Unexpected Treatments with Emergency Medicine Resident Dr. Adam Goodcoff

KKH Trailer Wide


Will: [00:00:00] Knock,

knock, knock. Hi. Hello and welcome to Knock Knock. Hi, we are the Glock fls. I am Dr. Glock Plein. I’m Lady Glock plein. We got an exciting show today. So, uh, we were talking, we were talking with Dr. Adam GoodCo, uh, who is an emergency medicine resident. That’s, and it was really fun talking with an, uh, someone in residency.

That’s, which we haven’t done yet. It’s, I, I still remember my residency. My time in residency is a lot of fun and very challenging and sometimes very sad and embarrassing moments. 

Kristin: That’s right. It’s in a very intense time of 

Will: life. It’s very intense, a wide range of emotions that you deal with and uh, and so it was awesome to hear Dr.

Good’s perspective, not only on residency and medicine, but also social [00:01:00] media cuz he is got a big social media following as well. That’s right. Um, and so we’ll get into that in a second, but first this month, April, you know what April is? What is it? Tell me. It’s, it’s National Testicular Cancer Awareness Month.

Oh, okay. It is the time to feel your testicles. This is really, there’s, it’s always a good time to be familiar with your testicles. Uh, but especially this month. Uh, and um, and I say this, I know I’m an ophthalm. Which is, you wouldn’t think that I’d be that interested in testicles. Uh, cuz ophthalmologists, I, I specialize in a totally different type of ball, but I did have testicular cancer and so this is a topic that’s very important to me.

Yes. And me as well as someone who went through all that as 

Kristin: well. Right. Because you had it not once, but twice. That’s right. Yep. So, and you caught it yourself both times. So maybe give the, I did the listeners and watchers here some 

Will: advice on what to look for. I am, yeah. I am, I’m so good at finding my own testicular cancer.

[00:02:00] It’s, it’s really a, a secret talent of mine. Um, party trick. Yeah. It’s, ooh, there’s gotta be a lot of alcohol at that party. Um, all right. Feeling your testicles, uh, you know, they should be kinda egg shaped, little oblong, not, you shouldn’t have any, uh, uh, like hard nodules or like bumps that weren’t there before.

Um, and, and if you do notice something unusual, definitely go and get it checked out. Testicular cancer, if you catch it early enough, it is imminently treatable. It is very, very treatable. And so, uh, uh, for me, I just, I had a couple surgeries. I no longer have any testicles, uh, which is no minor details, to be honest.

Totally fine. Uh, I, I really feel like testicles are a bit overrated. Um, But, uh, they do, they serve some important purposes, but so, so, you know, be familiar with your testicles. That’s all I’m saying. Yeah. You know, so, uh, and, uh, yeah, I don’t, I guess it, it’s good that we [00:03:00] get a whole month of, of talking about testicular cancer, so, yeah.

Kristin: I mean, it’s, uh, it’s a, it’s a long, long time. It’s a lot of testicle talk, but Yeah. But it’s important, like you said, because it is so treatable if you catch it early, which you don’t want, is it spreading to other things because you waited too long. So, and when I, 

Will: when I found mine, I went in, I got, uh, I got an ultrasound and like, it was like this same day I had my diagnosis.

It’s like, it’s that easy. Uh, and, and then I had surgery like two days later, so, um, which is a tough surgery cuz they go right in this, in the inguinal canal and you can’t, I think I’ve talked about this before, but you can’t use your ab muscles very well. And so I kind of like was turtled, you know? Mm-hmm.

Mm-hmm. Had to like roll to get up kind of thing. Right. I don’t know. You were 

Kristin: taking care of it, just, you’re not gonna find a lot of sympathy from someone who’s had two children is all I’m saying. 

Will: Okay. I could see it in your eyes. Yes, that’s true. And I’m doing just fine now. Just a little testosterone, you know, every so often and I’m good to go.

Um, so anyway, [00:04:00] testicular Cancer Awareness Month. Uh, and so should we get, I mean, that’s, that’s probably enough testicle talk. I think we’re good. I don’t think we talked about testicles with Dr. K. I don’t think so. We talked about, we talked about very sensitive parts of the body. Yeah. Mm-hmm. But 

Kristin: I’m surprised they didn’t factor 

Will: in.

That’s right. All right, let’s get to our guest, Dr. Adam GoodCo, uh, emergency medicine resident and social media personality. He can be found at See the medlife on Instagram, TikTok, uh, at the medlife on YouTube. Uh, he’s got over 2 million followers across social media. 

Kristin: So yeah, he’s doing some good stuff, educating people about 

Will: their health.

Yep, great, great educational, uh, content, interesting content. And so it’s, uh, great, uh, talking to him. So let’s get to Dr. Adam. Good.

All right. We got Dr. Adam GoodCo with us, uh, also known on social media as, um, uh, at sea, the Medlife. Uh, thank you so much for being here. It’s, thank you for having me. [00:05:00] Appreciate it. Yeah, we, we actually, you might be one of the, the first, if not the first, uh, resident guests that we’ve had. And so, uh, I’m, I’m very excited about this because you have a, a little bit, probably more of a unique path in residency than a lot of us that have been in practice for a while.

Because you started residency when? 

Dr. Adam Goodcoff: Exactly. Uh, it’s been, I’m coming up on the end of my third year, so I’m about to graduate, so it was, uh, 20. Oh gosh, 2020 I guess. Um, when I started, yeah. There was kind of like a 

Will: thing that was going on little bit, nothing. So it 

Kristin: seems like a good time to start a residency, right?

Will: Right. Because So you must have been, whenever the pandemic hit, you were done with, like, you, you, you knew where you were going for residency at the time, right? You were done with 

Dr. Adam Goodcoff: I I was actually, um, I was matched in everything already and I had gone to Japan and Thailand and so late, like when I look back, it’s, it’s pretty crazy.

But I was there like, if you remember that cruise ship that was pulling up in Japan? I was eating ramen in a bar [00:06:00] in Japan, not understanding Japanese thinking, why are there all those ambulances at the cruise ship? Um, so Oh my God. Wow. Yeah, it was, it was a trip. Obviously we had no idea what was coming, but you know, it was like, Hey, I’m finishing med school.

I wanna do this trip. I know, I don’t know, we should probably go home, but this, you know, I’ve been saving up forever for this. So we just stuck it out and we got pretty fortunate that, uh, you know, we didn’t, we didn’t get into trouble. We were able to get back. But yeah, that’s, that’s the start of residency story.

You know, after that, uh, June rolled around and moved to Chicago and there we are. 

Will: Yeah. And then, and then your, was was the first like six months of your really, probably the first year of your, of your residency just Covid, because you were in Chicago, right? Yeah, 

Dr. Adam Goodcoff: yeah. So, uh, you know, Chicago was a little bit different than New York.

I think there was kind of a, a small wave, what they thought was a big wave before I came. And then that summer, you know, summer always is better for viruses and things were, it’s like you said, it was very, um, I hate to call it a diluted experience, but it was a, like a, just a different experience than what emergency medicine should be.

The typical things weren’t there, you know, we weren’t seeing, um, we weren’t seeing [00:07:00] asthma exacerbations cause people didn’t want to come in. I remember, you know, coming into second year, uh, there was an attending and they said, well, what’s the dose of steroids? I’m like, I don’t, I don’t know. I’ve only ever given decks.

I don’t know what sorl, you know, like we just, we hadn’t done those things. So it was, it was a different, but, but on the flip side, I was an expert at a ventilator as an intern. So, um, that, that first summer was kind of slower in terms of covid. And then Chicago’s real peak was actually kind of the fall of my intern year.

So they had the, that second peak was really, um, devastating here and kind of overran the ICUs in a similar fashion to new. 

Will: And you spent a, a good amount of your first, your intern year on in other places in the hospital, right? Not just emergency department. How much of it was in the icu? We, or did they just tell you, Hey, we need you there, like, just stay there for a while?

Dr. Adam Goodcoff: I don’t know. Yeah, the, you know, the, the nice thing about emergency medicines that we’re, we’re pretty deployable or diverse, um, we actually ended up covering a fair amount of er, uh, because it was so busy and the volumes were so high with, with critical patients. We did, [00:08:00] um, we definitely did icu. I was probably two, two or three months, trying to think back of ICU time as an intern.

But our service didn’t get pulled to cover the ICU because there were so many other, you know, we, we have a very large internal medicine program, so a lot of them were just, you know, pulled off of floors and put into critical care and they were obviously making ICUs on the floor and, um, or versions of that.

