Transcript

Will: [00:00:00] 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 the physician be more efficient and reduce clinical documentation burden. It’s great to learn more about how DAX copilot can help reduce burnout and restore the joy of practicing medicine.

Stick around after the episode or visit Nuance. com slash discover DAX. That’s N U A N C E. com slash discover DAX.

Alright! 

Kristin: Hello! 

Will: Welcome everybody! Thank you for being here! This 

Kristin: is awesome! Look at you guys, you’re so pretty! Knock 

Will: Knock High Live! We got a unicorn right here. Look at this, this 

Singers: is good. Yay! Where 

Will: are the bike helmets? [00:01:00] Oh, we got one back there! Alright. Alright, and any surgeons in the crowd? Pediatric surgeon?

Ortho. 

Kristin: Wow. Are you an overachiever? 

Will: You’re just pretending to be a pediatrician? Pediatric orth Okay, I guess that is the thing. You’re trying to combine all the things in medicine into one. She’s 

Kristin: much smarter than you.

Will: So, we’re supposed to introduce ourselves. It would be weird if people in here didn’t know who we were. Yeah, for anyone who 

Kristin: walked in on the street. Why are you here 

Will: if you don’t, if you, yeah, you’re probably very confused right now. But I am Dr. Glockenflecken, also known as Will Flannery. 

Kristin: I am Lady Glockenflecken, Kristen Flannery.

Will: Did you guys plan that? 

Kristin: That was I bribed them. 

Will: That’s quite a bit of applause there. So, uh, do you remember, Kristen, do you remember what I told you when we first started dating? I do. 

Kristin: Uh, [00:02:00] I remember that you wouldn’t, uh, take no for an answer, which doesn’t age well. Okay, 

Will: that’s not a great place to start with this show.

But, uh, no, I said, I said, if you marry me someday, someday people will pay to listen to us talk to each other. 

Kristin: Yeah, you did say that. 

Will: I didn’t say that, but it’s true. So, anyway, I want to say thank you all for being here. This is, uh, we’re so excited about this. We got a great show. Uh, we are doing a Medical Eras show.

So, yeah. 

Kristin: Thank you. 

Will: So, uh, we saw the success of Taylor Swift. 

Kristin: We thought we could do that. 

Will: She’s a pop singer. And, um, and we’re like, well, you know, she made, uh, So like a billion dollars? Yeah. And so maybe we can make a billion dollars. I 

Kristin: would like to have a billion dollars, that’d be fine. 

Will: And so we’re like, let’s do a [00:03:00] medical eras show.

The first time I actually announced the show on social media there was somebody who’s like, you know, Taylor Swift is very litigious. 

Kristin: You should change that name. 

Will: You should change that name. I was like, well, you know, if they come after an internet comedian ophthalmologist, um, Pretending to be 

Kristin: Taylor Swift.

Will: I’d be impressed. I’d be impressed by that. So, uh, but it’s medical errors, right? So we have, uh, for you today, a newly matched med student that we’re going to talk to. Yeah, very exciting. Match day, last week. Uh, we also have a resident. And an attending, alright? And so, um, it’s 

Kristin: How many medical students do we have here in the crowd?

Anybody? Alright! Okay, okay. Residents? A few. Most of them are at work. That’s fine. Attendings? Yeah! 

Will: Whoa! Alright. And how many people have no connection to medicine whatsoever? 

Singers: Woo! 

Will: We got a couple of you, alright. Well, thank you for coming along, you know. [00:04:00] I make shorts on TikTok. I dress up as different specialties and record myself alone in my bedroom.

Watch out, she says 

Kristin: that’s what marriage is. I say watch out, you might end up on the stage. 

Will: Alright, so, um, should we get to our first guest? 

Kristin: Yeah, let’s do it. Let’s do 

Will: it. So our first guest is a fourth year med student at the California University of Science and Medicine in San Bernardino. Bernardino.

Bernardino. See, normally when we record this, we can like, edit things. We’re not able to do that, so, so I’m gonna do my best to not trip over my words. So, uh, our first guest, Tanya Alam, uh, newly matched into pediatrics. Pediatrics. Yeah! So when she comes down here, uh, we gotta give a huge round of applause because, like, she matched into her first choice.

Like, last Friday! Residency program. Nice! Yes! So let’s 

Singers: bring her out, Tanya! Woohoo!

Will: [00:05:00] Alright, have a seat here. So, uh, you’re probably still just, like, glowing from the match, right? Like, it’s Are you in this like post match haze, like just pure happiness, or is it set in yet that you’re actually going to have to like do residency? 

Tanya Alam: Um, you know, it still doesn’t really feel real. Um, yesterday I met my co interns, that feels so weird to say, for the first time.

Um, and they, yeah, you know, they referred to me as an intern and I was like, mmm, that’s not right. No, I’m a, I’m a medical student. I will always be a medical student. Um, no, but it’s just like, you know. Am I excited? Yes, but at the same time it doesn’t feel real, so I don’t, it just, it just feels crazy. I wonder 

Will: when it will start to feel real.

Maybe that first overnight shift in intern year. 

Tanya Alam: Maybe when they hand me the list on the first day and it’s 25 patients. 

Will: So did you, for match day, was it all the students in one room and you all at the same time opened up the envelope? 

Tanya Alam: Yeah, so my [00:06:00] school, um, did a ceremony in the courtyard, uh, where we all got there, you know, we were supposed to get there 15 minutes before 9 a.

m. And, um, we picked up our envelopes and then we got to stand there holding our destinies in our hands while we waited for it to become 9 a. m. Um, and then at 8. 58, um, and, um, The NRMP sent out the match results early by mistake. And so we all had to make sure we didn’t look at the envelope, or the email, to spoil it.

And then, um, yeah, 9am, we did a countdown, we ripped open the envelopes, and 

Will: All at the same time. 

Tanya Alam: All at the same time. And there was lots of screaming. Um, I was definitely screaming. Uh, I didn’t hear anybody else screaming. But when I watched my video later, I could hear everybody else screaming. Um, yeah.

Will: You know what we did in my, in my, uh, at my med school, is we We did it one student at a time. 

Kristin: Down to the front of the room. There was a 

Will: huge auditorium, and, cause there, I was at Dartmouth, so it was a relatively small class, like 70 of us. And, uh, and one at a time, we all went to the front, in front of everybody, and opened the envelope, and [00:07:00] read what it was on.

It was terrifying for a lot of people. I mean, I was an ophthalmologist, so I matched a little bit earlier, but 

Kristin: But you all had to select a song, too, to walk down to. So there was like a whole thing. That’s true. Like, you had to choose like a representative song for 

Will: yourselves. Yeah, we had, we had like walk in music.

Tanya Alam: That is so much pressure. To the microphone. On the morning of match day, I couldn’t even decide what socks to wear. There’s no way I could have done it. 

Will: Yeah, I couldn’t, I couldn’t think of a song. Well, why don’t you 

Tanya Alam: tell 

Kristin: everybody what your song was? 

Will: I, I recorded myself narrating myself walking to the microphone.

By that 

Kristin: point it was too late for me, but save yourselves. 

Will: It was like, it was like, Will’s coming down the hall, the, the aisle. Yeah, passing by, he’s going up to the mic. It was, in hindsight it probably wasn’t as funny as I thought it was, but I really enjoyed it. 

Kristin: I think it was foreshadowing. I think it said a lot about what was to come.

Will: But I have something for you. Because, uh, the NRMP actually sent a letter, knew you were gonna be here tonight. 

Tanya Alam: Oh, really? 

Will: Yes, so you actually have another envelope to open. [00:08:00] 

Tanya Alam: Another one? Sometimes they do this. I 

Will: didn’t know, apparently, cause the word got out, I guess you’re gonna be here. So, if you could, here, I’ll take, hold your microphone.

Alright. If you could just open that. Uh, I don’t know what’s in it, I don’t know what it is, uh, but it’s from the NRMP, that’s all I know. I’m almost as nervous as the 

Kristin: first time. You need to sing your song for her while she’s opening this. She’s opening up the 

Will: letter. There she goes. There you go, you can read that into the microphone.

Tanya Alam: Alright. Dear Tanya, congratulations on your successful match. During our routine quality control process, it has come to our attention that your match was incorrect. You have chosen the wrong specialty. We have taken the liberty to choose the correct specialty for you. You will now be an ophthalmology resident.

Congratulations! Studies have shown that ophthalmology is better than whatever it was that you decided to do. No No need to thank us. The look of happiness on your face is thanks enough. Enjoy your future career in ophthalmology. [00:09:00] Sincerely, N. R. M. P. President. P. S. Thank you for applying to so many programs this year.

Holiday bonuses will be very generous. That’s actually really hilarious because I applied to the maximum number of programs. See, 

Kristin: it’s from them. It’s official. 

Will: Wow, well, congratulations on your future career in ophthalmology. I didn’t know they did that. That’s so strange. 

Tanya Alam: I didn’t know either. I thought that, you know, they wanted to know every single detail about everything that I’ve done from birth until now to decide if I was worthy of such a specialty, but 

Will: I do have to ask you, did you ever consider ophthalmology?

Tanya Alam: Did you ever see an eyeball 

Kristin: in medical school, 

Tanya Alam: is 

Kristin: the better 

Tanya Alam: question. I actually saw an eyeball. When I was in my, I was a pre med student and I took a gap year, uh, where I was working in research at the hospital where I’m going to be doing my residency. Um, and while I was there, uh, I worked, uh, with the biobank.

So we would go to surgeries and we would collect tissue, um, to be distributed for research. And I went [00:10:00] to the OR and collected an eyeball one time. 

Will: So it was just one eyeball. It was just one eyeball floating in a little 

Tanya Alam: pea cup, you know? Yeah. And I, a lot of 

Will: doctors will just examine one eyeball. They forget that there’s a second one.

But anyway, so this was, this was like an individual eyeball. Yeah, it was an individual. 

Tanya Alam: Not attached to a person. Yeah, it was just kind of floating in the cup. Um, it didn’t look real. It, you know, kind of looked like a holiday prop. That’s the wrong 

Kristin: kind of ball for a pea cup. Yeah, you’re 

Tanya Alam: right, you’re right.

Will: And, and somehow that, that experience did not convince you that you wanted to do a career in ophthalmology? 

Tanya Alam: I mean, I wish that it was the coolest thing that I had ever seen in my entire life, but unfortunately it was not . 

Will: So you, you, you inter, you applied to do two different specialties though, right? As a, tell us about that.

