’s like what our parents kind of thought was, um, you know, I’m, I’m coming to grips with what YouTube, and, and, and social media is.
I mean, I even had, in my mind it’s the filter that matters. You know, it’s like how we teach our kids, but at the same time, It’s still not, not easy to, to get through. So I could tell absolutely. My daughter Typo would go to school and just be like, to her teacher, Hey, look, my dad’s on YouTube, and it’d just be like, I would be embarrassed.
So, uh, welcome to my world. Yeah, I imagine one
Kristin: of our daughter has a t-shirt with six of his faces on it, so Oh,
Dr. Ricardo Nulia: wow. [00:07:00] Yeah, she wears That’s kinda cool though. I mean, it’s better than the alternative, right? I mean, I guess it’s, I guess it’s, I’m not sure which
Will: is worse. It’s overall a positive thing, so
Dr. Ricardo Nulia: Yeah.
But yeah, no, but
Will: they’re, it’s, they understand they’re kind of a little bit more plugged into social media than I would like for them to be, but we try to, I think the key is like keeping him safe on it, right? And, and, yeah. Yeah. Yeah. So, and that’s, it can be tricky, a learning process, trying to figure that out, but,
Dr. Ricardo Nulia: um, and being parents.
Exactly. I know
Kristin: it sucks. All the fun out
Dr. Ricardo Nulia: everything. Can’t I just put click a button that say just parent, like, you know? No. Right. So, so
Will: what, um, uh, what. What med school is Bento Hospital, because we’re gonna talk a lot about Bento Hospital today. Yeah. So in, in Houston, Texas. And, um, so what, what, what, uh, I know there’s multiple, there’s a couple different med schools in mm-hmm.
Houston. So does everybody rotate through Bento? Do you pretty much see all the students at some point? Well,
Dr. Ricardo Nulia: so, [00:08:00] uh, Baylor College of Medicine staff, Ben Top Hospital. So it’s only, oh, okay. Baylor residents and Baylor, uh, staff there. Harris Health, so Bento is the flagship of the Harris Health System.
Another hospital is the l bj, which is staffed by the University of Texas or McGovern Houston. And we also have in the mix, uh, a new university, university of Houston Medical School. Oh. In town, which has started a couple, which an awesome place because. They’re founded with the principles of caring for vulnerable community, so Oh, that’s great.
Um, so there’s, but, but at Ben-Zvi you’ll only see, uh, Baylor, Baylor
Will: Docs and Binta, just to let everyone know, you know, give us a little background just about, because Binta is a very unique place. It’s a unique hospital in a unique city, uh, yeah. Of Houston. And, you know, as someone, I, I grew up in Deer Park, Texas, you know, [00:09:00] outside of Houston, so I’m very familiar.
I honestly haven’t, I didn’t do any of my medical training or education in Houston. Mm-hmm. So I don’t think I’ve ever actually been to Binta, but I’ve, I, I’ve heard so many, you know, stories and things about it. So Yeah. Just, you know, give us a little insight into Ben Top and Yeah. How it relates to the community.
Dr. Ricardo Nulia: Yeah, definitely. Um, I probably grew, I grew up like you having heard about Ben to not really knowing what it was. I think if I reach right back into my memory and what I, what I remember is like, You know, something on the news, like, uh, crews on the scene, victim taken to Ben to, because that’s right in, in essence what it, it, what it started up off as, as a, um, or what we come to know it as, I would say prior to like 10 years ago, as foremost, a trauma center in a burn unit, something, it’s one of the two level trauma centers for Houston, Texas now.
I mean, the recommendations are that there’s one, uh, a level one [00:10:00] trauma center for every million people, and Houston has two of them right next to each other for a population of 6 million. And that’s, that’s the city planning that we have. That’s not ideal Texas, right? No, it’s not ideal. Um, wow. But, but what I, I didn’t, it took me a while to realize what the history is and mm-hmm.
Really what, what kind of work is done at Ben Top? So, Ben Top, like I said, is the flagship of the Harris Health System, and this health system is a public healthcare system that’s afforded by taxpayer money. To provide healthcare for people who can’t afford or access healthcare in the city. So people who, it used to be that if you earned up to 200% of, uh, of, uh, federal poverty level, you got, you know, your care provided for, uh, by county tax dollars if you couldn’t qualify for Medicaid or Medicare.
Mm-hmm. And since it’s connected to an academic healthcare unit like Baylor College of Medicine, what that’s done, and also University of Texas, [00:11:00] it’s created a, a robust network of primary care, do, uh, clinics specialty care so that the care is not just purely patchwork, it’s also, you know, specialized care, forward thinking, care, preventive care.
And so this system has grown over the last years as the city has grown, and it reflects the diversity of what Houston is. Yeah. I think also it’s really interesting the story by which. This, um, hospital district was founded. So in the 1960s, there was one hospital, one charity hospital that provided care to the people who couldn’t afford it.
Mostly, you know, immigrants or African Americans who, who had no access to healthcare. And the hospital that they had to go to to receive healthcare was Jefferson Davis Hospital. Obviously, like the name has a lot of bearing there. And, uh, that charity hospital depended on the budget of the county and the [00:12:00] city who were always like at war with one another trying to dump their share onto the other, threatening in the papers like, we’re not gonna, we’re not gonna care.
We’re not gonna right up the, the, the, you know, the budget for, for, for Jefferson Davis. And that became a war in, in, in the newspapers. Well, what happened was one of the most amazing people that I’ve ever read about, this man named Janka Hard, Todd. This guy is a Nazi, a Nazi resistance leader, Dutch ship captain guy who captain ships into the Netherlands during the worst floods to rescue people.
Also a playwright and a writer, I mean, wow. Nominated for the Nobel Prize in literature. I mean, you can’t, you can’t make this stuff up. He ends up in Houston, Texas to teach creative writing at the University of Houston. Oh, interesting. And since he is a Quaker, part of him is, I need to volunteer somewhere.
And he comes to the faculty, he hears these whisperings [00:13:00] about this hospital. About the deplorable conditions. It’s, yeah, the wi, the, the whisperings are that the kids, the newborns in the maternity ward are crying because there’s just not enough milk to go around. The whisperings are that like a staph infection has roiled through the, the newborn ward and like kids died.
I mean, this is how much things have changed. Wow. And so he goes to volunteer. And he sees these same conditions. He sees cockroach crawling on people’s trachs. Oh, geez. So he decides to write about it. He writes a series of op-eds that are up here in the Houston Chronicle. And Houston at that time was the city of the future.
It was the Astrodome was being built. And so it was the first film structure. Mm-hmm. It was also the Space City. It was a home of nasa. I mean, we’re talking in the middle of the Cold War. And so that Houston had a lot of prominence. Big, yeah. Yeah. And so the business community internationally start to recognize, you know, what is this, what’s going on?