So, but there was such a high volume of patients coming in still crashing that, you know, we were, we were pretty busy with that in the er. And how, 

Kristin: how was that emotionally? Because, you know, intern year is a hard enough time in, in normal years. So, and you’re just fresh outta med school and I mean, you’ve seen some things, but it’s not like you’re a seasoned veteran or something at that point.

So what was that like emotionally? 

Dr. Adam Goodcoff: Yeah, it’s, it like gives you the chills to kind of think back on it cuz it’s one of those things like you were born into that you didn’t know anything different. Right. So it’s just like, okay, I, I guess this is what it is. And, and for background, you know, I was an EMT for five years.

I’ve, I’ve seen a lot in my life even before doing this, but, okay, [00:09:00] the problem in my opinion, or the hard part was not what you saw at work. That’s sad and we’ve all learned to deal with that. But when you go home, you talk to friends and family, you share a meal, a drink, whatever it is, we were going home and being alone, you know?

Yeah. And I’m very thankful. My first year I lived, uh, now I live alone. At the time I lived with another resident, good friend of mine from med school actually, and then one of our friends. So we had some comradery, but there were a lot of residents that were going home, sitting alone scared. I remember like getting naked in the, in the hallway and you know, running to the shower.

And so, right. You’re trying to figure all this stuff out. You don’t know anything. You’re reading on stuff that there’s no literature to even read about, and then you’re going home. You can’t hang out with your friends. You can’t make really good relationships with your residents without trying to feel like you’re sneaking around at night, you know?

Right. With the risk of covid, you know, you go to a party normally and you can’t take a drink from someone else or stand close to someone else, you know? So it, it was, um, I think that the kind of interpersonal aspect was actually a lot harder. Um, it was obviously devastating what we were seeing, but the fact that you didn’t have any real way to blow off steam.[00:10:00] 

Right, right. That’s such 

Will: a huge part of, of training is Yeah. Being around your, your co-residents, you know, passing them in the halls and or just getting together outside and being able to, Commiserate and then and vent. That’s like, that’s one of the core competencies of residency, 

Dr. Adam Goodcoff: I think. Yeah, right. I think measurable outcomes.

Yeah. You know, and it was, it’s funny too, like, um, from, from personal relationships in the hospital, now our program is a, is different cause we do rotate through a couple hospitals that we staff. But, um, you know, there were people at the end of the year that I, I didn’t even recognize them cuz it mask wearing was so strict that, you know, you’re going through a whole shift with your N 95 and goggles on the whole time That when the time came that we took masks off, I’m like, huh.

That’s, you know what I pictured All right. It’s, it was, uh, so it was kind of interesting. 

Kristin: Yeah. Do you think, was it like pleasant surprises or negative surpr? And you don’t have to name any names or anything, but just like, what is that like when you got this group of coworkers, did you tend to skew like, I thought you were better looking, or, oh, wow.

I didn’t know that was under [00:11:00] there. 

Dr. Adam Goodcoff: I, if I’m honest, I think it was, it was more of the other, like, I didn’t realize how much someone’s smile and mouth made up, like identity of the face. You know, you think of eyes. Yeah. And obviously we’re looking at eyes all the time and you know, it’s the same thing again.


Will: I really am looking at eyes all the time. Right. But yes. Yes, exactly. You literally are, 

Dr. Adam Goodcoff: I’m glad you said it. Good. Yeah. You know, it’s gotta be said, but um, It was, yeah, lower half is important. Yeah. It was alarming jaw structure. All that stuff is lost when you have a mask on. And so, you know, I don’t know that it was necessary.

I was like, oh my gosh. It was just more like I had no, like my, what? My brain filled in the details for you so wrong. That’s what like the Mr. Potato hat didn’t fit, you know? Right. 

Will: I mean, I, you know, I work with, uh, with a bunch of staff at our surgery center and even though, I mean, I haven’t seen some of their faces ever.

And so we, when we, we get together for like, you know, I think we had our first holiday party like in person this year, and all of a sudden I like wasn’t recognizing people that I’d been working with for five years. And I imagine it’s even worse whenever you [00:12:00] have even more PPE covering. Um, yourself, but then, you know, you’re 

Kristin: at a, I don’t know if it would be fair or unfair or advantage or disadvantage, but everybody probably knew what your face looked like because of the, you know, extracurricular activities you were involved in.

So they all knew what you looked like. Yeah. You had no idea 

Will: disadvantage. And that’s, and that started, you started the, the, the see the med life in a right at the beginning of your training. Right? Well, 

Dr. Adam Goodcoff: so I’d actually been on social media for a while before that, so I had an Instagram presence. Um, and I was doing social media in med school as well with a bit of a different focus.

But you’re, you’re exactly correct. I mean, right around the time, I remember opening TikTok in Thailand and being like, 10,000 views. This is wild. You know, and I hadn’t posted him forever. And it started to, started to grow and grow. And so when I came back, I’m like, I guess I have to figure out some way. I didn’t like TikTok as many of us.

I think like in the beginning I just, I didn’t like it. I wasn’t comfortable. I preferred Instagram and, but there was so much growth. And so yeah, that’s kind of, I, I went all in and doubled down and that’s when the growth started. 

Will: The growth is crazy, [00:13:00] right? That, around that time of year. Yeah. Uh, uh, in 2020.

Yeah. Uh, same thing for me. Like that’s when I, I was in, in lockdown and we weren’t able to see any patients in our clinics and, and so I started making videos and it was just shocking. And really not just TikTok, but all over social media, just that’s all people were doing, right? Netflix 

Kristin: and social media was everyone’s 

Will: lives because that’s the only way you could connect with people at that point’s.

And so it’s true, the the amount of, of just traffic. And, and what were you, what were you doing on social media, like around, because I, first of all, I can’t even believe that you were able to like, post content consistently during 

Kristin: residency Yeah, yeah. During a pandemic. Like that’s, that’s 

Will: what, there was a little bit going on there.

Yeah. So, uh, you know, how, how, how did you 

Dr. Adam Goodcoff: keep up with all that? Yeah, we can get into it a little bit. And that was, you know, and we may talk about it later on, and some of the speculation and the, the difficulties that I’ve faced personally as a resident, um mm-hmm. [00:14:00] But, you know, to answer your question, I started as, I was a medical student and I felt like I had did a teaching fellowship as well.

I’ve always been a big, you know, teacher instructor and, um, I really take passion in that. And so I was like, I have all this stuff that I wanna share with more than just the one class that I’m teaching. And so I started sharing that on social media that grew. And then, you know, exactly like you said during the pandemic, there was just this void of vacuum of knowledge gap of everyone in the public wanting some kind of reputable information.

And I don’t think you necessarily needed a degree to provide accurate health information. Um, and of course, I mean, at the time I did have, uh, you know, completed medical school, but it, it, you know, you still had knowledge and you could go and look and do knowledge translation for the general public. And so that’s what I was there for.

Um, the way that I did this during residency, the beginning was it was very, very hard. Um, cause I was doing it all myself. And what I tried to do is structure it around both popular content, but also things that may be helpful to me so I could almost like study and prepare for video at the same time.

That’s smart. Yeah. That’s good. And, and [00:15:00] ultimately though, it got to a point where I was just so. Burnt out. You know, I couldn’t, you, you know, the word, it doesn’t seem like a lot of work, but the work that goes into maintaining, you know, a social media, it’s a lot. And so, oh yeah. Uh, one of my best friends from growing up, uh, he was also sitting around at home and not doing much.

They said, Hey, I’ll give you a percentage of whatever we get. It’s not much now, you know, at the time it was, it was almost nothing. Yeah. And I, I really thank him for taking a leap of faith and, you know, so he took over actually executing. Cause the problem was I was going to work at all these hours and I couldn’t actually post the content, so I couldn’t, you know, I’m not gonna step away and just go, you know, make a video or post a video.

So I was having to record them at home and then try to get them up during those good hours. And so that’s what Josh had taken over, you know, getting the content up, managing the comments and things. And of course I’d interact when I could. Um, but I would, I would try to batch film, you know, I would get home and I’d film three videos and then pass out, and then the next day they would get uploaded one at a time, you know, so.


Kristin: I think there’s a good lesson there and kudos to you for, for doing that because, You have to rely on a team, like I think I don’t, maybe it’s just cuz I’m [00:16:00] married to him, this is how he is, but seems like. The medical training system kind of foster, I mean, yes, it’s collaborative, there’s a team, but you’re supposed to know everything and you get quizzed all the time at random times.

