Pulmonary Critical Care Intensivist, Dr. Mahmoud Ibrahim, M.D.

Today’s guest is someone who brings compassion, intellect, and a genuine love for medicine to everything he does. 

Dr. Mahmoud Ibraheem is a Pulmonary and Critical Care physician whose medical journey has taken him from Bahrain to New York, Florida, and Texas. Those experiences shaped who he is as a physician. 

Beyond medicine, Dr. Ibraheem is passionate about mental health, music, and making medicine more human. He’s also a proud husband to a brilliant cardiologist and devoted dog dad to Xena and Blue. In other words, he’s very well-rounded.

You might know him from Instagram, where he shares insight and humor about life in medicine under the handle @icuboy_meded.

As Mahmoud told his story, I was filled with wonder at his joyful personality. His journey reminds us that medicine isn’t just about surviving intense situations; it’s about bringing heart, humor, and humanity into every encounter.

In the five-minute snippet: Mahmoud’s gone to the dogs! For Mahmoud's bio, visit my website (link below).

Tik Tok

Threads

X

Contact The Conversing Nurse podcast
Instagram: https://www.instagram.com/theconversingnursepodcast/
Website: https://theconversingnursepodcast.com
Your review is so important to this Indie podcaster! You can leave one here! https://theconversingnursepodcast.com/leave-me-a-review
Would you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-form
Check out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast

I've partnered with RNegade.pro! You can earn CE's just by listening to my podcast episodes! Check out my CE library here: https://rnegade.thinkific.com/collections/conversing-nurse-podcast

Thanks for listening!

Transcript

[00:00] Michelle: Today's guest is someone who brings compassion,

[00:03] intellect, and a genuine love for medicine to everything he does.

[00:09] Dr. Mahmoud Ibrahim is a pulmonary and critical care physician whose medical journey has taken him from Bahrain to New York, Florida and Texas.

[00:19] Those experiences helped shape who he is as a physician.

[00:24] Beyond medicine, Dr. Ibrahim is passionate about mental health,

[00:29] music,

[00:30] and making medicine more human.

[00:33] He's also a proud husband to a brilliant cardiologist,

[00:37] and you should see his face when he talks about her and devoted dog dad to Xena and Blue.

[00:44] In other words, he's very well rounded.

[00:47] You might know him from Instagram, where he shares insight and humor about life in medicine under the handle icuboy_MedEd.

[00:58] As Mahmoud told his story,

[01:01] I was filled with wonder at his joyful personality.

[01:05] His journey reminds us that medicine isn't just about surviving intense situations.

[01:11] It's about bringing heart, humor, and humanity into every encounter.

[01:17] In the five minute snippet:

[01:19] Mahmoud's gone to the dogs.

[01:38] Well, good morning, Mahmoud. Welcome to the podcast.

[01:43] Mahmoud: Thank you so much, Michelle. Thank you for having me. Thank you for making this platform. I'm so honored to be here.

[01:50] Michelle: Well, you're welcome. And I am honored to talk to you. And I want to start out by saying that you told me that your friends call you Moody,

[02:00] and I consider myself a friend of yours.

[02:03] Mahmoud: Absolutely.

[02:04] Michelle: So is it okay if I call you Moody?

[02:06] Mahmoud: Absolutely, please. Yeah. It was my wife, who I've had so many nicknames over the years, and my wife uses Moody, and now I just love it even more.

[02:15] Michelle: Awesome. Okay,

[02:17] well, I'm excited to talk to you. I came across you on Instagram and just immediately started following you because I'm a big fan of any accounts that provide education.

[02:29] So, yeah, I said, hey,

[02:31] I think you would fit really well for my audience, so please come on and be a guest. And you said yes, and I was thrilled. So thank you so much again.

[02:43] Mahmoud: Of course. Thank you for having me. 

[02:45] I think, you know, in my, and I'm sure we'll get through this at some point, but in my,

[02:50] you know, career,

[02:53] I've always valued the respect of nurses so much. You know, it's like that, it's almost like that's a good barometer for how I'm doing as a doctor.

[03:02] So I think being invited on a podcast titled the Conversing Nurse Podcast means so much to me, especially being the first podcast I've been invited to. So I couldn't be happier.

[03:13] Michelle: Well, thank you so much for that.

[03:15] I have great respect for physicians.

[03:17] Worked with them my entire career.

[03:20] And I think the ones that I was especially,

[03:25] I guess you could say, enamored with are the ones that would always educate us.

[03:30] They took time out of their busy days to sit down and say, hey, this patient that we just had, what do you guys think?

[03:39] You know, let me know your thoughts. And then they would provide education,

[03:43] and that's just so valuable. So I had a lot of respect for them for that reason.

[03:49] So we're going to talk about your journey into medicine. Moody. And I saw that you trained across several very different institutions and regions from Bahrain to New York to Florida to Texas.

[04:03] But tell me, how did those experiences shape who you are as a physician?

[04:09] Mahmoud: Tremendously. Thank you for that question. I mean, I think I'm so privileged to be someone who was raised in so many different backgrounds and between the Middle east and North America.

[04:20] And now, you know,

[04:22] my in laws were born in Mexico. And I feel like there's so many cultural overlaps. I just think it really broadens, like who you are as a person,

[04:32] makes it easier for you to relate to your patients who may be from different backgrounds,

[04:37] easier to empathize with them.

[04:39] I just think it's been so, like, eye opening and I didn't necessarily pick for my trajectory to be so scattered. I think it really was like just taking the next step that made sense.

[04:51] And when I look back at it,

[04:53] it's, it's so bizarre, like, because people ask me like, where are you from? Or where did you train? And I'm immediately like, well, how much time do you have? Do you have 15 minutes?

[05:02] You know, so it's,

[05:04] I think I'm very lucky to have had the road that I have. And yeah, I mean, now I've sort of settled down in Texas and maybe this will be a long term home, but it's been very unique.

[05:17] Michelle: I think you're absolutely right on about just being exposed to all those different cultures.

[05:24] Makes you more well rounded as a person, as a physician,

[05:28] as a communicator,

[05:30] and understanding different cultures, traditions and everything, it has to just really lend to that.

[05:37] How did you end up in pulmonary and critical care medicine? What drew you to that?

[05:43] Mahmoud: You know, honestly,

[05:45] the nurses I was working with in my residency had a big role to play in that decision. When I started in internal medicine and residency, I liked internal medicine because there were so many options.