Houston, [00:14:00] uh, has all, is the city of the future, but they can’t take care of their war, you know? And so what this, what this stimulates is, is it becomes a civic issue. How are we gonna get healthcare for the people who can’t? It becomes a na, a referendum, a city referendum to the, uh, to the point where Houstonians vote on it and they vote so that property taxes can be taken in the way the school boards take in.
Mm-hmm. Uh, property taxes so that people can have, uh, access to healthcare and over the le over the next decades. That’s what grows into this
Will: system. And it’s, it’s, and Texas has no state income tax. Right. So somewhat limited in where you could draw that money from.
Dr. Ricardo Nulia: Right, exactly. And so that, I mean, that’s the, the, you’re, you’re limited by state legislatures to provide healthcare.
Mm-hmm. Now, the Texas does have laws about caring for the indigent, and they do make it the cap. They do designate it to the county, and different counties are [00:15:00] differently, uh, generous than others. Harris County because of its growth, because of, I would, you know, because of these academic centers has been.
Uh, much more generous than the county surrounding it. And so that’s one of the reasons why it’s grown. And I,
Will: and, and, and reading your book, um, you know, one thing you touch on, which I, I, I’ve found very interesting is we’re, we’re all concerned about healthcare spending and how expensive it is. And Ben to is so much lower kind of per capita spending.
Yeah. And, and so you’re in an environment that is, uh, you just don’t have as many resources. You don’t have as much money, you don’t have much funding, yet you’re still able to provide really high quality care. Yeah. And I think it’s, it’s great because, you know, it’s a, um, you. This idea that we need to be spending all this money that we need to have.
You know, it, it just, I love this story about Ben to, [00:16:00] because it’s, it just kind of throws everything in the face of that idea that it needs to be expensive.
Dr. Ricardo Nulia: Yeah. You know, I th I think that that’s kind of the genesis for this story. I mean, I went to, I mean, there’s a lot of reasons why I wrote this book, but one of them, uh, the part that you’re describing, I remember going to a lecture here in town, a policy lecture given by one of the premier policy experts, Vivian Ho, who works at Rice University, talking about pricing.
And, uh, at the end, I said, I asked her, she’s a friend now, but I asked her, what about, you know, comparing this to how much, uh, the county system costs? And she said, there’s no studies. You know, and it’s, and it just dawned on me, it’s just like we, we have a basic presumption in the United States that.
Private healthcare, the way it’s administered, it is just has to be the way, and that’s, and it’s a cost, we have a major cost problem, but we don’t want to investigate any other ways beyond what this private system gives us. You know, if we’re okay [00:17:00] using public funds to pay for people’s private healthcare, but we haven’t even questioned, we haven’t even studied the idea that, well, maybe public healthcare works.
And I think that after years of work, I mean, it took me years to work in this system to kind of realize this is a public system. And, um, actually if you provide services directly, not through middlemen, like insurance and everything, you can reduce the, you can lop off the costs Yeah. Quite a bit of cost.
And the question that everybody’s gonna ask you is quality. And, and, and, and the question everybody’s gonna ask you is, You know, um, but that’s just aren’t gonna be good. And, and that’s where the experiences of us working in the hospital and some of the stats that came out was like, well then what really is the reason why we’re not looking at this hel at, at, at a public healthcare system.
Kristin: Right. The data’s not backing up that
Dr. Ricardo Nulia: rhetoric. Yeah, exactly. That’s what, that’s what they’re, you know, that, that, that’s what they would always say. But I think that we need to have data, you know, I think we need to compare. We need to, to put [00:18:00] that in there and, and, and think about this. Fortunately, there’s
Will: probably a lot of, uh, forces that are trying to avoid Oh yeah.
Mm-hmm. That kind of work from being done.
Dr. Ricardo Nulia: Yeah. I, I mean ex I I think that there are too, you know, um, I’m, uh, I think one of the books that’s fundamental to me is, uh, you know, when I read it was Paul Starr’s, uh, social Transformation of American Medicine. And you get, get a sense even when he’s writing in the eighties of like how strong those forces are and they’ve only like multiplied.
Yeah. Um, you know, What you talk about with private equity is, is even more of a robust kind of force that’s, that’s occurring right there, you know? But that’s one of the reasons why it’s so interesting to me that this was formed a referendum because to counterbalance that, or one of the ways that we have to go against that force to weigh against that force, maybe it just might be public, it might be just democracy.
You know, like how mm-hmm. Yeah. Maybe we can, maybe we can compete against these forces if we, if we have something [00:19:00] public, you know? That’s, that’s my hope. You know, I’m, I’m trying, I’m trying to scrap hope together, you know, but I do take hope in where I work, you know?
Will: Yeah. I mean, I, speaking of private equity, you know, that, that is the big, if, if we could get like patient outcome data, Pre and post private equity acquisition.
Like that would be so telling, not, not even with an agenda, just to know like, what is, what is the result of, of having all these private equity acquisitions. But yeah, there’s no way we’re gonna get that data.
Dr. Ricardo Nulia: I’m not gonna get that. It’s gonna be, yeah,
Will: yeah. You can’t, uh, it, it’s just not in, there’s a lot of money and interest in avoiding that kind of thing.
Kristin: I do think it’s interesting though that these, you know, this experience at Ben Top, this is happening in Texas, you know, one of the historically, one of the most red states in the nation. And so it’s, I think that is just further proof. This does not have to be political. It doesn’t have to be, you know, oh, I, all the things that get wrapped up.
And it doesn’t have to be
Dr. Ricardo Nulia: that way. I think you’re so right about that. I feel like [00:20:00] there’s so much, uh, first of all, I think that, I mean, you probably feel this on a daily basis. There’s a lot of unity that we do not like our healthcare system. Right. And that goes beyond, that’s like, let’s, that crosses the political spread.
Will: I just have, I throw UnitedHealthcare into a video and then, and it’s universally beloved.
Dr. Ricardo Nulia: Yeah. So it’s so in, and I, and I think that that’s really telling, right. And it’s something that we can, again, let’s clinging to that hope because it goes beyond partying. We all agree that we want something different, right?
I mean, seven outta 10 Texans in a survey say that they want the government, it’s the government’s responsibility to provide universal healthcare access in this. Mm-hmm. That’s, that’s incredible. That’s, that’s like, that’s something that’s, that’s a surprise. That’s a surprising number. Yeah. That’s, you know, and so, but the problem, I think one of the problems that we have is, is that like once the, our political system, once these ideas come to the par, uh, to the level of party and [00:21:00] candidate.
