Transcript

Kristin: [00:00:00] Hey Will. Hey, what’s up? I’ve been thinking the US healthcare system, it needs some improvement. 

Will: Yeah, it’s, it’s, there’s room for improvement for 

Kristin: sure. Yeah. It’s a confusing, scary place for everybody involved. 

Will: Absolutely. 

Kristin: Physicians, families, patients, everybody. 

Will: Everybody. And I’ve experienced it from both sides, right?

I’m a physician, I’ve also been a patient, so I wanted to use my platform to give people practical education. Really the only way that I know how. By making jokes. So Dr. Glaucomflecken really fun and super uplifting. Guide to American Healthcare is Out and it’s a free resource that includes all my videos from the 30 Days of Healthcare Series, alongside deeper explanations, also reliable facts.

Emphasis on reliable. Yes. All right. Uh, uh, figures, uh, numbers, insights into how each of us can fight for a more humane, better healthcare system. Also it has jokes. Did you mention the jokes? I did. I [00:01:00] jokes. Okay. Yes, definitely jokes. Well, 

Kristin: this guide is great for anyone looking to learn more about US healthcare, but especially if you are experiencing it from the clinician side for the first time.

That’s right. We really hope you’ll check it out. 

Will: Get the free guide sent straight to your inbox by signing up for our mailing list. Glaucomflecken.com/healthcare. Enjoy.

Dr. Lakshman Swamy: Knock, knock,

knock, knock. Hi.

Will: Hello everybody. Welcome to Knock, knock. Hi, with the Glaucomfleckens, I am Dr. Glaucomflecken. 

Kristin: I’m Lady Glaucomflecken 

Will: Will and Kristin Planetary. Happy to have you join us for, uh, an episode. Where we’re talking critical care. 

Kristin: Yes. 

Will: Uh, how are you with board games? Um, so we’ve, we’ve talked about this. Yeah.

Your, your extreme lack of competitiveness. 

Kristin: I, well, there’s two things happening. There’s that like your, 

Will: your [00:02:00] pathologic there’s no, it’s not that I 

Kristin: listen, it’s not that I’m not competitive, it’s that I’m not competitive about things that have no practical. Consequence in the real world. What is so like things that are just for fun.

I do not feel competitive. Oh, what? Those are just 

Will: fun. What is something you are competitive about? 

Kristin: Well, I’m most, I’m competitive with myself a lot about work. I get competitive about work. I get competitive with 

Will: yourself. Come on, 

Kristin: gimme something like to, to, I don’t know, what’s it called? You never wanted 

Will: to like beat somebody at something.

Has that ever crossed your mind? Like, I wanna do this thing, I want 

Kristin: everyone to do? Well, I do. That is just Ja, like I don’t feel a need to like have winners and losers. Like, let’s all be winners. 

Will: It’s not that you want someone else, let’s just 

Kristin: don’t do our best. 

Will: It’s not that you want someone else not to do well, it’s just that you want to do better than they did.

I get it. But [00:03:00] like 

Kristin: in order to I, that just makes them feel bad. You know, it feels bad to lose. 

Will: I can confirm to my, to all of our listeners that Kristin is the worst person to play board games with because like every 30 minutes is like every 30, 30 seconds I should say. It’s just like, what are we doing this for?

Like existentially like yes. Like why? 

Kristin: Why am I spending my life? Why 

Will: is this a thing here that exists in the universe? I love, I love games. I am a very competitive person. If you put some 

Kristin: stakes on them, maybe, I don’t know. There’s just, for me, there needs to be some real world implications of something for it to keep my attention.

The other thing is I have a DHD, you can’t blame me. 

Will: Okay, well, I think, uh, this. This game, critical care of the game is actually probably up both of our alleys. Yeah. Because 

Kristin: it does have real world implications. 

Will: It does have real world implications kind of. I mean, it’s game I, it’s a 

Kristin: real world learning.

Yeah, yeah, yeah. But 

Will: also it seems like there can be like, there can be one winner, [00:04:00] but you could also like just. Learn a lot. And you love learning. 

Kristin: Yeah, I do love learning and of course, and I like collaborating, playing this 

Will: game 

Kristin: and cooperating. I like games that are cooperative. 

Will: Yes. And this is this, this is a, a is a cooperative, uh, type of game.

You could play it lots of different ways, but it’s, it’s really cool. We interviewed the maker of this game, first of its kind. I don’t, I’ve never heard of like. Like a medical themed game like this. Yeah. Other than like operation 

Kristin: Well, right. One is, is meant to be somewhat realistic. 

Will: Yes. Yes. So, uh, critical care of the game by, uh, Dr.

Lachman Swamy, who is a pulmonary and critical care doctor in Boston. Uh, and he, uh, does a lot of education in, in his line of work, uh, you know, with med students and residents and, um, and so it’s a very unique perspective. Uh, finished his, his training like. At the height of COVID too. Yeah. So man, he is, uh, uh, he’s been through a lot and it’s, um, uh, it’s this, this game is [00:05:00] several years in the making, talking with him and just, it’s so impressive.

We go through, uh, we just talk about some critical care stuff and, uh, I learned a lot. Yeah. You know, you did too, because I just don’t know a lot about critical care in general. And so, um, uh, it was a really fascinating conversation. Uh, so definitely check out. Critical care of the game, and I hope you enjoy our conversation with Dr.

Swamy.

Hey, Kristin. 

[music]: Yeah. 

Will: I know that you love when I talk about the cute little mites. 

[music]: Mm, mm-hmm. 

Will: Yeah. But I thought we could take a break from that. Is that okay with you? That’s 

[music]: fine. Yeah. 

Will: Uh, because, uh, I’d like to focus on the eyelid symptoms and disease that an overgrowth of Dex. Causes. 

Kristin: Okay. I like that idea.

No, might talk. 

Will: So edema, Dex blepharitis, it often gets misdiagnosed or just missed entirely because a lot of symptoms overlap with other eye conditions. 

Kristin: Hmm. Okay. So what are the top symptoms that people should look out for? 

Will: Uh, usually itching along the [00:06:00] eyelid, margin, swelling, irritation, redness. 

Kristin: Hmm. That sounds like it could be allergies or lots of other things too.

It could 

Will: be a lot of things, but Exactly. And uh, the key is if your doctor spots crusties. On the margin of the eyelid. Mm-hmm. 

Kristin: Technical 

Will: term. Well, yeah, we call ’em collarettes, but you know, crusty is a good term. Uh, that basically that tells you it’s dex blepharitis right there. 

Kristin: Well, I really like that there’s a clear sign to know for sure.

Will: And once you’re diagnosed, there’s a prescription eye drop treatment available for this disease. 

Kristin: Ooh, that is good to know. 

Will: To learn about the common symptoms of dedex blepharitis and more, visit mights love lids.com. Again, that’s M-I-T-E-S. L-O-V-E-L-I-D s.com to learn more. This ad is brought to you by Tarsis Pharmaceuticals.

Hey, Kristin. Yeah. There’s this podcast that’s every clinician should listen to. Ooh, what is it? It’s called the sepsis Spectrum. 

Kristin: Mm. 

Will: It’s all about sepsis. Mm-hmm. Which is a really important topic. It sounds 

Kristin: like a big deal. 

Will: It is. And, and it’s, it’s not just like [00:07:00] fluff and, you know, your typical ce. 

Kristin: Mm. 

Will: Uh, this is, it’s like gripping narratives.

Ooh. 

Kristin: I love a gripping narrative. Yeah. 