And you get, you know, you feel like you have to be this like independent to a fault. I have to know everything. I have to do everything. I have to, you know, be able to be counted on at all times for anything. But, um, you need to rely on the people around you in order to get things done. And I think anybody that, you look at them and you go how there’s only 24 hours in a day and they have the same 24 hours in a day that I do, how are they doing all of that?

No, they don’t have the same 24 hours that you do cuz they’re hiring a team. Right, right. Or they’re using a team in some 

Will: way recognizing that that’s, yeah. Yeah. But you alluded to the, the idea that, uh, maybe. The, your program or people weren’t too keen on, on you making content? Oh yeah. Is that something you can tell?

You’re, you’re still a resident, right? I’m a 

Dr. Adam Goodcoff: resident for a few more months, so [00:17:00] it’s a delicate, um, I think in a few months, you know, we don’t wanna screw 

Will: anything up here, correct? That’s correct. So please don’t get fired from going on Glock and Flecking podcast here. 

Dr. Adam Goodcoff: So, we’ll, we’ll do a part two now I can, I can share some of the details, um, kind of like the, the, uh, declassified version.

But, um, it, it, it’s what you would imagine, you know, um, a young, all, all of the stereotypes of what this young tall doctor that’s walking to the hospital for the first time is gonna act like are preformed, period. And then you go and watch someone on social media and all of the bad influencer, this, that, that all these labels are slapped on.

And so you walk in and you are the most hated person that has ever existed on planet Earth. And, 

Kristin: and why is it jealousy? Is it that they don’t think you are smart enough to be there? What is it that they’re 

Dr. Adam Goodcoff: projecting out? I don’t, don’t want to, uh, Don’t get myself in any situations, but I think that some of the, you know, the feedback verbally that I would get from people in passing is, don’t you think you should spend more time reading?

Or who, who are you to tell someone information? You don’t know [00:18:00] anything. You’re an intern. So, you know, that classical hierarchy of knowledge, um, you know, and it was, it was a lot of people sitting around waiting for me to make a mistake, right? Everybody could see everything I was doing. It was highly visible.

So I am, and among my friends are, he is like, you are so worried about everything. It’s like, because one mistake is all it takes for the bandwagon to turn around and say, see, we told you he shouldn’t have been doing this. And it really wasn’t until, and, and I’m, I don’t want to, um, make it like I’m on bad terms with my program.

I, they, I’m on good terms with them and they appreciate what I do. But I think rightfully so, you know, they were concerned. They didn’t know me personally, and I came in and I’m making all this content. It’s the same questions, you know, how could he possibly be studying? If he’s doing all of this. And it took really probably a year and a half, two years for them to be like, okay, he’s actually a competent physician, somehow gets his studying done and, and is, you know, effective and kind with his patients.

So that was, uh, something that had to be earned. Um, but it was, there were definitely some large speed bumps that are, uh, for a different time. Uh, you know, yeah. You, you show 

Will: you, you show them [00:19:00] that, okay. Yeah, I, I have this hobby. And it’s just a very public hobby. Like, and I, I’m always talking to, to, you know, trainees about this.

Like, you gotta, you gotta have the thing like, outside of your job Yeah. That you, that you still keep doing or that you like to do and yours just happens, you know, to be very public and Exactly. And, uh, it’s, yeah. But if 

Kristin: they’re not judging someone else for, oh, they go home and they read fiction at night, how could they be, you know, I mean, it’s all, you should 

Will: have a hobby or video games or sports or, you know, whatever it is.

Yeah. And so, uh, like 

Kristin: you said, you gotta blow off steam somehow, or you gotta express different parts of your, of yourself then you can at work. 

Will: Exactly. It’s great because we need it. I mean, especially around that time, I think we needed. You know, competent physician voices on social media. We still do. Like, it’s, it’s a really important thing to have because that’s where people are, everyone’s on social media in some respect, getting information.

And so, um, you know, I, I think it’s a great thing. You need there to be [00:20:00] accurate stuff out there. And I’m glad, I’m glad you didn’t get fired. That’s, and, and you’re, well, it’s not too 

Dr. Adam Goodcoff: late. You’re so close. So just back off. Yeah. Let’s take easy. No, I, I think, you know, to, to that point, um, I think hopefully we’re, we’re good and you know, I, I have everybody learns and, um, hopefully, you know, mistakes are things that you make one time and learn from.

And so, you know, the mistakes that I’ve made along the way are things that have helped, you know, shape the way that I practice social media, so to speak, outside of my real job. And, um, I, I think that, uh, it’s also, you know, when done right can, can be a tremendous opportunity. It’s, it’s one of those things, it’s like a calculated risk, but the amount of people that you can help with social media, as you mentioned.

Well, with, with, you know, reaching. Educational reach and filling a knowledge gap is, is super rewarding. Um, and it’s, it’s worth something. It’s worth the time and so 

Will: Interesting. Yeah, it is. And, and you know, we’ve, we’ve talked about your ability to, um, to juggle all these things, you know, the pandemic training, you know, [00:21:00] your content.

Uh, the most important question that’s been on my mind for the last, like 10 minutes. How did you learn the slit lamp exam? That’s the most important thing that, I mean, I don’t know how, how, how are your skills these days? 

Dr. Adam Goodcoff: Is this. So I, I think, uh, I pride myself on my slit lamp. Uh, I’ve actually seen SEL and flare independently, so I’m very proud of that.

You have? Yep. Oh, good job. That’s once, but hey, it counts. It counts. Well done. So, uh, we, you know, without divulging too much details, we’re at a very, very big eye center here. And so I have befriended the oppo residence and anytime, which is, is often that we’re working there, we consult them, they’re there all night, unfortunately for them.

Um, anything that’s cool, I’m like, Hey, just grab me. I, I’d love to learn how to do that because, uh, eyes are creepy. That’s great. And, uh, you know, I want, I wanna do it now so that later I know what I’m doing. So. Absolutely. It’s absolutely, it’s tricky. 

Will: But, uh, I love doing that. Whenever I was, you know, I went to Iowa and a very busy level one trauma center and yeah, I was very frequently grabbing the, the emergency medicine residence [00:22:00] and yeah, kinda showing.

Because I, I, I could, there’s only so much I can show off to an emergency doctor. Right. Like, there, you know, so much like you, you do. And so like, and that balance tips the other way when you look at it like in one respect, it’s like, you know, it’s these cool eye things, but also like, you know, they’re just finished, like saving lives.

And I’m like, Hey, look at this corneal ulcer. Yeah. Isn’t this interesting? 

Dr. Adam Goodcoff: No, I think it’s, it, it really is fascinating the relationship that we have with our, with the specialists and, um, I think a good ER physician really respects the amount of knowledge that consultants can bring to the table. Um, and there’s, there’s so much, you know, I’ll look at, especially with eyes, but like, I had a, someone that had like a battery acid burn and I’m like, there’s no way they’re gonna lose their eye.

You know, I’m sending pictures to the ophthalmologist and I’m like, they’re gonna say transfer emergently all this. And they’re like, looks like, great, you did a great job irrigating. We’ll see him tomorrow morning. And I’m like, is this a, yep. Is this a play? You just don’t wanna come in or is it really okay?

Like, you know, and I go home and read on it and I’m like, oh, it’s actually okay. Like this is, this guy’s probably gonna recover here. So [00:23:00] there, you know, there’s just, there’s only so much that we can know and we have to know about a lot of things. Right. And so I love having those conversations with, with all the specialties and be like, wow, this is fascinating.

I had no idea. 

Will: Yeah, acids. Acids are much, uh, better than bases. Bases are when we’re, those are the, uh, the pants patients as I like to call them. Those you tell me about an a basic, uh, you know, like a lie or a, uh, you know, sodium hydroxide or something. I’m putting my pants on and I’m coming in to see the patients.

So I’d like that. Um, the acids, uh, just for everyone’s reference, it’s, it’s still an emer, it’s still something you should, you see someone about. No, we’re 

Kristin: not recommending pouring acid 

Will: in your eyes, it’s still a bad thing. It’s just not quite as, like, devastating as like a basic injury. Right, right. Have you, do you feel like you’ve, over the course of your residency, you’ve hit up all the, all the specialties.