They start to disintegrate, you know? Mm-hmm. Yeah. That’s why, I mean, that’s why I wrote that we should have a, a referendum, you know? Uh, like we should have like a a some, I know it’s never been done. I’m not trying to be ni I’m, I know how difficult that would be. Right. But, um, I challenge people to tell me like, would you vote for a new healthcare system?
We, we don’t have to have a plan before we could just have a referendum. Do we need Yeah. A, a universal, and then that sends a, if we say have a majority years, that sends like a message to Congress, build us one, you know, in this term, you know, we can start electing people. We’re behind the referendum.
Mm-hmm. You know, we have to be, we have to be creative with our democracy in order to, you gotta start somewhere to combat these, to combat these forces, which are extremely strong, you know?
Will: And you’ve been at Ben, Ben Top for how, how many years?
Dr. Ricardo Nulia: I’m totally inbred there. I mean, I am like, I was like a med student born and raised.
Were you born and I mad menthol. Oh, I was. I was, I came to Houston in second [00:22:00] grade and I’ve stayed, and I was one of those people who was just like, I’m, I’m getting outta dodge, like the first chance I get. But, uh, I did go away for college, but the, the, the pull toward medical school is like so strong to stay in Texas, you know?
Yeah. I mean
Will: it’s, but the Texas Medical Center, like, it’d be hard pressed to find a better place to learn how to
Dr. Ricardo Nulia: be a doctor. I, you know, I think that’s one thing that the Texas legislature does really well. They, uh, subsidize medical education so that like I paid. $6,500 a year for tuition to go to Baylor.
You know, that’s, you hear that you’re welcome.
Will: Manageable. I was, you know, I was, I was gonna go to Texas for med school. And then, then Kristen was like, no, no, no. We’re going to, we’re going to
Kristin: Dartmouth. I said, that’s where I was going. You made your own decision. That’s true.
Dr. Ricardo Nulia: I’ve, I, well, you know, I followed you.
Love, love trump’s money, you know, so I, it worked
Will: out well for him. It, it’s, uh, but yeah, you can’t beat that, uh, that in-state
Dr. Ricardo Nulia: Texas tuition. Yeah. It’s, you can’t beat [00:23:00] it. And so I was like, my whole, you know, idea of like leaving the state, moving to New York or San Francisco, wherever I was, that I was thinking at that time, it just, um, I’m gonna go back to Houston.
I was also struggling at the time with whether I was gonna write mm-hmm. Or become a doctor. Mm-hmm. And, um, I ju it just seemed right to me to come to, to Houston. And so I stayed as a student. As a resident. I stayed because of Ben Top. I, I loved. The healthcare. I love being able to work the way that I wanna work as a doctor over there.
And, um, I just love that I’m not worried about reimbursements. I’m paid a salary and I can focus on medicine.
Kristin: Do you find that that helps the doctor patient relationship, do you think? I mean, I know you have maybe just that experience to draw
Dr. Ricardo Nulia: from, but For me it certainly has. And I think a lot of my colleagues, like, they think that they can speak with patients on, on a level where it’s just not about that financial incentive, like lurking over [00:24:00] your shoulder and you have to have that other, you know, like, uh, angel on your other shoulder to say it’s okay, you know?
Um, you know, for me it’s, it’s, it’s been liberating. That’s all I’ll saying. I mean, it’s just been like, I just go and do my job now. I mean, I, I like that the system that I work in, you know, pays me a, a good salary like market. I’m not, you know, we’re not, I’m, I’m subsidizing my own. I’m not working through free and I’m not subsidizing my own.
We, we go by market, but it’s just that there’s not these robust bonuses that I feel like is, and, and all like little things, like I work, I have a cap of patients, you know? Mm-hmm. As a hospitalist, you know, we get to 15 and it’s just like I can’t take anymore admission. Mm-hmm. Yeah. And there’s a reason for that so that we can provide quality to each of those patients and we feel it.
Mm-hmm. When it’s at 14, you know, and everything. So it’s, um, but, but you hear the stories of people who are working, admitting 25 patients in a night, or who have like, [00:25:00] uh, 22 patients and it’s just like, I, that’s why I feel liberated, you know? Yeah. To be able to, uh, you know, to practice medicine the way I want to in, in that system.
Will: What must it have been like to, cuz in, in your book you, you know, lots of stories about, you know, different patients and just the. You know, when you’re going through med school, you hear all the, you learn about all the, the regular things. The typical things, the horses. All right. But then, yeah, you talk a bit about just the unbelievable breadth of things.
Yeah. Like everything you actually learn about in med school, you’re gonna see, you know, yeah. In, in that kind of environment. And so, uh, yeah. Speak to a little bit about, about
Dr. Ricardo Nulia: that, if you would. Yeah. I mean, I, I’ll say this, I, I, one of the reasons I fell in love with medicine, I was struggling between like, whether I was gonna stay in medicine or if I was gonna leave and do something and, and become a writer, you know?
Mm-hmm. And, um, there’s a lot of reasons for that. But I fell in love with morning report event top, which was the [00:26:00] story of diagnosis, the story of people’s, you know, um, of these illnesses, you know? Oh, yeah. Described. And I, I just, I would, I would even come on my off time to like kind of, uh, when I wasn’t on, uh, medical rotation, To listen to those stories because they were just, I was just like, wow.
I, you know, tuberculosis of like the peritoneum, um, amyloidosis. I mean, those are, those are some of like the, the ones that we see more often, you know, but it’s just like, have
Will: you ever seen tuberculosis of the
Dr. Ricardo Nulia: eyeball? I have seen it, but I have. Oh, but I haven’t because I haven’t You haven’t, you haven’t seen it
Will: because I haven’t,
Dr. Ricardo Nulia: no.
Yeah, I, I mean we’ve diagnosed people with tuberculosis of like the, uh, like I think it was U V I. You have to, but I know. No, no, that’s right. We had ophthalmology. Yeah. We had to have ophthalm. I mean, you can tell in the enthusiasm of the residents and of the staff why they’re there, [00:27:00] you know, when they get Yeah.
These, these diagnoses and, and that’s one of the most beautiful things about where I work, you know? Yeah. Is. Um, you will see so much medicine there, and that’s one of the reasons I fell in love and, and, and I, and I mean, I don’t know if I would be in medicine Yeah. Or it not for Ben Top. If I was at a, I mean, I don’t want to speak ill of any, because I think there’s a lot of beauty in, even in like the, you know, the.
