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Welcome everybody to the Neuro critical
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care podcast. This is the perspective
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series. I'm your host, Nick Morris
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from the University of Maryland, shock
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trauma hospital. And today I have the
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honor of interviewing Dr. Tommy T.
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Thomas.
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Dr. Thomas is neuro intensivist and
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associate professor at the Emory
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University School of Medicine. He
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completed an MD PhD from University of
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Alabama, Birmingham, followed by a
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medicine internship there. He then went
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on technology residency in neuro
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critical care fellowship at Partners in
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Boston. He has been at Emory University
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in Atlanta ever since. I've had a real
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pleasure of working with Tommy through
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the inclusion and neuro critical care
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committee at NCS. It's been really nice
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to get to meet him. I wanted to invite
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him on the podcast and talk a little bit
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about his perspectives on neuro critical
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care and some of the work that he's done
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through Inc. in the DEI space and how
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we can do better. So Tommy, welcome to
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the podcast. Thank you so much for
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having me right maybe for the listeners
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it would be helpful if you could start
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by tongue a little bit about your path
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into neurocritical care, which you got,
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we got you excited about it. How'd you
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find yourself here now many years later
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in Atlanta? Excellent. So well, my
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path was fairly direct. I mean, after,
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as I was finishing up residency, I
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started looking around for fellowships,
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started talking to people. And I was
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really torn between neurocritical care
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and believe it or not, neuro oncology
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And I liked the idea of kind of patients
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with advanced disease and illness and
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the opportunity to help those patients.
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And I talked a with number of people,
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including Galen Henderson. And I also
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talked to friends and family who kind of
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knew my personality. And one friend
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provided me with the most age advice,
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which one of them scares you more. And
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I was like, oh, definitely
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neurocritical care. Like it's a bit
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insane. It's kind of odd sometimes And
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she said, Well, you should do that one.
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And so here I am. Uh, but I always
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found the disease fast and the
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pathophysiology fascinating and the
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opportunity to really bring medicine
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back into my neurological practice and
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become an intensivist was exciting. And
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it's been even more rewarding than I
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imagined that it would be. Yeah,
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fantastic. I also thought about
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neuro-oncology. I think it makes a lot
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of sense to me, a lot of medicine in
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neuro-oncology, right? So I think
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there are some clear overlaps. We end
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up taking a terrible lot of tumor
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patients in the ICU, at least in the
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post-op setting. So that makes total
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sense to me. Can you take us back, I
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guess? So as you're a resident in
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neurology, you're looking around and
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trying to make the decision between
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neuro-oncology and neuro-critical care.
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And you mentioned Galen Henderson, and
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Galen Summond I worked with, and
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actually is on in committee with us, I
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just would.
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As you were looking into make this
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decision and you talked to Galen, what
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were you seeing in people like Galen
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that inspired you to go into
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neurocritical care? Was it just the
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content of the different specialties or
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was it the people involved as well that
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kind of drove you towards the decision?
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No, certainly the people and the
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personalities within neurocritical care
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that I found to be very similar to mine.
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Of course, there were differences, but
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they were all very similar to mine.
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There was an intensity, a desire for,
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a desire for kind of procedural
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knowledge, but there was also this kind
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of, I don't want to say go get her
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attitude, but there was definitely a I
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want to do something and see what
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happens pretty quickly after that. And
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the neurocritical care offers that
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feedback where a lot of other past don't,
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especially neuro oncology, where
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there's kind of a longer lag phase and
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and and kind of reaping the rewards of
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your interventions. Neuro oncology also
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fit into my research at the time, but
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there were also, I saw neurocritical
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care as kind of an unbeaten path. There
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was a lot of opportunities for a lot of
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different things and a lot of
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advancements within neurocritical care.
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And so that really guided me. And Galen
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always has a spirit that when he talked
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to me about kind of the professional
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life within neurocritical care, how he
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integrates it into his personal life,
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it really seems like the career for me
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at the time. Could you talk a little
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bit more about that? How do you think
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this is? I think something people
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struggle with a lot is how do you
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integrate the professional life of
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neurocritical care into a personal life?