[05:57] But I thought I wanted to be a cardiologist,

[05:59] and then I thought I wanted to be a gastroenterologist.

[06:02] And then I was completely lost, and I had no idea what I wanted to do. And somewhere around my mid-second year of internal medicine residency, the ICU nurses, I remember one of them particularly told me,

[06:13] you really come alive when you are here and you're and your bedside manner with the patients, all this sort of praise and stuff.

[06:22] And I just felt so valued and needed and seen. And I was like, this is it. This is what I'm gonna do, you know, and so it's interesting. Cause it wasn't the plan from day one.

[06:33] It sort of evolved.

[06:35] Michelle: That's amazing that someone can witness your passion and

[06:42] not just witness it, but then really communicate that to you, because you don't need to. You know, you could just say, wow, this guy's really passionate about this. I can really see this and appreciate that.

[06:54] But then to say to you, like, I think you found your niche, you know, that's really profound. And I've spoken with many nurses on this podcast that they've gone into a certain specialty just because another nurse said,

[07:10] I think you would be a really awesome postpartum nurse or whatever.

[07:16] So I think it's great that people share their observations.

[07:21] So Moody, what's one lesson from your training that still sticks with you today?

[07:28] Mahmoud: I think the thing that comes to me immediately when you ask me that question is to be so mindful of how we communicate with each other, and it kind of builds on what you were just saying about how you never know when you might give someone a small compliment or praise that might change their entire trajectory.

[07:46] And the same goes, you know, I think part of what I'm hoping will shift in medicine in the years to come is just really having no room for sort of like toxic behavior or mean or yelling behavior.

[08:04] And so I think,

[08:05] you know, the experiences that stick with me the most are sometimes the negative ones and also highlighting the positive ones of when I was, you know, yelled at in a certain situation or embarrassed in front of a

[08:16] my colleagues and, you know, and just really being mindful of never doing that to anyone ever.

[08:23] And I think that would just help so much,

[08:27] I think, to just keep people loving and enjoying what they're doing, you know?

[08:31] Michelle: Yeah. You know, I think it is changing. Thankfully,

[08:35] I retired almost four years ago now, and towards the end of my career, I saw a big change in the toxic culture kind of being tamped down.

[08:49] I think professionals are just tired of that, and they're like, you know, I want to enjoy my life. I want to enjoy my craft, my work.

[08:58] I don't want to be weighed down with this.

[09:01] And so I think in my environment anyway, that that change.

[09:06] So I'm glad to see that.

[09:08] I want to talk about the person behind the physician.

[09:15] So you describe yourself as passionate about mental health.

[09:19] What sparked that passion?

[09:22] Mahmoud: Well, part of it is my personal journey. You know, it's something that I never really talked about before in my medical education account, but I have my own personal journey with depression and anxiety from sort of my teenage years and trying to navigate that on my own and understand it and.

[09:39] And, you know, and manage it, you know, and I think there's so much shame around, you know,

[09:46] therapy and medication and seeking help. And are you a good clinician? If you have these conditions, can you care for patients? And I think the reality is that there is a very large prevalence of health care workers who struggle with mental health issues.

[10:00] And I think Covid really brought that to light. And we see the suicides and things like that. And I think what drives people to that really extreme point is feeling a tremendous amount of shame and feeling like they have to be perfect and there's no room to be human.

[10:16] And so I think, when I started the medical education page, I didn't have as much courage to talk about it, but as the platform grew,

[10:25] I just kind of took the leap of faith, and I was like, maybe this might help someone who's feeling a little bit,

[10:32] you know, out of place. And I just think that's so important to sort of normalize it. And it's just like taking, you know, insulin for your diabetes. You know, if you have problem and you need help, like, get help, you know.

[10:45] Michelle: Yeah, I think the stigma is kind of out of the closet now, and things are changing in the direction of acceptance and normalcy and just positivity.

[11:00] Have some of your listeners or some of your followers,

[11:04] has that resonated with them?

[11:07] Mahmoud: Yeah, it's a good question. Honestly,

[11:09] so far, it's been a smaller proportion of my followers. I feel like it's, and maybe it's because it's such a, like, in the shadows topic that not that many have felt that comfortable to reach out.

[11:20] Sometimes people will. Or they'll heart it or something.

[11:24] I would love for them to, you know, and I think because my platform is between medical education and mental health, I do think the medical education draws more people because they see the immediate value.

[11:35] But I also know that it resonates with at least some of my followers. And even if it's just one person,

[11:41] that's good enough for me.

[11:43] Michelle: Yeah, and I think just you tackling that topic,

[11:48] it humanizes you,

[11:50] you know, because I think a lot of people,

[11:54] even in healthcare, certainly in the lay community,

[11:57] really have physicians on a high pedestal and they can't imagine physicians having depression or anxiety or a fear of flying.

[12:11] Mahmoud: Oh my God, I horrible fear of flying. Oh, airplanes.

[12:15] Michelle: Same, same.

[12:17] So I think by you tackling those tough issues, it shows people, hey, I'm a human being,

[12:25] so man, keep doing that.

[12:28] Critical care can be really emotionally heavy work.

[12:33] So how do you take care of your own mental well being?

[12:38] Mahmoud: Yeah, I mean, I rely on my family a lot, definitely. You know, my wife is a huge part. My wife Ivana is a huge part of my support system. And she, you know,

[12:48] she's really like the rock that carries so much of it. You know, my two dogs, Xena and Blue, they keep me grounded in the present moment. And then I do, you know, therapy, medication, all that other stuff, I try to get some movement, I try to get outside.

[13:02] And some days, you know, it's just reach when I'm off and I just want to be in bed watching Netflix all day with my family. Some days that's okay too, you know, it's just,

[13:12] it's whatever it is in that given moment and just trying to have.

[13:15] I think the hard skill for a lot of us who struggle with these issues is sort of self compassion, you know, either it wasn't modeled very well to us, or we're in an environment where it's seen as weakness, but actually like, it's just sort of realizing that vulnerability and self compassion is actually,

[13:32] you know, that's what makes you better and better. You don't have to beat yourself down to make yourself perfect. So it's a work in practice though.

[13:42] Michelle:  Man, sometimes we are our own worst critics, right?

[13:46] And we can have a friend or a family member that's going through a crisis. And you know, we can be so compassionate and empathetic and give such great advice,

[14:00] but it's like Alice in Wonderland, you know,

[14:03] it's like I give such great advice, but I hardly ever take it.

[14:07] Mahmoud: Right.