’cause that’s, that’s a lot of, so wait, wait, 

Kristin: wait. So you didn’t know. Where you would match, but you also didn’t know what you would match in that’s correct. Yeah, that sounds like Like the deepest level of Dante’s hell. Why did you do that? Yeah, 

Tanya Alam: it was very um, [00:11:00] I didn’t realize how Nerve wracking it will be until I was in that week where you know, it was coming up and I was like, oh my god What am I gonna do with the rest of my life?

but um, I decided to I do applied in pediatrics and family medicine and I decided to do that because um I have a very strong geographical preference. My family is here. They’re my main support system. There’s no way that I would be able to be successful if I was so, so far away from them. Well, maybe, but it would be very hard.

And so I really wanted to make sure that I was able to stay close. And so for that reason, I applied in two specialties. And I chose those two because I really felt like I could be happy in either one. I’m kind of passionate about primary care. You know, I think that in a perfect world, um, primary care would be so great that we wouldn’t need any specialists, right?

Because the primary care and the preventative care would be so awesome that nobody would ever get sick. I’m 

Will: sitting right here. It’s okay. I, I agree with a lot of what you’re saying here. 

Tanya Alam: Yeah, so, um, so I chose both of those specialties, um, because I felt like I could be happy in either one. [00:12:00] Okay, all right.

Will: But then you ended up at your number one, right? 

Tanya Alam: I did, yes. And that was, um, Um, I don’t know if you got a chance to watch my match reaction video, but it was kind of intense. 

Will: Had a lot of views on TikTok. 

Tanya Alam: Yeah, it was the I didn’t think I was gonna go viral. Top of your CV now, right? Number one, 30, 000 views on TikTok.

Number two, medical student at Right. 

Will: That’s the thing with Match Day and Really, Match Day and Graduation, there’s just the happiness and just the joy of, is, is, it’s so much fun to be around. And so you got all the love in the world from people, right, from, from PostNet, so I’m glad you did that. Um, that being said, I want to talk about what you’re afraid of 

Tanya Alam: going 

Will: forward, okay?

We’re actually gonna do this together. 

Tanya Alam: Okay. 

Will: So, I asked you to come up with, uh, three fears that you have. 

Singers: Mm hmm. 

Will: for, uh, your future career in medicine. And I, as someone who’s already been in practice for 

Kristin: a number of 

Will: years, uh, [00:13:00] I have come up with three fears that I have for my future career as well.

Alright, so, want to go through these? 

Tanya Alam: Sure, let’s do it. 

Will: Why don’t you start? 

Tanya Alam: Okay. Um, well, if you had asked me this question two weeks ago, my answer would have been so different. I would have been like, well, maybe I won’t match. Maybe I’ll never get a job, maybe I will be poor for the rest of my life because I have all of this debt and I have no way to pay it off, you know, um, two weeks ago.

Uh, but, for a little bit of context, you know, medical school is very challenging for me in a lot of ways. I had a lot of personal difficulties that came up, um, that led to academic difficulties. I ended up needing to take a gap year that I was I was so terrified about having to explain to program directors that I took a gap year, like, so scary.

Oh, no, you’re actually 

Kristin: a human being. 

Will: Like, God forbid you do other things in your life. I know, right? 

Tanya Alam: But, I mean, maybe God doesn’t forbid it, but some program directors do. Yeah. And they think they’re God, so, same thing. Yeah, and so, but yeah, you know, and so it was, it was [00:14:00] tough to get, you know, But then, it ended up turning out that, you know, as you mentioned, I did match in my number one program.

Um, so in terms of fears, it kind of feels like I’ll be okay, because I made it out of what I thought was the worst situation in my whole life, and now I’m fine, you know? Um, so I kind of feel like it’ll be okay, uh, but that being said, maybe one thing that I’m afraid of is, you know, I know it’ll turn out okay, but maybe, like, being miserable again?

Because I was miserable for a little while, and it really sucked. Um, I’m not really looking forward to, you know, looking out the window of the hospital at my friends partying on the street outside. I’m trapped in here, you know? Um, but 

Will: I don’t think anybody in medicine is miserable these days. Nobody?

Tanya Alam: Really? 

Will: Right? You guys? 

Tanya Alam: That’s crazy. Right? It’s 

Will: fine. So we’re all doing fine. It’s 

Tanya Alam: great. 

Kristin: Ha, ha, ha. 

Will: Protect the 

Kristin: children. 

Will: I think a lot of people can, can empathize with you on that, on that fear. Um, okay, can I share one of mine? Yeah, go for it. Okay, [00:15:00] uh, so, uh, inpatient consults.

Kristin: I’ve seen him have to do one of those. He wet his pants a little. I, 

Will: I think, I think you went a little, like, bigger picture than me. Which is fine, um, but yeah, I, I don’t, I don’t. I really try. In fact, you know, if you ever see, those of you who work in hospitals, if you ever see somebody in there who’s like, dressed kind of nicely, carrying luggage.

Like, right? That’s an ophthalmologist. So, if you could, just like, please. Figure out where they’re trying to go and just help them out. That person is hopelessly lost and a little scared. So that’s, that’s one of my fears is, is inpatient consults. 

Tanya Alam: I will make sure when I’m in the inpatient wards and I have my first ophthalmology, pediatric ophthalmology patient, I will put in the consult with you.

You 

Will: know, we do have a lot of overlap, but I, I’d appreciate you not doing that. Yeah. [00:16:00] Is it, uh, what do you like more, the outpatient or the inpatient? Inpatient. What kind of speaks to you more? You 

Tanya Alam: know, that’s a really great question. Um, when I do inpatient, I really enjoy the like, medicine part, but when I do outpatient, I really enjoy that I get to have a life.

So, you know, it, it really kind of, I think I like them both. 

Will: Oh, good, good. Okay, what else do you have? What are your other fears? 

Tanya Alam: Um, the second one, um, this is also kind of pretty big picture. Um, it’s not directly medicine, but it’s definitely related to medicine. I am terrified. That the government will end public service loan forgiveness within the next 10 years and I will have to pay all of this debt back on my own.

Terrified. 

Kristin: Yeah. What would that be like? Do you think they’re watching this right now? 

Will: What, um, how many people here have done the public service loan forgiveness? Do we have anybody that successfully completed the process? You’re in the process? Yes. It’s in the promis. [00:17:00] They can’t get rid of it. There you go.

Tanya Alam: Nothing to be afraid of. 

Will: We’re right. We’re we’re, we’re helping you out. This is, 

Tanya Alam: this is, thank you. 

Will: This is wellness. You guys. Yeah, this is good. 

Kristin: It’s therapeutic. Thank you. 

Will: Yeah. I, I, I I love those when I, how 

Kristin: come you didn’t do that? 

Will: Because I chose to, to refinance. Because you didn’t live family. That’s probably why.

Yes. That’s part of it. She says, 

Tanya Alam: that was my money. 

Will: Um, well even if you end up not being able to do it, like, you’ll, you’ll, it might take you until after you’re dead, but you’ll get there. You’ll, it’ll be fine. And eventually, the loans die with you. That’s the most important thing. We did ask 

Kristin: that before we got married.

I’m not kidding you. That was actually 

Will: very, very reassuring to us. 

Kristin: That the loans died. It’s like, 

Singers: Kristen, Kristen. 

Will: I had to get a loan to pay for your wedding ring. I’m But the loan dies with me. It’s okay. Despite knowing that, she still saved my life, you guys. 

Kristin: I did. I had an easy out, and I didn’t take it.

Absolutely. 

Will: Absolutely. Okay. [00:18:00] Alright, so, my second one, um, is, uh, Cause I can’t remember it. Oh, yeah. Responding to in flight medical emergencies.

Terrified. Has anyone 

Kristin: had to do that? Yeah? Oh, a few. What, 

Will: what happened? Here, sit that mic over there. Yeah, yeah, yeah. I want to hear, I want to hear an experience of responding to an in flight medical emergency. 

Tanya Alam: Story time. 

Audience Member: Okay, so it was a flight from Heathrow to New York. We had just taken off. Keep talking.

Someone had been, someone had been like sprinted for the plane. We got stuck on the runway for a long time before we took off. And then as we took off they became very unwell and fainted and had a seizure in their seat. Um, and so they put out a call for a doctor. I turned up wearing a Vampire Weekend t shirt.

What do you do? What kind of doctor are you? I was in ICU anesthesia doctor in London. Oh my god. Well 

Kristin: that [00:19:00] person got very lucky. And 

Audience Member: I was just like, you know, at the end of the day this guy’s not dead, he’s fine. He’s probably just vasovagal and needs some fluids. Let’s put him on the ground, he’ll be fine.

And after a little while they’re like, We called our insurance broker and we have to divert the plane back to London because even though he’s medically fine, we’re not willing to take the risk of the insurance. Oh. 

Kristin: Figures. Yeah. 

Audience Member: So, you know, it is what it is. 

Kristin: Well good job to you though. Yeah 

Audience Member: Maybe maybe it was a vampire weekend t shirt and the and the sleep mask that looked like wayfarers that made them think they shouldn’t trust this guy Man, 

Will: ICU Anesthesiologists, uh, can you imagine if it?

Oh 

Kristin: Some strong feelings about that. Fantastic. 

Will: Yeah, sounds like you’re just really letting loose tonight. That’s good Your job sounds stressful. So I’m glad you’re here. Yes um Yeah, if that was me, like, so I just actually saw a post on social media, someone was talking about their experience responding to an in flight medical, this was like earlier today, and, [00:20:00] uh, they were talking about, it was an anesthesiologist, They were talking about, um, how they had to start an IV and there were only, uh, there were only 22 gauge IVs available and there were only two of them and, and, and then they had to like fashion a, like, one IV, ICU, ICU?

Kristin: He can’t even say the acronym, he doesn’t know anymore. IV 

Will: fluid bag, they had to hang it and I was like, what, like, I would just go up to that person and be like, uh, are you wearing contact lenses, sir? Like, what do I, like, I, there’s no way I do any of that stuff. 

Kristin: May I introduce you to my wife? 

Will: Yeah, like she thought made me go into medical school like she’d get all this extra like expertise about everything in medicine That’s not the case.

Kristin: I would have rather married a nurse. That would have been a more useful 

Will: Would have been more helpful 

Tanya Alam: I Actually have a story that relates to this as well Um, I was a third year medical student fresh out of my emergency medicine rotation and I was on a plane And they came on [00:21:00] the plane, or on the overhead, and they said, Is there a doctor on board?

And I’m sitting there in my chair going, God, I hope there’s a doctor on board. I hope there’s a doctor on board. But I’m like looking around and nobody’s standing up. And I was like, well, should I stand up? Because like, maybe I know more than the average person, but also I could kill this person. So what should I do?

So I’m sitting there and I’m looking around. But your lungs are with 

Kristin: you, so it will be okay. 