Have you, have you, have they, have you gotten all of them into the emergency department at this 

Dr. Adam Goodcoff: point? Oh, yeah, yeah, yeah. We, I’ve even had, even the. Even the dermatologist. I had derm, actually it was just this year earlier this, and it’s actually gonna be presented at a case report in New Orleans. So [00:24:00] not that they came into the er, but the case itself.

Um, so do you guys have like a 

Kristin: bingo card of the time? Yeah. The ones you’re trying to get in? Yeah, we should, should. And then at the end of residency, the one that has the most wins a prize. 

Dr. Adam Goodcoff: I’ll start it. I’ll start it. That’s a good idea. There you go. Yeah. Well 

Will: that’s good. You’re welcome. And plastics, is that the other one that’s hard to get into?

Dr. Adam Goodcoff: Plastics, hard plastics come in a few times. Yeah. Um, again, these, these things are easier to get done at the university center. We work at a couple sites, so, um, it just depends. But yeah, that would be, those are probably the two hardest getting radiology to appear in the department. That’s like, 

Will: doesn’t happen.

It’s like coming to the what? In what situation would they come? Uh, interventional. 

Dr. Adam Goodcoff: Oh, okay. So like if they’ve done a procedure that would happen to be bleeding profusely at 3:00 AM that you’re not able to stop despite figure of eight stitch or anything like that. 

Will: Specific because, because I don’t, I don’t, uh, at this point it’s been like five years since I’ve been in a, in a, like an academic center.

Sure. Um, and so I cover a lot of, uh, like four different community hospitals. Do you, do you get out into the [00:25:00] community as part of your training? Is that, is that, yeah, so 

Dr. Adam Goodcoff: we, we have a really diverse, um, training setup, which is, I think what’s really valuable about our program. So we have a hardcore academic site, um, where you just, like, the joke is if someone comes in with a stub toe, they also happen to have an a k i and their transplanted kidney because their liver is failing.

That was transplanted two months prior. So it’s just like nothing is straightforward. Um, you know, and then we have kind of a community fast-paced hybrid. It’s, it’s not really academic, but it, it has a lot of residency programs in it. And so you get to see what high efficiency is. Um, we have like kind of.

I don’t call it like a community trauma center, it’s a level one, but it’s more like lower acuity level one stuff. And then, you know, we have a true community site that is in, in the south side. You’re the patients are the incredibly sick there and it’s just super rewarding because, um, you’re just seeing mm-hmm.

Not even bread and butter. I, I don’t even know how to describe it. They’re so, so sick and so, uh, very, very high action. And you’re, you know, learning about that process of transferring and dealing with consultants that don’t come into the hospital or maybe don’t have a service there. 

Will: [00:26:00] Is there a, a setting that appeals to you as far as your future career?

Dr. Adam Goodcoff: You know, I personally enjoy that kind of community or community hybrid setting. I think, um, yeah, academic is a special place, but it’s, it’s probably not a place that fits my personality the most. Um, yeah, and, and on the flip side, I think, you know, community alone can be tough. Um, they see a lot of patients and have a lot of, uh, you know, a lot of things put on them as well.

So it’s a unique challenge in every setting. But I, I, I kind of like, you know, I think the perfect world is maybe that community, community hybrid. Um, and that’s kind of where, where I’ll be going, um, next year. 

Will: You mentioned the, just the breadth of, of things that you, you know, um, you know about and that you encounter and you have to deal with.

Uh, and so the learning opportunities are seemingly endless in emergency medicine. But I, I want to let you get to some of these stories that you brought with us, with you today cuz we asked you to, you know, we love stories on this podcast. Sure. Especially from trainees or people in med school residency, cuz that’s when some of the [00:27:00] really interesting learning opportunities happen.

And so, oh, uh, tell, tell us about some of these experiences you had, uh, early on. Again, 

Kristin: nothing that will get you fired. Right, right. I don’t wanna be responsible for that. Right. 

Dr. Adam Goodcoff: One are good. One of my favorite ones, and I don’t know if it got included on the list, but I’d love to share it. It’s, it’s pretty pg Um, I was a med student, so I was a fourth year med student doing an away rotation at a very, very well known, we’ll call it like an Ivy League EM program.

And so this was a big deal and I’m a do so for me to get this rotation was huge. I needed a big letter that was like my power piece to be able to go wherever I wanted. Mm-hmm. And. So I’m doing this laceration repair on this woman’s face and I’ve done a ton. So of course, you know, med students are very cocky in fourth year, so I’m like, oh yeah, this is gonna be great.

Yeah. So this lady’s great and I’m talking to her. It’s a nice old lady. I’m closing up her face. It’s like a cut right here. And uh, and I guess it kind of comes down here. And so I had injected lidocaine or whatever, and we’re going, I close the thing up. I’m like, how’s it feel? She’s like, it’s good. I’m like, can’t she cannot raise this side of her face at all?

And I’m like, oh no. [00:28:00] So it’s, it’s going down into her brow, right. And I’ve now, and there, there’s some tissue and stuff, but again, I’m like, the fourth year, I don’t care. I’m just going away closing this up. I’m like, wow, I did a great job. And I dunno what made me say it, but I’m looking at it and I’m like, can you raise your eyebrows?

And the, the other side goes up. Mm-hmm. And the affected side just doesn’t move. And I just like instantly defecate my pants and I’m like, what hit I’m, what did I do? Can you smile? So her face is moving. I’m like, I just lid her nerve. Like I must have sutured her nerve. And so I go and I’m like, I just have to be honest, and I come clean on this and I go to the attending and I’m like, I’m really sorry.

I don’t know what I did, but this woman’s eyebrow doesn’t move anymore. And he kind of like smiles and gets up. And again, I’m like profusely sweating. Like, this is my one chance. And he goes in and, uh, looks, has her move whatever, looks at the sutures, okay. Comes back out and he’s like, so, uh, what happened in.

And I was like, I don’t know, I closed it up and I’m going through the whole thing and he’s like, well, what would happen if you [00:29:00] instilled a lot of lidocaine around a nerve? And I was like, I would go numb. And he’s like, and what’s on the inside of the sensory component? And I was like, motor? He’s like, yeah, just numbed up the motor component.

And, and sure enough, like, you know, he called her the next day and she was able to move her eyebrow, but I was like, oh my God, I just cut this woman’s nerve to her face. I’m going to prison. Like all, you know, all the above. So I just gave a little Botox. That’s 

Will: all. 

Dr. Adam Goodcoff: Exactly, exactly. So that was, that was a, uh, a good one.

So here’s, here’s something. Oh my 

Will: gosh. Uh, just real quick about lacerations to the face, forehead, brow. Uh, so because, you know, I have to do a fair number of last, actually, you know, emergency physi, you guys are really good at the, at facial lacerations. When it gets below the brow, that’s when it can get tricky.

And sometimes the ophthalmologist gets called in. You can’t really screw a whole lot up. With laceration of the forehead. Right. And if you get into the brow, it’s when you get below the brow, uh, onto the eyelid, that’s when you can really start. Because there’s an eyeball [00:30:00] under there, Adam. Right. It’s, you know, so, so the, with the brow you can put deep sutures in, that’s fine, but you don’t wanna do that on the eyelid.

Right. It’s, it’s, uh, all surface kind, closing the skin. So, 

Kristin: so just like a very thin, tiny working space for you versus 

Will: more like, you know, significant structures around the eye lid 

Dr. Adam Goodcoff: don’t tend to like it. The brows fine. It’s like suing on top of a balloon paper on top of balloon. But if you go through the balloon, you know Exactly.

That’s what we call an open globe. 

Will: Yeah, exactly. I’ve unfortunately, knock on wood, never seen like an atrogenic open globe from a, an attempted, uh, eyelid repair. And so I feel like that that would be actually fairly difficult to an accomplish who do what Atrogenic, uh, where the, the person fixed it, caused it.

Oh, kind of thing. Gotcha. 

Dr. Adam Goodcoff: Fancy covering the whoopsy. Yeah, that’s right. The 

Will: whoopsie. That’s good. All right. Tell us, uh, what else, what else do you got here? Because you [00:31:00] got some good ones. I, yeah, I, 

Dr. Adam Goodcoff: I have two that come to mind. One is just pure embarrassment and, uh, I own it to this day. So I was on surgery and I had, I had gone to a, like a medical school that focused on rural rotations.

And so there were no residents in this hospital. It was me and the attending surgeon. And so female surgeon, she was fantastic and she was tough. And so she’s like, go round on the patients, tell me what needs to be done, whatever. So I’m like, great. We have this wound check. So she says, okay, well you’re running the service, so I’ll turn the patient and you take a look.