Will: Fascinating to listen to and, and so you’re having fun. Listening to it and learning. 

Kristin: Gripping narrative and ce. Yeah, you don’t hear those two things often. The sepsis together, the 

Will: SSIS spectrum by sepsis alliance and critical care educator, Nicole Kic. You can listen to the sepsis spectrum wherever you get your podcast or watch it on Sepsis Alliance’s YouTube channel.

To learn about how you can earn free nursing CE credits just by listening. Visit sepsis podcast.org.

All right. We’re here with Dr. Lman sch Swamy, thank you for joining us. Oh, it’s so exciting to be here. Thank you for having me. So, uh, we, uh, used to, to interact on Twitter back in the day, back when RIP. Beck when Twitter was a, a thing that, that a lot of medical professionals still enjoyed using. Mm-hmm. So, uh, it’s good to finally see in person You too.

Those were, those were [00:08:00] certainly the good old days in, in many ways. All right, so, so I’m sitting here with a box in front of me. And as an ophthalmologist, I will say it does strike me a little bit of anxiety into my heart to see, uh, critical care of the game, even just critical care in general, makes me a little bit nervous.

Uh, uh, it reminds me of my, my time. You know, when I used to actually go to the hospital. 

Kristin: I like that. That’s why it makes you nervous. It’s not that it reminds you of the time you were a patient. 

Will: Oh, no, no. Being critical care. No, just, you know, the, the, the ICU months that I would do, uh, that I would do, you know, during my intern year, you know?

Yeah. As an ophthalmologist, we, we develop a, a, a, a legit allergy to it. Like I get, I get a rash. 

Kristin: Right. I think that’s probably like an evolutionary strategy maybe to protect the patients. 

Will: When was the last time you saw an ophthalmologist in the ICU? Oh my gosh. It has been 

Dr. Lakshman Swamy: pre pandemic many years. 

Will: Many years.

Are you, are we still, are we still a, a consc? ’cause I haven’t gotten one of these in a [00:09:00] while. Are we still consulting for patients with candida? Candidemia. Listen, we, I try. Okay. I try. 

Dr. Lakshman Swamy: You should see the stuff we get Ed for. Okay. 

Will: I figured I gotta, I gotta see what the evidence, uh, shows. Uh, uh, the most recent evidence.

’cause before it was like, whenever there’s any kind of fungus in the blood, uh, on cultures, then it was like, oh, we gotta check the eyes. We gotta get the eyes checked to see. 

Kristin: Mm. Why? 

Will: Because it can be, um, a kind of an. Indolent, you know, not obvious until you actually like look back there and you see a, like little fungal spots in the retina.

Just, 

Kristin: it’s an easy place to see inside some, I mean, the fungus can go anywhere for, 

Will: uh, for some of us. Yeah, yeah, yeah, yeah. Foreign an ophthalmologist. Yeah. Yeah. How are your fundus exam skills these days? 

Dr. Lakshman Swamy: I, you know, I, my eye exam is limited, let’s say. Yeah. Yeah. But I do look at the eyes. 

Will: Oh, that, that’s all I ask for [00:10:00] that, that all I ask is that, and you, you make sure that the patient’s doesn’t come in wearing contact lenses.

Oh, oh, that’s a bad one. That’s, that’s the big thing. That’s a bad, bad one. Yeah. 

Dr. Lakshman Swamy: It, it is kind of a good, you know, it’s, it’s, it’s, to me, it’s, it’s really optimistic that we would ever call you for something like that, because what it’s saying is we’re thinking that far ahead. You know? 

Will: Yeah, 

Dr. Lakshman Swamy: yeah. We’re not just worried about this per person living, you know, through the next day.

We wanna make sure, 

Will: sure. Yeah. I think it’s fine. You can always con consult ophthalmology for anything, and we come in, we show up wearing our, like business clothes, carrying a luggage. It’s, it’s hilarious for everyone involved through 

Dr. Lakshman Swamy: the unit. Yeah. Did you see, 

Will: is that, is that how they’re real? Is that the ophthalmologist?

All right. So, um, I, before we get into, you know, what you’ve been developing here, because I gotta say this game, looking at it, it’s, it’s impressive. It is amazing. Oh, thank you. Uh, so critical care of the game. So we’ll talk all about it. Uh, but first of all, uh, I have just [00:11:00] a question about two questions, uh, that relate to, to some somewhat.

Traumatic experiences that I had as a trainee, like in the ICU. I’m just curious. Oh yeah. Yeah. Because you are like the epitome of critical care. You’re like, you’re at, you’re teaching, right? You’re, you have residents and fellows and all, all the things, right? Yeah. Epitome is 

Dr. Lakshman Swamy: strong. I think, you know, the interesting thing about critical care is probably similar with ophthalmology.

There’s, there’s so many flavors of it everywhere you go. Oh, okay. And I really think all of it’s important whether you are taking care of like the sickest people on ECMO and, and all that. Or, or you are kind of more in a community hospital and taking care of people who just need some life support for a little while.

Right. Just 

Kristin: some light, light support, a little bit 

Dr. Lakshman Swamy: of support, 

Will: a little bit of basic life support there. That sounds so 

Kristin: weird. As a non-medical person, lemme tell you, 

Will: well, how long have you been at, uh, at, so your employee, is it Harvard Medical School? Are you, like, what’s, what’s your So it’s, it’s an affiliation 

Dr. Lakshman Swamy: through the university.

So I work for [00:12:00] Cambridge. Uh. Cambridge Hospital, Cambridge Health Alliance. Right. Which is, uh, essentially the, it’s a public system, right. Um, and it, the hospital has an affiliation with Harvard. So we get Harvard medical students. All of our trainees are Harvard and all that. Um, I, I am certainly not at, you know.

The, the really big, fancy high tech, sort of like, um, very elite Harvard institutions. But I do get to say that I have a Harvard affiliation, which is exciting. 

Will: There you go. That’s good. Um, so, so where are you in relation to like, uh, everyone knows like, you know, mass General, right? Right, yeah. You know, Brigham and Women’s, is that, yeah.

So, so you’re, you’re not a part of those hospitals? No. So those, so 

Dr. Lakshman Swamy: it’s, there’s so much, so much money, so, so much politics around all this stuff in the city. Right. So. Har, it’s, it’s really interesting ’cause there’s a, there’s a, a number of different hospital systems that all affiliate with Harvard. So the, the biggest one that people think of is like the, the MGB system, right?

Yeah. Formerly known as partners, which is Mass General Brigham. They have a bunch of other hospitals too. [00:13:00] Um, and then there’s like the Beth Israel, right? Beth Israel. Oh, right. That’s another system. Um, and then, you know, Boston Children’s, right? I trained, I did all my training at Boston City Hospital, which is bu not Harvard.

Um, and. Now I work for Cambridge Health Alliance, which is affiliated with Harvard as well. So it’s, it’s kind of a, it’s, yeah. Yeah. It’s kind of like a confederacy. What we have in common is a lot of the educational stuff. Right. But Gotcha. You know, my, our, our sort of salary and everything comes more through the hospitals.

Will: Alright, so here are my questions. Um, what are your thoughts about this, um, voice of God ICU system? Thing, the remote thing. Yeah. Is that still a, is that still a thing? Does that, ’cause that was, I had to, I had to deal with that as an intern. 

Dr. Lakshman Swamy: Oh. Oh boy. Yeah. It’s okay. So there are, there’s different ways to use technology in the intensive care unit.