Tanya Alam: And so I’m like, okay, if nobody stands up in the next five seconds, I’ll stand up. And I’m like, fine. And then somebody stands up and he’s like, I’m a doctor. And I’m like, oh, thank God. And I didn’t have to save anybody’s life that day.

Will: You and I reacted the exact same way. That’s exactly what I would have done. Okay, what’s your, what’s your final, what’s your third one? 

Tanya Alam: Um, my third one, we’re gonna go maybe a little bit more sentimental. Um, so, So, a little bit of context, I’m a first generation American and first in my family to pursue a career in medicine.

Um, and so, you know, I have had a lot of support behind the scenes. Primarily from my parents, um, also from, you know, my siblings and the rest of my family. [00:22:00] Where even though they didn’t really understand a lot of what I was getting myself into, Um, you know, they always wanted, like they always supported me without any questions.

Um, and so, I really hope, one of my, you know, goals is to be able to finish this horrible process and then be able to give back to them and share with them. And so one of my fears, because my parents are a little older, is that the time is gonna run 

Kristin: out. You’re a better person than us. 

Will: That’s, that’s really, that’s really thoughtful.

And I hope that everything works out. 

Kristin: Me too. Trying to go as fast as I can. And let me tell you, I can tell you, we’re parents. So, so I know, as a mother, you’ve already done it. You’ve already done it. They’re so proud of you. 

Will: God, man, why didn’t I think of that? 

Kristin: Why? 

Will: She’s, she’s so good. Anyway, um, well now I feel silly saying my third fear.

I, I should have gone first. You can 

Tanya Alam: change it, it’s okay. [00:23:00] No, no, no, 

Will: that’s okay. We’re already in it. Okay, so my God, this is so stupid. My third fear is walking in the woods and I’m not paying attention and a branch hits me in the eye. And it gives me an open globe. And then I, because it’s a, like a vegetable matter injury, it gets in my eye and gives me fungal endophthalmitis.

And then I lose my eye. And when you have that kind of injury, it increases the risk of sympathetic ophthalmia, which is when you could have a severe inflammatory reaction in the fellow eye that can cause you to lose that eye and I go completely blind. 

Tanya Alam: Aren’t you an ophthalmologist? You should be able to fix that.

Will: It’s really hard to fix. 

Kristin: He just wanted to show you that he does know some medicine.

Will: Does anybody else have that fear? Just me? Okay. All right. Well, anyway, um, That’s why I felt silly. It’s in minor for you, but 

Singers: think about it from 

Will: time [00:24:00] to time. Okay, so, um, I have three real quick things for you. We’re gonna do it on a scale from one to ten. That’s what this game is called. On a scale from one to ten, I’m gonna give you three things, and you just tell me.

Singers: On 

Will: a scale from one to ten, how much did my videos influence your specialty choice?

Tanya Alam: Four. Oh, okay. Not bad. I told you I chose pediatrics and family medicine, and I was really inspired by how your family medicine character just said they would take anybody. It made me feel like I had a spot. Hey! 

Will: You know, I love hearing that actually. That’s really nice because the most pushback I get is on the family medicine portrayal.

Yeah. Like every time I put a family medicine video out there, like I’ll get some family medicine doctors like, you know, you’re making students not want to do the family medicine. 

Tanya Alam: Oh no, that absolutely convinced me. We’ll just send them to you next time. Yeah, exactly. Okay, 

Will: next one. On a scale from one to [00:25:00] ten, how much student loan debt are you in?

Tanya Alam: Fifteen. 

Will: Okay, alright, so above ten. Alright, there we go. On a scale from one to ten, what is the value of hemoglobin that requires transfusion? 

Tanya Alam: Woo! That was quick! 

Will: Is that right? That’s right? Is that 

Tanya Alam: right? Yeah. 

Will: There you go. Oh, you did learn a thing or two in med school. She verified, yeah. Look at that.

Alright, so, uh, before you go, um, we’re gonna have you do one more thing. Um. 

Tanya Alam: Okay. 

Will: Let’s see. Actually, two, yeah, two more things, real quick. So, I want, do you see this, this poster board here? Now, this is gonna make sense to everyone later. Uh, I want you to draw a nephron. Okay.

Kristin: You’re at peak smartness right now, so if you can’t do it now, you never will. 

Will: Draw a nephron, please. Make it big so everyone can see. 

Kristin: No pressure. 

Will: Draw a big nephron. Okay. 

Kristin: [00:26:00] Alright, alright. 

Will: I know what that is. That’s the glomerulus. 

Tanya Alam: That’s what I was thinking it was. 

Will: That’s good. Keep going. 

Tanya Alam: There’s more? Oh, oh, 

Will: oh.

That’s a good, you know what, that, that’s actually, that’s a good start. 

Kristin: Oh, oh, oh, oh. There’s, there’s, there’s. Oh, there you go, getting some help from 

Tanya Alam: the audience. Good, good, good. Other way? It’s an upside down nephron. It’s an upside down nephron. Like this? Yeah. 

Singers: It 

Tanya Alam: goes down then up, 

Kristin: right? So, oh, oh, you’re running out of room.

Upside down. There we go. 

Will: Okay. 

Tanya Alam: Alright, alright. 

Will: Is there more? That’s okay. I give you a pass on that. Thank 

Tanya Alam: you. That’s what I got in medical school. You got a 

Will: pass. You got a pass. Okay. And then the final thing. Kristen, I’m going to need you to help me out here. Because we’re obviously not going to see you before you graduate.

Uh, we’re gonna do a little graduation ceremony here. 

Kristin: Okay. [00:27:00] Dun, dunna dun, dun, dun, dun Dun, dun, dun, dun, dun 

Will: Congratulations so much. Thank you for being here. Yeah. 

Tanya Alam: Thank you so much for having me. Absolutely. Yeah, 

Will: yeah. Alright. I’ve got a whole closet full of those unicorn headbands. Believe it or not, people send me those.

Kristin: I know, I live with you. I get those in the mail. I check the mail.

Will: Hey, Kristen. 

Kristin: Yeah. 

Will: AI tools are everywhere now. 

Kristin: That is true. And they’re here to stay. That’s 

Will: right. Well, have you heard about Precision? 

Kristin: What is it? This is 

Will: great. This is the first ever EHR integrated infectious disease AI platform. 

Kristin: Ooh, that sounds useful. Infectious disease. 

Will: It’s a hard field. You got to figure out when to start antibiotics and [00:28:00] try to decrease resistance and how long to keep the patient, it’s, it’s really tough.

Singers: Yeah, well, 

Will: this is a, an AI tool that automatically highlights better antibiotic regimens. It empowers clinicians to save more lives while reducing their burnout. To see a demo, go to precision. com slash KKH. That’s precision spelled with an X instead of an E. So P R X C I S I O N. com slash KKH.

All right, next guy. You know, I was going to have her like do like a, a, like a whole nephron, but I’m not like a. Use up the whole space. I’m glad she only went with the corner because then our next guest can draw one too. 

Kristin: Well, uh, I want to see you do it. 

Will: Oh. Okay, maybe I, maybe I will. We’ll see. We’ll see, we’ll see how it goes.

All right, so let’s go to our next guest. Okay. Our next guest is Adarsha Sivakumar. He’s a PGY2 psychiatry resident. We have any psychiatrists here? Hey! All [00:29:00] right, we got some people in psychiatry. Over there, 

Kristin: yeah. 

Will: And uh, so I, I, he sent me, uh, he sent us a, an intro that was, uh, kind of stream of consciousness , which is great.

I love it. Um, it says, ADHA is a tology also, but also the most accurate description of him according to all of his friends. Um, he loves, uh, endlessly quotes. SpongeBob, uh, loves Godzilla as a RAB 49 ERs fan apparently. Oh, 

Kristin: no one. Wow. 

Will: I guess we’re not in the Bay Area. Yeah, we’re not in the Bay Area. And, um, Adarsha is, uh, One other thing I thought was really good.

He said, uh, he frequently turns into a dinosaur. So, this is what happens when you ask Chad GPT to make your bio. I understand he’s busy, he’s a resident, he doesn’t have time to write it himself. And so it makes a lot of sense. Come on up, Adarsha. Come on up.[00:30:00] 

Adarsha Shivakumar: You know, this mic is probably unnecessary, as my friends would say, but, uh, I’ll try not to blow it out. 

Will: Yeah, yeah. 

Kristin: Alright, alright. 

Will: You, uh, um, you seem like someone that’s, that would be fun to talk to from, like, a patient physician patient relationship standpoint, which is probably what you want as a future psychiatrist, right?

Yeah, 

Adarsha Shivakumar: I think so. At least with, uh, it’s a good number of my patients. It’s like, yeah, I want to have that fun, you know, talk to. Sometimes with some of my patients, I have to just be like, Yep. Neutral and bland. Very serious. 

Will: People want to hear you. That’s a rare statement. So, so you’re a PGY2. How are you surviving?

Like, how’s your mental health these days? I feel like I need to ask you that, because you’re always probably asking other people about theirs. 

Adarsha Shivakumar: That’s true. And introspection is not something psychiatry is necessarily keen to do. But, uh, second year is, it’s pretty good. 

Kristin: Wait, I’m sorry. It’s not? 

Will: Doctors are the worst patients.

You know that. Exactly. 

Kristin: He’s speaking for his entire field. [00:31:00] 

Will: He said 

Kristin: psychiatry is not keen to interest. This makes me worried. 

Adarsha Shivakumar: It’s do as we say, not as we do, you know. I get that. I’ve said that. I see that all the time, yeah. Okay, I didn’t say that for the record, you know. That was, uh, their observation. But, uh, second year’s going good, actually.

Will: How does it compare to intern year? 

Adarsha Shivakumar: Oh, so much better. So much better. I think that, uh, on one hand, there’s, uh, like, there’s no magic switch when you become, like, a second year. Like, you go from an intern to a senior, which I was always confused by, because I thought it’s like, you know, high school or college, you know, freshman, sophomore, junior, senior.

So I thought all the seniors were fourth years. And they’re like, no, the day you’re done with your intern year, you’re a senior, and people, you know, Assume you know something. And when I realize that, I’m like, oh, that’s, that’s not true at all. That is not true. But um, I think that, to be fair, a lot of it is you don’t know how much you’ve necessarily learned as an intern.

Like things that, you know, actually learning, for example, how to put in [00:32:00] orders, or how to do a discharge summary, things like that. They may not seem like a big deal when you’re an intern and you’re learning to do them because it’s just part of the job. But when you’re a second year, I think you really see your own growth.

When the new interns come in, and they’re like, How do I do this thing? And part of you is like, What? You just do the thing. 