The heart failures and all that stuff, but it, it’s stuff that is like, has to be learned so many rather than, it’s just so vivid, you know, the mosaic that you find, you
Will: know, I do remember those morning reports and med school, they were always so fun, especially when you’re training, you know, because, uh, yeah, so just for people that don’t have no idea what a morning report is, you know, it’s, it’s usually, you know, people, different members of the healthcare team anywhere, you know, from students to residents to attendings and specialists and whoever, whoever’s around, and you just come in and usually somebody presents a case, right?
Right. There’s something, uh, [00:28:00] and a lot of times it’s, it’s kind of like an episode of, of House in some ways, house md, right? Because you got the whiteboard up there, you’re kind of throwing out suggestions, like, what do you think it is now? And then you give a little bit more information and you’re like, oh, what, what could this be?
Now? It’s just very, it’s a, it’s kind of an exciting, and I know that this sounds very nerdy, but it’s, it is a very exciting kind of fact finding mission and, uh, And learning opportunity. You learn a lot. It’s like a, it’s like a
Kristin: detective
Will: now. It’s like kinda like a detective. Yeah. You’re a detective. Trying to figure it
Dr. Ricardo Nulia: out.
And when, and when I was training, um, it was like also like right at that like kind of cusp of like old school meeting, new school, you know, where it was just like you had the old school attendings who like just bled for all this stuff. And if it would be arguments and things. I mean, I feel like that happens less now, you know?
But it’s, um, it’s a shame cuz that’s where
Will: I get a lot of my content. That’s too bad.
Dr. Ricardo Nulia: I,
Will: I know if you’re listening, like please argue with each other. I, I want to hear about it, but do it online so he [00:29:00] can see it.
Dr. Ricardo Nulia: Yeah.
Will: Yeah. Take it online. I need, I need some more. I’ve already addressed the cardiology, nephrology battles.
I need, I need a little bit more.
Dr. Ricardo Nulia: I mean, there were, there was crazy stuff back in the day. I mean, there were like literal, like, kind of like, uh, fistfights and stuff like that over my goodness stuff. Did that kinda
Will: thing happen in
Dr. Ricardo Nulia: rounds as well? You know, I, I’ve heard of people taking each other up against a wall because of like, just, I mean, I mean, and now it’s, this didn’t happen right when it happened like five years or so before.
I, I mean, it’s just, it’s, it’s just a different, its different. World gets passionate. Yeah. Passionate. That’s it. But that’s the passion that people had toward like these diagnoses. Yeah. And I think some of it had to do with, you know, um, we didn’t, we didn’t have Google at our fingertips and we couldn’t figure that out.
And so it was just like people’s memory were on display. Mm-hmm. That was a lot about filtering and like figuring out, you know, like, you know, I don’t know, like, how to implement those [00:30:00] diagnosis right. In, in patients,
Will: you know? Well, I wanna make sure that, um, you know, because you’ve, you’ve been working in this, in such a, this unique environment.
I’m sure you could just probably tell us stories forever, but I did, I did ask you if you could you bring a couple of stories from your life as an attending, uh, physician at, at Binta. Would you care to share, uh, one of those experiences? Yeah,
Dr. Ricardo Nulia: sure, sure. Well, I can, I’m gonna, you know, I’m gonna tell one of them that is kind of an embarrassing, uh, story first, and it was perfect.
I, I was, um, I was an attending who I still am an attending who focuses on bedside rounds. And I tell the team, you know, we’re gonna present at the bedtime, at bedside as like default, but you all tell me if there’s a reason not to. And there are compelling reasons not to. But we, you know, because of the nature we, of, of how we admit, one day we got, like, [00:31:00] we got eight admissions, and I was taking, and I was, you know, going through them all, like at the bedside and the, as as we’re getting toward the last one, you know, the, the resident had already told me, you know, oh, this person’s probably gonna go home.
So, uh, I was like, okay. You know, and as we, we were just in a hurry to get everybody moving and going. And as I get to the, to the last, uh, patient, she’s like, oh, I think we should, we’re walking into the exam room where she’s, where, where she’s like, I think we should talk about this briefly. And I was like, that’s okay.
We’ve had such a good moving, uh, um, morning. That’s okay. So we get to the bedside and we’re all around this patient. He looks really, really comfortable. He looks normal breathing normally young person doesn’t look like the person belongs in the hospital. So immediately in my mind, Because I’m just, you know, trying to foresee the future, even though I’m not, I’m, I’m impatient to like, kind of Right.
I’m like, this guy’s fine, you know? But, um, and, and she’s already told me he’s gonna be discharged, you know, so I’m listening [00:32:00] and they start telling the story about how he had no past medical history and how he was at his fraternity house and how he was helping Yeah, exactly. And how he was helping them move boxes, helping somebody move into the house where they decided that it was gonna be kind of funny to make him to, to give him some brownies with some pot, you know?
Mm-hmm. And I’m just like, in my mind, I’m like, oh, good for him. He had, he got a little high and like, I don’t know why the ER admitted him. Yeah. But like, whatever, he’s recover. They just probably wanted to watch him. Yeah. And so I’m just kind of like, I’m saying stuff kind of like, all right. I, I get, I get, I, I get the story, you know?
And, and, and I’m like, well, so he looks like he looks good right now. And she’s like, yeah, but he, so he had the, the brownies unbeknownst to him, he sits down, he’s a little bit dizzy, and I’m like, yeah, but he’s doing fine. He’s doing fine. Like in front of him. And, and then she’s like, then he’s, he becomes unresponsive and uh, he loses a [00:33:00] pulse.
Oh my gosh. And he starts doing, and I’m just like, oh, I just, that took a turn. Know it takes a, it takes a total turn. And they, you know, first respondents come and they intubate ’em on the field. And I start, and I literally break down laughing. They’re right in front of him. It’s like laughing. This is weed.
Well, I mean it, yeah. Well, I’m just like, what was in the felonies? It was just because I was just like, we, I was like, what, what, what happened? But I, part of it was because I was just seeing him right there and he was doing fine. Right. And part of it was just because it was just, it had like, the whole narrative had been spun in my head in a certain way.
Yeah. And, and I was also thinking like, Those bastard friends of his, you know what I mean? Like Yeah. Who gave him like this thing and like they’re, I, I’m putting myself in. So I just kind of like lost it and I started laughing and, and I, and I, I had to like, leave the room and I had to come back and say, listen, I am, that was so unprofessional of me.
I’m so sorry. I’m really happy. You’re, I just really kind of took you by surprise. It took me by surprise. Yeah. It just, it just [00:34:00] roll, you know? So I, I still feel, uh, you know, feel bad about it, but it was just one of those things where I was just like, when your mind is working in one way. Yeah. You know, it’s just like you foresee it and then it’s just
Will: like I’ve, I’ve been in situations like the inappropriate laughter thing.
It, it because it’s, it’s just kinda like a, like a, it’s almost a reflex.