Um, and I gotta say, you know, say this kind of carefully. So, um, I think that there’s, there’s there. There are [00:14:00] some of these, these, uh, these, these tools that have really powerful uses, but in like kind of select scenarios. So let me give you an example. Um, we recently, uh, I edit a critical care journal and we published a paper last year about the use of VR VR headsets for patients who are.

About to go to cardiac surgery and we’ll end up in the ICU. So, so this is like pre-op, right? They’re outpatients. They put this on, they see what the ICU experience is gonna be like before they go there. Super cool, right? Because you can imagine that it’s giving them like a real sense. You, you know, it’s, otherwise you have no, you don’t know what’s coming, right?

Because most of the time you don’t know that you’re gonna end up in an ICU, but in this case you do. So it it, it, and it was pretty cool. Now that’s very different. And you’ll see lots of debate on this, on social media using virtual reality. And I think this is kind of some, it’s gonna get there, it’s gonna get there.

Virtual reality for people who are in the ICU to help with getting more, more mo mobi, like getting them moving early mobilization, um, there’s like a virtual reality with a bike you can put [00:15:00] people on. This is like on a ventilator and all this, so you’re like, you know, biking in south of France. Mm-hmm. Um, and that has some benefit in getting people to move.

Right. And then you have. Sort of like the voice of God. Right. And I think that these things get more and more dangerous. The sicker the patient is, the less they know what they’re expecting here. Right. Because then it’s, it’s, I think, can actually make you really, really delirious, really confused. Right. We already know how horrible it is to have delirium in the ICU and to, to really be confused, to think that your nurses and doctors are trying to kill you.

It’s really, it’s really sad. It’s really scary. And I think we have to be very careful. ’cause in this environment, you, you can trigger, yeah. Yeah. Oh, interesting. 

Will: Okay. Yeah, that was a, you know, I was in a community hospital in Chicago and uh, and so there was limited coverage at certain times. Yeah, yeah. Of night.

And so, uh, sometimes, you know, I would go into a room as an intern and then. You know, the, the, the voice would be like, someone like me is watching. Exactly. It was like, it may have, [00:16:00] may have been you. I don’t know. Um, anyway, I just, I, it was like very like jarring, like, oh my God, what is that? Yeah. Who is what, you know, they’re, they’re seeing everything I’m doing.

Uh, so that was the first time that I ever experienced that. But, uh, speaking of the, the VR headset, I think that would be actually useful for ophthalmologists. So, so that we can know what it’s like to be in the ICU. I just, just a thought, oh my gosh, there’s a study that can be that to be done around this.

So anyway. Absolutely. That’s, that’s a good idea. 

Kristin: Be more at ease. Yeah, 

Dr. Lakshman Swamy: it’s really, it’s just, you know, Chris is exactly what you said. Like, how is it that for an ICU survivor, that is what you are. Yeah, you are more, you have more anxiety about your training experience. 

Will: I, I don’t have, I have very limited memories.

Well, that’s my time in the ICU it was this, it was like a, i, I have like flashbulb type of thing. You was dealing 

Kristin: with some short term amnesia, so I 

Will: had quite a bit of, of amnesia around the event. [00:17:00] Um, but here’s the other question I had for you. Uh, have you ever, um, grilled a, a med student about. Or intern about Winter’s formula.

Dr. Lakshman Swamy: Oh. Oh my gosh. 

Will: Oh, is that a, is that a thing? Is that, okay? 

Dr. Lakshman Swamy: So let me tell you what, there’s, there’s two, there’s two parts to this. The first is, is there great joy and pleasure in grilling a medical student on arcane day? Of course there is. Okay. Do I use that? Do I even like weaponize that? Abso I’m that guy.

Okay. Let me give you an example. And I hope none of my future, future, uh, interns are watching this when I’m doing a central line with them. Yeah. They’re doing the whole thing. They’ve done a great job. Right? I like our glove, like I’m holding our gloved hands, like I’m holding their hand and like helping them do everything.

They’re, they’re sweating bullets, right under the gown, the mass, the heat, the lamp, all this stuff, and everything has gone really well. Hopefully. Yeah. And at the, at the very end, they’re cutting the suture, right? This is the smallest part of the central line. Like you’re, you’re putting a little stitch in and tying it off no matter [00:18:00] what.

It doesn’t matter what they do. Second that their blade, or, you know, they, they, they cut the suture out of nowhere the whole time. I’ve been very quiet, very calm with them, too long.

And every time the they’re, they just go so pale, like all the blood drains out. It’s like, oh, I just killed the 

Will: patient. That’s what they’re thinking. Great. 

[music]: I know, right? 

Dr. Lakshman Swamy: So, okay. So that’s the first part is that I, I, you know, this is like, that’s if you ask me to go back to medical school and say like, why do I wanna be a doctor?

That’s it right there. That’s the reason. Okay. Yeah. Yeah. Number one. But, um, but do I, but like, let’s talk about winner’s formula for a second. I, I also believe. That it is a lot more important to do right by the patient and to deliver great care than it is to obsess about like quizzing each other and internalizing all this stuff.

So I, I do this whole like, like lecture. I give them on acid-based stuff and at the end I say, and I keep telling them, you don’t need to write, don’t write this down. Just listen. Just listen. Don’t write it down [00:19:00] at the end I say, here’s my dot phrase that has all the formulas in it. Now I want you actually do the formulas because you won’t, if you try to do it all for memory, it is important to use these formulas in the right setting.

It does not matter if you memorize this. Yeah. Use the dot phrase, work through the little worksheet in your note and you will always do the right thing. So I, I believe in, you know? Mm-hmm. Making it easy. I think medicine should be as easy as possible ’cause it’s already so hard, but. Yeah, of course. I mean, you gotta grill them 

Will: and, and help me also because I actually don’t have as much critical care content using like a critical care medicine like character as I should.

You know, part of that’s just ’cause it’s limited. I mean, it, it’s 

Dr. Lakshman Swamy: pretty fantastic, but Sure. 

Will: You know, so, uh, what, uh, one relationship I feel like I could mine quite a bit is that I feel like there’s gotta be some dynamic between like you and surgeons. I mean, I feel like if there’s gonna be some conflict, [00:20:00] oh my gosh, some pet peeves, some like, oh, I can’t, why are they doing this again to me?

Uh, that’s probably the way to go. So can you, can you clue me in here? Absolutely. 

Dr. Lakshman Swamy: So tell me. It’s really, it’s really interesting because I’ll also say that the surgeons are often so reliable, right? Such said, like, I, I just, I love them because you, you, you call a surgeon to the ICU, they show up. Right. Yeah.

Yeah. It’s not like the medical, my dear beloved medical colleagues who are like, yeah, yeah, we’ll, like, we’ll get there. We’ll send, no, no, no. You’re like, Hey. And they come and they’re so nice. They’re like, I know, I know. You don’t put your hand on the patient’s belly. I know, I know. You don’t do that. Let me just do, let me just tell you, so, so the, 

Will: so the cardiologist takes this time, the cardiothoracic surgeon, she’ll come right in, 

Dr. Lakshman Swamy: right, right.

Trauma surgery. Oh yeah. All, all the surgeons, they show up right away. They show up right away because they’re also like, this person’s really sick and they, like I what I do might make a difference like very soon. Um, they’re generally, yeah, well, they’re often nice [00:21:00] and um. And, but the thing is, is that in many, you are in a community hospital, right?