Will: Yeah, it’s obvious. 

Adarsha Shivakumar: It’s obvious. And then part of you is like, Oh no, you used to be in that spot too, you know, Have a little empathy. And that kind of, I think, feeling is a good one to have.

Will: Well, I have a question about orders, actually. Do you remember the first order you put in as a doctor? 

Adarsha Shivakumar: Yes, unfortunately.

It was not my finest work. It was, um, I feel, I feel bad for my senior. So, uh, thank you, Winston, wherever you are. 

Will: Is he dead? What? 

Adarsha Shivakumar: Honestly, he may, he may have wished it. Winston, you’re not dead, I hope. Please. But, um, it was, uh, after, like, orientation, and we use Epic, so [00:33:00] after we’re using it, and this patient’s like, Okay, what do we need to do?

Okay, it’s a discharge. Okay, do I, do I just tell them, like, Hey, sir, you can go. And they’re like, No, you put in the orders. I’m like, 

Will: Would it be awesome if it was that easy to discharge a patient? It 

Adarsha Shivakumar: really would, like, you can go, bye! 

Will: That’s it. I think that’s what they do at the VA, actually. 

Adarsha Shivakumar: That’s true. I think 

Will: that’s all it takes.

Adarsha Shivakumar: You say bye, and then they loop back around here. Yeah, bye, see ya. Exactly. And I’m like, so what do you do? Oh, you put in the discharge orders, and I’m like, hmm. Yeah, sure, okay. I had no idea what to do. No idea, you go to this tab, you click it, cool. And I’m like, okay, it shouldn’t be that hard, you know, I click it and then all those like red pop ups come because you haven’t, you know, I clicked all the things and it’s like, do you want to, you know, uh, continue this medication?

Like, discontinue this? And this guy’s on like four antibiotics and I’m thinking, am I gonna kill this guy because I send him home without his medication? And it’s just like, someone said yes.

And, [00:34:00] and it gives you all, you know, all those red flag warnings, like you can’t dismiss this alert. And I’m like, I, Man, my first patient, I’m just gonna kill him. I’m just gonna send him home, and I’m just sitting there. Get it out of the way. It’s a rite of passage to, you know, almost kill one of your patients and be saved by your senior, I suppose.

And fortunately, my senior was like, just, just, he saw my paralysis and confusion. More accurately, he didn’t hear any noises coming from me, and usually when a doctor is quiet, it’s like, something is happening. Something. I’m not sure what, but something is wrong. And, uh, he fortunately came in to save me and taught me how to put in discharge orders and do a discharge.

I turned to him, I’m like, I didn’t kill someone? He’s like, no, you didn’t. 

Will: This was Winston? Yep. Rest in peace. 

Adarsha Shivakumar: Rest in Rest in peace, Winston! 

Will: What is that, were you using Epic? Yeah. Oh, yeah. 

Kristin: That’s the problem, right? Am I right? Oh, you got a big 

Will: Epic fan! You like Epic? Oh! 

Kristin: Do you work for Epic? 

Will: Pick up that mic in front of you.

Pick up, pick up that mic in front of you, right there. [00:35:00] Let’s hear, let’s hear why you like Epic so much. 

Kristin: Oh, oh, this is a picture of her with the founder of Epic. 

Will: Oh. Oh. Oh, wow. I do not work for Epic. I spend my life. 

Kristin: Helping people, so the worst Epic is, the more job security I have. Oh, there it is, there it is.

The worst Epic is, the more job security this woman has. That makes sense. 

Adarsha Shivakumar: It does. You know, there wasn’t really a lot of applause when Epic came, it’s just like, uh It’s 

Will: like, uh, okay, alright. I worked as a super user for Epic for, uh, um, right between fourth year Actually, it was like This is why fourth year in med school is so amazing, right?

You can do things like work as a super user for Epic. At the 

Kristin: time, the only criteria was like, must be in your late 20s. 

Will: Yeah, right. That 

Kristin: was it. Pretty 

Will: good. Early 20s. 

Kristin: Early 20s. Yeah, 

Will: so like what I did was I, I walked around to all these physicians who were just trying to navigate Epic, right, for the first time.

Trying to do discharge summaries. And I, I remember, um, I [00:36:00] was working with this physician. He was, he was old. He was probably like near retirement age. And, at one point, I was helping him out with a discharge summary, a discharge order record, and, uh, he just got up and walked away. And I was like, I must not be very good at this job.

Like, and he just didn’t come back for a while. And, like, toward the end of the week, I was there for a week, I was like, I asked him, I was like, I was helping this guy, like, where did he go? And they’re like, he retired. 

Adarsha Shivakumar: Congratulations. Right? 

Will: Like, that, that, he, he chose to retire over listening to me talk about Epic for one more second.

Um, yeah. So but my I was gonna tell you my first order was of course Tylenol I still remember it too because I ordered a suppository on accident 

Adarsha Shivakumar: Yeah, one of the nurses probably was like, hey, uh, 

Kristin: yeah, see it’s the nurses. That’s what the nurse 

Will: Yeah, absolutely nurses, especially when you’re trying to figure out orders and all it’s just they’re so helpful but also pharmacists Like, you know how many [00:37:00] times, I’m sure you, like, you just order something, you’re like, this is probably wrong.

And then, sure enough, you get a page 30 seconds later from pharmacy like, you know what, you should really not, this will kill the patient. 

Adarsha Shivakumar: Did you put the decimal in the wrong place? It’s like, I guess I did. I guess I did. 

Will: Do you 

Kristin: think one of their classes is like, trying to figure out how to tell the doctor that they screwed up the order in a like, professional manner?

Do they have a class in that? I think they do, because yeah, they 

Adarsha Shivakumar: are. They probably need it anyways, you know, cause it can be a touchy subject, but it’s like, no thank you, please save us from ourselves. It’s probably 

Will: the same class that um, anesthesiologists have to take to tell surgeons that their cases cancel.

Did you take a class? Yeah, it’s like, there’s like a method to it. Like, you gotta end up having them think it’s their idea that they’re canceling the case. Also, 

Kristin: that’s true in marriage.

Will: Yeah, phone a friend. Yeah, phone a friend. Um, so, [00:38:00] I have another question about, now we’re getting in more specifically about psychiatry, alright? Uh, what is your favorite part of the mental status exam? Ooh, that’s a good one. What do you really just sink your teeth into? You just, just, is it the serial sevens?

Adarsha Shivakumar: You know Is it 

Will: identifying a hippo? 

Adarsha Shivakumar: The animals is always a good one, to be honest, on the MOCAs, but I think for the mental statics exam, uh, and for those of you who, uh, don’t know what that is, it’s basically a way to see, to the, to judge in your patient, how are you here with us right now, mentally, in addition to physically, basically.

Uh, and one thing that I, um, always find telling is, uh, and I think we can take for granted is when we determine, uh, how oriented a patient is. So Commonly we say someone is AO times a number from one or from zero to four and it’s like do they know their name? Do they know where they are? Do they know today’s date?

And like, why are you here? What’s the date today? 

Will: I have 

Adarsha Shivakumar: no idea. That’s the thing because, uh [00:39:00] It turns out, even people who are floridly psychotic sometimes, you think to yourself, this person is seeing things that are not real. And they sometimes are the people who are most oriented. Like, what date? Like, July 15th.

I’m like, I pull out the phone and I’m like, It is. It’s also most noticeable because I usually have absolutely no idea what date it is. To the point where, um, In the front of this building, they had a, um, I wasn’t sure this was the right place, I went to the wrong side, I guess. They had a list of, like, the speakers for the day, and I’m like, okay.

Kristin: I’d like to call some speakers. 

Adarsha Shivakumar: You’re, you guys. It’s basically what we are. And I’m looking, and I’m like, like, you guys aren’t there. I’m like, maybe they’re not using, like, the Glockenfleck name. And it’s like, there’s no one there, and I’m thinking. I’m, I’m in the wrong place. Maybe they meant Louisiana, not Los Angeles.

They actually, 

Will: um, we actually never, we never have our names on like marquees out front. Yeah, we’re not big enough. They don’t know how to spell glock and flecken. It’s very hard to spell. [00:40:00] That is fair. Um, so, so They run out of 

Kristin: letters. 

Will: Yeah, so the orientation thing is not, not the best part of the, of determining someone’s mental status.

It 

Adarsha Shivakumar: really isn’t, because it actually turns out that I was looking at Friday’s schedule. So it’s like, oh, today’s not Friday. Oh, what about the clock? Now, the clock is, uh, it’s sad. Sometimes you’ll see people do a great one half of the clock and you’re doing great, sweetie, right? Like, you know, they are the numbers in the right place.

And then that other half is just like a, It’s like, they just, you know, Maybe they just get 

Will: bored. 

Adarsha Shivakumar: I mean, kids these days probably don’t know like an analog clock. It’s one of those things where like, how do we actually tell it? 

Kristin: It’s like, 

Adarsha Shivakumar: can you draw a clock? And they’re like, what’s They’ll draw like a smart watch.

And it’s like, uh No, but good effort. They’re like, what are the hands on the clock? 

Kristin: Technically that’s correct, I guess. 

Will: Like, use this rotary phone. 

Adarsha Shivakumar: Yeah. 

Will: They’re like, I was born in 2000 whatever. 

Adarsha Shivakumar: Exactly. I mean, kids don’t even know dial up these days. They’re like, what? 

Will: Just for the record, I was not born in 2000 whatever.

I was born [00:41:00] much earlier than that. 

Kristin: You were born in the last century. 

Will: The late 1900s, yes. 

Kristin: It feels like 

Adarsha Shivakumar: that. Oy yoy 

Will: yoy. Um, okay. The people want to know, what is a misconception that, that, that That may be some of these people, but the general public, what is a misconception people have about psychiatrists?

Adarsha Shivakumar: I’d say I think a common one is that, um, It’s I guess it’s a flattering one in a sense that sometimes other specialties feel that okay My patient isn’t taking their medication or you know, they’re not you know, they they’re disagreeing with like, you know this plan They’re refusing for example dialysis or something You know who we can call psychiatry.

They are the ones they can get people to take their medication, you know, agree to procedures, do all these things. You know what they 

Kristin: think you are, right? They, they see you as a dog trainer, , 

Adarsha Shivakumar: this is what you’re describing. I mean, it basically is. It’s like you want me to give them treats or something. So they’ll like, you know, take their medication.

It’d be nice. Some of our medication we can kinda like sprinkle it, you know, [00:42:00] like let’s sprinkle it in a hot. You know, it’d be nice, and it’s like, I’m flattered, we’re flattered you think that we have the power to get our patients to, you know, take medication. I wish that was true, because our lives would be a lot easier if our, like, chronically ill patients, uh, for example, with, um, schizophrenia and the like, took their medication.