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Well, at the time, Galen talked about
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it being kind of. on and off
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and it's not like the clinic patients
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where you're following them all of the
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time. There's an intensity to it, but
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there's a time for recovery that seems a
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bit greater than some of the other
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fields. However, the intensity is also
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a bit higher. But he talked about kind
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of integrating it and specifically from
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the standpoint of time because there was
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time to, there were larger blocks of
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time to do other things. And he also
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talked about the way that neurocritical
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care is done because it's a
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247 field. There isn't really a start
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or a finish. It's just kind of when you
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start and when you finish. And so he
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really talked about the flexibility
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within within the field as to kind of
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how you how you did. things, how you
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treated patients, when you rounded,
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how you rounded, whether you rounded
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kind of a multitude of different times
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for short periods, one long period.
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And so you really talked about kind of
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molding the the career to fit my
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personality and my my interests both
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inside medicine and outside.
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Great. And it sounds like you have no
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regrets with the decision. What over
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the years have you found that you really
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liked most about the field? What's
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resonated with you? Has that changed
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over time or has it stayed steady? I
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think as the field has evolved the same
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types of things have generally kind of
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brought me joy and resonated with me the
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the opportunities to really kind of help
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people
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have have really significantly increased.
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I mean even if we look at things like
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thrombectomy for stroke and the advances
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and and that we've really been kind of
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able to see an evolution within
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neurology and critical care as to how we
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care for stroke patients, how we care
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for subarachnoid patients, and how
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those patient outcomes have improved.
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We've also seen changes in the way the
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work has done with regard
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to predictive analytics and bringing
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other types of things into the pursuit
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of neurocritical care. And so I think
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the field is advancing more rapidly than
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I could have anticipated. And I enjoy
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that. I enjoy that there's a novel
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aspect to it that keeps coming up and is
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reiterated over time. And is there
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anything in particular that you're
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finding really exciting right now, some
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area of the field that you think is
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really about to take off or explode? Oh,
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I think there's so many areas, I think.
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I think with regard to things like
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consciousness, John Klausen's work and
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Brian Edler's work on states of
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consciousness and kind of surveillance
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are really going to change things like
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brain death within the field. I think
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all of the neuro-interventional work and
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the recent kind of advances in who gets
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thrown back to me is who gets
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neuro-interventional care are really
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going to change not only kind of the
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patient pool that we take care of, but
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how we take care of them. And hopefully,
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we'll offer some advancements and
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improvements and outcomes from that.
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And so I'm excited to see kind of all of
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these new technologies coming in. We're
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still on the cusp of AI and getting
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predictive analytics in there. And I
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think rather than kind of taking over
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any roles, those analytics and AI will
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help us to do our jobs. better, faster,
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more efficiently, and kind of again
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integrate our lives both inside and
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outside of medicine more efficiently. I
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wouldn't that be nice.
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What are some of the frustrations you've
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had in the field? Some of the
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challenges you've faced? The
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frustrations that are numerous as well
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unfortunately, I think a lot of them,
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if I were to kind of do a root cause
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analysis of my frustrations with the
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field. Most of them start to stem with
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kind of the corporatization of medicine,
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as we have seen over time,
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while the numbers of intensivists and
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APPs
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and people around us hasn't really
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shifted significantly, the numbers of
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people within the corporate structure of
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medicine increased dramatically, the
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number of middle managers and the amount
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of effort it takes to get small changes
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implemented is really, really kind of
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frustrating. It really, really kind of
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stagnates change. And
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I think we as physicians, I think part
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of our personality is to accept things
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and to take part of our payment and the
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pride that we have done good work. And
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I think with the corporatization of
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medicine, we are going to have to kind
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of push things along and take a more
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kind of leadership role in both how
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things change and kind of being more
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actively involved in the evolution of
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medicine before it's kind of taken out
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of our hands and before we become kind
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of shop floor workers, which I don't
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particularly
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You know what I mean either. I joke
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with colleagues that here we have these
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kind of position tags that go on your ID.
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And I think as you walk down the hall in
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our hospital, it's like every third
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person says either manager or director.
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And I imagine like what that's like for
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someone who doesn't work in the hospital
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who's like, who are all these people
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managing? 'Cause it seems like the
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whole place is full of managers. Just
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speaking to this corporization
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This is a little bit off the cuff, but
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let's go there. So you mentioned floor
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shop workers. We don't want to be that.