In many community hospitals, um, the, the medical intensivist or whoever the intensivist is, is managing the surgical patients as well. So people who go to the, you know, the OR and then need an ICU for a little while, this is, it’s not even necessarily such a, such a. Scary. Like, you know, someone who has vascular surgery, they need, they need like close monitoring.

They need that level of, of nursing care to just keep watching them. They’re doing great. Everything’s fine. They don’t necessarily even need life support, but they are coming up to be, to be watched. Hmm. We are co-managing these people with surgery. Right. And it is, it is just, that’s the place, that’s where you gotta go.

It is such a mess. 

Will: Yeah. The co-management, because I, I mean, for the surgeon, it’s probably just like, I, I’m gonna look at the incision. And that’s, yeah. 

Dr. Lakshman Swamy: But, but they’re also kind of like, but don’t do anything without talking to me. But also you can’t reach me ’cause I’m in the or. So wait on every decision until I come outta the, or six hours later.

But it’s kind of like, that’s good. I like that. I see you. I [00:22:00] don’t, I can’t wait for you. That’s 

Will: what I could, that’s, that’s what I could use right there. Yeah. That’s perfect. Yeah. I know 

Dr. Lakshman Swamy: a certain intern who would be caught right in the middle of that. 

Will: Exactly. Um, that’s great. Well, so let’s tell us, uh, the origin of this game.

Like what made you, uh, want to gamify critical care? 

Dr. Lakshman Swamy: You know, it’s funny, it’s funny that you mentioned Twitter from the starting because that’s actually where it started. There was a resident, I think her name is, uh, Jen Darby, surgical resident. And who, um, we were like tweeting. We were talking on Twitter about, um, about how rounds in the hospital could be like a game.

And we were just kind of like saying things. Fast forward, I think a year or two later, this was, this was pre like before the pandemic 2018 or something. And then, um, apparently that idea was sitting in my head and the. The, the pandemic was bad. It was really bad for us. And, and also in like a bizarrely kind of arrogant, like extremely arrogant way where in that first month and in March and March and April, it in the ICU [00:23:00] in Boston, we were like watching these surges come across the world and it, it, it sounds, it’s, it’s unbelievable, even like, say this out loud now, but it felt like the entire weight of, of dealing with this pandemic was on critical care.

No one else was involved. Yeah. This is just critical care, right? Yeah. That was like that, that flash moment there. And then of course, of course everything, you know, changed, but, and so there’s, the pressure was just really intense. And my, I was just, uh, just about to graduate fellowship, um, at Boston University, um, and in critical care and at, at the height of the pandemic.

Will: Yeah. Like that’s when you were in fellowship. Oh, wow. 2020. Yeah. 

Dr. Lakshman Swamy: Yeah, yeah. Gotcha. So you, you know, and it was, it was, um, both. You know, it was great training, but it was, I learned a lot in those last few months. Yeah. But it was, it was, it was a lot. And the thing is that for some of us, and I, I mean this is certainly true for me, I think it was true for a lot of people, the work in the hospital.

Yeah. It was bad and it was, it was a kind of a lot, they actually protected us pretty well. Like we would do stints and like keep rotating and all this. Yeah. [00:24:00] But. It was, it, it was like in my head, like it had soaked all the way through to my core. All I was thinking about all day, all night, all the time was COVID.

Right. Um, and how society was gonna fall apart and all this. Like, it was like very doomsday in my head at that time. And, and it was kind of confirmed every time I went to the hospital. It was really, really bad. But it was getting. It was getting out of hand and I was kind of, I was, I was unwinding. I was like really, truly falling apart and breaking, you know, and all of my sort of coping mechanisms were, were, were really kind of coming apart at the scene.

They were just not enough. Just not enough. Yeah. Right. Running, whatever, all this stuff. And, um, and then my, my wife, like, she had this like conversation with this like, like flashbulb memory you’re saying, right. Where it’s, it was almost like she slapped me in the face. She’s done that before. That wasn’t what she did this time.

That was when we were, when we were sleep training. That’s when I got slapped in the face. But, um, 

Will: but hey, wake up. Wake up. Wake up. 

Dr. Lakshman Swamy: Good turn. It was, I have to [00:25:00] go to him. I have to go to my baby. But we’re supposed to wait for the timer. No. Oh gosh. Oh man. Here’s the 

Kristin: timer. 

Dr. Lakshman Swamy: Yeah, yeah, yeah. Right. So, so, um, so she was kind of like.

You know, this isn’t okay. You’re, I’m trying, I’m like raising these three young kids in, in this pandemic alone, and you’re kind of like making it a lot worse. She was, she used more mm-hmm. Stronger words than that. And, um, it snapped me out of it. It snapped me out of it, and I don’t know why, but like, I saw them sitting and doing like, arts and craft stuff as, as kids do, especially, you know, in, in March and April, 2020.

And, um, something clicked. I remembered that. And the next thing I knew, I was just like sitting here and it was Ja, I didn’t know what I was doing. I just started. Yeah, writing things down and making it and could have been, you know, could have been anything, could have been like a screenplay or whatever, but it turned out to be I was making a board game.

I dunno why. Yeah. I started making a board game and, um, that, that’s kind of where it started and then it really took off when I realized what you said in the starting, you know, it says a lot [00:26:00] that you have so much anxiety thinking about what it was like being a trainee in the unit. Right. Yeah. And so in the starting it was just, this was just a pet project for me, but it turned into so many other things.

And one of those things was imagine if you’d, if you’d been able to play through this once before going to the unit the first time. They don’t teach you any of this stuff in medical school. They don’t teach you. Like, I’ve had students ask the simplest things like, which one of the numbers on the monitor is the oxygen and which one’s the heart rate?

Right. Like they just don’t, this isn’t the kind of practical stuff that you get until you show up. 

Will: Those are, those are the questions you’re like, kind of afraid to ask because it makes you, you know, feel like you’re an idiot. Like you should already know this stuff, you know? Right. 

Dr. Lakshman Swamy: That’s, that sums up the entire problem of medical education, right?

Like Yeah, exactly. So that, that was a big part of addressing it was like, I wanna, I want people to not be so anxious about it because critical care is, it’s not just important, like there’s a reason we do it. We, we love it, right? Yeah. It’s amazing to be at, to be with people when they’re. At the extreme to be at the extreme of like vulnerability and to, to help them.[00:27:00] 

And there’s a part of that for patients and families too because, you know, so much of my time is spent talking to patients and families and every time I’m working from like below the ground up, right? People have really so little understanding. I’m sure you know what it’s like when you try and talk to people about their eyeballs.

Like, I mean, come on, none of us even know what’s in there. 

Will: Yeah. Right. Yeah. 

Kristin: Squishy beauty stuff. And I, I 

Will: absolutely would’ve loved to play this game before my fir even during my first shift, although I don’t know how the patients would feel about me. Like, rolling a dice. 

[music]: Yeah. Yeah. Rolling, rolling. Dice outside 

Will: their room.

But, uh, but yeah, let’s take a, let’s take a quick break. We’ll come back and the, the dive into to some of this stuff here.

All right, we’re back with Lman. Um, let’s, alright, let’s talk about, uh, more about of the details of the, the critical care, the game. So first of all, who’s it for? 

Dr. Lakshman Swamy: Oh, this is such a good question. It’s for you. It’s for me. It’s for you. I. [00:28:00] It’s for me, for 

Kristin: ophthalmologists that’s s 

Dr. Lakshman Swamy: yeah. Designed it entirely just for ophthalmologists to feel more comfortable with critical care.