I would be the happiest person if I could just, like, mind control them just by saying them, take your meds, please. And they just did. Not true, though. But it’s, uh, always nice to be like, can you guys convince our patient to do it? And I’m like, no. Go 

Will: find 

Adarsha Shivakumar: a nurse. 

Will: What’s, uh, what are What are some of the other consults you got?

I know, is it capacity? Competence? 

Adarsha Shivakumar: Competency versus capacity? The capacity consult, which is almost, I’d say 95 percent times. I’m trying to get you fired up now. Oh yeah, yeah, no, 

Will: no, no, let me tell you something. See how mad we 

Adarsha Shivakumar: can make the psychiatrists. Poke him. 

Will: You’re gonna leave here and go do your own therapy.

Do you get therapy? 

Adarsha Shivakumar: I’m asking you too many 

Will: questions. 

Adarsha Shivakumar: No, no, of course, and I can answer all of them. Of course I get therapy. Uh, most psychiatrists, like, should get therapy [00:43:00] frequently so you can, you know, understand your own strengths, weaknesses, and your stuff that you work on. Of course, though, it’s always entertaining in therapy when, you know, I’m sitting there thinking, Wait a minute, I’ve, these terms are familiar.

Are you using DBT on me? And my therapist’s like, Yes, I am. It’s like, Oh, I, I know what you’re doing. That’s pretty interesting. 

Will: Well, speaking of therapy. We are, we have a little thing we want you to do. We want you to conduct a therapy session on us. 

Kristin: We want you to solve a marital disagreement. No pressure.

Of course.

Will: So you have to, you have to wear my uh, That 

Kristin: is so much, you know, it’s a little uh, 

Will: It’s a little large. You know, You know, when I, when I first Good enough. Good enough. When I saw you for the first time like an hour ago, I thought, this is gonna be perfect. I 

Adarsha Shivakumar: think it fits quite nicely, actually. You know, the contrast with [00:44:00] the dinosaurs is a very nice, uh, professional blend.

Will: So, um, so you’re our psychiatrist. 

Adarsha Shivakumar: Yes. 

Will: Uh, we’re coming to you. Now you’re gonna pretend to be me. 

Kristin: That’s pretty good. That’s actually not bad. 

Will: Uh, so, uh, we have, um, something, an issue that is destroying our marriage. 

Kristin: Mm hmm. Do tell me more. It’s very serious. 

Will: So, Kristen, so we record podcasts every week.

Kristen is chronically late. 

Kristin: I am not late. I am exactly on time. Kristen thinks 

Will: that five minutes early, or sorry, five minutes late is early. 

Kristin: Incorrect. 

Will: I think five minutes early is on time. And 

Kristin: she 

Will: refuses, she refuses to show up until, like, maybe three seconds after 

Kristin: the talk. He chronically misrepresents my stance here.

I get there on the dot, on the money. Time is [00:45:00] money. I am using my time to do things. You get there, you just sit at the computer, you do your man spread. It makes me very uncomfortable. You just stare at a clock. Well, that 

Adarsha Shivakumar: makes me uncomfortable. doing anyone? I can’t say I blame you, ma’am. Thank you. You 

Will: should also know, though, that, in general, I am perfect.

Mmm. Like, I just, I just don’t, like, I don’t make mistakes. And, and, and so, if someone’s gonna be wrong here, it’s clearly going to be my beautiful wife. 

Kristin: Uh, I’m thinking that next time I just maybe won’t save your life. 

Will: See, see what I mean? See what I mean? See what’s going on here? Can you help us out? Well, 

Adarsha Shivakumar: I think I can help.

Well, I’ll do my best to try. Let’s say that we’ll start off with a nice low bar there, you 

Will: know, 

Adarsha Shivakumar: just in case. 

Will: The date is March 23rd. 

Adarsha Shivakumar: I’m going to take you for granted there. I’ll assume you’re right there, sir. And [00:46:00] I noticed, you know, you two were jumping in, you know, just a little bit of conflict right there from the start.

Has this ever caused Some notable issues, have there been any big meetings you’ve missed or not missed? 

Kristin: No, I am there exactly on time, every time, like clockwork. 

Will: It just, uh, makes me sigh really loudly at times. If 

Kristin: he wants me there five minutes before the hour, then make it five minutes before the hour and I will be there right at that moment.

Thank you! So, 

Adarsha Shivakumar: why haven’t you done that then, sir? 

Kristin: No, I haven’t. Uh 

Adarsha Shivakumar: huh, uh 

Will: huh. Can I ask the audience a question? How many people are like, on the dot, I’m gonna show up or even be a little bit late? How many people are just 

Kristin: We’re talking like two, three minutes. Okay. Yeah, okay, okay. On the dot. Okay, 

Will: okay. How many people are, if I’m on time, I’m late?

How many people are like that? 

Kristin: [00:47:00] You’re 

Will: Thank you all. I knew I liked you. I knew I liked this audience. 

Kristin: I’m not saving anyone’s life. I’m recording a podcast. For 

Will: record, I’m not saving anybody’s life either. 

Adarsha Shivakumar: Same here. Clearly. That makes three of us, you know. 

Will: But I would say, um, no. The only thing, really, the only big life event that you were early on was our children’s birth.

Kristin: I wanted those out of there ASAP. 

Will: But in general, no, I can’t say that there’s been any major event that we’ve been late to that caused us to, to, you know, some kind of problem in our lives. 

Kristin: So it seems to me that the problem is only that you have a problem.

Adarsha Shivakumar: And piggybacking off what your lovely wife just said, why does it make you so upset? 

Will: Um, Think carefully. [00:48:00] Because I love her so much. I just, she means so much to me that I want, I want to always be with her. Especially five minutes before we record a podcast. And it just makes me so sad. When I’m sitting there, 

Kristin: ready, 

Will: on time, and she’s not there.

And I’m like, where Because I’m 

Kristin: doing your children’s laundry. It’s like, 

Will: where is, where is my lovely wife? Um, I just want her by my side. Cleaning up behind 

Kristin: all of you. Running your business. Well, it seems that, you know 

Adarsha Shivakumar: So 

Will: fix us. 

Adarsha Shivakumar: Look, I’m a psychiatrist, not a miracle worker, you know. 

Will: Is that a routine psychiatrist line?

Because Yeah, is that, is that what we got? Yeah? Okay, alright. [00:49:00] 

Adarsha Shivakumar: It comes with the jacket, okay? The power’s all in here. Yeah, 

Kristin: that’s right. Okay. 

Adarsha Shivakumar: Well, why do you feel so strongly about your husband having an issue with this? 

Kristin: Um, because he’s unreasonable in every way. 

Adarsha Shivakumar: Clearly. What do you mean? He’s unreasonable.

Every way. 

Kristin: Well, because I’m working very hard, making our lives work, and you’re just sitting there in a chair. And then you’re getting mad at me. 

Adarsha Shivakumar: Uh huh. 

Will: Okay, I don’t think we’re gonna come to a conclusion here. 

Adarsha Shivakumar: Oh, don’t worry, this is just the first session, you know. So 

Will: So we’ll, we’ll end there, but I, I do wanna ask you, do you ever, in your, in therapy sessions, is, is it a bad idea to like say, okay, you’re right and you’re wrong 

Kristin: because I’m 

Adarsha Shivakumar: clearly right.

It Do you 

Will: ever do that? Is that essentially that’s, it sounds like a bad thing to do. 

Adarsha Shivakumar: Never that bluntly. 

Will: Okay. Never that 

Adarsha Shivakumar: bluntly. Sometimes there are it more like objective fruits. Have you 

Kristin: ever considered sir that your wife may be right. ? [00:50:00] 

Adarsha Shivakumar: Yeah. And, and it sounds like that, you know, she’s a little diplomatic of, Hmm.

Point, if you think like there’s an obvious truth of like, mmm, and internally you think that person is right and that person is wrong, you can still actually, you know, bring it in a tactful manner. Have you considered that this certain aspect of the truth is, you know, true and correct? And then try to lead him to the idea that, hey, maybe if I think about the other things, I can see that my partner or the other individual involved, 

Kristin: So what I’m hearing is, again, you’re saying that marriage is just making him think that it was his idea.

Adarsha Shivakumar: Yes. That’s what I heard. Basically, yes. That’s my non professional opinion. 

Will: Alright, thank you, Adarsha. I appreciate it. 

Adarsha Shivakumar: And that’s why I never got invited back on again. 

Will: Thank you so much for coming on. 

Adarsha Shivakumar: I keep the jacket, right? Yeah, yeah, yeah. 

Will: I’m gonna need that back. You can wear it for now. I don’t need it right now.

Oh, wait, before you go, um I need you to draw a nephron. [00:51:00] I know. Alright, start. Can I, should we, should we guide him? Like, you guys, yell out tips. No, no, do it, I want you to do your own separate. Yeah. Come on.

Kristin: I like that this has become a crowd activity. 

Adarsha Shivakumar: Woo! There 

Kristin: you 

Will: go. Well done. Nicely 

Singers: done.

Will: Hey Kristen. 

Kristin: Yeah? 

Will: Notice anything different about me? 

Kristin: You look the same as always. 

Will: Uh, I’m covered in mites. 

Kristin: Uh, well, you don’t have to tell everyone that. 

Will: Maybe you need a mite too. What do you think? I, 

Kristin: I, Prefer to be mite free. You know what these things 

Will: are? They’re demodex. I 

Kristin: know. They’re enormous. 

Will: Have you ever had red, itchy, irritated eyelids?

Kristin: No, but that does sound very uncomfortable. [00:52:00] It 

Will: could be caused by one of these little guys. Now, they’re a lot smaller in real life. 

Kristin: Well, that’s comforting 

Will: at least. But it’s, it’s, they’re called demodex and it’s, uh, yeah, it can cause problems with the eyelids. They’re the mites that live on your eyelashes.

Kristin: Just chomping on all that goo. 

Will: Now, it might seem gross, You don’t wanna get grossed out by this, 

Kristin: okay? All 

Will: right. You gotta get checked out. 

Kristin: That is very sens your eye. Go 

Will: to your eye doctor. Ask about deema d blepharitis. Alright? That’s really what you gotta do. Or db if you wanna be a little shorthand with it.

Kristin: Yeah, make it sound like you know what you’re talking about. Exactly. 

Will: To find out more, you can go to eyelid check.com. Again, that’s E-Y-E-L-I-D check.com. To find out more information about these little guys, 

Kristin: tell ’em Dr. Cute, welcome black consent check. That’s 

Will: right. Deem aex Blepharitis.