[14:08] Michelle: So we have to turn that around and take our own great advice a hundred percent. How do you think conversations about mental health are changing, especially among physicians?

[14:20] Mahmoud: Yeah, I think like you said, we have seen a raised awareness and you know,

[14:26] some sort of normalization of it. But there's always resistance, right? There's always little bits of like, sort of like these little voices that'll sneak up and be kind of like, you know, are you sure you want to be talking about that?

[14:38] Like, are you sure?

[14:39] You know, maybe people will see you differently or, you know, or push back from, you know, certain physicians as well who are like, oh, like you, if you have these issues, you really,

[14:48] you shouldn't be caring for patients. And so there is, there's always the status quo that's difficult to, to overcome. But I think, I think it's through sort of pushing through and continuing to be unapologetically open about it,

[15:02] that I hope that it will change over time where it can just be a very normalized thing and just a standard part of,

[15:09] of just who you are. And there's no shame about it. It's really the shame, I think, that makes it so heavy. It's not the issue itself, it's the shame around it.

[15:18] Michelle: Yeah, man, you said it. Well, you just have to keep doing it Moody because one person at a time, that's how we change things.

[15:28] Mahmoud: Totally.

[15:28] Michelle: I want to talk about you and your wife. So your wife also works in a very high stakes specialty, cardiology.

[15:37] And what is it like balancing two demanding medical careers under one roof?

[15:44] Mahmoud: Definitely, definitely. I think a lot of, you know,

[15:47] either dual physician or dual nurse households can probably relate to this. You know, it can be a challenge. You know, you're both kind of struggling with multiple things and you both have your own stressors.

[15:59] But I think I'm just very, very lucky. You know, my wife is way, way smarter than me and just brilliant and incredible. And I think that,

[16:09] I think having a partner that is willing to be open and constantly learning and just, just so graceful is, is just a huge blessing that I have from God. And I think that you really need that.

[16:23] You know, I think if you're both going to be really critical of each other and get in the way of each other's growth and not cheer for each other, that's going to create a lot of problems.

[16:31] But I mean, I am her biggest cheerleader and vice versa. You know, I,

[16:36] if she ends up making three times as much as I do, I have no problem with that. You know, there's, it's really not a competition. I think that's so important.

[16:44] Kind of letting go of certain sort of gender household roles that no longer serve us, you know, I have no problem cleaning and doing the dishes and we're a team, you know, and sometimes she's busier and, you know, the other way around.

[16:57] We just. it's not always 50/50, as they say. You just work together to be the best you can be.

[17:05] Michelle: Moody, I love that you said, you know, it's not a competition, it's a partnership.

[17:11] And that is so, so important. And I know our listeners can't see you because I don't do video yet, but just watching you talk about your wife,

[17:21] the look on your face was just like pure joy.

[17:25] So it really comes through.

[17:27] Thank you. That's awesome.

[17:29] Okay, we want to talk because you mentioned about your dogs and anybody that has ever owned animals know how important a part they play in their lives.

[17:39] How do they fit into your routine and how do they help you unwind?

[17:45] Mahmoud: Dogs are amazing.

[17:46] I think they're just a gift, you know,

[17:50] I think they have a unique ability to bring you into the present, you know, and we learn so much nowadays about mindfulness and our breathing. And dogs have such an incredible way of just bringing you back to the moment.

[18:02] You know, you're in your thoughts and you're in your feelings, and they come up to you and just lick your face. And suddenly you can't really be, you know, worrying about what's going to happen tomorrow.

[18:11] And so they're just such a blessing. I think they really remind us so much from day to day to just be playful and be silly and not take ourselves too seriously.

[18:21] They also kind of force you in a way to get outside and to get some sunlight. And so, yeah, it's funny, you know, we initially, when we adopted Xena first,

[18:31] We didn't think we were ready to have a dog, but you just take the leap of faith. And then before we knew it, we had Blue as well. And I can't imagine house without them.

[18:39] They just, it's so much joy and play. And I just encourage everyone to adopt an animal. You know, I think they're just,

[18:47] There's something special about that relationship that you just can't really get from another person. It's a unique relationship.

[18:54] Michelle: Yeah, I would agree.

[18:56] I've been a dog owner and it is a absolute wonderful relationship. And again, our listeners can't see you. But the love on your face, I can see that you have that for your dogs.

[19:10] Yeah, that's very cool. Moody, you mentioned that you love music and singing.

[19:16] How does it show up in your life or even in your medical practice?

[19:20] Mahmoud: Oh, it's so important. It's so important. You know, even in the ICU on the most stressful days, whenever I can, I find a way to, you know, get a little bit of space and just kind of try to listen to something 

[19:34] And that can just really, like, rebalance me and recharge me. And so I think music from a very young age has been just such an important part of my life.

[19:43] And, you know, my wife recently got me a new guitar and a little amplifier, and I have a little part of the house that's like my little band spot.

[19:51] And it's just. Yeah, it's just an energy filler. You know, there's going to be things and days that sort of empty your battery, and you really just need something to recharge it.

[20:00] And so when you identify something that is a passion, especially something outside of medicine, I think it's so important, you know, so, you know, it's not selfish to take care of ourselves and do these things.

[20:10] We have to kind of fill our cup to give to our patients and to give to our loved ones, you know, and so I think it's been such an important part.

[20:19] It's also something that connects me to my wife. One of the things from early on was a shared love of music and art. She's an excellent artist as well. She draws.

[20:27] And so I think it's just, you know, engaging that creative right side of your brain. I think there's something about that that is just really therapeutic.

[20:35] Michelle: I could not agree more. And I've been a creative all my life. And in podcasting,

[20:42] one of the things I love about it is that it is a creative outlet.

[20:46] You know, there are so many things that you do creatively to prepare,

[20:53] to execute.

[20:57] It's absolutely something that's necessary in my life to be creative.

[21:02] And being in the NICU so many years and being a developmental specialist,

[21:08] one of the things that I got really interested in was music for the NICU.

[21:14] And there's been several studies now that have shown that premature babies can really benefit from live music in the NICU.

[21:24] And so for a while, we had a guitarist come in,

[21:29] and, yeah, it was so awesome. He just sat in the corner and he played these really chill songs,

[21:37] and the parents absolutely loved it, and the babies loved it. We saw babies that have less bradycardia and apnea episodes.

[21:46] And has there been any studies done that you know, of in, like, adult ICUs for the same thing?