And so, Fine. I’ve seen some wounds. We do the wound clinic roll over and I go, oh my God, that is the, there is a profound sacral ulcer here. We probably have to take her to surgery or something. And she goes, really? I wasn’t expecting to find anything. And she looks, and there’s family in the room, there’s the nurse.

And I’m, I’m like, oh man, that’s the worst sacred ulcer I’ve ever seen. 

Will: You made a call right there. You put your nickel down on sacral ulcer. Okay. So she 

Dr. Adam Goodcoff: looks over the top and she goes, we could talk about it outside. Okay. Oh [00:32:00] no. So we go outside and she goes, that, um, that’s a rectum, that’s a prolapse rectum.

And I was just, I was just beat red in the face. Oh man. Oh no. 

Will: So, and you were a, you were a third year? Fourth year. I’m a third 

Dr. Adam Goodcoff: year, yeah. So it’s third year. It’s excusable, but, um, yeah. Yeah. But I just was like, still embarrassing. I’d never seen one and I was like, I guess it’s in the area. I’ve seen these other wounds and it was, it was mortifying.

So, so 

Kristin: was she expecting to see something like that? 

Will: That was probably wholly unexpected, right? For 

Dr. Adam Goodcoff: to see it. Yeah. No, I, I think, I don’t think they knew that she had that condition. And so, you know, to me it looked like a, like just massive fungating wound. But in fact that was just, oh my gosh, mental tissue.

The prolapse 

Will: rectum. Yeah. Now, which is either way, that doesn’t sound great. Well, it’s, it’s something that you, you’ve probably seen a lot more of, of since then, I imagine in emergency medicine, right? No, it’s 

Dr. Adam Goodcoff: like I said, yeah, everything’s a learning opportunity, so I, I never missed that again. But, uh, and I actually, I 

Will: learned, you know, I’m cuz as an ophthalmologist, like the only, I [00:33:00] only get like, learn things outside of my field that I just happen to see on social media and actually learn how to like, reduce a prolapsed rectum.

Yep. Do you know what you, can you guess what you do? Do 

Kristin: you, well, do you have to digitally 

Will: you’ll never guess you’ll No, yeah, you don’t get no digits. You don’t do that. Okay. I’ll give you a 

Dr. Adam Goodcoff: clue. I’ll give you an easy clue. Okay? Okay. I mean, it won Won’t help. But knowing I know nothing 

Kristin: about any of 

Dr. Adam Goodcoff: this, well, we have, we have to go to the cafeteria to solve the problem.

Kristin: You need some utensils? 

Dr. Adam Goodcoff: No, we’ve got instruments. Okay. Uh, it’s an ingredient. 

Kristin: Oh, reducing what, when you say reduce the rectum, does that mean that you put it back in? Putting them back? Okay. Yeah. Uh, I have 

Dr. Adam Goodcoff: no idea. No, I just tell her it’s, uh, go for it. So if you pour sugar on a rectum, it dehydrates the tissue and actually lets it volute back in.


Kristin: if you literally pour some sugar, domino 

Dr. Adam Goodcoff: sugar all over 

Will: the rec, Yeah, there you 

Kristin: go. Well, it’ss a handy tip that I hope never 

Will: to have to use. Man. I, that’s one of those things, [00:34:00] like the first person that did that was, they like, that is a genius move. Yeah, yeah, yeah. 

Kristin: I wanna know how they figured that out.

Will: I almost don’t wanna know. It’s, it’s just like chemistry and biology. I mean, it’s like, I guess if you think about it from that standpoint, it’s a very smart person. 

Dr. Adam Goodcoff: Yeah, no, I mean, it makes a lot of sense. So you sprinkle 

Kristin: a little sugar on it. Yeah, well a lot of times. Do you have to like, put it in the oven at three 50 or what?

Dr. Adam Goodcoff: How does that work? 15 minutes usually. Yeah. 15 minutes will 

Will: do it. All right. You got one more? Tell us, tell us the other one, cuz this is also a pretty good one. 

Dr. Adam Goodcoff: Yeah. So this one is, this is a residency story. There was for the record, uh, everyone’s de-identified and there’s no poor adverse outcomes. But, um, so again, this is during covid.

We’re putting in lots of lines in the icu and uh, I had thought for a little that I wanted to do anesthesia. So I came into residency with like, again, rural, no residents, crazy numbers. I had done maybe like 50 intubations, 25 central lines, all as a med student. Um, so I [00:35:00] was quite competent putting in lines on my own.

And so the seniors in the ICU were busy with all these crashing patients. So if there was a line, they were like, you can go do it. You know, we, we feel comfortable and you get us if there’s a problem. So I’d done a bunch of lines and one of the anesthesia second year residents that was rotating was like, Hey, I haven’t gotten to put in a line yet.

Would you mind showing me how to do it? I said, fine. So I take her, we go to the room and again, in turn learning the ropes, didn’t really check the chart cuz the senior told me, go put the line in. So I said, okay, great. So it turns out, first of all there was a dialysis line and I’ve actually at the. Had only maybe done like two or three dialysis lines.

And for the record, I don’t have anything to even show the, the caliber, but, um, like a central line. This, this is decent. I don’t know if it’ll come through on camera, but a central line is small. It’s maybe like this, this thick, so it fits between your hands and, uh, a dialysis line’s bigger than a pen. I mean, it’s, it’s pretty impressive.

Wide diameter. Yeah. Oh yeah. Almost like a guarding hose. And so a small hose. So, you know, I get the kit out and we get ready and she’s doing the procedure and I’m watching or supervising as an intern, which is again, [00:36:00] yikes, you know, different times. And, um, of course the, the attending is supervising as well from outside the room.

Um, but, uh, right there, right there. So we’re, yeah. So we’re, we’re, 

Will: uh, for the most important parts 

Dr. Adam Goodcoff: of the procedure, keep, keep port Yes. Key portions of the procedure. Um, You know, she finds the vessel under ultrasound. I say it’s great. And you know, I’m, it’s different when you’re hands out on the probe. You know, for me, they work in, in tandem at this point, and so I know exactly where I am on the screen.

So I’m watching her. I think you’re, I think you’re good. It looks good. So she detaches the needle. It’s bleeding a little more than normal, but I’m like, ah, nothing, nothing crazy. So now with a hemodialysis line, there’s two dilators. So we put the first dilator in and normally after this, of course you, so the dilator, um, is, is this like piece of plastic that’s like, um, uh, almost like a reverse cone.

So you’re like spreading the skin in the vessel apart. So we put the first dilator in, we take that out, it usually bleeds. So we take that out. It’s like more bleeding than normal to the point that I, I go, I really hope like that that can’t be the artery, cuz this is a big vascular emergency if you dilate an [00:37:00] artery.

So I stop and we look with the ultrasound, the wire, there’s a G wire in at this point, the guidewire’s definitely in the vein, so I feel good. Mm-hmm. Say, okay, why don’t you put the next one in? She puts the big dilator in and takes this thing out and does not know to put pressure on, and there is like a fountain that just comes back out, like worse than an artery, just a constant stream spitting fountain.

And I’m like, same feeling actually, when the woman’s face became paralyzed, I was like, I’ve done it again just a year later. And here we are. And, um, career flashing before your eyes. There you go. It’s like, yep, there’s so much for residency. So I’m, I’m like, put your hand there. Push whatever. So we go and, um, Uh, I’m, I’m like thinking through like, what can I do?

What can I do? The, the senior of course is there, but also doesn’t know what to do. And so I’m like, well, the best thing we do is fill the open hole. So we end up just going through completing the line, sticking the dialysis line in and suturing it down, and actually the bleeding stop. And afterward, I’m sitting around, I’m like, ah, man, I’ve done these, I’ve done a million central lines and I’ve done a, you know, enough HD lines to [00:38:00] feel comfortable, like, what did I miss?

I’m going through the chart. And it turns out the patient was like a stroke patient and had gotten tpa, and so probably shouldn’t have been getting a line in that amount of time. Is the 

Will: clot busting medication? So you thin the blood, like, it’s like, it’s like water, 

Dr. Adam Goodcoff: right? Yeah. So probably not the best time to do a procedure.

And again, you know, whoopsy, thankfully no, no adverse outcome. And there’s lot of, a lot of learning that happens in residency. But that was, um, that was eye-opening. And I can tell you, I always chart review before I do any procedures now. There 

Will: you go. Yeah. That’s, that’s learning from the mistakes, right?