And now for the, you’re always laying. What’s the deal with the nephron thing guy? Like why? What are you doing? Well, I’ll tell you why, because our next guest, [00:53:00] nephrology is Dr. Ed Taba. So he’s a nephrologist, you guys, 

Singers: he’s a clinical 

Will: nephrologist practicing in San Antonio, actually in San Antonio, Texas. He flew out here, like, just to do this, you guys, so let’s give him a huge round of applause.

Come on out. So he’s, he’s a So we follow each other on, on, on Twitter. And, alright, 

Kristin: here we go. He came prepared! Dr. T!

Good, sir. 

Singers: Nephrology.

Cardiology

Will: He came prepared, he’s already improving on my design Because I have a salt belt that I’ve used in some of my videos He actually improved, he’s [00:54:00] got velcro And they just like attach, so it’s right there 

Kristin: Oh! 

Will: I love it, I love it So, so He’s 

Kristin: a professional I 

Will: didn’t even finish, you just saw it, you’re I’m glad you’re so excited to come out I didn’t finish your intro, you’re a writer Yes.

You’re a writer, and you just came out with a book. It’s called These Vital Signs, right? Yeah. Does it, it came out about a year ago, is that right? 

Sayed Tabatabai: Yeah, almost a year ago, exactly, yeah. Tell us about the book. So, I write on Twitter. Um, I write these threads on Twitter. I won’t call it X. Um, and uh, 

Kristin: Yes. 

Sayed Tabatabai: No one calls it X.

I was lucky that the story Wait, hold on. 

Kristin: Are any of you, have you been on Mad Twitter? Do you remember it from the good old days? Anybody? Yes! Yeah! Those are our people. 

Sayed Tabatabai: Yeah, so, I wrote threads on Twitter. And, uh, those, I was lucky those threads resonated with people. They became popular and that’s where the book came from.

It’s a, it’s basically an anthology of those threads. And a lot of autobiographical stuff. That’s a cool idea for a book. 

Kristin: Like, it’s very unique. 

Sayed Tabatabai: Very hard sell. [00:55:00] Yeah, I basically had like three years of like straight nose

Will: Well did any of those threads have to do with the conflict between cardiology and nephrology I 

Sayed Tabatabai: think all of them in a way well All of them. 

Will: I got it. Is it true? Wait, so have you have you had any dust ups any fisticuffs any? Any, um, blowouts? I’m 

Sayed Tabatabai: more of a grappler. I feel like cardiology is kind of more, they go for the boxing.

I’m more, I take it to the ground. And so, and then I have my salt shaker, so you get that in the eyes, it’s over. 

Will: So I gotta say, the first video I put out of the conflict between cardiology and nephrology, Like two days later, there was a news story About an actual fistfight between a cardiologist and a nephrologist over fluid status.

I 

Sayed Tabatabai: remember that. 

Will: I remember that. It was [00:56:00] amazing. They like were punching each other and got like kicked out of the hospital. It was over, over like over fluid status. 

Sayed Tabatabai: Is it that serious, doctor? Have you ever seen Beat It, Michael Jackson? Yeah. It’s, it’s that serious. We, we mean after your work. Yeah. To hash it out.

Will: Can you, can you give people like a back, like what is the, what is the, the uh, underline, the underpinnings of this conflict? 

Sayed Tabatabai: Well we believe. Yeah. 

Will: Correctly. That. Well first, do we have any cardiologists here? Thank God. Really? 

Kristin: Wow. Woo! 

Will: Okay. 

Kristin: Are there any other nephrologists? Just none of you are here. Okay, perfect.

Alright. 

Sayed Tabatabai: I felt like the air was pretty clean and clear. That 

Kristin: means 

Will: you have a whole audience that you can persuade to your side of this conflict here. So, yeah, give us the lowdown. 

Sayed Tabatabai: So, like, we believe, correctly, that the heart exists to supply the kidneys with blood. [00:57:00] 

Will: I agree with the eyes, too. Yeah, exactly.

Sayed Tabatabai: The heart is basically there to just be the servant and help other organs get them the blood supply that they need, right? Exactly. 

Will: Yes. Yeah. 

Sayed Tabatabai: We got the 

Will: orthopedic surgeon up front. Said, and to provide ANSEF to the bones. To 

Sayed Tabatabai: circulate the ANSEF. 

Will: Exactly. Absolutely. 

Sayed Tabatabai: Cardiologists, they just don’t, they just can’t see the truth in front of their eyes.

And so, we just are constantly, it goes back to Hippocrates, you know, in that time. This goes way back, alright. Way back, yeah. I mean, this is through the years, I mean, the ages. In fact, that’s my next book. Hippocrates was, was, 

Will: was breaking like, like, uh, papyrus over, you know, neph, neph, uh, cardiologists. Wait, which one was Hippocrates?

Was he a cardiologist or a nephrologist? 

Sayed Tabatabai: He was a nephrologist. 

Will: We’re just making shit up now. 

Sayed Tabatabai: That’s good. That’s where this conflict is at this point. We’re just making shit up. But 

Will: is it true? Is it, is it, is this all just a joke? Honestly. 

Sayed Tabatabai: Oh, I want to [00:58:00] say it’s all just a joke. Um, actually it is all just a joke.

I work with great cardiologists, but I do hate them on some level. You just don’t talk about it. We just don’t talk about 

Will: it. Is it passive aggressive? Like, do you guys argue in the notes? 

Kristin: Do you also sigh loudly? Oh 

Sayed Tabatabai: yeah, yeah. No, exactly. There’s a lot of note fighting going on. Volume status. That’s what it is.

Right. You know, it all comes down to volume status. Okay. 

Will: Lasix? Do you care about Lasix? Or am I making that up? 

Sayed Tabatabai: Use it if you need it, but they’re always wrong. Whatever they said, the opposite. If they want it, you probably don’t need Lasix. Okay. So, 

Will: so I did, I wrote down some of the, um, the things I’ve said in my nephrology videos.

Alright, and so I want to just bring these up, and I want you to talk about how either, we’re calling this real or fake, so is it real, or is that fake? Okay? So the first one. Will nephrologists make fun of you for drinking water when you’re not thirsty? 

Sayed Tabatabai: That’s real. [00:59:00] Okay. That’s a, that’s a common one. We, we, me and my fellow nephrologists, if we see someone drinking and they’re clearly euvolemic, we will, we will laugh.

Hard. 

Will: That’s such a cool, uh, skill, to be able to just look at someone, you’re so euvolemic. 

Sayed Tabatabai: Yeah. I feel like they’re not even sweating, look at them. Look at these two. Are these 

Will: people you 

Sayed Tabatabai: believe in? Yeah, look at these people, they’re all drinking, they’re clearly not, well, that one’s, that one’s fine, she’s a little dry.

Will: I’m glad, I’m glad you’re hydrating, that’s good. Okay. I give that one a thumbs up. Alright, so. So it is a thing. So those water bottles, how many people have those water bottles where it’s like, it tells you, okay, like, like, uh, it’s motivating you to drink water. It’s like, keep going. Almost there. You can do it.

Sayed Tabatabai: We laugh so hard. Yeah, that’s, 

Will: that’s a big running joke. Okay, all right. So people should, really, [01:00:00] you just, you don’t have to drink water unless you’re thirsty. 

Sayed Tabatabai: Honestly, if you reach that final level of nephrologic power, you just don’t need water. You absorb it through the air. 

Kristin: We do not provide medical advice on this show.

Sayed Tabatabai: My practice right now. 

Will: So you’re able to, you just have the unique ability to concentrate your own urine to the point It’s kind of like a, like, what is it like an, an, an It’s just 

Kristin: a powder. Yeah, it’s just a 

Will: powder. It’s just, comes out of the sludge, powder, okay. Wow, that’s so cool. What year of residency do you learn that, or fellowship?

Sayed Tabatabai: Pty 29. 

Will: Yeah, yeah, yeah. That’s the thing I’ve always wondered about people that I didn’t do a fellowship. How do you get to the end of residency and decide, I want more of this? Why did you do that, exactly? What was it about nephrology, kidneys, that really spoke to you? 

Sayed Tabatabai: You know, the truth is, I hated nephrology.

I really did. In medical school, it was my worst [01:01:00] subject. And, um, in residency, I thought renal patients were sick. I didn’t understand how to make them better. I didn’t understand the physiology. But then like most things in life, I had a great mentor, and um, I had this rotation in nephrology, which I tried really hard to get out of, but um, I was fortunate to work with a wonderful nephrologist, and uh, he like basically single handedly, um, gave me an injection of a substance that blanks your mind and makes you want to do nephrology.

It’s the only way we can recruit, um, No, no, no, he was a great doctor. Is ACG 

Will: me aware of this? I don’t think they’re. Okay. 

Sayed Tabatabai: Now, he was a great physician and he turned me on to it. I loved it and I wanted to pursue it. 

Will: I think you’re the smartest doctors in the hospital. 

Sayed Tabatabai: We think so, 

Will: right?

It’s a, it’s, it’s, it’s, it’s a tie, honestly, between you guys, uh, rheumatology and infectious disease. And just to like, to give you a sense of, of how. Terribly, [01:02:00] um, uninteresting our lives are sometimes. Like, I remember in med school, like, going to, like, a morbidity and mortality conference, and just, like, when you, when the nephrologist and, like, the infectious disease doctor there started arguing with each other, you’re, like, on the edge of your seat.

Like, yeah, this is, this is good stuff right here. They’re, like, go at it. They’re just, they’re really off, you know, in each other’s So, anyway, um, a couple other things in my videos for nephrologists. Uh Do you sleep in the dialysis suite, ever? 

Sayed Tabatabai: Yeah. Frequently. Actually Have you ever tasted dialysate? It is fantastic.

It is fantastic. So that’s what we do. We have dialysate parties and We will often end up at the end of the night just flat out in the dialysis unit just laid out there 

Will: But you’re still euvolemic because oh, yeah, okay 

Sayed Tabatabai: volumes not an issue anymore like I don’t Water sweating whatever. It’s all it’s all fine.

Will: All right. Here’s the here’s the next one. [01:03:00] Okay? Is Osmolarity a real thing? Because I think I have claimed that it’s fake several times. 

Sayed Tabatabai: So, true story. Um, there was a conference in 1940, I want to say 49, 48, where med school was too easy, and they wanted to make it harder. And so nephrology was basically invented then, and osmolarity was like one of the main things we came up with.

Like I wasn’t there, but we were like, how can we just like come up with these impossible concepts that just like math, just like lots of math. And Osmolarity was one of them. We’re proud of that one. It’s totally fake, it’s totally made up. 