So, oh, I love it. I love it. Uh, no, we made it, you know, first and foremost it’s for the general public. You know, I, I’ve played this with, um, in my local town, uh, with, uh, like high school students, right? We, we want, we, I think that. Kids don’t know much about medicine. What? What do you know about it? You’re like, I can be a doctor.

Yeah, I can be a nurse. Right. And that’s the extent of it. It’s not, I can be right. A doctor that does this thing or that it’s like surgeon or not surgeon, kind of right there. There’s so much more. But you know, it was really important to us to say there’s so much more in medicine than doctors and nurses.

And we put all that in the game. So, you know, I want, I, I would love to hear that someone out there is playing this game in high school and they pull out the respiratory therapist card and they win the game with it. Oh my gosh. What is, like, who knows what a respiratory therapist is in high school, right?

Yeah, yeah. Right. Like 

Will: that’s, I never, I didn’t think about it that [00:29:00] way. And it’s like, it just to, to get people, get exposure to like, what are these roles in healthcare and, yeah. And, uh, and what do they do? And, and I think that’s great. That’s a really cool idea. We tried to take it all in 

Dr. Lakshman Swamy: there. We’ve got it.

We, you know. Of course we, we have like all the, you know, a bunch of doctors and nurses and all that stuff. A bunch of like therapists, like, uh, you know, ot, pt, you know, SLP. We have like music therapy. We’ve got a chaplain, environmental services. We tried, we tried to get everything. That’s awesome. 

Will: Well, I noticed it does come also with a glossary of terms, uh, because, you know, there’s, there’s a lot of of terms and things that you encounter in the ICU.

So I thought I could have Kristin just, um, randomly select awesome one and then I Quiz me. Let’s go. 

Kristin: Okay. Alright, 

Will: let’s go. 

Kristin: Okay. Uh, 

Will: let’s see what I got. Uh.

Kristin: It’s high [00:30:00] flow nasal cannula. Oh, oh, I know 

Will: what high flow nasal cannula is. Uh, it’s just a nasal, you just crank it up. What, how? Uh, 10 liters per minute. Oh. Oh. You can go, you can go higher with the nasal cannula. Come on. Yeah, yeah, yeah. See how, how high can you go with a high flow nasal canula? How do you, you wanna go?

Kristin: This says up to 80, 80 up to 80 liters of oxygen, and you get the nose 

Will: and then you gotta go to BiPAP. Right? Hey, 

Kristin: that’s what’s in here next. 

Will: That’s right. That’s right. I got, I’ve seen the pit. I, I, come on, I got, I Geez. Come on. Don’t, don’t sell me short here. Let’s go. All right. Gimme, gimme something else.

Kristin: Okay. Um, I’m just looking randomly. Yeah. And I landed on Devoted Family. Oh. Oh. How does, so 

Will: how does that factor into the game? What, where, where does that come into the game Devoted 

Dr. Lakshman Swamy: family? You know, because, so I started with. Diagnoses and like the medical stuff, right? Yeah. The complications [00:31:00] you can get.

Then the treatments you use, all the ventilator, all the meds and all that stuff. And it quickly became apparent that there is no ICU without the people and like that is the whole point. Yeah. And, and there’s, there’s, there’s a few parts of the people. One is the people you work with, that’s the staff, all the staff in there.

But the other part is the, is the patients and family. So all of the. Patients have real, like we had writers work with us to create backstories. It’s like super representative. We wanted people to see themselves in the game. Oh, that’s cool. So that’s the patience. And then the family, I mean. Anyone who’s spent any amount of time, you know, practicing in any capacity in the ICU knows that the families, you see families at their best and at their worst.

Sometimes the worst is that they’re not there. Right? So we try to put, you know, the game tries to be very authentic. There’s a when, when there’s a devoted family that shows up that’s like all together. They’re there, like unified. They’re, you know, it’s, it’s a magical best, right? Beautiful thing. The best thing.

You also see very often the opposite where there’s, there’s discord, right? Where people are, are fighting, they’re fighting in the room, like, like literally [00:32:00] throwing punches sometimes and all this, and it’s, it’s a lot, right? We don’t, we didn’t wanna shy away from that. We put all of that in there, right?

It’s. So the family’s a huge part of the game and it comes out in the game play as well. Yeah. Because you can win the game by curing a patient, sort of, of their like, medical problems. I was gonna ask, 

Will: what’s the goal? What’s the, how do you win the game? 

Dr. Lakshman Swamy: So yeah, I have, I have one of the boards here I can kind of show you.

Uh, okay. I. So, so this is like the board, and then a patient would go here, the diagnosis that they come in, like sepsis or whatever goes here. Then over here you can see this is like brain, heart, lung, blood, and then inflammation. We had to make things a little abstract and this is like the, this is like their, so this is their supposed to, their chart, right?

And this is like as they get sicker and sicker and then this is their, the lightning bolts are like the level of crisis because it’s sort of, you know, you can have a lot of this or not a lot of this, and you can still code, right? So as this, when this reaches the top you code, there’s like a mini game that’s really hard to win because it’s not tv.

And, um, and then, but, and then you can, 

Kristin: yeah, I’ve, I’ve, I’ve won that one. [00:33:00] Yeah, she won that one Once you have won that one, she a bet 

Dr. Lakshman Swamy: you have won that one. Um, and then, but then the whole other side here, this purple side is a little track. And it starts down here. And this is the goals of care track. And so as you, as you kind of play certain kinds of cards, a lot of the cards that have to do with alleviating suffering or bringing the family to the bedside and having like, like you know, the high touch care that goes up and up and up.

And so you can also win equal win by bringing someone to essentially to hospice. Right. By easing the passage, because that’s a huge part of what we do too. Yeah. 

Kristin: Yeah. That’s a reality sometimes for sure. 

Will: That’s so cool. Okay, let’s pick, pick another one. 

Kristin: Okay. I’m, I’m just noticing since I’m on the d’s, it’s very close to the c’s.

I’m noticing there’s no, uh, co survivor in here, so, you know, maybe round two. 

Dr. Lakshman Swamy: Round two. Yeah. Just keep that in 

Kristin: mind. 

Dr. Lakshman Swamy: Yes, absolutely. 

Kristin: Okay. Um, let’s see here. Some of these are too easy for you. I know you’ll know them. Trying to find a [00:34:00] good one. Yep. Um, I, 

Will: I appreciate the, the confidence you have 

Kristin: inhaled. Oh, this backfired because I don’t know how to say this.

Epoprostenol, you said close, uh, 

Will: and held epi epoprostenol. Um, yeah, it’s, um, it’s a medication. Uh, and um, and 

Kristin: they breathe 

Will: it in. You breathe it in. It’s probably some kind of, sounds like a, it’s steroid likes on rounds right now, right? Yeah. It feels like that sounds like a steroid of some kind. Nope. Nope.

Not a steroid. Um, um. It’s a, oh, a nitric oxide to dilate the vessels. There you 

Dr. Lakshman Swamy: go. It works to it. It’s a vasodilating therapy. Yeah, 

Kristin: but I, I don’t think it is nitric oxide cheat. Look, it’s not 

Will: nitric oxide. Yeah, it says, 

Kristin: or nitric oxide. Oh. Or nitric. Such as cheat. Alright, 

Will: so this is, this is a medication.

Never heard of this medication. Epi Epitol. Okay. Yep. 