[21:54] Mahmoud: There absolutely has. That's so funny that you mentioned that. I was just reading something the other day and it was looking at a trial where they were trying to reduce the incidence of delirium or acute brain dysfunction in elderly patients on mechanical ventilator, where we know the incidence is extremely high, up to 80%.

[22:10] And we know that prevention is key. And once you have delirium, there is no FDA approved treatment. And the longer you have it and the worse it is, the worse your outcomes in terms of long term cognitive dysfunction,

[22:23] even mortality.

[22:24] And so they did this randomized trial where on one group they would play some sort of low,

[22:30] you know, chill music, sort of like you said, for a certain number of hours a day. And in the other group they just had noise canceling headphones. Now, from what they could tell, and I don't remember the sample size, it didn't reach the marker of statistical significance that they wanted.

[22:43] But you still wonder, you know, what is the role for music?

[22:48] And you know, is there something that could have been designed differently or was it the sample size? Because I, like you,

[22:54] have trouble believing that this is not an area that we can improve on. You know, and I just, I know there are people out there, actually, I remember meeting someone online once who reached out to me and she told me she was a, like a musical therapist coach.

[23:07] And she said that she was working with patients with specific cognitive disorders, I think like Parkinson's and things like that. And so this is a field that's evolving that I find super fascinating, cuz it's an overlap of my passions.

[23:19] But I agree, music is healing.

[23:22] Michelle: Absolutely. And you know, I learned so much from one of my guests. And you might know her. Kali Dayton.

[23:28] Mahmoud: Yes. Oh my God, Kali! Brilliant Kali.

[23:32] Michelle: Yeah, she's done so much work in, in the ICU on delirium and just I have so much respect for her. But yeah, it, it is fascinating and I think we need to continue studying things like that.

[23:47] Mahmoud: I agree.

[23:48] Michelle: Yeah. What role do you think empathy and emotional intelligence play in medicine, particularly in the ICU?

[23:58] Mahmoud: Oh, near and dear to my heart. Very near and dear. I think I consider myself someone who has never been like the smartest person in any room. I think I am a hardworking person.

[24:11] But one thing that I think,

[24:12] I don't know if it comes naturally to me or if it's something I've developed over the years is the emotional intelligence side. And I find that it is so important in every way because people receive your energy before they receive your words or your actions, you know, and I think everyone knows what I'm talking about,

[24:32] especially from a physician standpoint, when a doctor walks into the room and they're kind of like, you know, barking left and barking right and just kind of, you know, everyone kind of stiffens up from the patient to the family to the staff.

[24:43] And it's complete opposite when you approach it from a different angle. And so I think it's so important to me that everyone that I am a member of a team with feels that I care about them, that I value their opinion.

[24:56] And yes, you know, there will be high stress moments where we fall short of like our best self, but I do think that it's important to come back and repair whenever we do that, you know, and I think that that's just so important, especially, especially in the ICU where the stakes are so high.

[25:12] And a lot of the families are really looking to us to guide them. And I think we have to be so careful as we navigate these conversations about life and death and organ support and ethics and religion.

[25:25] It just feeds into so many areas. And I think if, if we're blind to that, we're doing our patients a huge disservice.

[25:33] Michelle: Do you think that's something that's changing in the curriculum for physicians?

[25:39] Are those things being introduced more? And I asked this because my niece and my nephew-in-law are both family physicians and they're in their late 30s and you look like you could be in your late 30s.

[25:51] and so you guys probably all went to school around the same time.

[25:58] But I feel like their training was so much different than physicians that I worked with, you know, back in the day.

[26:06] Do you think that's changing?

[26:08] Mahmoud: I do, and I think it's only going to get better and better.

[26:11] I know that in my training we did like simulations where we would have to, you know, sit in the front of the class and they would get paid actors to come in, volunteers and they, we would be like breaking bad news and then someone would like start yelling at you or someone would start crying profusely and sobbing with their chest.

[26:28] And, and so, you know, and the instructor could sort of pause the simulation.

[26:33] And it was just, you know, a lot of it was about learning to tolerate the uncomfortable and awkward emotions. You know, I think that's what ties in so much between my meded and my mental health part is something that I've learned over the years, is just learning to sit in that discomfort,

[26:49] you know, we're not really trained to do that. We're trained to, you know, someone's crying, you know, fix it. Fix it right away. Make it better, you know, but you can ask, like, 95% of people who are suffering in a given moment do not want to be fixed.

[27:01] They really just want someone to sit with them as they process their emotions. And so resisting the urge to keep talking when someone starts crying or yelling, like, just take a step back and create room for emotions.

[27:15] It's such a skill. And I think over the years, hopefully we'll see more and more emphasis on that.

[27:21] Michelle: I love to hear you talking about that, because I feel like that is maybe a superpower of nurses for sure, you know,

[27:30] and I just love that. Now physicians are also embracing that.

[27:36] And really,

[27:37] all medical professionals, I think, you know, we all need to be aware of those patterns that,

[27:45] you know,

[27:46] don't really help patients,

[27:48] but make us feel better in the moment.

[27:50] How do I sign up to be one of those actors? Because I would love to do that.

[27:56] Mahmoud: I could get you in contact with my old residency program. It was great.

[28:00] Michelle: Oh, my gosh. Yeah, that would be great.

[28:02] Mahmoud: That was great.

[28:03] Michelle: That would be great.

[28:05] Mahmoud: I agree.

[28:05] Michelle: Okay. What is one misconception that people have about critical care medicine?

[28:11] Mahmoud: Hmm.

[28:12] I think. Oof. That's a tough one.

[28:16] One misconception that people have about critical care medicine.

[28:19] I think a lot of times people don't realize the severity of an ICU admission.

[28:27] I think a lot of times, because we have so many machines and tools to sustain life,

[28:33] a lot of people don't grasp sort of the seriousness of it.

[28:38] And a lot of times the permanence of the downstream effects of everything we're doing in the ICU.

[28:43] I do think this is especially true from family members who maybe are not able to come in and see it for themselves. And sometimes seeing what's happening is very different than hearing it on the phone.

[28:54] And so I think that can sometimes be one of the harder things, is when you're trying to explain that, you know, organs failing and all these sorts of things, even if the patient is to survive, that what their survival will look like is going to be completely different than what it was months ago.

[29:10] This is not always the case. You know, some people come in for something a lot milder, and they're in the ICU for 24 hours.

[29:16] But I'm talking about my maybe more sick patients. And so sometimes that can be a big misconception of sort of like, okay, but they'll be awake and walking by tomorrow.