Kristin: It’s like a nervous
Will: response to something. Do they know what happened to the, to the patient?
Kristin: What did,
Dr. Ricardo Nulia: what happened, what he. You know, the, the, the uds didn’t show anything but marijuana. Um, interesting. You know, I, you know, he, he got into it.
He was quickly Yeah. Uh, you know, extubated and I mean, they sent him to us basically just to watch for a few hours because Yeah. He, I mean, and, and we discharged him because his vitals were completely fine and everything. So as another,
Will: as a fellow young person who’s Yeah, whose heart stopped, I get, I get interested
Dr. Ricardo Nulia: in these types of things.
Yeah, yeah, yeah, yeah. I know. Well, yeah, yeah. Makes sense. And Oh, interesting. It’s, it’s, it’s, I don’t, I don’t know if they had, if, if they didn’t find that the brownies had [00:35:00] anything else in it, but
Kristin: is it possible that he just like randomly had an idiopathic cardiac arrest at the same time that they gave him these brown?
He’s like,
Dr. Ricardo Nulia: I mean, I, I wonder if, if it’s like, he’s one of those very rare people who had, like, who got so, I mean, Who knows how much they put into the brownies, but he just, just had a reaction. He just had like, he’s won. Maybe there is like a very, very few amount of people who have a response like that.
And he was
Will: one of the, you know, well marijuana is one of those things. Like there’s the cyclic vomiting syndrome that you can, like when you have a, when you get really high, I, I think it’s a thing. No, right.
Dr. Ricardo Nulia: That’s a good point. You know, maybe he, maybe he EVAs a vegal or something like that, that that happened.
Something strange. Oh yeah. Oh man. Something very strange. And I think that’s one of the reasons why they were like that we wanted, we wanted to um, just keep him here and see what I’m them a little bit. Cuz that was very strange.
Will: But I’m sure he was probably, he probably accepted your apology. I’m sure. He was just fine.
Oh, he
Dr. Ricardo Nulia: just wanted to go home. He’s like, get me outta the hospital. [00:36:00] He accepted my apologies. Just like, he was just like, I, I understand, you know, way. But yeah.
Will: Well, let’s take a quick break and then, uh, we’ll be right back with, uh, Dr. Ricardo Nea.
Kristen, you know that as an ophthalmologist I don’t tend to get excited about stethoscopes. I do know that, yes. But I have around my neck the Echo Health’s 3M Litman Core Digital Stethoscope. This thing is incredible. It’s got active background noise cancellation up to 40 times amplification. That’s pretty impressive.
It. I could practically hear the individual myocytes talking to each other and
Kristin: I have one too. And mine is rainbow. Yours is much cooler than mine. I know. I might just wear it around the house with its noise cancellation so I don’t have to hear you and the kids.
Will: That’s fair. Yo, this thing would be perfect gift for anybody in healthcare.
What? So we have a special offer for our US audience. Visit [00:37:00] ecohealth.com/kk h and use code knock 50 to experience echo’s digital stethoscope technology. That’s Eko O Health slash k, and use knock 50 to get $50 off. Plus a free case, plus free engraving with our exclusive offer.
All right, we are back with Dr. Ricardo Noela and we are going to be, Playing a little game. I don’t have a good name for this. Um, I didn’t really do all the planning
Kristin: for it. Body medicine versus ophthalmology. Yeah.
Will: Something like that. So basically it’s kind of like a medical trivia game, but in the past I’ve like put my guest on the spot and made them answer ophthalmology questions.
I’m, I’m still gonna do that to you. Yeah. But, but I’m gonna take the pain as well. Okay. And so what we did was we asked chat, G p t, uh, to come up with a list of, what’d you say? What was the prompt? Well
Kristin: [00:38:00] just, you know, medical trivia. Medical trivia questions No. That a hospitalist should know. Oh man. And so he will, is going to answer those questions and you will be presented with medical trivia that an ophthalmologist should know.
And we’re gonna see who can get the most Right. Board
Dr. Ricardo Nulia: certified. Yes. I get that’s how that works. Yes. Okay, good. That’s exactly how
Will: it works. You’ll be double board certified. You’ll the first person in history. Yes. Double certified in
Dr. Ricardo Nulia: internal medicine in ophthalmology hospital. I have a YouTube to prove that I am board certified in ophthalmology.
So I,
Will: so we’ll take turns and we’ll, uh, just, we’ll just go until, and until one of us embarrasses ourselves enough that we have to stop.
Kristin: Yeah. So I have a list of Tenny chair, but I’m not gonna do all 10.
Will: We’re gonna, we’re gonna see, gimme something first. I’m, I’m excited. I, I, I haven’t, I haven’t thought about internal medicine in a while.
Okay. So let’s see what I, let’s see how, how I do here. And I haven’t, by the way, I have not seen any of these. Right. I, so I, I don’t know what she’s gonna ask if [00:39:00] it’s gonna even make sense coming from an AI generated.
Kristin: We’ll find out because I can’t tell either.
Dr. Ricardo Nulia: Awesome. All right. Love it. Okay.
Kristin: I’m love it. I think this might be a softball, so I’ll throw you a softball to start with.
Okay. Okay. Will, what is the purpose of a hospitalist program? Like
Will: what is it that a hospitalist does? I’ll answer that. Yeah. Essentially. Okay. Yeah. A hospitalist is a general internal medicine doctor who, uh, admits patients to the hospital and treats them slash coordinates. All the care for that patient during their hospitalization.
Kristin: Okay. Dr. Delila, how did he do? Is that right?
Dr. Ricardo Nulia: I think that’s pretty good. I struggle. Everybody asks me what a hospitalist does, and I’m like, well, you see, you know, the thing is with hospital medicine, you know, like they
Will: specialize in hospitals. Yeah,
Dr. Ricardo Nulia: yeah. You, you can’t have a [00:40:00] hospitalist without a hospital, but you know.
No, I think you did,
Kristin: you did really well. PT says the purpose of a hospitalist program is to provide specialized medical care to patients who are hospitalized. So it says pretty much the same thing.
Will: Great wonder.
Kristin: Perfect. Okay, so over to you, Dr. Nila. What is the purpose of the retina in the eye?
Dr. Ricardo Nulia: Well, the retina is the, I mean, it’s, it’s basically the brain and it takes the photons and changes them into electrical signals that could be interpreted by different parts of the brain.
That is
Kristin: very good. That is correct. Yes. It says The retina is responsible for detecting light and transmitting visual information to the brain. Perfect.
Will: There you go. That was really
Kristin: good. I’m a word just about Yeah, you did much better than he did on that first question. Yours was harder.
Will: I I did pretty good.