Will: That’s what I thought, along with rheumatology. I don’t think that’s real either.

But anyway, that’s another thing. Do we have any rheumatologists here? 

Kristin: Okay good, you’re safe, you’re 

Will: safe. Is 

Kristin: anyone here? I do not have 

Will: a lot of internal medicine fans, I guess. I guess not. That’s not true. Maybe, I don’t know, maybe it is true. Anyway, I make fun of them a lot, so I don’t [01:04:00] know. Um, do we have any emergency physicians here?

Usually we have a few. Yeah, we got one in the back. 

Kristin: That’s great. 

Will: Um, Alright, so, alright, the next thing I wanted you to do. That’s pretty much it. I don’t know, for the things in my videos. I mean, all of it’s made up. I don’t know what I’m talking about. I’m making up a lot of stuff in there, guys. I do a little research, though, so I try to make it as accurate as possible.

But, uh, one thing that nephrologists are known for is is your propensity for whiteboard presentations. You love yourself a whiteboard presentation. This is about that, isn’t it? Well, we’re getting there. We’re about to get there. 

Kristin: Everyone groaned. They all just collectively groaned. Oh, he’s going to 

Will: teach us about hyponatremia, isn’t he?

Kristin: Like, can we get another drink? God, I thought I got away from this. 

Will: Orthopedic surgeon, our friend’s like, what a no, I didn’t sign up for this. That’s the refund 

Kristin: policy on this show. 

Will: Um, and so, but we don’t have limited time. But I thought I’d give you, I want you [01:05:00] to feel at home and welcome. So instead of your typical, you know, three to four hour, uh, whiteboard presentations that usually give on renal physiology.

I assume that’s how long they are. I don’t know, I haven’t seen one in person. But, I want you to explain renal physiology to the crowd here. But you have two minutes Two minutes and not only that you have to use this So first before you begin Please give us your thoughts Drawings here, what do you think?

They’re honestly kind of beautiful Well done you guys nice job. Kind of like those 

Sayed Tabatabai: abstracts 

Will: like yeah I’ll be honest. I I I I think she thought I said draw a kidney. I, I, I think that’s what’s happened. That’s okay though. I mean, it’s just like, you know, fourth year med student, they checked out, you know, I don’t, I don’t blame them.

This is pretty good for a nephrologist. Oh, sorry, for a, for a psychiatrist, if you ask me. 

Sayed Tabatabai: It’s really great. [01:06:00] 

Will: Do you, would you like to draw one? 

Sayed Tabatabai: Um, not particularly. 

Will: Okay. All right. I’m looking at the timer back there. Um, and so I want you, I’m gonna start, I’m gonna say go and you’re going to explain. He’s gonna stand up for this, you guys.

You’re going to explain renal physiology. Alright, ready? 

Kristin: Oh, wait, wait, wait. Here you go, here you go. Gotta get your sharpie. 

Will: On your mark. Let’s see, who’s standing in front of that clock? 

Kristin: That’s Aaron. 

Will: That’s Aaron. Move, Aaron! Alright, ready, go! 

Sayed Tabatabai: Okay, so, somewhere out here is the heart, and it’s pumping blood down, and, uh, the blood is full of evil humors, and the only thing that can protect you is your kidneys, and sort of your liver, maybe a little bit.

So, blood comes over here. And, um, a bunch of poison comes out of the blood straight into the squiggly thing and out through the squiggly thing into this tube. And then there’s exchange of stuff. And, uh, there’s stuff down here. Well, it’s just not important. Sodium, potassium, a bunch of like, not important.

But stuff exchanges here and you have water like pee going down through [01:07:00] here. It’s becoming pee. It’s not quite pee, but it’s going through there. There are channels here. Exchange is going on here. There’s blood all around here and things are absorbing. And there’s And then at the very end here, there’s like little gates where it’s like we need more water or less water, open or close or whatever.

And, uh, there’s hormones controlling that, and how much time do oh my god. So, um, and then You got 

Will: one minute left. 

Sayed Tabatabai: Okay, so I’m gonna, you have one minute? Okay. 

Will: Alright. 60 seconds. 

Sayed Tabatabai: Alright, God. Um, then, uh, those channels, open or closed things get more or less concentrated. March. March, tear, drink some salt,

Okay. Alright. 

Will: Alright, good. 

Sayed Tabatabai: Keep going. Um, and then down, here’s your bladder and stuff keeps going in there and it sort of fills up and doesn’t feel so great when it does. And then you empty it and then actually this, that’s it.

Kristin: 20. Pretty good. That’s pretty good. Yeah. 

Will: So why does rounds last so long? Like you’ve clearly, this is going on social media, on the podcast, so [01:08:00] people are going to know I just tricked you. Well played. All the med students out there and residents can thank me for that. I just, I just proved you can really slim down rounds.

Well done, thank you for that. That was good. 

Kristin: That was 

Will: impressive. Ortho, Yeah, thumbs up from Ortho. 

Singers: Very good, 

Will: thank you. Alright, I have a few more questions for you. Fire away. Alright, uh, I really actually kind of want to know a little bit. You’re the first nephrologist I’ve ever talked to, by the way. They won’t come near me.

Alright, so, can you give us top three ways to maximize the health of the kidney? What are the three things we can do to make our kidneys stronger and better? 

Sayed Tabatabai: Stop drinking water. No, I’m kidding. Um, so just in general, I’ll give like real responses to this. I’m thinking of jokey responses, but I’ll give real responses.

I think the first thing is just to know what your numbers are. Know what [01:09:00] your kidney function is. The vast majority of kidney disease is silent, so people just don’t know what’s happening. Let me 

Kristin: ask you a question. Who knows what their numbers are? 

Sayed Tabatabai: Exactly, but when you go to your primary care doctor, Be like, are my kidneys okay?

And it’s a simple question. The number one thing I hear from patients is, I feel fine, why am I here? Or, you know, I’m like, well, three years ago, your creatinine was 1. 8. They’re like, well, no one ever said that to me. And, you know, the PCP’s notes are like, disgust CKD, and all this stuff. But people just aren’t Thinking about the kidneys that way, as long as they’re peeing.

Okay. Okay. And not, you know, peeing blood or anything like that. They’re like, oh, my kidneys are fine. But I think awareness would probably be number one. 

Will: So, so, so people should be getting routine labs at some point in their life? Yeah. This is 

Sayed Tabatabai: part of a routine physical Yeah. At some point in your life, yeah.

You should probably get labs done. Yeah. , 

Will: it’s a good idea. How many people have never had any labs drawn? 

Kristin: You all had to do it in medical school. You’re asking the wrong people. 

Will: Okay, alright. Yeah, they’re all Everybody here knows it. What’s your creatinine, [01:10:00] sir? 

Sayed Tabatabai: He has no idea. He’s proven your 

Kristin: point. 

Sayed Tabatabai: It must be pretty good.

I’m assuming it’s good if he doesn’t know that. 

Will: Okay. What’s normal? One? It’s one, right? One? 1. 0? 

Sayed Tabatabai: Yeah. 

Will: Okay, alright. Alright, that’s number one. Give us two more. 

Sayed Tabatabai: Number two, take care of any other medical problems you have. The most common causes of kidney failure in America are usually diabetes, uncontrolled, etc.

So make sure your other medical issues are well managed, and that’s usually good for your kidneys. 

Will: What does cardiac arrest do for your kidneys? 

Kristin: Asking for a friend. That’s basically when Yeah, 

Will: I know a guy. 

Sayed Tabatabai: It’s basically when that slacker of the heart finally just sort of gives up, and it’s like, come on.

It’s always the heart. It’s not great. I’ll just put it that way. 

Will: So take care of your other medical problems. Just be healthy in general. Easier said than done. Yeah. What’s the third thing? 

Sayed Tabatabai: Um, I would say the third thing, just in general, uh 

Will: Anything you can eat that will destroy your kidneys. 

Sayed Tabatabai: Um, blueberries.

I [01:11:00] made that up. That’s false. That’s totally false. I made that up. They’re actually really good for your kidneys. I totally made that up. God. That’s totally made up. God. Sorry. Misinformation is so easy. This is terrible for my profession. Holy shit. This is really bad. 

Will: It’s a room full of doctors. You guys are like, oh man.

I love blueberries. Blueberries. 

Sayed Tabatabai: Antioxidants are horrible for the kidneys. Oh my god. No, no, no, that’s, no one watches this anyway, right? No one’s gonna Yeah, no one, no 

Kristin: one, no one listens to this show. It’s fine. 

Sayed Tabatabai: Just get your blueberries, 

Will: they’re good for you. Yeah, yeah, blueberries are 

Sayed Tabatabai: great. 

Will: Alright. Sorry. We could let that be the third thing.

Sayed Tabatabai: Yeah, we can let that be the third thing. How do 

Kristin: you feel about ibuprofen? Oh, I love 

Sayed Tabatabai: it. 

Will: Oh. 

Singers: That’s 

Sayed Tabatabai: a good question. I mean, it’s okay. I think the backlash against NSAIDs is a little overgone. I think the backlash against NSAIDs is a little overgone. He’s talking to me, I think. [01:12:00] I’m 

Will: always making fun of that.

Sayed Tabatabai: But, I mean, in certain situations it can be problematic. So, if you’re guzzling a bunch of those and you’re chronically volume depleted and, you know, other stuff. 

Will: You will not take away my vitamin I. No, no. Vitamin 

Sayed Tabatabai: I, I hate that.

Kristin: What about a juice cleanse? 

Sayed Tabatabai: What about what? What are your 

Kristin: thoughts on a juice cleanse? 

Sayed Tabatabai: Uh, I don’t have any thoughts on it. He’s like, I 

Will: get asked about this all the time, you’re gonna fuckin do this right now? Yeah, 

Sayed Tabatabai: this is getting too, I thought this was supposed to be fun, no. Um, in general juices are fine, but some of these cleanses are, they can actually be worse for you.

Especially if you have other medical issues, you just gotta be careful and right by people. Cause in general your body cleanses itself pretty good, you don’t really need to. 

Will: Along with the liver, I mean, you gotta get the liver. You know about the 

Sayed Tabatabai: liver, right? 

Will: You gotta 

Sayed Tabatabai: give him 

Will: a little bit of credit. Okay, a little bit.

I think I know why I like talking to you. [01:13:00] Because, because, uh, we both have redundant organs.

Like, how cool is it to have two of a thing? 

Sayed Tabatabai: That’s true. 

Will: Right? I think it’s great. Like, you lose one, you’re like, oh, it’s fine. We’ve got a backup. It’s good. That’s 

Sayed Tabatabai: the real reason I went to nephrology. It’s like, no matter how bad you screw up, there’s another one. There’s another one. And then there’s dialysis and transplant.