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One thing that we've seen happening in
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residency and training programs recently
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is unionization. There's a reason why
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unions form among floor shop workers
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to protect their rights. I'm wondering
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as this generation of residents or
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fellows who are now unionizing kind of
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graduates to early faculty, whether
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there might be a push to see some
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immunization at the - position level or
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at least some way for us to band
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together to have more of a
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voice in corporate American medicine.
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And what are your thoughts on that? And
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is that something that we should be
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doing or? Well, I can't say should or
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shouldn't, but I can say that that I
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mean, we're we're we're both the part
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of ink and we're both talking about we
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both talk about representation a lot.
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And
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I think I think if we take this away
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from that that that lens of necessarily
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diversity for for a moment, I think if
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we if we look at at what happens in
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representation, then representation
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really kind of shows you what you can be,
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but it also gives you a voice. It also
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provides people it also provides some
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sense of protection. And frankly, I
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mean, we've been doing this in a in a
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similar fashion
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know some some small changes but but in
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a pretty similar fashion as as when when
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Osler was doing it and that's that's a
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long time to be doing things the the
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same way and um usually as as time goes
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along there there there becomes a little
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bit of of creep especially as you age
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within in the career and it becomes a
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little harder to see some of the
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eccentricities and and idiosyncrasies
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that that need to be corrected um and I
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think with with youth there comes a also
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a vitality for for change and an
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intolerance of of of things that seem
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unjust or injustices and so whether it
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be a union or just kind of louder louder
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voices um I do think that there is a a
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real need for for people to to speak up
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and to be heard and to make some noise
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and to make changes within the way
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medicine is practiced today.
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I completely agree. And maybe we can
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use this as a segue into talking about
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some of our work and ink together. I am
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struck by this quote. I read how to be
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an anti-racist, not too long ago by
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even Kendi. And he said something that
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I found very powerful, which is that in
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cityist forms of racism, people are
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often blind to because, but they hold a
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pivotal role in upholding racism. And
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people don't see it because these
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attitudes are often so deeply ingrained
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and it takes the ability to be deeply
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self-critical to examine and challenge
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these attitudes. I think there's a lot
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of corollaries to this in medicine. We
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have these deeply ingrained parts of our
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culture that we're often blind to. What
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are the insidious forms of not just
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racism but unjustness that are happening
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in the hospital that you see and who do
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we need to give a voice to? Well. I
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think
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we often tell ourselves a single story
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about
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existence, about people that we meet,
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about situations that we find ourselves
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in from an evolutionary standpoint.
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This is how we survive so long as a
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species.
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We make quick decisions and we stick by
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those decisions. But in doing so, we
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really kind of tell only one side of the
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story We only really, really kind of
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attend to one perspective. And in so
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doing, we miss out on all of the
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possible other multitudes of stories and
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perspectives and truths that can
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simultaneously exist. And when we talk
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about kind of the construct and
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construction of society today, it was
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really based on kind of injustice and
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injustice, it was really based on
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unpaid labor and building, building a
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foundation on the backs of that unpaid
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labor. Now, when we talk about kind of
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moving forward from that and making
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changes, if we don't take that into
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account, then it's hard to really kind
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of make changes because we're skipping
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over so many
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steps. And when we talk about kind of
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getting a seat at the table, we don't
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really look
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at one who made the table, who
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constructed this table, who was
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supposed to sit at this table, and why
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we would want to have a seat at the same
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table that has ignored and kind of
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maligned us for so many years. And so
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it really, in order to kind of build
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constructs and justice, we really have
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to kind of tear down some things. And
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I'm not sure that people are really
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ready to tear down things so much as
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they just wanna kind of make a general
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diversion. And I don't necessarily
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think that's enough to make substantial
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change. Certainly we'll make
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incremental and glacial change. But in
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order to make substantial change, there
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has to be some sort of reckoning about
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the past and how it has created the
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present in order to move forward.
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That's really powerful. Have you seen
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changes in your career that you would
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consider significant in this regard?
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Well, I think as time has gone along,
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I have become more comfortable in who I
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am and not having to necessarily
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demonstrate or prove I am in given
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settings and that's That's a
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double-edged sword because when I walk
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into a room, there's
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generally an air of lack of familiarity.