That’s right. Absolutely. And everything, everything ended up okay. Everything was okay, but it definitely, and you know, there’s, you know, there are a lot of, I, I’ve got so many stories. I mean, obviously I didn’t put any, I, I’ve never done any hemodialysis lines, if you can imagine that as an ophthalmologist.

Um, but, uh, certainly have plenty of mistakes I’ve made. And the key is figuring out, What led to that [00:39:00] mistake. Right. And then not ever doing that again. Right, right. So, of course, correct. 

Dr. Adam Goodcoff: Yeah, exactly. Yeah. I, I think the thing that a lot of people forget, and you hear this all the time, the comment, Sue, I’m gonna sue, like, medicine is a practice and it is something that requires a tremendous, tremendous amount of skill, but also refinement and continual improvement.

And so you’re going to make mistakes. There are going to be things that you don’t know and things are not going to work the way that they’re supposed to. But it’s about, you know, just like you said, how do you localize what that problem was, fix it and make sure that it never happens again. And that you have a system in place to avoid those things.

So I think every time there’s a, an adverse event, it’s like, what could I do differently to avoid even getting here? 

Will: Very well said. Well, let’s take a quick break and we’ll come back with Dr. Adam. Good.

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All right. We are back with Dr. Adam GoodCo at See the medlife on social media. And, uh, we are going to do something I, I just came up with last night. Um, I was thinking about my experience in emergency medicine cuz I did two rotations in intern year in, uh, the emergency department. And it’s, there’s, uh, probably the most vivid memories I have are just like seeing things on the status.[00:41:00] 

I just, the status, it’s such a big part of that experience because for me it was somewhat traumatizing. The status board. Yeah. Uh, and so first of all, can you just give us a quick, like just tell people what the ED status board 

Dr. Adam Goodcoff: is? Yeah. So, so status board tracking, shell, every system kind of has a different name for it, but it’s basically, you know, all of the patients that are checked in, in the waiting room, all of the patients that are in rooms.

And then it’s, you know, depending on what you have set up their acuity. So how, how sick they’re projected to be, what their vitals are, what their chief complaint is, which is usually just a one worder that is oftentimes inaccurate. Um, and so, you know, and then their wait time. And so a lot of things that create anxiety, you know, they’ve been here for 10 hours with chest pain.

It’s like, oh man, are they still alive out there? Right. Um, you know, or 75 in the waiting room. 

Will: So just a, a, a giant summary of everything happening in the, in the emergency department. And so, uh, I wanna focus on that chief complaint because that was, that’s what I remember the most, even with residency, cuz I remember going in and seeing eye [00:42:00] pain, like five times on or eye problem is what it was.

No. Wasn’t even differentiated by like, actual thing is like eye problem. Uh, and so what I wanted to do was, um, I’m gonna give you, uh, two, so look, this is the situation, all right? You’re sitting there with like your, we’ll say your co-resident and two patients pop up at the same time and your co-resident turns.

You said you get to choose. What do you wanna do? All right, so I’m gonna give you two chief complaints and you’re gonna tell me which one you choose. I love it. All right. And why? All right, so we’re gonna start chest pain versus shortness of breath, chest pain all 

Dr. Adam Goodcoff: day. Oh yeah, really chest, chest pain’s, easy chest pain.

So there are certain things where you can, once you’ve done your, you know, a thorough history, you can kind of turn your brain off. Chest pain is one of them. If you’ve made sure it’s not some of the other things. There’s a very clear pathway in the United States that we work up chest pain, that we decide who comes in and who does not to the hospital.

So it is a very. It’s easy to boost your numbers and if you’re trying to, a lot of the second years [00:43:00] wanna see a lot of patients, they’ll pick up things like, well, I don’t wanna spoil them, but they’ll pick. That’s one thing that they’ll try and pick up because it’s very, get your troponins, get your labs, make a decision.

It’s very quick. 

Will: You got the algorithm there, you know, you know exactly what to do. Plug and 

Dr. Adam Goodcoff: chug. Exactly. 

Will: All right. All right. So there you go. Uh, tough, tough, uh, first round for shortness of breath. Sorry about that. Uh, cuz that could be a lot of things, right? I guess. Yeah. 

Dr. Adam Goodcoff: And then you differentials, the real reason we don’t, I don’t wanna pick shortness of breath, is you go down the dime route into PEs and then you’re like in the weeds, and then maybe you need a scan.

Now you’re really adding time. So that’s a tough one’s. Okay. 

Will: All right. Back pain versus abdominal pain. 

Dr. Adam Goodcoff: That’s rough. Yeah. With just, with just those words. I’d probably be back pain. I’ve, I’ve become, yeah. I’ve become, Much more comfortable with back pain. Um, okay. It’s one of those complaints that you initially, like as an intern hate because you’re like, I can’t give, I can’t make them feel better.

And they want narcotics. And the truth is they don’t, people just wanna feel better. They can’t move. Their back is spasming. And so when you find out what it is that you, you know, give people to fix that and they are [00:44:00] so thankful, um, it could be really rewarding. So, and, and then educate. It’s a big chance for education.

Cause everyone’s like, I need an mri. I’m like, no, you don’t. Not right now. You don’t, you know, there are indications for an mri, but, um, you know, helping someone understand what those red flags are can also be rewarding. Mm-hmm. So, um, is, is a, is 

Will: there a, I guess when you’re going through, when you’re first starting out in residency, are you trying to just kind of make yourself pick up those, those complaints that you’re not so comfortable with?

Obviously. I mean, that makes sense, right? Because you’re, you have to learn, you have to, to gain that experience. Yeah. 

Dr. Adam Goodcoff: So, You need to pick up everything that you can, right. Early on. I mean, you always, you know, but, um, everything that you think, and like you said, it’s one word. It’s, it’s not what you think, you know, so that abdominal pain Yeah.

That you think is appendicitis ends up being an abscess on the SOAs and you’re like, wow, I would’ve never thought of that. You know? So, um, the more of something that you see, not only the more comfortable of course, but the, the more broad your differential gets in the future for the things that you can’t miss.

So you gotta, you gotta push yourself, and I’m sure [00:45:00] we’ll get into it. There’s one complaint that everyone shies away from that is just a, you gotta fall on the sword. I’m, I’m sure we’re gonna get there. Wait, but before 

Kristin: we move on for back pain. So I would think as a patient, Are there, well, are there certain things that present as back pain versus abdominal pain?

Because in my mind it’s all just in there in the torso. That’s a good point. And like, I don’t know where it is. It’s just on the inside 

Dr. Adam Goodcoff: it hurts. Yeah. So actually that, that, that brings up a really good differentiating point. Like if you were telling me that it was abdominal pain so deep that you weren’t sure if it was back pain or abdominal pain, that’s actually much more concerning to me than discreet back pain or discrete abdominal pain.

And usually people will tell you like, my stomach hurts or my back hurts. But when it’s both, that’s when you really worry about the aorta and the retroperitoneal organs. 

Will: Um, it’s hard to put all that information on the status board though. 

Dr. Adam Goodcoff: Yeah, no, that’s, that’s what we get paid. The, uh, the, the big bucks.

The big, 

Will: so, all right, here we go. Eye pain versus ear pain. Mm. Ear problem versus eye problem. Yeah. 

Dr. Adam Goodcoff: I hate to [00:46:00] get you with it, but we gotta go your problem wisely. You’re, 

Will: you’re choosing 

Dr. Adam Goodcoff: ear. I gotta do it to you. It’s just, it’s so much easier. I, I problem just, it’s, uh, 

Will: we do have a whole specialty dedicated thing, so it is a bit more complicated than the ear.

No offense to any otolaryngologists out there. 

Dr. Adam Goodcoff: And you know what, like satisfaction wise, people are always disappointed that I’m not an ophthalmologist. Like even though they’ve come here knowing that they’re going to see an ER doctor, like, what do you mean you can’t do surgery today? I’m like, I don’t even know how to do that.

You know, be lucky I can stain your eye. So there 

Will: you go. You guys are good with the fluorescein, I’ll tell you that. 

Dr. Adam Goodcoff: Love a good fluorescein 

Will: stain. Altered mental status versus headache. 

Dr. Adam Goodcoff: Altered mental status. Yeah. Yeah. 

Kristin: Okay. That was quick. That was, he had some 

Dr. Adam Goodcoff: certainty on that. Yeah. Yeah. Cuz I think alter mental status, and again, this is a very age, God, it’s, it’s strange.