Will: Exactly. I once said the exact same thing on, I got, I got a lot of people mad at me for saying 

Sayed Tabatabai: that. 

Will: Anyway, you say you get a lot of people mad at you in a lot of ways on social media, but anyway. Alright, here’s a couple other questions for you. If you could tell your freshly matched self. One piece of advice about your career in medicine, what would it be?

Sayed Tabatabai: Um, I’m going to go serious here for a second. I think what I would tell my freshly matched self is bring your best self home. And what I mean by that is, we’re so [01:14:00] focused in medicine on, you know, I gotta make sure I don’t look stupid out there, I gotta make sure I take care of people, there’s so much stuff to learn, I can’t screw up.

But in my experience, um, You’ll be fine. The medical part will come to you. You’ll get the experience, you’ll get the training, you’ll be fine. You bring your best self to work every day, but don’t leave them there. Um, make sure you still take care of yourself. Make sure you still do things that gave you joy before you came into medicine.

Don’t put them aside. Make sure you still spend time with people who matter. Um, make sure you still hold on to relationships that were meaningful to you. Um, because at the end of the day You can’t just grow in one place and kind of stunt the rest of you. You have to come forward. And, you know, I wish I’d known that, um, because life for me was hard.

I went through a lot of stuff, um, where, you know, if I’d had the things that gave me joy and support networks that, that I had before, before I let them kind of wither, it would have been better. 

Will: That’s a good answer. 

Sayed Tabatabai: Thank 

Will: you.[01:15:00] 

Tell us about a fork in the road moment in your professional life. How would your life turn out if you had made a different choice? 

Sayed Tabatabai: There’s so many. Um, so much of what, where we end up is luck in a way, right? There’s so many forks in the road that we don’t even realize until retrospect. We’re like, wow, that was a big fork in the road.

But to me there’s actually one distinct one. It’s actually in my book. Um, where it was actually right after my first night of night float as an intern. It’s And it was the worst night. And, in fact, residents told me that. They were like, man, I’m sorry, this was like one of the worst nights to start out on an internship.

There were horrible medical traumas and all sorts of things. I went home super late because I didn’t get to do any notes and I was documenting. Then I had to get back to work the next day. And I’m on the subway in Boston, sitting on the orange line. And, um, going into work and just, I’m just dreading it.[01:16:00] 

And I feel like I, I totally screwed up the night before. And the fork in the road moment for me is the subway car is pulling into the hospital stop. And I see other people in the train who are getting ready for the weekend, and they’re so happy. And I know I’m working the weekend. And I’m thinking about all the other things I like besides medicine.

And I’m like, you know, if I let those doors close and just sit here and ride the orange line, it could be so different. I could have a weekend to look forward to. I wouldn’t have this giant anvil hanging over my head. Maybe the people in the hospital would survive, because my incompetence wouldn’t be killing them, you know, that’s how I felt.

And so that was a fork in the road for me, because I felt like this gravity holding me to my chair, and like, don’t get out at the stop, just let it, let the train keep going. Um, but then I I 

Will: think we’re all glad you 

Sayed Tabatabai: Yeah, then I heard my dad’s voice in my head, he was like, give it one more day. And I was like, just give it one more day, you came this far, just give it one more day.

I’m like, okay dad, one more day. That was it. 

Will: How many years has it been now? 

Sayed Tabatabai: Now it’s been [01:17:00] 20 years. 

Will: 20 years. That’s a lot of kidneys, my friend. That’s 

Singers: a lot of kidneys, yeah. And then 

Will: my last question for you. Um, I want you to help me. We heard a, uh, a newly matched med student and a resident, you know, very early in their career, uh, up here talking.

What would you say to them to help them feel hopeful about their future? The field of medicine because there is a certain internet comedian ophthalmologist Who kind of tends to depress people? About the field of medicine at times and so what would you say to them and other people like them to make them feel?

Hopeful 

Sayed Tabatabai: that’s a great question. I I would say two things The first thing I would say to them is Yes, there’s a lot wrong with medicine The systems of medicine, the delivery systems, the way we do medicine, there’s a lot wrong. But I don’t think there’s any [01:18:00] generation of doctors better equipped and more willing and fearless to stand up to the system and change it than this group coming through.

And I’m not just saying that, um, I was there in residency when the work hour rules were just kind of being rolled out. And we had no idea what was going on in other institutions. We didn’t know kind of where this came from. You know, there was no sense of community. Whereas with MedTwitter now and the way residents are talking at all these programs and the way, you know, these initiatives get out, I think the future of medicine in terms of the people who are guiding where it’s going, um, and are able to stand up to these forces that you often, I really appreciate that you bring to light these forces that are molding medicine in ways that may not be the best for medicine, but may be the best for other people.

Will: United Healthcare. United Healthcare. Optum. Private Equity. Cigna. 

Sayed Tabatabai: Um, but I feel like they’re well equipped for it. And then the second thing I would say is, um, you know, to [01:19:00] keep your optimism. The things that drew you to medicine never go away. They get buried under a pile of, you know, a ton of crap. They get put aside.

They get obscured. But they never really go away. And, um, that joy you had on match day, hold on to that and have these anchor points to that joy. And, you know, when you go through medicine and the training, it’s always, what’s the next step? And you’re always kind of looking at this mountaintop and you’re like, okay, I finished this.

I got to take this exam. I got to take this board. I got to do this. I got to get the job. It’s always this linear path. But when I look back on medicine, it’s not a line at all. Actually, when I think about my career, it’s not looking at a mountaintop, it’s looking into a kaleidoscope. And it’s all these shifting images and moments, and most of them are small moments.

They’re beautiful moments. They’re moments that drew me to this career. They’re moments of connection, moments of empathy, moments of being able to change someone’s story for the better. And anytime I feel like I’m like, it’s just a job, which it’s okay for it to be, you know, from time to time. It’s okay for it to be just a job.

But I want that joy back. I look into [01:20:00] the kaleidoscope and I see all those memories and they come flooding back. And all the feelings and all the things that drew me to this career, they never went anywhere, you know? Even if I couldn’t see them. 

Will: You should write a book. That was beautiful. Thank you. 

Kristin: Okay, that was one thing.

What was your second? I’m 

Will: sorry? 

Kristin: That was, you said you had two things, so that was your first. No, that was the second. That was two? Yeah. I just got so drawn into that metaphor, I 

Will: lost count. So tell us about your book, what’s the name of it again? It’s 

Sayed Tabatabai: called These Vital Signs. Um, it’s available everywhere, it’s online, it’s um, well that’s not true, it’s not available in every place.

But you can find it on the internet, pretty much everywhere. Um, and yeah, I’d appreciate the support. Well thank you for joining us. Thank you.

Will: And thanks for, uh, you know what, before you go, here, you, you, you gotta do that. Yeah, draw a nephron. I’m just gonna be talking here while you just draw the most beautiful [01:21:00] nephron that we’ve ever seen in our lives. No pressure.

Kristin: He’s very quick. He’s a quick draw. Lots of squiggles. Lots of dips. 

Will: Oh, he’s always putting, he’s putting transporters in there, you guys. This is real. Oh, oh. 

Kristin: They’re actually sunglasses. They’re sunglasses. Okay, oh, and a smiley face. Is that? I don’t think we can sanction a cigarette. Perfect. You know, that kind of looks like you.

Will: Blueberries are bad for your kidneys, but smoking is fine. 

Kristin: Yeah, that’s what we’ve learned today. 

Will: Not for the, I guess people are going to hear that maybe out of context whenever they listen to this episode. Smoking is not good for your kidneys. He just drew a little smoking nephron there. Well, um, [01:22:00] God, thank you to all of our guests today.

Like, that was awesome. Thank you for being here for our first Medical Eras show. Uh, I’m sure we’ll end up as successful as Taylor Swift. Um, I did, I do not yet have a sequined jumper. 

Kristin: That’s what you think. 

Will: Oh, okay. If you think I’m going to rip off my clothes and unveil a sequin jumper, it’s not going to happen.

But maybe if we do more of these, we’ll see. I don’t know. We’ll see. That’s incentive. If we can sell out. I think it’d look great. Yeah, we’ll see. Um, let’s see. Are we, should we, do we have any time? I think we’re like right at the end here. So, um, thank, I want to all again for being here. And it’s really, Doing this podcast together, well one thing, it’s forced us to talk to each other.

Always a good thing when you’re married. That’s good. And we still are happily married and enjoying our time. We are, for the most part. But it really has been a joy to get to talk [01:23:00] about things in medicine for longer than like 90 seconds at a time on TikTok. I still make the videos, but doing these, having guests, and having you all here.

It means so much to us to get to see you in person and just having the support from you all really means a lot and And so I we want to end just by thanking you all for everything. It’s been I started Glockenflecken in 2016 And it’s just steadily grown from there and now You guys came here to listen to us talk to each other and to other people and and 

Kristin: I want to thank all of you For laughing at his jokes.

Will: Oh Yes, absolutely She hears them all the time, so it’s 

Kristin: just I don’t have to do it anymore because now there’s all of you It’s really been the biggest gift that I could ever imagine 

Will: So that’s it. We just really appreciate you. So thank you guys

Thank you, thank you all for coming have a [01:24:00] wonderful night

I’m gonna sing it. I’m gonna sing it. You’re 

Kristin: gonna 

Will: sing it? Okay Here we go. Thank you, everyone.

Singers: Goodbye.

Will: Hey, Kristen? 

Kristin: Yeah. 

Will: What do you think about my Dax co pilot? He’s 

Kristin: very cute. Almost as cute as mine. 

Will: Oh, he’s great. He just sits right there. Can I tell you about Dax? 

Kristin: Yeah, tell me. 

Will: It’s fantastic. The Dragon Ambient Experience from Nuance. They call it Dax co pilot. That’s cute. He helps with documentation burden, reducing burnout.

In fact, 80 percent of patients Say their physician is more focused using the DAX copilot. That’s huge. That’s pretty good. We all want to be able to connect more with our patients. 

Kristin: Right. 

Will: And [01:25:00] all the documentation we have to do now, it makes it almost impossible. 

Kristin: Yeah. Easy to burn out. Absolutely. That’s your job.

And 

Will: 85 percent of patients say their physician is more personable and conversational. 

Kristin: I like that. 

Will: I want to, I need help being conversational sometimes, and DAX is one of those things that can help you get there. So, uh, to learn more about the Nuance Dragon Ambient Experience or DAX Copilot, visit nuance.

com slash discover DAX. That’s N U A N C E dot com slash discover D A X.