Dr. Lakshman Swamy: [00:35:00] All right, great. This is like, we use this stuff for pulmonary hypertension and all that. Oh, gotcha. What is, and this is, you know, the severe A RDS type stuff. Well, what you’re seeing though is that we used all the real words, right? Yeah. We didn’t try to end.

The point of that is that, as you know, there is such a, there’s power in language, right? Yeah, there’s, and there’s a power dynamic that’s always present in the hospital between the doctors and the patients, where the doctors know all the stuff and throw all the words around, and the patients are like, what do you, what’s happening to my loved one?

Right. So, mm-hmm. This is our little attempt to say like, that shouldn’t exist in that way. It’s, it’s, you know, we all go into family meetings saying, I’m not gonna use jargon. Um, but. You forget what 

Kristin: jargon is ’cause it’s so basic to you that it feels like it’s basic to everyone. 

Dr. Lakshman Swamy: Exactly, exactly. So this is our attempt to, uh, kind of give people a little bit of a guidebook so that they can learn some of the jargon because otherwise, you know, you get access to your notes, it’s gonna say in their HFNC.[00:36:00] 

And what 

Kristin: is this? Yeah. Where the thumb in, 

Will: or if you’re, like, if your residents or fellows are talking to an ophthalmologist who came in and it’s like they’re not gonna use HNFC ’cause uh, clearly. HFNC, uh, because I didn’t know what that was. Um, so, you know, learning how to, to really explain things like you’re five years old or an ophthalmologist in the hospital.

Kristin: Yeah. Equal, I love it. Equal, equal levels. Listen, 

Dr. Lakshman Swamy: listen, it’s very smart. Listen, it’s very smart. I’ve got, you can’t, you can’t get away with this, do you? There’s no one, no specialty in all of healthcare That is. Worse with their jargon. Yeah, it’s true. None of us can understand that. I enough. I have, that’s fair enough.

I have to like Google Translate to understand what your notes say. 

Kristin: Is ophthalmology a language listed in Google Translate now? It should be. 

Will: It really is. Uh, um, you know. Yeah, we’re bad at it. You’re, it’s a problem. We have a lot of acronyms. [00:37:00] We throw a lot of, of P’s and H’s into our words for really no reason.

The acronyms don’t 

Dr. Lakshman Swamy: even correlate with English words. It’s Latin. 

Will: Yeah. I mean it, you know, you, it’s Glaucomflecken is a, it’s an ophthalmology term, so, you know, it’s a, yeah, it’s a problem We have, uh, alright, go ahead. 

Kristin: Okay. 

Will: Gimme another one. 

Kristin: Plasmapheresis. 

Will: Oh, uh, plasmapheresis is when you, um, you take the blood out of the body, you, you remove things from it in the plasma and then you put the blood back in.

Kristin: Uh, what things do you remove? 

Will: You can remove almost anything. Uh, you can remove, uh. Heavy metals. You can remove potassium, I think. Little, little on dialysis, I think. Oh, that’s dialysis. Uh, plasma. What’s in the pla? Oh, you can [00:38:00] remove antibodies. 

Kristin: There you go. 

Will: Um, what else is in your plasma? Uh, the plasma. You can just remove all the plasm in there.

Bad humors. The bad humors. Absolutely. Um, what else can you plasma forese? What, what? Let’s, what, what? Give us the, the full definition. Let’s hear it. Yeah, let’s what we It’s 

Kristin: which again, like you gotta think like a 5-year-old. What the heck is plasma, right? Yeah. You left that part out. Removing the liquid part of the blood, okay.

Along with any antibodies in it, uh, can help treat a variety of inflammatory conditions. This plasma is replaced with a fluid, usually albumin. 

Will: Hmm. Albumin. I forgot about the albumin. 

Kristin: I’m gonna get that’s in italics, so I’m gonna guess that’s over here in the ace. You got it. See, I was a good student. I know how glossary 

Dr. Lakshman Swamy: works.

I love it. You have no idea how long 

Will: it took us to write that. Oh, that’s [00:39:00] great though. Um, yeah. Do you have any, any eyeball, uh, things that came up in the, 

Dr. Lakshman Swamy: you know, making I really should have? I, you know, I, I have to say, because I was, I was making this game starting in 2020. Yeah, yeah. Twitter was like, that was like, you know, still happening.

And I remember. I was talking to Vince, my co-design, we were like, is there any way we can get cri the, the critical care ophthalmologist in here? Like we, we really wanted to, and we’re like, we just can’t, we just can’t make it work. I, there’s 

Will: really not, there’s not a, not a, a whole lot of overlap between our specialties does come up.

Well, what, what would happen 

Kristin: if you there is, here’s what I know about critical care, ophthalmology. You’re not supposed to leave the context in. 

Will: Yeah, that’s. 

Kristin: Something that’s like 90% of it, something, something bad can happen there. 

Will: Well, if, if, if, if somebody often, you know, patients will come in, they’re already sedated or unconscious 

Kristin: uhhuh 

Will: and, um, so you might not know if they were, if they contact, but if they 

Kristin: leave their contacts in, there’s a, uh, you know, [00:40:00] what is, it starts with a p.

Pseudomonas, is it pseudomonas? Oh, 

Will: that’s one of the, the terrible, uh, hospital things that can Yeah. Can be growing. Yes. 

Kristin: So, you know, you could have that happen. Yeah. Uh, the other thing, and I, um, it’s good you’ve learned, just am embarrassed to say that I had to ask Good. His, uh, doctors, whether they had, you know, like lubricate closed and lubricated his eyeballs.

Oh yeah. Every day. Yes. 

[music]: Yeah. I was 

Kristin: like, I’m so sorry to ask you this. I just know I, it’s, it’s my job as his voice right now. 

Will: She did. She had the, were standing here next to me. Yes. 

Kristin: He would make me ask this, so I did. I was very embarrassed, but I did. I love it. 

Dr. Lakshman Swamy: I love it. Well, I mean, both of the things you said you cannot talk about, and this is a big part of the game too, but you can’t talk about critical care without talking about critical care nurses.

Right. And all of this stuff when I was like, oh, of course the contacts. I have [00:41:00] no idea. That’s the nurses do everything to take care of a patient like that, right? Like, yeah. Yeah. We, I, I am completely useless without critical care nurses. Right. And, and honestly, that’s like where so much of the patient, like hands on, caring for the body, preventing all this horrible stuff from happening is, is, is through that.

So, 

[music]: yeah. 

Will: One thing I learned during COVID, and maybe it’s in this game as well, is the concept of proning. Oh yeah, that’s again, I didn’t, yeah, I didn’t even know that was a thing. Um, so can you explain that? Yeah, like I, I’m actually just kind of curious, like, what, what does that do exactly? So, you know, 

Dr. Lakshman Swamy: it’s, it’s, this goes back to sort of, to the way we don’t really learn that much about the human body, right.

In school, elementary school, high school. I’m sorry, what? 

Kristin: Oh, okay. I thought you meant as No, in med school. Eventually we knew. Yeah. 

Dr. Lakshman Swamy: And I think one of the things interesting is that I don’t know how, but I somehow like, because I learned everything, like from textbooks in medical [00:42:00] school. There’s a sense that things are, are static, like that they’re always just a certain way and that that, um, mundane things like the orientation of the body and space could matter.

Right? Um, I think it’s pretty amazing that you can swallow upside down and stuff like that, right? Yeah. Um, so you would think like, I don’t know why, but I at least always had this idea that like, stuff just is, like, the body is like in its encapsulated itself, just works. It doesn’t matter. Turn upside down, left, right, whatever.