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Sure they know I'm a doctor, sure they
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know I'm black, but they don't
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necessarily know any other parts of my
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story. They don't necessarily know
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kind of how my foundation was built and
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what that means for me to be who I am
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now and walk into this space. And so as
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a kind of a hidden unicorn within the
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space, the assumption is that I'm the
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same as everyone else, I'm a horse.
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And it's not true and
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it skips a lot of steps and makes a lot
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of assumptions that if you look at those
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steps and assumptions, They really
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create kind of a different being than,
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than. anyone else and everyone there is
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an individual to their own degree with
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their own thoughts and beings. But they
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really don't look at my career path,
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kind of how that has gone, the things
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people have said to me, both good and
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bad, the little things. Like when we
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talk about representation and no, I
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don't see a lot of black doctors I don't
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see a lot of black men in the medical
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profession. But I do hear a lot about
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all of the diseases that
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disproportionately affect the black
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community and the Hispanic community and
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the list goes on and on. I do hear
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about inequities that aren't even
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corrected with socioeconomic status when
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we look at maternal mortality. These
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are the things that I hear with
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different ears because this is the
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community that I belong to. This is the
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community that I'm from. And so these
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things affect me more viscerally than
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they do on the surface. And that's not
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to say that someone can't understand
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them if they can't feel them, but
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they sometimes need to step outside of
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themselves in order to kind of make that
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happen and tear down the constructs that
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have been there and place there before.
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Got it. And so it strikes me as one
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solution to this, obviously there's no
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one solution to this problem, but one
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solution would be
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to
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increase the number of black men in
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neurocritical care, increase number of
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black women, increase the number of
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everything in neurocritical care. So we
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have a more diverse workforce that
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better represents the communities that
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we serve. really can interpret those
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patients and their illnesses through
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that lens.
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We just finished our, we have match day
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actually, it's coming up on Thursday,
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I believe. We just submitted our list.
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The group of applicants out there is not
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overly diverse. I think it's something
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we look at as a major deciding factor in
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our program is we'd like to diversify
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the trainees that come through our
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program. And yet, that's been a
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challenge for us because the applicant
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pool is not overly diverse. How do we,
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you hear always about the kind of
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growing the pipeline, or how do we do
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this in neurocritical care? And
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probably it has to go back before
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neurocritical care to neurology
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residency and even to just getting
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people into medicine to start with. But
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we put all of this in context with the
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recent court decisions on affirmative
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action. I'm seeing that, potentially
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things are gonna get worse and not
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better. What are your thoughts? Well,
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I think my thoughts really kind of go
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back. I mean, I have, I've posed this
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question to myself over and over again,
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and I don't, I don't necessarily have
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an answer. But I
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think a lot of it goes back to re kind
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of assessing those foundations upon
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which all of this is built Right now,
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what we're trying to do is we're trying
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to build diversity within a field that
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was frankly designed for
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kind of historically rich people,
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particularly rich white people. And if
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we suddenly shift our lens and say,
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well, we wanna make this diverse, well,
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is this the most socioeconomically
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uplifting for someone to think about,
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about joining? Is this the most
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supportive feel for someone to join and
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feel supported in who they are as an
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individual or is there kind of a cult of
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personality and a zeitgeist that exists
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within this field? You know, I
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think
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there is a comfort with bringing people
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into the field as it is, but there is
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not a comfort with changing the field to
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accommodate differences in personality,
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gender, race. I don't think the field
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is ready to make any type of shift
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towards that. And that shift is
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necessary and that shift doesn't mean
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that we accept subpar applicants, that
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shift doesn't mean that we don't have
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excellence
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changing both the people that are
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thinking and the different types of
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thought that are available within the
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field, it makes things better. I think
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there's
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always a desire within medicine,
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especially for consistency and
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maintenance. And I don't think, I
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think last year, I think last year,
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there was a question during one of the
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sessions So, and it was, so how do we
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encourage diversity and still maintain
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excellence? And I think - That's such a
-
loaded question, right? I think that's
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a loaded and dangerous question because
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one, are we maintaining excellence or
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are we maintaining a status quo? And -
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And it seems to assume that if you add
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diversity, that excellence is in
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question, right? Exactly.