[29:24] Right. And that can be a hard thing to try to manage expectations in a more realistic way.

[29:31] Yeah, that can be challenging,

[29:33] Michelle: It just brings back a story to me. My sister was a critical care nurse for many years,

[29:39] then went into flight and everything. But I remember she had a patient in the ICU one day that was just super, super sick, you know, intubated,

[29:47] multiple drips. And,

[29:50] you know,

[29:50] she said the family was asking if he was going to get dinner that night.

[29:55] Mahmoud: Right.

[29:56] Michelle: You know, her response was,

[30:02] What she wanted to say was, you know, obviously not appropriate.

[30:07] So she said something that was much more compassionate and appropriate. But,

[30:13] yeah, there is a big misunderstanding,

[30:16] and I think there's also a misunderstanding within the medical profession maybe, and the nursing profession.

[30:23] You know, there's. I know that your channel, which we're going to talk about in a minute,

[30:28] you use humor a lot.

[30:30] And there's always those competitions, I know, between nurses, you know,

[30:35] who's better? ER nurse, ICU nurse. And,

[30:40] you know, we did that in maternal child health, too. It was like, you know, NICU is up here and postpartum's here and all the hierarchies. Right. That we do.

[30:52] I think that's. I think that's something that's really interesting.

[30:56] Mahmoud: I agree.

[30:58] Michelle: Moody, if you could change one thing about how we train or support physicians, what would it be?

[31:06] Mahmoud: I think never, ever, ever pitting people against each other and instead creating an environment where we support each other. We don't need to be perfect. We don't need to be flawless.

[31:21] It's okay to make mistakes, and it's okay to learn from them. And creating a culture where,

[31:26] you know, being a flawed human being is an acceptable model for being a physician.

[31:32] Because I think the most dangerous physicians are the ones who think they know everything and don't see their blind spots and refuse to acknowledge those things and maybe continue to practice in a way that isn't best for the patient.

[31:45] And so I think really removing the ego as much as possible.

[31:49] And, you know, I, for one, will often use the term, I don't know. You know, I had one of my colleagues, one of the nurses. The other day in the ICU, we had a patient who had mottling of their skin where, you know, usually assigned a very bad perfusion.

[32:04] And she asked me, she was like, hey, like,

[32:06] how long does that usually last, you know, after people recover from septic shock? And I told her, you know, Eileen, I honestly don't know.

[32:14] A lot of the times I've seen mottling and the patient didn't survive. So I really do not know the answer to that question, you know, and I think, I think it's just about having some humility that I think a lot of physicians think that we're expected to know everything and that we can't admit it out loud that we don't.

[32:29] So just really just getting rid of that useless framework that doesn't serve anyone.

[32:34] Michelle: Again, just being a human being, fallible.

[32:38] You know, doctors aren't perfect and.

[32:42] we need to realize that and accept that and be okay with it.

[32:48] So I love that.

[32:50] Okay, one more question before we get to your social media, because I love it and I want, what's your schedule like? Like, how are you off today?

[33:01] Tell me about that.

[33:03] Mahmoud: I'm glad you asked. It's a very unique situation. 

[33:07] And part of this has to do with, you know, my, my visa pathway in America. So I'm Egyptian-Canadian. I was born in Egypt and I also immigrated to Canada.

[33:16] So I came to America for my training on my Canadian passport.

[33:19] At the end of my training,

[33:21] one of the conditions of my visa, the J1 visa, is to go back to Canada for two years. And since, you know, I'm married to Ivana here, I really wanted to stay.

[33:29] So I did something called a waiver where you work in an underserved community for three years and then you're granted a green card application.

[33:37] So because of that, the waivers are usually done in very rural, underserved areas. So there was not an opportunity for me to do that here in Galveston, Texas at the time.

[33:45] So I actually found a job three and a half hours away by car in a city called Nacogdoches. Beautiful town,

[33:51] beautiful place, beautiful people, very happy to be there. And so my schedule, I negotiated with the hospital so that I could see my family is two weeks on and two weeks off.

[34:01] It's an amazing flexible schedule. But it's also challenging because obviously oscillating between being away from my family, working two weeks in a row, and then being back with my family and being off for two weeks has been a very interesting change.

[34:15] Something I'm not used to.

[34:17] Michelle: You know, that sounds like a sweet schedule to me.

[34:21] Mahmoud: It does.

[34:22] Michelle: But I know, you know, working in a really high intensity, you know, setting, two weeks, that could be exhausting.

[34:33] Mahmoud: Yes.

[34:33] Michelle: How long does it take you to recover after those two weeks?

[34:37] Mahmoud: It's highly dependent on what the two weeks looked like. But I agree, I think there's at least a 48 hour period where I'm just, you know, catching up on sleep and just resting my brain.

[34:48] But I agree. I think I'm very lucky to be in a situation where my employer is that flexible with me, you know, because I think that's a very

[34:57] Like you said, it's a great schedule. I'm off for half the year, and honestly, that gives me a lot of opportunity in my free time to explore other things I want to be doing.

[35:05] Michelle: Yeah, Very, very cool.

[35:07] Okay, let's talk about your social media. So that's where I met you. And you are on Instagram @icuboy_meded.

[35:16] And you surpassed me so fast. We were kind of like neck and neck with followers,

[35:22] and I was trying to get to that 10,000 mark, which I did. You got to it, and now you're already at like 26,000.

[35:30] So bravo for you.

[35:32] But one of your.

[35:33] taglines on your page says, ICU made simple.

[35:38] What inspired you to start simplifying critical care concepts online?

[35:43] And what do you wish more people understood about the ICU? And I think you touched on it a little bit, but yeah, give me your thoughts on that for sure.

[35:52] Mahmoud: Thanks. Thanks so much for the plug for my page.  I also think your page is incredible and fantastic, and I'm trying as much as possible not to fall into the rabbit hole of paying too much attention to the followers.

[36:03] It's an honor and it's incredible,

[36:05] but I think what you're doing is so, so, so valuable. And, you know, so, so valuable. I can't emphasize that enough.

[36:12] Michelle: Thank you, Moody.

[36:13] Mahmoud: Of course, Michelle. I think the ICU made simple was a big part of my inspiration for doing this is I think I find that a lot of people get very overwhelmed by the ICU, which makes a lot of sense.

[36:24] And I actually think that we can dilute it into something that is not difficult to understand.