Let’s, let’s, let’s,
Dr. Ricardo Nulia: alright. He was just faster
Kristin: and more, more eloquent.
Will: He was, he was more confident.
Kristin: All right. Okay. Okay. Let’s, let’s say that, um,
Will: I’m trying, I’m not looking at a paper,
Kristin: so I don’t know what’s, some of these [00:41:00] are like, I can’t ask you that because you already know from your personal health
Will: history.
Yeah. Don’t, don’t gimme something. I’ll know. Yeah. Okay. Gimme something that I
Kristin: think of. Uh, what is sepsis and what are some common signs and symptoms?
Will: Oh my God. Back to med school. What is
Dr. Ricardo Nulia: sepsis? Yes. Start there. Sepsis
Will: is when you have an infection that, uh, that causes. Failure of, of like several organ systems.
Um, I’m gonna go with that. Okay. Okay. Uh, there’s like, I know that there’s like sepsis criteria because I’ve like, yeah. I’ve made fun of that in my videos. Oh, yeah? Yeah. Because every, no one, like, it’s like a big like thing with like where you admit the patient and do they, do they like qualify for under sepsis protocol?
Mm-hmm.
Kristin: Okay. So what are, what are some common signs and supports?
Will: What are some common signs? Okay. Like, like [00:42:00] a vital sign problem. So l like hypotension, low blood pressure, um, uh, fever over a certain amount, high, uh, white blood cell count. No, um, that’s true. That sounds, yeah. Uh, and you know, then like organs will stop working.
So, you know, your creatinine will, your kidneys will start failing and you’ll start losing blood flow to things and they shut down. Right.
Kristin: What do you think? Is that,
Dr. Ricardo Nulia: is that correct answer? I think that’s very good. And you know what? If you ask v sepsis criteria, I would probably not get it because of all, cuz of like, all all, but no, it’s, that sounds pretty good.
Like, I mean, sometimes it, it, most of the time it’s triggered by infection, but it, it’s an inflammatory response a lot of
Will: times. Okay. Inflammatory. But I, this, this whole, this process is scratching my brain in a particular way that has an in prescription. It’s make him quite uncomfortable. All right. Let’s go, let’s do the,
Kristin: alright, Dr.
Anita. Mm-hmm. Um, let me [00:43:00] pick one here. Give you, okay. What is a cataract and how is it treated?
Dr. Ricardo Nulia: Cataract is on the cornea. It’s basically scarring of the cornea and it’s treated by excision. Mm, no,
Will: not quite.
Dr. Ricardo Nulia: It’s okay.
Will: It’s, it’s the layers. It’s bad. It’s the
Dr. Ricardo Nulia: lens. Oh, the lens. I knew that you knew it. The rest was correct.
Will: It’s one little word. It’s the layers of the basically writers layer, the corneas that, that front layer. Right. And the lens is inside the eye. But yes, you,
Dr. Ricardo Nulia: you do extract it. You know, usually, usually if that would come up on rounds, I would just look at my resident, just be like, well, what, what is a catter?
Let all, let’s all think about that, you know? But now it’s like my lack of knowledge is on. I will forget it now. I will tell you, there’s,
Will: in no way w should you ever like, be talking about cataracts during, like internal medicine rounds that, that should, that’s like, uh, on the list of problems. That’s very far [00:44:00] down the line.
Yeah. So don’t worry about it.
Kristin: Not urgent generally. That’s right. Yeah. Okay. Will, what is the purpose of a Foley catheter and how is it inserted?
Will: Well, a Foley catheter is, the purpose of it is whenever someone cannot urinate and you need to decompress their bladder, and it might be an extended period of time before they are either conscious or able to, they can be awake, but they’re able to pee on their own.
So you put the catheter, which is a little tube through the urethra, into the bladder. That was an easy one. I’m
Kristin: sorry, I asked. Um, that’s disgusting.
Will: Gimme something harder. Come on. Uh, that’s, that was
Dr. Ricardo Nulia: too much. No, it’s
Kristin: not your turn. It’s not your turn. Okay. Okay. All. Okay. Um, okay. Let’s see. Let’s see. I don’t even know what some of these are.
I’m trying not to give you any that are too hard, but like, I don’t know. Um, okay. What is macular [00:45:00] degeneration and what are some common risk factors?
Dr. Ricardo Nulia: Ooh. Macular degeneration is a harder one. It is, it’s parts of the retina. Sorry. It’s not, is it? Yeah. Parts of the retina start to, the pigment in the, in, in the retina starts to degenerate for different reasons, but you start to see, you start to have blindness in, in certain areas of your, uh, areas of your vision.
Will: Yeah. Your, your, your, your retina atrophies, atrophies, and so yeah, you end up with this kind of de pigmented look, uh, to the retina because you, it’s called, it’s just total atrophy. And so you’re losing the photo receptors. Yeah. And it does that obviously, that part of the retina is not working anymore.
Mm-hmm. So it’s
Kristin: a big blind spot. You lose vision in the center.
Will: Yep. Of it is, that’s right.
Kristin: In the Mac. So you have like donut vision,
Will: uh, the the whole, the donut hole being the in the center. Loss of [00:46:00] the vi. Yes, correct. Exactly. That’s,
Kristin: here you go folks. Donut vision is macular degeneration. It’s
Will: probably the, it kind of makes sense.
Okay.
Kristin: Okay. But wait, common risk factors. Oh, for macular
Will: iGeneration. Expect, I would be very impressed if anybody isn’t. Some
Dr. Ricardo Nulia: of it genetic Yes. Isn’t absolutely. And I mean age is probably look at him. Go.
Will: Those are two, the two biggest ones. Absolutely. Okay. I’m gonna leave it like bathroom.
Kristin: Yeah. Just quit while you’re ahead.
Yeah, it’s good chat. G p t also includes smoking.
Will: Yep. Smoking. We always tell people make sure they’re not smoking. Alright. Yeah,
Kristin: absolutely. Let’s do a couple more. Alright. Will, what is a, oh boy, what is a pneumothorax and what are some common causes? Hope I didn’t butcher that too badly. Yeah,
Will: you did it.
Yeah. Um, okay. A pneumothorax is where, uh, the part of the lung has [00:47:00] collapsed because air has escaped from the lung or from the outside air and is occupying the space between the lung and the pl pleura. Which is like the little, like the case of the lung? Mm-hmm. Like the little, like a little, uh, like, uh, you know, you have like a sausage casing.
Oh, okay. Like that
Dr. Ricardo Nulia: Uhhuh. Yeah. Yeah. That’s good way.