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So it makes a counterfactual argument
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that diversity somehow limits excellence.
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And I think that that is one of the
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things that's subversive, going back to
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that quote, that's one of the things
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that people don't know that they have in
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their minds. People that
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don't know that they carry this with
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them. However, I think this colors and
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jades the types of thoughts that people
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have about the table, bringing people
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to the table, encouraging, encouraging
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leadership that looks different, that
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acts different, that sounds different.
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And so I think when we ask about kind of
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how do we diversify medicine, I think
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we
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have to ask ourselves, well, well,
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who is this currently good for? And who
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can currently do
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this? in the way that it is right now.
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And is that the way that it should
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maintain? I mean, if you're a poor kid
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from rural Alabama, I mean, I was a
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poor kid from rural Alabama, is this
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the best choice to make? Or
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is the cost too great? Does it
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ultimately become a pure victory within
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your life? And so I don't know what the
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answer is, but I think there are lots
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of questions that we skip over in
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pursuit of the answer that we have to
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sit and uncomfortably address before we
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can kind of talk about solutions. Yeah,
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I remember there was a survey of
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recently matched neurology residents
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that came out several years ago. And it
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was basically asking there the reasons
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for going into neurology and why did
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they choose there? Why did, you know,
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what factored into that decision? What
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did not? And one of the things that was
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at the very bottom much known when into
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neurology, you know, for the financial
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perks, which is well informed thought,
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but it's also it's very privileged,
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right? And the discussion was sort of
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centered around, you know, how great
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that people go into neurology, mostly
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for this pure academic love of
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neuroscience and to understand sort of
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the essence of humanity. And yet, it
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just kept striking me as, wow, this is
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really a privileged space to look at
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this from. And, you know, I, I I'll
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admit, my story is I'm the son of two
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physicians, white male.
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I went in for the same reasons as that
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survey kind of highlighted. And yet,
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you know, I, I know people, some of
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the plenty of people that I went to med
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school with, who were loaded down with
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debt. And they were really making
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practical decisions in part in choosing
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their, their specialty. And I don't
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think that that's a bad thing Thank you.
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Right, I mean, at the end of the day,
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I mean, there is a quest for survival
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and thriving. And sure, medicine still
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has a law, it still
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garners a respect from certain members
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of the community. However, pay in
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passion and having a prestige career is
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a trap and it eliminates a certain pool
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of people who can't afford to live their
-
lives that way,
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who can't afford to, who can't lift
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their families up out of poverty, who
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can't move themselves within the
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stratosphere of survival. And if we
-
look around, if we look around at the
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socioeconomic of medicine, if we look
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around at who becomes doctors
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and why it's hard to compare because
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most of those people are from the top
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quartile, if not top 10 of
-
not salaries, net worth. And if you
-
try to make this offer as kind of an
-
appealing career choice to someone from
-
a lower socioeconomic, socioeconomic
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status, the amount of things that
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they'll have to sacrifice in terms of
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unpaid positions,
-
kind of poorly paid positions, compared
-
to their peers,
-
it's hard to make the case that this is
-
a viable option for them. And can we
-
take this opportunity then to talk about,
-
for those that do, we hear about the
-
minority tax, right? This unfair
-
burden of placing all of this hard work
-
on those people that represent those
-
groups that have made it through. And
-
you know, how have you dealt with that
-
in your career? Are you still, is it
-
still a struggle continuously? And how
-
would you advise young faculty to manage
-
that? Oh, I mean, it's a continuous
-
struggle.
-
It's a privilege and an honor and a
-
struggle yet and still. I feel like in
-
all advocacy work, there becomes a bit
-
of self-sacrifice. And part of that
-
self-sacrifice aligns with this kind of
-
black tax, minority tax.
-
A lot of the times when you're sitting
-
in a room and you're the only one,
-
you're also the only one that has the
-
potential to answer certain questions.
-
And you're also the only one that people
-
look to So you end up in a lot of things.
-
that are steered around kind of who you
-
are. You end up on a lot of committees
-
because they need your voice and the
-
career needs your voice.