[36:30] And I think the better you are at something, the more you're able to explain it like you could to a 5 year old. Like they say, you know, and they say if you can't explain something to a five year old in a simple way, then you don't really understand it.

[36:41] And I find that's true. You know, even the most complex thing, like vasopressors and sedatives and the ventilator, sure there is nuances and there's intricacies, but we really can explain these things in a way that learners don't feel completely overwhelmed by it.

[36:55] And the frustrating thing I went through in certain parts of my career. I've been blessed in a lot of my career to have amazing mentors and educators who have inspired me and developed me.

[37:03] But I've also, of course, seen examples of the opposite. And I remember in certain parts of my career have people talking to me as if this, like the ventilator was like a blue box I could never understand.

[37:12] And it doesn't help. You know, I think sometimes people think by talking from that position that they're like, ooh, I could never explain this to you in five minutes.

[37:20] Go read 15 books. And like, that is such nonsense. Like, I can definitely explain this to you in five minutes. Not everything about it, but you'll walk away knowing one thing you didn't know.

[37:30] And so I think it's about, again, it's sort of taking away this weird hidden power that I think some of us want to hold about knowing more than others and making knowledge affordable to everyone.

[37:41] You know, And I think that's what I'm passionate about. I think is making this something that everyone can understand.

[37:47] Michelle: And I think you totally do that. I think, again, that's a gift of many people that have accounts like yours that provide education.

[37:57] So I interviewed Sarah Lorenzini, the rapid response nurse.

[38:01] I know, right? She's awesome. And Sarah Vance, she's a critical care educator.

[38:07] Mahmoud: Yeah.

[38:08] Michelle: And they both have this knack for just really,

[38:12] you know,

[38:13] easily and succinctly, like, breaking down these really difficult concepts into these little small bites that when you hear them over and over,

[38:25] they really add up to a big impact.

[38:29] So that's obviously a superpower of yours too.

[38:32] Mahmoud: Thank you.

[38:33] Michelle: How do you strike a balance?

[38:36] Because there is a balance between keeping medical education accurate,

[38:42] but then also making it accessible for a broad audience.

[38:46] Mahmoud: Yeah, it's a goal post that's constantly moving, I think. You know, and I think a lot of times I not sure whether a post is almost good enough or accurate enough to go out.

[39:00] And I think I'm always just trying my best.

[39:02] And I also find that I don't. You know, a lot of people will sometimes say to me, like, oh, you need to, like, make sure you're, like, referencing every single thing you're saying.

[39:10] And I, at some point, I don't really want to be a walking encyclopedia. You know, I do think that part of my account is how to think like an intensivist.

[39:19] And the idea is to help you see my thought process.

[39:22] And I never claim that my thought process is the perfect one. And I try to cite the resources that I have. And some of my posts will be purely evidence based, like, this is a trial.

[39:31] This is what it's about. This is my thoughts on it. But sometimes my posts are just about, I had a situation the other day that was difficult, and I don't really know what the best answer is, but this is what I did, and I'd welcome anyone else's thoughts.

[39:43] And I think I've had a few colleagues discourage me from that and say, like, oh, you really need to be careful. Like, you should only say things. And I'm like, it's a little boring.

[39:51] I think if we only talk about what we know with certainty. I think when we create an environment where we can just say, like, this is what I think, and invite others to say what they think.

[40:01] There is so much gray area in the critical care world. Like, I always often joke with Ivana because she's a cardiologist, and I'm like, I am so jealous of cardiology.

[40:10] You guys have so many trials that show mortality benefit to medications that show real impact from these amazing medications. And the critical care world is not like that. We have very few interventions that actually reduce mortality.

[40:24] Most of our interventions sustain life, but they don't necessarily reduce mortality, you know, and so it's just, you know, exploring that gray area is something of interest to me. So I try to balance it well.

[40:37] Michelle: And I would think by opening it up and asking for people's opinions or experiences that you learn from them as well.

[40:45] Mahmoud: Yes, Michelle, yes. And I wanted to emphasize that, too, because I know you said earlier that some of your favorite doctors that you were enamored with were the ones who would teach you.

[40:54] And I can't emphasize enough. One of the things that I tell to younger doctors and even older doctors is that I still learn from the nurses, too. I learned from the respiratory therapist, I learned from the dietitian,

[41:04] I learned from the physical therapist. I learned from the speech therapist. And I think, you know, it's important to have that humility. I'm an expert in my area, but I don't know everything about nursing.

[41:13] And there are so many things that nurses do every day that I would love to learn about. And so, yeah, we learn from each other.

[41:20] Michelle: Yeah, I love that relationship.

[41:22] Well, you mentioned just a second ago about thinking like an intensivist, and that's one of the things on your page that you teach others how to think of like an intensivist.

[41:32] But what does that mindset look like. And how can it help people even outside of medicine?

[41:39] Mahmoud: Oh, yeah, great question. I love that question.

[41:42] To me, thinking like an intensivist is built on a few simple principles.

[41:47] One of those principles is the ability to stay calm in stressful situations.

[41:51] And another one of those principles is the ability to decipher what is relevant, important, time sensitive information and what is noise. And I think those two factors are so important.

[42:03] So I think in the ICU, one of the hardest bits is understanding what pieces of information are relevant to me in this moment and what do I need to do.

[42:10] So, for example, if I get called to the bedside and the patient suddenly has a change in their mental status, I could spend 15 minutes looking at their history while the patient is altered in front of me.

[42:20] Or I could focus on, okay, like, is our airway safe? Did we check a blood sugar?

[42:25] What is our suspicion for stroke? Did we give any medications that are acutely sedating that we could reverse? And so you see those, like, very few key points that only take like 30 seconds would give me a lot more information.

[42:37] But you have to know what to look for. And I think that's what I'm trying to teach people is A,

[42:42] panicking and yelling at people is not going to make you a good intensivist. B, you know, take the time and have the clarity to pick out what are the pieces of information that are relevant to you.

[42:52] And hopefully over time what happens is you develop a degree of pattern recognition. I had a great program director in my residency, Dr. Abdul Asmar, who is a brilliant, brilliant educator, and he spent so much time teaching me about the concept of pattern recognition.

[43:05] Now, it doesn't mean that every patient isn't unique, but it does mean that you have a sort of what we call illness script where you recognize a pattern and you can pull from that pattern and see what is the important information in that moment.

[43:16] Michelle: Wow.