I guess I, I have been in residency for a little cuz I really like, instantly I’m like, what is the age? That’s what I would decide, like. Mm-hmm. But um, You know, altered mental status in an older person is a very clear cut again, workup. It’s, you’re not, probably not gonna find the answer, or if you do, it’s [00:47:00] antibiotics and admission.

So it’s, it’s usually pretty straightforward. Hmm. The, the caveat to that is, like a young person with altered mental status is very difficult and a very complex workup where you’re getting into an LP and potentially, you know, doing an m i definitely ct, um, lots, lots 

Will: of age cutoff that you think it kind of starts changing.

Perception of, okay. Younger versus older, not to, I don’t want you to, you know, not to piss off any, any age groups out there, but like, is it over 60 or starting to, you know, 

Dr. Adam Goodcoff: than 60. Yeah. My number for most things is like 60 to 65. And that’s not to call them old, it’s just like that’s where my threshold starts to be like Right.

The nerves aren’t as good, they’re not as good at localizing things and the differential starts to change a little bit. Right. And it depends on, and you know, I hate to put a number on it cause it’s everyone’s health. I’ve seen 80 year olds that I think are 55 and I’ve seen people that are 40 that look like they’re 90.

So it really depends. But I, I would say in that bracket is where I start to think of those, you know, sepsis, e type, really reasons. Right. 

Will: Alright. Let’s see. I’ve got a whole bunch of ’em listed here. I’m trying to decide what to go with. [00:48:00] Um, all right. How about hand laceration versus scalp laceration? Scalp?

Dr. Adam Goodcoff: Hmm. Okay. Can staple a scalp all. 

Will: Yeah, I figured like the hair, maybe it gets in the, I don’t know, but maybe you’re not, just not worried about, don’t 

Dr. Adam Goodcoff: you just shave it off if you’re No, no, 

Kristin: I leave it. Yeah. Oh wait, the lacerations there. You’re not making the laceration, right? We’re not doing 

Will: surgeries, 

Dr. Adam Goodcoff: right.

No. Right. No. Yeah. So, so hands, you gotta remember you got all the tendons and nerves and potential foreign bodies, and that’s true. So it can be, um, and, and as well as a lot of flexion points. So a lot of difficulty with like, keeping those wounds closed, um, versus, you know, the scalp is easy to numb up, easy to staple, and hopefully it’s somewhere that’s not cosmetically gonna affect the patient, you know, under their hair.

So you can kind of just, they’re happy, you’re happy and they get out quickly. With, with hand 

Will: lacerations, do you call ortho or plastics or is there like a hand hand specialist? Does that exist? I assume 

Dr. Adam Goodcoff: it does. Absolutely. Oh, hands, hand’s a big thing. And there’s a ton of obviously, liability in, in hand repair, so anything you.

What’s [00:49:00] that? 

Kristin: They’re important. They’re important to patients. I feel like your hands other, 

Will: other, other than like the scalp now, 

Kristin: who cares? Yeah. Like what are you gonna do? It’s hard to mess 

Dr. Adam Goodcoff: up. Yeah. Anything that, that touches a tendon, uh, hand surgery is gonna be involved. All right, 

Will: here we go. Here’s a big one.

Vaginal bleeding versus rectal bleeding. Probably. What makes you more nervous? 

Dr. Adam Goodcoff: More, more nervous? I, it depends on the, depends on their vitals really, because both of those can bleed like crazy. Um, I think really probably like heavy vaginal bleeding probably makes me more nervous, um, because it, it’s just, in my opinion, harder to control.

Um, you don’t, I don’t see a ton of like prouse rectal bleeding. Like it’s, if you talk about upper gi eye bleeding, that’s, that’s scary stuff for sure. But lower GI usually is a bit slower. Um, it’s not to say, you know, you can’t have exceptions to the rule, but, but vaginal bleeding, like, um, you know, postpartum hemorrhage and like any of these things can be life-threatening, bleeding within the, I mean, I’ve, I’ve seen someone almost arrest from vaginal bleeding, so, um, It’s [00:50:00] scary.

That’s that’s crazy. 

Kristin: You know, we’ve talked a lot more about rectums than I had predicted for today. That’s 

Will: true. We we’re, we’re get, we’re getting into the, yeah. I mean, both of those sound absolutely terrifying to me. Um, yeah. But you know, I haven’t asked a patient to take off their pants in years. That’s probably a good thing.

Yeah. You know, if that’s a request you get in the eye clinic, you should maybe see a different eye doctor. Um, all right. How about this double vision versus anything? Anything, anything, 

Dr. Adam Goodcoff: anything else? 

Will: There’s so much. That’s actually almost my, my, uh, choice as well, because I also don’t like double vision in the emergency department.

Right. That’s a hard one. 

Dr. Adam Goodcoff: That’s tough. And then you get into the, you know, is it a stroke, is it not? And that’s always an argument with, is neurology gonna take this? Is this an opto problem? So undifferentiated ground never does. 

Will: Well, that’s a, that’s, that’s something that we fight over as well. And so we don’t, it’s a, 

Kristin: to figure that out.

You come in with double vision. If you come in with double vision, [00:51:00] you’re essentially like a hot potato where the specialists are passing you off to 

Will: each other behind the scenes, kinda it’s, yeah. I think from an emergency physician standpoint, you can just call both and just let us figure it out ourselves.

Yeah. Um, that’s probably a good, 

Dr. Adam Goodcoff: good way to go about it. I think it’s from, from both sides too. It’s a, it’s from an area of good heart, you know, they want to, like, an ophthalmologist doesn’t really manage a stroke, so they don’t want to miss that. And a neurologist is like, I don’t deal with the eyeball, so I don’t wanna miss that.

Right. So I think it’s a team approach. 

Will: It is, it absolutely is a team approach. And, um, the, the difficult thing with. With double vision or kind of neuro-ophthalmology type issues is, is there is a lot that we can do in the eye clinic that we can’t do. That’s actually just more difficult to do diagnostic wise workup, um, figuring out exactly where the problem might be.

Uh, but, you know, usually getting an MRIs is right there on the, on the workup for a lot of double vision. Actually, I, I’ll tell you the, the one thing that I, I teach whenever I talk to emergency physician [00:52:00] groups is, is, uh, the difference between monocular and binocular diplopia. That’s, that’s like the number, so for all everybody listening who’s wanting how it’s still awake.

Yeah. If you really are interested in this stuff, um, uh, monocular. So basically, if a patient take a good time for me to take a restroom break Yeah, please feel free. Go ahead. Uh, if you cover an eye. And the double vision goes away. That is binocular diplopia. They have to have both eyes open in order to have the double vision.

If they cover an eye and they’re like, oh yeah, I still see two or three or four images, that’s dry eye. That’s like, you know, go see your ophthalmologist, you know, eye doctor, you know, what does dry 

Kristin: eye make double vision? 

Will: Uh, it’s just the cornea is, uh, I mean, you’re looking through it all the time, and if there’s dry spots on it, it can defract light and cause you to see it’s, it’s not so much double vision.

It’s like a ghosting of images. Mm-hmm. So it’s, it’s, you’re not seeing like, I’m, it’s not like I would see two of you if I had dry eye and do double vision. Mm-hmm. I’d see kind of like a shadow of you. Okay. And, uh, and so yeah, patients blank and I could, I could go 

Dr. Adam Goodcoff: [00:53:00] all day. Let’s, let’s, let’s not do this.

And, and you love Vine’s a great thing for that. That’s really, really gets you going there. That’s what I’ve 

Will: heard. That’s, um, you know, if you ever, if you ever need someone in the emergency department to, to talk to a patient about I’m, I’d be more than happy to be on call for you. So please, if they’re like, should I, you know, what’s the problem with Vine?

I’m happy to take that. Love it. That’s a consult. I wouldn’t mind. He makes a lot of friends. I see that. I, yeah, yeah, yeah. I’m very passionate about a handful of things and of Vine, you know, again, I don’t have a lot of use in the emergency department. Um, and so if, if whatever I can do to help out, I, I’m more than happy.

I love it. All right. That’s, what did I miss? I feel like I got most of, like the big things that you guys see. The only one 

Dr. Adam Goodcoff: that’s like, uh, run the other way for most people is a dizziness. It’s just, oh, dizziness is tough. A nightmare of a chief complaint because is it central? Is it peripheral? Is it orthostatic hypotension?