-
But
-
it doesn't come with the prestige that
-
there is no, their promotions aren't
-
based on it It's not recognized as the
-
time sink and effort and important
-
effort that it is. And so it becomes
-
more of a tax than it is an opportunity
-
to help. And so that's a problem. I
-
think it deserves and warrants more
-
recognition and more understanding of it.
-
And I think it is something that is so
-
prevalent within all careers but
-
especially within medicine because.
-
because now as time has gone along for
-
great reason, there is more attention
-
to the problems, but there are not a
-
lot of solutions. And I think more
-
people are needed to be at this table,
-
but they need recognition for coming to
-
the table and offering what is kind of
-
oftentimes trying in traumatic stories
-
about kind of what has happened to them
-
in their past and how they prevent this
-
from happening in the future. As far as
-
kind of the next generation, you really
-
do have to look within yourself and say,
-
can I afford this? Can my psyche afford
-
this? Can my family afford this? Can
-
my life afford this, this tax? Is this
-
something I can do? And there's no
-
right or wrong answer I think it comes
-
down to a really a personal choice, But
-
you have to know that this at times is
-
going to be requested. And you also
-
have to know that that that no is a
-
power word. You have to be able to say
-
no and no takes you no takes you a long
-
way.
-
Can you talk a little bit more about
-
what you just said? You mentioned that
-
the matter attacks, it plays a role on
-
your psyche. And I think this is
-
probably overlooked that maybe some
-
well-meaning people think, oh, I'm
-
giving you this great opportunity, this
-
is probably something you're going to be
-
really excited about, what is the kind
-
of the cost to the psyche involved in
-
doing this work? Well, I think it
-
starts well
-
before this starts to occur
-
professionally I think it starts to
-
occur with with the statements just in
-
medical school about
-
kind
-
of the social determinants of medicine,
-
which they're just starting to call it.
-
But I think when you start to talk about
-
kind of who's affected by these diseases
-
and you just say things like, oh, it's
-
disproportionately this or it's this.
-
You don't even say disproportionately.
-
You say black people are more affected
-
by this disease. And that's it. You
-
keep going. You don't talk about why.
-
You don't talk about social determinants
-
of health. You just say, oh, this is
-
a black disease. This is a woman's
-
disease. This is an ex disease. And I
-
think that starts to build kind of
-
within your core. And you don't know it.
-
And I think that's part of what's under
-
looks.
-
throughout this whole experience is that
-
part of what racism and social injustice
-
does is it makes you look at your own
-
group the same way that everyone else
-
does. And so it starts to build within
-
you. And then suddenly you're in a
-
position and you already had this. You
-
wrote, you leaped over all of these
-
hurdles that have been created by who
-
you are through no fault of your own.
-
And then you get to a position and
-
you're asked to do these things. You're
-
asked to be on these committees. But
-
these committees oftentimes don't have
-
a power in
-
the ethos of wherever they are in the
-
structure of the organization they
-
sometimes are a checkbox.
-
they oftentimes don't offer an
-
opportunity for advocacy. And they ask
-
you to speak for an entire group,
-
assuming kind of this group is a
-
monolith. Whereas there are so
-
many differences and unique
-
eccentricities within the group that
-
there's no possible way that you can
-
speak for everyone. And they don't
-
allow you to be an advocate. And what I
-
mean by being an advocate is rather than
-
speaking for someone, they don't allow
-
you to bring other people there to speak
-
for themselves. They don't allow you to
-
dismantle the table that has been
-
created. So it wears on you because not
-
only are you doing this, it seems like
-
you're on a treadmill. It seems like
-
you're just kind of running in place and
-
you're sweating and you're huffing and
-
puffing but you aren't really going
-
anywhere And so.
-
You have to decide whether incremental
-
glacial change is something that you
-
find rewarding, is something that is
-
not going to kind of eat away at your
-
soul and your psyche and contribute to
-
kind of your own breakdown and
-
stress. We don't really kind of attend
-
to that enough, kind of how we feel
-
basically Yeah, and it strikes me as
-
something you said in the beginning of
-
the interview, which is one of the
-
things you liked about neurocritical
-
care is you like to make a change and
-
then see the response in a fairly acute
-
way, unlike neuro oncology. And that
-
personality is the exact opposite of
-
what you just described of this
-
treadmill of hoping for glacial change
-
trajectories. It's a real maybe
-
challenge in our field that's somehow
-
perhaps more challenging in our field
-
than others. Oh, absolutely. I mean,
-
we are not a field that's designed to
-
tell our own stories and to talk about
-
our own moral injury and burnout and
-
kind of foster a compassion among each
-
other. I mean, we do a lot about and
-
talk a lot about kind of fostering
-
compassion and healing of patients, but
-
we don't look within our own career and
-
kind of foster compassion and promote
-
healing of each other within the career.