[43:17] And one of your posts yesterday was so spot on and it was kind of humorous. I was kind of chuckling, but it was really serious because you reiterated a story where you had somebody call you and say, we need you here now, and then hung up the phone.

[43:38] And just the importance of, like you said,

[43:41] I want to know what I'm walking into.

[43:44] And a lot of that has to do with emotional intelligence too.

[43:47] Mahmoud: Yes, I agree.

[43:49] Michelle: Yeah, that was a great message. I loved it. And you did it with such humor and grace.

[43:55] Mahmoud: Thanks, Michelle. I was nervous to post that because I. And that's why I wrote in my caption, you know,

[43:59] I'm never ever, ever trying to ridicule anyone or make light of them, you know, I'm really just using it as a teachable moment. That person who called me and hung up and panic, I totally understand why they did it.

[44:10] They were scared, they were panicked. Maybe no one was right next to them. And I'm not judging them for it. I think it's about just the pattern, you know, just learning that that is not going to set up the team for success, you know, and so I'm glad that it landed that way because I really wanted to make sure it landed in a humorous,

[44:25] graceful, teachable moment. Because I myself, I'm sure, have done less than ideal things to my colleagues too.

[44:32] Michelle: It really did. It was, it was filled with compassion and, and just like, here's what you could do instead, you know, so I thought it was really done well.

[44:43] Mahmoud: Thank you.

[44:44] Michelle: Okay, since your platform blends education and, I guess, humanity, what is one non-medical lesson that every great intensivist should know?

[44:57] Mahmoud: Wow.

[44:58] A non-medical lesson that every great intensivist should know.

[45:02] I really like the quote, and I know that I'm not going to say it right, but it talks about the role of a physician and it's really the role of a healthcare worker.

[45:10] And it's something along the lines of like, to cure sometimes, to heal often, and to comfort always.

[45:18] I definitely butchered that. But essentially it comes down to the concept of we're not always going to be able to make the badness go away,

[45:26] but at the basic level,

[45:28] we as healthcare workers are there to alleviate suffering and to provide comfort. And I love, love, love the movie Patch Adams by the late Robin Williams. And I think he does such a great job.

[45:40] I love his example of a physician, how he challenges what a physician is and challenges the idea of approaching heavy topics like death with a certain lightness of heart in the right context, and approaching everything with a certain humanity.

[45:55] And he says it perfectly, I think. He says, if you,

[45:59] you treat a disease, you win, sometimes you lose, sometimes you treat a person. I guarantee you, you win every time. Again, I hope that's accurate.

[46:07] It's just about bringing the humanity back to the bedside. You know, we're not miracle workers, and that's often not what our patients are looking for.

[46:16] Michelle: Well, I really love your message today.

[46:18] It certainly resonates with me and I know it's going to resonate with so many of our listeners. And thank you so much for coming on and just sharing what you do and why you do it and how you do it, because I think how you do it is so,

[46:37] so important to bring that compassion and that empathy and that humanity and the humility of like, yes, I'm a physician.

[46:48] I don't know everything.

[46:49] I'm still learning and, and let's do it together.

[46:54] So thank you so much for, for sharing that today.

[46:58] Mahmoud: Of course, Michelle. Thank you so much. And I think, you know, I could say all the same to you. I mean, you are someone with 30-plus years of experience in this area that I am sure I could learn so much from you about it.

[47:11] And so I thank you for, you know, really creating this platform. And I think that you are doing so much good for so many learners out there.

[47:21] And I just think this is such an incredible platform. And for me, like my first time ever being on a podcast as a guest, this is like the best first experience I could have had.

[47:30] I appreciate you being such an open and welcoming conversationalist and nonjudgmental and just, just fantastic. So I can't thank you enough.

[47:40] Michelle: Thank you so much, Moody. That means a lot.

[47:43] And you did amazing for your first podcast. And I'm going to recommend you for Sarah's podcast and for Kali's podcast.

[47:53] Mahmoud: Absolutely.

[47:54] Michelle: So, yeah, I'm going to send you their way because I think you have so much to offer their communities as well.

[48:01] Mahmoud: Yeah, so Sarah Lorenzini, actually, we have a date in mind, so I am going to be on hers.

[48:06] I'm so excited. You've mentioned both Sarah Lorenzini and Sarah Vance and huge fan of both of them and Kali as well. Kali actually changed my mindset about sedation so much and opened my eyes to so many things.

[48:18] So she is truly revolutionizing things. So I'd be.

[48:22] Send me their way. Absolutely.

[48:23] Michelle: Okay, Will do. Well, you know a lot of people. And is there someone that you recommend as a guest on the Conversing Nurse podcast?

[48:32] Mahmoud: Oh, man, that is a tough question. There's so many. Michelle. Honestly,

[48:37] the names that come immediately to my mind are they kind of go together is Nick Gioni and Melody Bishop, @Pulm Toilet and @MelodyRT. Just because they are both really brilliant and clinically directed people.

[48:53] The other names that come to my mind who I also think of in a pair are Dr. Verenkal and Dr. Alice de Morello. I can send you their contacts as well.

[49:02] And they're these. This is just sort of a group of,

[49:05] you know, young physicians and, and people that are just really passionate. But that's, it's. Honestly, there's so many other names that could come to mind. They're the ones that are sort of in my immediate circle, but yeah, absolutely.

[49:17] Michelle: Okay. So cool. And Nick Gione and I actually had a date to record and he had to cancel and we just haven't caught up yet.

[49:25] But I love his account too.

[49:27] Pulm Toilet. Yeah. Very cool.

[49:30] Awesome. Well, I know people are going to want to reach out that people that have questions. So where can they find you?

[49:37] Mahmoud: Absolutely. I am now on Facebook, TikTok,

[49:41] Instagram and Threads. My account on all of those platforms is @icuboy_Meded, except for Facebook, where there's no underscore because they don't allow one.

[49:52] Michelle: Isn't it crazy how all the platforms are so different?

[49:58] It's like, how do you keep up with them and how do you keep up with posting all that stuff on social media? Like, do you have someone to help you or do you do it all yourself?

[50:06] Mahmoud: So far, I do it all myself. And I won't lie, it's challenging, especially for the half of the year that I'm on.

[50:12] I find Instagram to be the most user friendly and it's where I've been most successful in gaining a following.

[50:18] I've been on TikTok for a few months and Facebook and Threads. I just joined this past month and I agree, it is such a humbling experience, this content creation experience, because each platform is very different and what resonates with the followers from different platforms is different.