Kristin: Might it be
Will: considered the chest wall? Oh, the Or the chest. Yeah, the chest wall. There you go. That’s good. And the, the cause common causes, I mean, trauma, um, spontaneous. I think I, that’s the thing. Yeah. I think you can have one just Yeah, that’s spontaneous spontaneously.
That’s, and, and like, I don’t know, cancer, there’s like probably a lot of things that could cause a pneumologist. That’s
Kristin: your, that’s your medical professional opinion. A
Will: lot of things. A lot of stuff, yeah. Yeah. Probably a lot of stuff. That’s probably,
Kristin: how did he do Dr. Noela? What are some common causes?
Dr. Ricardo Nulia: [00:48:00] Well, C O P D, you can have labs that once they, uh, once the, the, they break like the, um, I’m, I’m losing the word.
You know, the, uh, the sack break and so like air can go through Oh, gotcha. Through that, you know? But, um, also, yeah, trauma is, is one of the major, major ones also. All right.
Will: Yeah. Okay. I nailed ITish. Do I I don’t sound confident though. No. I, I’m like, I’m, I’m really like a beginning, like third year med student trying to explain Yeah.
I’ve forgotten some of these things, but not being real sure about it. Right. And, and being a
Kristin: afraid gonna was in there one time, but that, it’s a little fuzzy
Dr. Ricardo Nulia: now. I got the, but you, but you, you, you can fish it out well, though. You’re fishing it out. Well, you’re like, it’s like you’re fi you’re like old man in the sea.
Just really like, it’s gonna be fishing
Kristin: it out there. It fights you on the way out, but you get it eventually. All right, let’s give him one more. All right, one more. What is amblyopia and how is it treated? Oh, how
Dr. Ricardo Nulia: am [00:49:00] aop I’m so sorry. That’s, that’s amb because I think about, think to Latin. Yeah. Am it’s.
Amblyopia is, um, we see double. No, that’s diplopia. That’s diplopia. This, this is like
Will: the, Hey, let him have a chance. Okay. No, I feel bad because like,
Dr. Ricardo Nulia: gimme a hint. Gimme a hint.
Will: Yeah. Do you wanna give a hint or should I, the ophthalmologist you
Kristin: should probably give,
Will: um, it’s related to when an eye doesn’t want to
Dr. Ricardo Nulia: work real well, so it’s like, it’s not sinking.
Like the eye is like, basically it should be together from one thing, but, but, but because of a, of a, of a nerve palsy, you know, that’s one reason. Like the movement, it’s, it’s, it’s not sinking. So you can get, well that could be a cost for double vision, right?
Will: It can be. You’re talking about [00:50:00] strabismus in particular.
Okay. Where the eyes aren’t working together. I see. But then strabismus can lead to amblyopia because amblyopia is when your brain. It happens at a very early age, like as a kid. So, see, this isn’t affair because he’s, he’s a, he’s an adult medicine doctor. I know.
Kristin: Well see, I don’t know which ones are hard or not hard.
Will: Nobody knows anything about amblyopia, so that’s where your brain doesn’t develop the normal vision out of an eye. Oh, okay. And so, you know, that’s, it’s,
Kristin: you’re going a little deeper than Chad, g p t here. Come on Jess. G p t. It says, okay,
Will: get it together. You should have asked him about, I see that you should have asked him about presbyopia.
He could probably get presbyopia.
Kristin: Well, okay. Amblyopia also known as lazy eye. Ah, yeah, yeah, yeah. Is a condition in which one eye is weaker than the other, causing poor vision. It can be treated with eyeglasses, eye patches, or vision therapy.
Dr. Ricardo Nulia: Ah, yeah. Got it. All right. We’ll, okay. I gotta
Kristin: get, last question. Oh, do I get, I get one more for you?
Yep. Yep. Okay. All because now I have to give you a really hard [00:51:00] one. But again, I have no, how are you gonna,
Will: way to, how are you gonna know? You have not heard any of these words?
Kristin: I have two. Okay. Um. Some of these I do know will be too easy for you, so I’m, I’m trying to skip over those. Yeah, so I think the only one I, I have available to me right now is what is A D V T and what are some common risk factors?
Oh no, it’s too easy, isn’t it? I got it. Okay.
Will: Deep vein thrombosis, that’s it. It’s a thrombo in the deep veins, and that is, it’s uh, like a blood clot you get in your legs and it can go other places where you don’t want it. Okay. Risk factors, uh, like blood clotting disorders where you, you just, you know, that seems like clot the blood too much.
Like, you know, that’s, uh, the classic one that the board exam question would be like, uh, a young woman on, uh, birth control who’s smoking mm-hmm. Mm-hmm. And develops blood clots [00:52:00] that Okay. That go places to give you like, Embolism and stuff. All right. I’m tired. Let’s, I don’t wanna do No, no, we have to do
Kristin: one more.
We have to do one more, but it’s gonna be an improv one. Oh, Dr. Nila. Just to even things out, cuz I feel bad. Toss him your hardest body medicine question. Okay. And let’s
Dr. Ricardo Nulia: see what he can do. Medicine question. Oh gosh. As
Kristin: far away from the nasal bridge as you can manage.
Dr. Ricardo Nulia: Oh man. Um, what is, let’s see. Um, I have to think about, what was the
Will: question you gave one of your trainees?
Yeah. Like a board question or on
Dr. Ricardo Nulia: rounds? Step one. Okay. Um, what, what is the, uh, what don’t you see? What, what feature do you not see on an EKG that you normally see on an EKG in atrial fibrillation? What part of the whole Q
Will: Qs complex? Yeah. Yeah. The uh, um, Yeah, you don’t, uh, [00:53:00] you don’t see PWAs.
Dr. Ricardo Nulia: There you go.
Hey, nice. Love it. Look at that look done giving me Well done. I’m so proud of
Will: myself. Yeah, there you go. That’s a smu. You deserve it. I, you know, as I think, uh, I think both of us are board certified in each other’s specialty now. I think so. So, uh, somebody alert the boards that we may be practicing outside,
Kristin: but you would’ve to go into a hospital to do his.
That’s
Will: true. We won’t do that. All right. That was great. Thank you. Let’s, let’s take another quick break and we’ll be right back.
All right, we are back. Let’s take a look at some of our favorite medical stories sent in by you, the listeners. We also have, uh, Dr. Noela here, who’s gonna, uh, you know, react to these with us. So we have, uh, a story from Anastasia. Anastasia says, I work at a wolf rescue, and it was vet day. Woo. We see a lady, a wolf rescue.
That’s right. Which I wasn’t aware that, I mean, I assume there’s gotta be a rescue for probably every animal on earth, but, uh, we see a [00:54:00] lady in scrubs arrive and assume that’s her. We go up to her under the assumption, this is a vet, this is a veterinarian, and ask, do you have a muzzle with you? She says, no, and we keep chatting.