-
And I think
-
that is kind of
-
a siloed manner of kind of ethical
-
decision-making that is really
-
problematic.
-
How can we be good allies?
-
I think we talked about this a few
-
moments ago, but I think being good
-
allies means rather than telling other
-
people's stories only, I think you
-
really have to pull those people to the
-
table to tell their own stories.
-
I look at, I think two people that were
-
pivotal within the society for me, one
-
above me, one below me, or not below
-
and above, but one
-
was there before and one came after,
-
but Christina, you know, failing
-
really kind of, kind of pulled me into
-
wink, when, as kind of one of, as the
-
only male member, and the only kind of
-
black, I was a black guy, and she said,
-
Hey, you should join this group. I
-
joined, and I think that was
-
instrumental in being able to kind of
-
tell my story and other people to tell
-
their story, and it evolved into ink I
-
think Amy Eisen who. came after me,
-
she was a few years junior to
-
me, but I think she has spoken up for
-
me and underserved people within the
-
society and within leadership. And I
-
think how to be an ally means really
-
kind of bringing people to the table,
-
to tell their stories, to telling
-
different stories yourself and kind of
-
fostering, kind of listening to those
-
stories and understanding that there are
-
so many multitudes of simultaneous
-
truths and perspectives. And in a given
-
moment, that kind of colored these
-
lived experiences that need to be heard
-
and ordered for there to be changed.
-
And I think allyship really means kind
-
of allowing people to stand on your back
-
and speak for themselves.
-
For people within NCS or beyond who want
-
to start this journey into being a
-
better ally, resources you recommend or
-
ways to get started? Well, I think it
-
starts, I think it really starts with
-
listening. I recently have been
-
involved in, and I think it's kind of a
-
new thing, but it's called narrative
-
medicine. It came out of Columbia. And
-
it's really kind of the practice of
-
mindfulness and kind of communicating
-
and assessing all of these, these
-
perspectives and truths that we're
-
speaking about. And I think you really
-
have to kind of start to learn to
-
closely listen to the stories that
-
people are telling you, and closely
-
observing what's going on around you,
-
and looking for different perspectives
-
than your own, stepping outside of your
-
own silo or spaceship or bubble. and
-
really looking into to kind of others'
-
lives and seeing what's missing.
-
Certainly there are all types of
-
resources that will tell you steps in
-
the ally ship. But I really think that
-
in order to kind of take those in, the
-
first step is to really understand and
-
learn how to listen and be mindful and
-
to be introspective and step outside of
-
yourself And I think without that, it's
-
hard to subsequently take in all of
-
these steps and become a true ally.
-
Absolutely.
-
Maybe we'll just wrap up now. There's a
-
few questions we sort of ask everyone
-
who comes on the podcast. There's kind
-
of quick hits we call them. Okay. That
-
was pretty deep and powerful and these
-
are gonna seem perhaps out of place, I
-
like it, I think we need a little
-
levity. Yeah, we need to bring a
-
little levity to the podcast. But this
-
has been really fantastic, and I've
-
learned a lot. What do you do outside
-
of the ICU? What do you do for fun?
-
What are your passions or hobbies?
-
It's funny, the last time I answered
-
this question, it was eating and
-
drinking, but. Me too. But I would
-
lie if I would say it's not that. I
-
mean, when I travel, I travel to go to
-
certain restaurants, and so I
-
experienced culture through food, I
-
like to call it peasant food sometimes,
-
but it's not all kind of Michelin star.
-
I really like to kind of experience kind
-
of what people are eating, how they eat,
-
how they gather together and commune.
-
And so I think that's a big hobby.