I mean, like, the list goes on and on and on and like, really the only answer, and this is like the, the [00:54:00] dissatisfying part is you have to get an mri, which takes a tremendous amount of time. So, And may not be available where you are. Um, but you know, a CT scan’s not gonna tell you the cause of, 

Will: I, I always feel bad like asking, sending, you know, cuz I’ll get a patient that has um, like a central retinal artery occlusion or something.

It’s, which is a stroke and it’s like, okay, I need you to go to the emergency. I feel bad asking you guys for an mri cuz I feel like it’s impossible. It’s 

Dr. Adam Goodcoff: just depends on the site and what the, what the study is. I mean, we definitely can do it if there’s an MRI machine, it can be done as long as the tech’s there.

But, you know, budget is different everywhere. And so some of the places we work, we don’t have an MRI tech overnight, so we have to, you know, make that call. Is this an emergency to call in the tech or can they do it in the morning? Um, but, and then some places don’t have an MRI and you, you, you know, it still exists and you 

Will: have to transfer them.

See Texaco, Mike. Okay. Um, I think that’s it. That’s, that was great. Uh, so let’s, let’s, uh, take a quick break and then we’ll come back with a few, a couple of, uh, listener stories and we’ll finish up here.[00:55:00] 

Okay. Back with Dr. Adam GoodCo. And so, Adam, what we do here is we have a couple of fans that, uh, uh, fan stories that we like to tell and, uh, and, uh, get our reactions to them. So here we go. The first one is from Chris. I’ve got an odd story about something that happened with one of my eyes when I was young.

See, that’s all it takes. You, you, you talk about eyes like you’re gonna get on the show here. That’s it. I was out riding my bike and rode right into a swarm of Nats, or as I would call it, a bug fight, because it looks like they’re all fighting. I soon realized one of my eyes was very blurry and it felt like I had something in my eye.

I blinked and rubbed and blinked and rubbed and no avail. My mom thinking that I most likely got a dust or something in my eye. Said, sleep on it. All right, and if it’s still like this in the morning, we’ll go to the walking clinic. Of course, I’m sure you can guess where this is going. I still had the issue in the morning.

We get to the walking clinic, I’m seen and sure enough, I had a gnat in my eye. They managed to get it out of the clinic. Thankfully it wasn’t all bad. I did get to get, I did get the day off of [00:56:00] school for emotional damage, 

Kristin: so I can relate, I can empathize with that. I would have emotional damage if I had an insect in my eye.

Also, it makes me wonder if Chris is from the Midwest, because they have those nets there that do that. Right. They, it is just like cluster, I guess, nets, and then they just like dive bum your face like they’re, they’re trying to get into all your orifices. 

Will: I don’t know if you get, um, people that come into the emergency department with like, thinking they have some kind of parasite or bug or something because those are probably the most anxious patients that I will get.

It happens probably, maybe, you know, once every other month. Yeah. Where someone’s convinced they have a parasite in their eye or they saw something, they’ve some kind of 

Dr. Adam Goodcoff: insect. We, we get that and we get it in the ears also. Um, but you know, the eye is nice cuz you can, you know, what we get actually more is, is contact lens.

Um, they’d be like, I can’t remember if I put a contact in or not. I don’t know if it’s still in my eye, but it feels like it’s there. And so, you know, we’ll stay in the eye and look around and, um, you know, try and look as, as [00:57:00] far up and down as we can. 

Will: They can, they can, they can hide from you. Oh, fragments of contacts.

Yeah. That’s happened to me two times. I people come in and like, I’ve lost a contact and sometimes we find them and sometimes we don’t. Yeah, yeah. But they, they never disappeared. But you know, the 

Kristin: tricky thing about it, your brain, unfortunately as a person with the contact is that if it were to have just fallen out.

Yeah. Because sometimes that could happen, right? Mm-hmm. And you think it’s back there cuz you didn’t see it. But the problem is now you don’t have your contacts in. That’s 

Will: how you see it. So it’s hard to find. Then you put another one in. Well, 

Dr. Adam Goodcoff: and then, you know, with two contacts, you know, they’re, they’re irritating their eye repeatedly.

So they’re giving whether it’s an actual Korney abrasion. Yeah. So now they, they feel something in there, so 

Will: makes it worse. Okay. Our next story comes from Arthur. Uh, full disclosure. This story is actually from my great aunt’s memoirs. She went to medical school in the 1930s in Ireland, and later became a general practitioner.

This story is from when she was still a student. She had the task of dating a pregnancy and a woman who had come into the clinic as part of an assessment. [00:58:00] After an exam. After an examination, she estimated that the patient was five months pregnant. The patient was furious. She loudly proclaimed that she had only been married for three months.

Oopsy, my aunt, who must have been quite naive at the time, backtracked and said she was three months pregnant. Instead, her lecturer. Had to fail her, but apparently found the whole thing quite funny and asked that she had asked if she had ever heard of sex before marriage again. This was Ireland in the 1930s.

I imagine that’s, that’s a difficult topic. She repeated the assessment and must have passed because she did go on to qualify as a doctor, no mean feat for a woman in Ireland at that 

Kristin: time. Yeah. That’s a tough situation to be in. 

Will: That’s, that’s tricky. Yeah. Um, but good on her. I mean, that’s, that’s impressive.

Like, you know, I can’t imagine how many, you know, female physicians. There were, you know, in Ireland, 1930s, bad time. Yeah. Those, you’ve gotta publish. Arthur, you should publish those memoirs because those are the [00:59:00] types of stories people would love to hear. So thank you, uh, both of you, Chris and Arthur, for those stories.

Send us your stories. Knock, knock high@humancontent.com. Dr. Adam GoodCo, thank you so much for being here. Adam, it was a pleasure to get to talk to you. Finally, after seeing all your content on social media, tell us, you know, where people can find you, what you got working in the works, other, see if I can talk, uh, yeah, tell, tell us what’s coming up for you.


Dr. Adam Goodcoff: yeah. At see the medlife on, uh, Instagram and, and TikTok and, uh, the medlife on YouTube, and we have some fun stuff. Uh, we do interactive cases, so if you like to test your knowledge or kind of play the doctor, they’re, uh, posted on my Instagram every week. So, you know, whatever the audience chooses is actually what happens.

So I spend a long time filming both outcomes. So, you know, some weeks the patient doesn’t make it and some weeks they get it right. Um, so it’s a fun way and then the content that we make actually supports those cases so that you can go and learn what you needed to know to get that case, right. So, oh, that’s, that’s such a fun idea.

And, um, yeah. And then, uh, we’re, we’re. Soon to be relaunching the YouTube a little bit with some, a new kind of [01:00:00] forward-looking health tech MedTech focus. And we’re very excited about that too. Awesome. 

Will: All right. Take it out. Very cool. Well, thanks again for being here. Best luck. Thank you, boss. Appreciate you 

Dr. Adam Goodcoff: having me.


Will: Well, that was a fun conversation. It’s about time we got somebody in training on here. Yes. Just a different perspective on things and 

Kristin: you know. That’s right. And that’s when all the good stories are happening. I mean, if you listen back to previous guests a lot from are from residency stories 

Will: could do.

That’s a, we could just make the entire podcast, you know, interviews with the residents and probably have a lot of fun 

Kristin: residents 

Will: and nurses, I think. And thank you all for Yeah. And thank you all for sharing your stories. And, uh, if you have like stories from training, if you’re in medicine and, and any kind of role and you have, those are a lot of times the, the most embarrassing, the best learning experiences.

Uh, or whenever you’re training to be a doctor or nurse or, or whatever it is. Um, and so share ’em with us. You know, share us your thoughts [01:01:00] about, uh, the episode today and, um, if you have any ideas for games I could play with our guests. Like that’s, I I’m always open to ideas as well. Lots of ways to hit us up.

Email us, knock, knock high@humancontent.com. Visit our social media. Uh, we’re on Instagram, TikTok, YouTube, Twitter, uh, I think that’s all everything, but like Facebook, we don’t have, on Facebook, we’re working on, we gotta work on that. Do our, because my stuff shows up on Facebook all the time. Yeah, that’s true.

We got, we gotta get on there. Um, and, uh, Hang out with us and the Human Content Podcast family on Instagram and TikTok at Human Content Pods. Thanks to all the great listeners leaving. Wonderful. They’re all great. All of you are great. There’s none, none of you that are not great. You’re all great and you’re all leaving wonderful feedback for us.

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