Kristin: I feel like my muzzle is an important piece of, of wolf rescue life.
Will: Then she is, then she asks, oh, are, are, are these all wolves? Odds, but, you know, maybe a miscommunication with whoever told her she was coming. After a minute, we realized that she is a traveling nurse for an elderly patient who lives on the site.
Oh. Oh. And we just casually walked up to a human nurse and asked if she had a muscle, a muscle, and she just went with it. I can’t imagine what was going through her head, but we all had a good laugh about it. Oh
Dr. Ricardo Nulia: no. That is funny.
Kristin: I’ll just, well, you see all kinds of things in healthcare, so I guess you doesn’t phase you if you’re asked for a muzzle
Dr. Ricardo Nulia: people these days.
People. That’s right. All [00:55:00] right, well,
Will: uh, oh, that’s funny. Yeah. Uh, send us your stories. Knock, knock high@humancontent.com. Uh, Dr. Noela, thank you so much for, for joining us. Uh, it’s been a pleasure talking with you. Let us people know where they can find you. Tell us about your book. We wanna hear about that.
Yeah,
Dr. Ricardo Nulia: so the book. It is the People’s Hospital hope in peril In American medicine, uh, it’s it’s about five Houstonians who can’t access healthcare for all the routine Texas reasons. They’re either underinsured, uninsured, or they’ve been kicked off of Medicaid and they’re struggling to find their, uh, you know, they’re struggling to find care and they make their way to the public health figure system where I work.
Ben-Zvi and their stories are woven in with a history of how private health insurance became the point of entry into American healthcare with how hospitals became for-profit versus nonprofit versus, um, you know, what [00:56:00] are public hospitals. Also, with the history of how healthy for service, uh, took off in the United States, that it’s.
My, you know, my way of arguing that public healthcare can be something that we can be proud of in the United States. It can be something that can address both of these big problems that we have. We want universal healthcare access, but we also want to control costs. So we have to think about other ways to do that.
And I think that public healthcare is actually one of the ways, and, and I take my, the, the system where I’ve worked is an example of how it can succeed in, in, um, in, in the United States. It’s a fantastic, super interesting,
Will: and, uh, so I definitely encourage everyone, uh, to check it out. Lots of good stuff in there.
So thank you so much again for being here.
Kristin: Uh, and where can people find you?
Dr. Ricardo Nulia: They wanna hear more, can find me on my, uh, uh, I have my website, ricardo nua.com. Um, the book is available anywhere where you can find books. Uh, it’s published by Scribner and you can find it on. Amazon Indie books, [00:57:00] orange and Noble.
And, uh, I, I just, you can also look me up. I just had an op-ed in the New York Times and, and there’s a segment of this book that’s on the New Yorkers website. Um, just, just Google me. Awesome. Find me. Right. Great. Well good luck
Will: to you. Thank
Dr. Ricardo Nulia: you joining so much, and I appreciate all of what y’all are doing.
Y’all are wonderful. I appreciate it. Oh, thanks. All right. Take care. Bye-bye.
Will: That was a great
Kristin: conversation. Yeah, he’s got some super interesting work that
Will: he’s doing. That Ben Top Hospital, like honestly, that book, the, is what an Interesting Edge is a fascinating place to work. I was wondering like how many hospitals are like that out there? Yeah, because they’re, you know, the safety net hospital I’m sure for every major city and metro area probably has one, but maybe, I mean, Houston is just a massive, massive place and so, uh, I don’t know, it’d be a.
I’d love to hear, uh, stories from other similar types of [00:58:00] hospitals and how they, what the similarities
Kristin: between them. Yeah. If any of you listeners work at a hospital like that, let us know and share some stories if you can.
Will: Absolutely. You’re sitting on a gold mine of stories that’s right at, at, at all these, uh, say a public, uh, safety and safety net hospital.
So, uh, thank you also for sending in your stories. Uh, we love reading those on the show. Uh, so please, you know, let us know. Hit us up. There’s lots of ways to reach out. You can email us, knock knock high@human-content.com. Uh, we’re all over social media. Uh, we’re on Instagram, TikTok, uh, Twitter, YouTube, and uh, you also hang out with us and our Human Content Podcast family on Instagram and TikTok at Human Content Pods.
Thanks to all the listeners who are leaving. Wonderful 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, isu Imple on [00:59:00] Apple. Imple on Apple said the husband and wife team keep the pace moving. Fascinating stories and guess well worth the listen.
Give ’em a try. Uh, it, it, it’s, it keeps moving because Kristen keeps me moving. That’s true. I she doesn’t let me perseverate on anything that’s,
Kristin: I get bored easily. So you gotta you gotta
Will: keep a quick face. Exactly. Yeah. It’s, I really appreciate that. For, for, for this podcast, uh, we’re also all full video episodes or up every week on my YouTube channel at D Glock Flecking.
We also have a Patreon with lots of cool perks, bonus episodes where we react to medical shows and movies. Uh, come hang out with other members of the Knock-knock High community. Uh, we are there and we wanna see you there. Alright, come join us early ad free episode Access Interactive q and a livestream events a lot more.
That we’ll come up with as we go. Uh, patreon.com/glock flein, or go to glock flein.com. Speaking of Patreon, community Perks, shout out to all the [01:00:00] Jonathans out there. Patrick, Lucia, C Sharon, s Omer, Edward, k Abby, h Steven G Ros Box, Jonathan f Marion W Mr. Granddaddy Caitlin c Brianna, l Dr. J Cha w. Thank you all.
A virtual Jonathan Head nod to you all. Patreon roulette for the random Emergency Medicine Tear Patron, uh, that we will give a shout out to now. Joyce o Thank you Joyce. O for I I said that way too loud. You yelled it. Or Joyce, I’m sorry for everyone’s, uh, ears, but Joyce o thank you for being a patron and thank you all for listening.
We are your host Will and Kristen Flannery. AK the Glock Flans. Special thanks to our guest today, Dr. Ricardo Noela. Our executive producers are Will Flannery, Kristen Flannery, Aron Korney, Rob Goldman, Ashanti Brooke. Our editor and engineer is Jason Porto. Our music is by Omer Ben-Zvi. To learn about our NUN Highs program, disclaimer and ethics policy [01:01:00] submission verification, licensing terms and HIPAA release terms, you can go to glock flecking.com or reach out to us at Human at hu at knock-knock high human-content.com with any questions, concerns, or fun medical puns.
I tried to,
Dr. Ricardo Nulia: you
Kristin: always say that word with utmost disdain
Will: and not a pun, guy, I don’t do a lot of puns. Knock-knock High is a human content production.