It’s always the same. That’s not true. It’s not, it’s like obviously not true, right? Yeah. Like physics matter, even within the body, right? So, um, one of the things that that is, is when you are, when you are, um, supine, right? Holding the bowl of soup, right? This is how I remembered it. Like lying, lying, lying down, face up, right?

When you’re lying down, face up, um, the, the weight is pushing down, right? And so you are going to have some effects over time where things that are on the bottom are different than things that are on the top. Right. Um, and [00:43:00] you, you see, we see this like, like with, um, different kinds of, of sleep apnea type stuff too, right?

With the airway collapsing and all that stuff. But in this case, what we, what we see is that the lungs are not. When, when you take a breath, right? The lungs are not inflating perfectly, fully equally all the time. It’s different based on how you’re positioned. It’s different if you’re awake or asleep. It’s d All these things make it like different, this is a really long way of saying this, I’m sorry.

But basically it does the back of the lungs, right? Which if you’re lying down, is sort of the bottom, right? 

[music]: Yeah. They, 

Dr. Lakshman Swamy: they can, um, collapse more, right? Mm-hmm. Okay. So they’re all, everything else is on top of it. They’re kind of pushing against more. To open up pushing, like there’s not as much space for them to open up and all that.

So what happens is that if you leave someone in a hospital ed for a real long time, like days and days on end, and they’re ne and they’re just like that all the time, that, that you, you don’t, you, you’re not making use of all that lung as much as you could. So by flipping people upside [00:44:00] down, which sounds kind of ridiculous in a way, and proning them.

Yeah, you are, you’re converting not I’m 

Kristin: by their toes. I just need you to clarify. Yeah, yeah, yeah. You’re, you’re turning them over is what you’re doing. Yeah. 

Will: Well, I, I, so, no, go ahead. And then I have a comment about this. Well, like if you’re 

Dr. Lakshman Swamy: sleeping on your stomach, basically that’s what we’re doing, right?

Yeah. And that, that takes a lot to do to someone passively to make sure, especially when they’ve got like tubes and stuff in. Um, this is one of the cool things about seeing, like a whole team work with like respiratory therapists, nurses, all these people working together like efficiently and safely flip some.

And then what you see often is that when you have. Something like a RDS, like when you have like a really bad lung disease problem going on that all that injury in the lung, you’re like kinda like, oh, there’s actually like more, there’s more lung that we weren’t using as well as we could. Oh yeah. Yeah.

And you see like big improvements then. Cool. So 

Kristin: what I’m envisioning do we turn patients like rotisserie chickens? 

Will: That’s exactly what I was thinking too. You know, make beds that do that now. I imagine they do like, ’cause that’s, that’s got like, it’s kind of like put you in like a little cage and just Yeah.

And just kinda [00:45:00] turn you over, get 

Kristin: everything moving. 

Will: It’s amazing. 

Dr. Lakshman Swamy: We just take like the Dick’s Hall Pike begs beds and just, you know, oh, that’s right. Just, 

Will: just 

Kristin: whew. 

Will: Go around and around. No. Um, um. That’s fascinating. 

Kristin: Yeah. That’s really cool. I mean, it makes sense. It’s like you said, it’s so obvious, like in retrospect, but for some reason Yeah.

We never, like, we don’t learn it that way, so we don’t continue to think of it that way. Right, right. I say we, I mean you. 

Will: Alright, gimme, gimme another one. Gimme another one. Okay. 

Kristin: Okay. One more. Um, oh boy. Oh, I see this Severe acidosis. 

Will: Severe, severe acidosis. Is like acid based disorders, you get like too much of, uh, of, for, there’s a lot of different reasons why you could have an acidosis.

There’s respiratory acidosis, there’s a metabolic acidosis, and it just, uh, basically how much, uh, acid or lack of base you have in your, in your body. [00:46:00] 

Kristin: Okay. Why is that a problem? 

Will: Uh, because the, um, it. Will damage tissue if you’re not at the right pH. In what? In what way? Your physiologic pH What do you mean?

In what way? In what way? 

Kristin: What kind of damage and which tissues, 

Will: what kinda it causes cellular damage. It, it, it will, it will make it to where your organs don’t function well. And then, uh, you have to. Do plasmapheresis 

Kristin: and and proning analysis 

Will: and di di sorry, dialysis. Maybe even a little proning. I don’t know.

Um, to, and to call you have to call the, the nephrologist in which I’m sure the nephrologist is somewhere in this game. Oh, yeah. So, uh, and that is my explanation of acidosis. 

Kristin: Okay. Well, wow. 

[music]: Um, [00:47:00] uh, 

Kristin: the glossary definition, yes, let’s hear, is a precise balance of the acids in the body. In other words, the pH is managed by the lungs, lung for respiratory, acidosis, and kidney, the kidney good kidneys for metabolic acidosis.

Too much acid. Reduces the blood pressure, weakens the heartbeat and limits oxygen transfer in the lungs. 

Will: Basically what I said, that’s, I don’t know how clear I could be. I, it’s pretty much 

Dr. Lakshman Swamy: exact actually what I said. You did the thing where you used the word in its own definition really. Uhhuh. 

Kristin: Yeah, exactly.

Will: I’m really good at that. Uh, so where does the, where’s the nephrologist come in? 

Dr. Lakshman Swamy: So the, um, what we wanted to do was try to try to show that. When you call a specialist into the ICU, which, you know, you, you have this experience, right. Um, it’s a big deal. It’s a big deal that someone comes to help. Right. A lot.

That’s the way that we really wanted to show this, is that you’re calling someone for help. They’re coming to help you phone a friend, [00:48:00] phone friend. Exactly. And the neph. So, and it’s not just doctors. That was the important part. This is where like the, the, the occupational therapists and physical therapists come in here and all that.

Um, but the nephrologist comes in and, you know, one of the, one of the, one of the major things, I have to be really careful what I say, my father-in-law’s a nephrologist. So, um, uh, oh, one of the things that Nephrologists really care about is, is, uh, the, in, you know, acid level in the body, right? And like, just like we were reading, this is like they get.

This is what they help with. This is what dialysis can help with. And so the way that it works in the game, because one of the important things is that everything in the game that has like this thematic thing, it’s not random. It has, it has like an, an interaction in the system, right? Yeah. So the little inflammation tokens, these like little wooden.

Yep. You know, as those build up, that means that the, the acid level in the body is building or the inflammation is building or whatever, right? And, um, the nephrologist has the ability to kind of help get those off in some way, to use that ability, you know, to, to help in those ways. So [00:49:00] same with the cardiologist, pulmonologist.

They all have different ways of doing stuff to affect that. 

Will: Well, I am looking at the list, the stack of specialist cards Yeah. In this game. And, uh, I see a couple that caught my eye. One is the ultrasound guru. Oh yeah. Gotta have one of those. Yeah. An official, uh, training program called, uh, guru Ship of Ultrasound.

Guru Ship. Yeah. It’s a guru 

Dr. Lakshman Swamy: ship. 

Will: And uh, also a Zen Zen. Intensivist. 

Dr. Lakshman Swamy: Intensivist. 

Will: Yeah. As intensivist. 

Dr. Lakshman Swamy: I like that. These are, these two. Were like a little bit of a stretch, but we really, you know, first of all, since we made the game, we gotta put whatever we wanted in it. That’s right. Oh yeah. It’s a game. And, and these are, so there’s a lot of sort of our philosophy, uh, our belief system about the ICU that’s in here.