[50:34] So it's really cool. This content creation curve has been like learning a new skill, like learning to ride a bike. And so it's very, very humbling.

[50:43] Michelle: Well, do you ever think that a podcast might be in your future?

[50:46] Mahmoud: I've thought a lot about it, Michelle. You know, I would love to. I think I'm just, I'm still trying to look inwards and find the question of being what, what is my flavor of podcast going to be different from all the incredible pods that are out there?

[51:01] And I think there, if you ask about, like, ICU, there's so many great ones and, and yours, of course, and the great. You know, there's just so many. And so I think that's where I.

[51:10] There's still a bit of soul searching to do, I think, but it 100% has crossed my mind.

[51:16] Michelle: I think you'd be awesomely suited for it yourself.

[51:21] Well, we've reached the end and so, you know, at the end, we do the five minutes of fun. I feel like we've already had a lot of fun through this whole conversation,

[51:31] but it's just something that I have a lot of fun doing it. And I know our listeners love it too. So are you ready to play the five minute snippet?

[51:40] Mahmoud: I am so excited. Let's go.

[51:42] Michelle: Yay.

[52:23] Okay. If your dogs Xena and Blue could talk,

[52:27] what do you think they would say about your bedside manner?

[52:32] Mahmoud: That's a great question.

[52:34] I feel like Xena would probably be the one to give me, like, tough love.

[52:40] She'd be like, I think you're doing a good job, Moody, but here are the areas where you could do better, you know, because Xena's a bit of a princess, and I think Blue.

[52:48] Blue is like a big teddy bear. Blue would just be like, oh, my God, dad, you're doing a great job. I love you so much. Let's go on a walk, like, just all bubbly, you know?

[52:58] And I love that they have different personalities because they're so different.

[53:02] Michelle: That is so fun. Oh, my gosh. Okay. If you had to describe your ICU personality as a song title, what would it be?

[53:12] Mahmoud: Mm, that's a really good question.

[53:15] Michelle: I know.

[53:15] Mahmoud: The first one that comes to my mind for some reason is Can't Stop the Feeling by Justin Timberlake. And I don't know if.

[53:22] Yeah, And I don't know if the feeling is like.

[53:25] There's. It's all the feelings, I guess. The feeling of, like, the intensity, the joy,

[53:30] the sadness. I feel like the ICU to me, and probably what feels, draws me to it is the incredible amount of, like, emotion that exists between those walls. And so I think that's.

[53:40] And that's what keeps me going back. It's almost like an. Like an obsession, you know? And I think that's what comes to mind. Can't stop the feeling.

[53:47] Michelle: I love it. It's such a high energy song.

[53:51] Okay. Would you rather have a stethoscope that sings or scrubs that dance every time you save a patient?

[54:00] Mahmoud: Scrubs that dance. Easy one. And that's because I can't dance to save my life. So any help that I can get would be welcomed by all parties.

[54:08] Michelle: Oh, my gosh. I could just see that. Okay, if your life had a medical TV show title, what would it be? And who would play you?

[54:18] Mahmoud: Oh, my God. These are amazing questions. Okay, what would my title be?

[54:24] That's a really interesting one. I feel like the title might end up being ICU Boy,

[54:28] because I think of ICU Boy as sort of like my alter ego,

[54:31] you know? And so I feel like it would probably be something along the lines of ICU Boy. Who would play me? I would love for Rami Malek to play me because he is actually also Egyptian-Canadian, and he's a brilliant actor.

[54:43] He's the guy who won an Oscar for his role in Bohemian Rhapsody playing Freddie Mercury.

[54:48] So, yeah, if Rami's available, I'd love if we could give him a call.

[54:52] Michelle: Wow. I didn't see that movie, but I know that actor, and I think that would fit very well.

[54:58] Okay, between you and your cardiologist wife,

[55:02] who gives the better doctor's orders at home?

[55:06] Mahmoud: My wife does everything better. That's an easy, easy, easy question. Honestly, I think she gives better doctors orders.

[55:13] It's true. She's a better chef. She's a better person. I mean, it's just like. It's just a no contest for me.

[55:19] Michelle: Yeah, that's so funny. Okay, what's your secret karaoke song that always brings the house down?

[55:26] Mahmoud: Oh, I love that. I love so many songs. Let me think I could do one song I really like.

[55:37] I'm trying to think there's one that comes to mind, but I don't know if a lot of people like it, which is a Jack Johnson song. I really like Jack Johnson a lot.

[55:45] Like, very acoustic guitar. And the one that I remember performing a lot when I used to perform my older days is a song called Flake.

[55:52] It's a really cool song from one of his albums. I don't know if it would bring the house down. I think maybe something more high energy. One time I performed Can't Stop for the Red Hot Chili Peppers.

[56:01] That might do something.

[56:03] Michelle: Wow. Oh, my gosh. That's amazing. Okay. If you could prescribe one thing to the world but it couldn't be medicine, what would it be?

[56:15] Mahmoud: It would be probably equal parts of love, humor, and silliness.

[56:19] You know, don't take yourself too seriously.

[56:22] Be kind to other people and try to create a world where there's no room for other people to be cruel to other people and just. Yeah. And just be silly and joyful.

[56:33] Life is this short,

[56:35] interesting trip, and there's no need to take everything so seriously.

[56:39] Michelle: That's so beautiful, Moody, you just have been such a blessing today. Yeah. I'm so glad that I met you.

[56:47] Mahmoud: You're so sweet, Michelle. Likewise. I think, you know, the connection was there from day one, and I love what you're doing, and I love that you're approaching it from such a special angle.

[56:59] And I think you also have this unique gift. And again, like, I can't sing your praises high enough because I think you're being so humble here about really not talking up, because I looked into, you know, before our podcast, you know, your background and your history.

[57:13] It's just incredible. I mean, it's really incredible. And so for you to be sitting here and saying anything good about me is really,it's an honor. Thank you.

[57:21] Michelle: Well, thank you so much for those kind words, and I really love it. I have felt so blessed to talk to so many healthcare professionals, nurses, physicians,

[57:32] social workers.

[57:34] Just,

[57:35] it's been a blessing in my life. And so I just thank you for coming on today and sharing yourself with the world, and I hope you have a great rest of your day, whatever you're doing.

[57:46] Mahmoud: Thank you so much, Michelle. Yeah, you too. I'm probably going to go find my dogs and see what they want to do next.

[57:54] Michelle: That sounds great. All right, you take care.

[57:56] Mahmoud: Bye.