-
That's a big hobby, and I spend a lot
-
of my time then pursue that and pursue
-
kind of kind of. food in that
-
experience. Cool. I mean, I just, it
-
was in Minneapolis with a bunch of
-
another neuro-intensivists. We went to
-
this restaurant called Awanmi by the
-
Sous Chef, and its whole deal is it
-
highlights the food of indigenous people.
-
Oh, yeah. They have no, like,
-
post-colonial ingredients, so there's
-
no dairy, right, because there's no
-
cows. There's no beef. There's no pork.
-
There's no chicken. There's no flour.
-
There's no sugar cane. And it was wild.
-
And it was delicious. We had a great
-
time I think that's amazing. I also
-
think that lots of people and most
-
people show love through food. And so
-
if you gain an understanding of kind of
-
people's foods, then you really do get
-
an understanding of kind of how they
-
care for each other. So that's stuff.
-
Yeah, it was really cool. There's the
-
pride and enthusiasm from the staff was
-
so infectious, it was like we all kind
-
of walked out. It's just a huge smile
-
on our faces because of
-
that What other specialty would you like
-
to attempt or would you would you You
-
mentioned your oncology, but outside of
-
neurology, maybe completely, but
-
something you would like
-
to try. So I think about kind of
-
neuro-crewic care and neurology within
-
the frame of kind of hardware software.
-
And I think about kind of neurosurgeons
-
as being kind of the expert hardware
-
kind of technicians and then
-
neurologists someplace in between and
-
then psychiatrists to really deal with
-
the software. I kind of like the
-
software. And so if I were to do
-
something else within medicine, it
-
would probably be either psychiatry or
-
anesthesiology because I find
-
consciousness to be strange from an
-
existential standpoint. And I don't
-
think any of the work thus far, Emory
-
Brown and lots of people are doing lots
-
of different work on the nature of
-
consciousness But I would - probably
-
move out of medicine if I were really to
-
do something else different. But within
-
medicine, I think those two get the
-
closest to consciousness and
-
existentialism. And so that would
-
probably be what I did. All right. And
-
what's especially that you would not
-
like to do? Oh, there's most
-
of the best.
-
I think this chose me more than I chose
-
it I couldn't see doing most other
-
things. Maybe cardiology, but I think
-
of that heart as a lump of muscle,
-
neurosurgery, but standing and looking
-
in this tiny little surgical feel for
-
hours seems less than a feeling. So
-
most things I think I would sway away
-
from. Yeah, yeah. I remember my first
-
experience in the OR in neurosurgery as
-
like a third year med student.
-
heaven for 30 minutes and then about
-
nine hours later. Right.
-
Is there a sound or smell in the ice to
-
you that you like?
-
So this goes along with my alarm fatigue,
-
but I love the cacophony of alarms.
-
It's not it's not the same now as it as
-
it used to be because because we have
-
become more attuned to alarm fatigue,
-
but walking in and hearing the the
-
ventilator alarm, I used to just I just
-
just loved that. I felt it made me feel
-
like I was I was at home and hearing
-
hearing everything kind of kind of go
-
off asynchronously.
-
I those were the sounds that I that I
-
really liked. Yeah, I'm I'm with you
-
on that. If I had a sound machine to
-
put myself to sleep, it would be
-
asynchronous ventilums. Exactly. And
-
is there a sound just from on the ICU
-
that you just hate? Oh, there's so
-
many, there's so many smells that like
-
the smell of the ICU is, is something
-
that I find terribly revolting. And,
-
you know, I'm almost ashamed to admit
-
it, but, but I just, sometimes the
-
smells are, are just a little bit, a
-
little bit too much. But, so any smell
-
within the ice.
-
And finally, what general advice would
-
you give it to a fellow about to
-
graduate?
-
Be yourself, make yourself, make your
-
own way within your career, say no, as
-
much as if not more than you say yes,
-
and really plot a path out that fits
-
within who you are and the life that you
-
want to lead.
-
All right. Well, would that be the
-
last word? Tommy Thomas, this has been
-
a real pleasure. This is, Probably the
-
the deepest and most impactful interview
-
we've we've done and maybe whoever will
-
do on the
-
But like that's what I really enjoyed it
-
and I think our listeners will too So
-
thanks so much for your time and I hope
-
to see you in sweaty Phoenix indeed
-
Indeed.