This intensivist like really captures that. The, the old sort of way of thinking about the ICU is that we do everything to everyone all the time. Yeah. If you come into the unit, you’re getting every tube put in you that we can put in right [00:50:00] away, this is just like, what, what happens? Right. You must see so you save lives.

Will: Yes. 

Dr. Lakshman Swamy: Right. Right. But now we are realizing that like the, there’s a lot of harm that can happen from overdoing things. Mm. So this intensivist is an example of like sort of, um, you know, don’t just. Do something. Stand there, right? Yeah. Like, like watch the patient look. Really be high touch instead of high tech.

Will: I noticed you have names for all of these specials. These are all real people. These are all real people. Great. These are all people that 

Dr. Lakshman Swamy: like influenced me usually like during the pandemic in some way. Oh, how often? A bunch of them are like Twitter 

Will: friends. So. I am just not seeing an ophthalmologist named Dr.

Glaucomflecken here. That’s, that’s, that’s all I’m saying. We need a mini expansion that’s entirely focused, 

Kristin: not ophthalmologist on ophthalmology. This is too, too much to ask. I don’t think it’s too much depth. 

Will: Um, well this is, I just a fantastic, I can’t wait to really dive into this and, uh, and, and play this.

And so 

Kristin: I love the idea behind it too, right? That you’re like trying to give regular [00:51:00] people a sense of. Many things, right? Demystified like what happens in icu, but also, yeah, like what it is, how doctors think a little bit, right? Yeah. Like what you’re looking for and what these. Things that you’ll see are, and just with all the misinformation that’s out there right now, um, among the general public about bodies in medicine, like, I think yeah, something like this that meets people in a, in a different way than a lecture or Yeah.

A lesson. You know, like I think these kinds of creative ways of getting information out there are really valuable in this moment in history. So I love it. 

Will: Yeah. Like no way in hell would I sit and listen to it like an ICU lecture, but I would absolutely play this game. 

Dr. Lakshman Swamy: That, and, you know, part of the idea also was one, one of the most fulfilling parts of it has been, and this is not, it’s also very like hospital medicine.

It’s not just ICU, right. A anyone who practices in the acute care has this. I think many of us have this feeling if we have a friend [00:52:00] or a partner who isn’t in medicine, isn’t in healthcare, they don’t know what we do. They really don’t know what we do. Right. Yeah. And playing this game is a way, I remember when someone was playing it a little while ago, one of, one of the residents, one of my residents was playing with their, with their family.

And they’re, they’re kind of like 20 minutes into the game and her parents was like, wait, do you. Do you know all this? Like yeah, that’s, what do you think you paid for? Exactly. So it’s like, it’s a really nice way to bridge, to share that. ’cause otherwise it’s really hard to talk about it. I had a lot of trouble during the pandemic talking about the bad stuff I was seeing even with my wife, right?

So this is kind of like creates a little bit of a bridge to, to do that. 

Kristin: Yeah. I love that. 

Will: Well, congratulations on this and I hope people will check it out. Where can they find this game? Oh, yeah, it’s, um, critical care of the game. 

Dr. Lakshman Swamy: Yeah, critical care. You just Google critical care of the game, critical care of the game.com and, uh, critical care game.com.

And I should know my own website. I’m so bad. You’re good. And, uh, quick care game on social media, and it’s, uh, you know, we, you [00:53:00] can, we also, we, we are, we have. The Kickstarter, which thank you for supporting it. We did a Kickstarter back in like 2021 something. Um, a bunch of people paid for games to be donated to, um, like academic institutions to libraries and stuff.

We still have a couple left, so if you have like a training program or a library or something, um, you know, send That’s a great idea. Reach out to us. We’re happy to like, send a donation. Copy. The game is available for sale through our website. Uh, and, and before that, like after that from my garage. So, um, we’ll try to get it out to you.

Um, it’s great. It’s super fun. I hope you, you really like, get a chance to dig into it. Yeah. Oh, I have to say thank you so much to Sarah Merwin. She helped write that whole glossary. She’s like a patient, demystifying expert, and it’s, it really was, I couldn’t have done it without the whole team. 

Kristin: Oh, that’s nice.

Will: Yeah, I was just sitting there reading through the, the, the, like, the terms and I, they’re very well written. Yeah. And, and explained, and honestly, it’s like, it’s like almost like you have a whole like [00:54:00] critical care fellowship in a box kind of thing. But it’s like, but but you don’t have to be a fellow to understand it.

Which is, which is super. And the glasses. Glasses is online. 

Dr. Lakshman Swamy: You can just go and, and read it. Yeah. Like anyone can access it and read it so 

Will: Well, uh, lman, thank you so much for joining us. Uh, this was, uh. You know about time we did this. Yes. Long overdue. And so I, I’d love to anytime have you come on just to Oh, to, to teach me about critical care.

Oh, thank you. Something that’s, that’s never going to help me in my professional career at any time. But it is fascinating stuff. So thanks again. Thank you so much. Thanks for having.

Critical care at the game. What other, I wonder what other parts of the healthcare system that would benefit from a game insurance. Mm. 

Kristin: Ugh. Health insurance. I don’t know if that’d be a very fun game. Aren’t we already all playing a game? We’re already playing 

Will: a game there. Yeah. Uh, anyway, if you, if you guys [00:55:00] have any ideas of what, uh, what else you want us.

The, uh, gamified in the healthcare system, um, maybe we could find someone that would be willing to to, to take it on and make it. 

Kristin: Yeah. 

Will: Ophthalmology the Game s News Fest. You can email us, knock knock i@humancontent.com. Uh, hang out with us on our Human Content Podcast family on Instagram at TikTok. Over at Human Content Pods.

Check out all the podcasts that we have to offer. And, uh, thanks to all the great listeners leaving feedback and reviews. If you subscribe and comment on your favorite podcasting app, we can give you a shout out like on our YouTube channel at Glaucomfleckens, by the way, at new Friends on YouTube said, I love how fast Kristin came back with Not all poop is brown.

I remember you saying that. I do. Yeah. Yeah. 

Kristin: It was when we were talking about Code Brown. 

Will: Oh, gotcha. Yeah, true. And I said that code, 

Kristin: was it code? No, banana bag. 

Will: Yeah. 

Kristin: Should be about urine. And you said not all urine is yellow. And I said, well, not all poop is brown. 

Will: It’s a very true statement. Uh, full video episode.

Uh, [00:56:00] full video episodes are up on our YouTube channel at Glaucomfleckens Check that out. Uh, tons of cool perks on over on Patreon bonus episodes or react to medical shows in movies. We just recently did a hangout with, uh, some of our patrons. That’s right. That was always fun. Just answering questions and just chatting, chatting about things happening in the world.

Uh, early ad free episode, access as well in interactive QA livestream events. Much more. patreon.com/clock and plugin. Shout out to the Jonathans as usual, Patrick Lucia. See. Edward. K, Mr. Granddad, Caitlyn. C Brianna, L Mary, H Keith, g Parker, Muhammad, L, Klee, A, David, H Gary, M Eric, B Marlene, S Scott, m Kelsey, M Brian, s Patrick, s Sean, m Jessica.

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[music]: shiny 

Will: Patreon roulette time. Random. Shout out to someone in the emergency medicine team. Shout out to Laura t for being a patron. And thank you all for listening. We’re your host Will and Krista. Bla also is the Glaucomfleckens. Particular producers [00:57:00] are Will Planet Krista Planer.

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