Episode 12: Rayen-Ayoub Chakra, MD

Physicians undergo incredibly intense and stressful training to become the most capable and trusted leaders of the medical team. Go behind the scenes to learn why you want our physician members in the room during a medical crisis. 

Transcript

SPEAKER_02 0:14

Well, hello, and welcome again to Medical Mastery, the podcast of the Emerald Coast Medical Association. I am your Amaranthean host, Don Davis MD, and very happy to be here today with a friend and a colleague in an infectious disease expert, I hear, according to my paper. And that's Dr. Ryan Ayub Chakra. Did I say that correctly? That's that's a good thing. Oh my goodness. Podcast is over. We did it, everybody. Congratulations, okay. Um man, so thankful to have you here. And we're we're excited to talk to our membership and perhaps some of the lay audience about some of the things that you do and learning a little bit more about you and your family. Um so thank you very much for being here.

SPEAKER_00 0:50

Thank you. Thank you for inviting me. Honestly, it's an honor. I I was super excited when I heard that you guys were starting a podcast, and I thought it'd be a great thing. It's just that it seems like a new way to consume media these days, and uh everybody's really into it. So, you know, I think it's a great way to get information. I think it's gonna be great for other providers, and I think it's gonna be great for uh patients as well who want to learn more about the provider they're talking to.

SPEAKER_02 1:10

Well, we certainly hope so. Now we're gonna see, we're gonna put that theory to the test here today. Okay, now before we get into all of that fun stuff, let's start off with you. Tell me about where you're from.

SPEAKER_00 1:20

Okay. Um, so born and raised in Charlotte, North Carolina, okay. My parents, uh, they immigrated here from Lebanon. And uh, you know, I grew up in Charlotte. I grew up in Charlotte all my life until I was 18 years old, and then I went off to East Carolina University for college. EQ, okay, all right.

SPEAKER_02 1:38

Um so so um uh when you grow up and you are first generation or second generation, shall I say, um, coming from the Middle East, um uh what did you feel like um that you can look back in hindsight and say, how was your upbringing? Was it more Americanized? Was it Lebanese? Uh is it some hybrid of those two? Good question.

SPEAKER_00 1:59

So um I I would say hybrid. So more, maybe more on the stricter conservative side for me growing up, but definitely by the time my youngest brother, because I'm the oldest of three. Okay, and uh my youngest brother could get away with murder. Like do whatever he wants. You know, that uh and you know, very uh much more Americanized raise.

SPEAKER_02 2:22

I have a youngest brother, I know how that goes.

SPEAKER_00 2:24

So it's so um, you know, but yeah, maybe uh, you know, uh parents were a little bit stricter about uh uh grades, you know, school couldn't stay out at late, that kind of thing. I I don't know, and I don't know how much that is uh uh a cultural thing, as as much as it is like this is the first child, we gotta make sure that's right. That's right.

SPEAKER_02 2:48

Well, I if if I understand correctly, it's a little bit more of a patriarchal society, and so in general, you are gonna be in charge of the family. Is that uh way to think about that?

SPEAKER_00 2:57

Uh it is more of a patriarchal society, and uh, but I I would argue uh no. I mean, I I guess the it would fall on to me, should anything happen to my parents, that I I would need to make sure that my brothers are okay and that they're doing all right. But you know, in the end, everybody kind of as you grow up, you you have your own family, you're gonna start worrying about them as well. So it but yes, I I there is a huge amount of responsibility placed on the eldest son. Like, well, well, yes, I I will say that. And um it is a uh it was interesting growing up. So food-wise, you know, I'm I'm obviously biased towards Lebanese food, you know. Well honestly, it's pretty delicious. I mean, there's that. That's um but I mean I love a good old-fashioned American barbecue as well. So, you know, it's like if we're talking culture-wise, I think my parents did a really good job of assimilating and adapting into the culture here while also bringing all the stuff family traditions, family values, like that kind of um really strong family bonds. You know what I mean? That's it's it's it's a huge thing in Lebanese families, you know, like your cousins, your your your extended family, even it's you're very, very, very close. And you're always looking out for each other and always trying to help each other, and that's that's part of it. That's part of Lebanese, yeah.

SPEAKER_02 4:27

I I think it's a huge part of what life probably should be, uh, is that that strong family bond.

SPEAKER_00 4:33

One thing I will say about in the United States is uh there's a lot of individualism, and that's good because uh that's what allows you to go out and pursue your dreams and and and uh generate certain amounts of creativity. Like the creativity that you see in the United States is different, you know? And there's a lot more individualism, a little less support, you're almost like sink or swim a lot of times. Yes. Uh in Lebanon, they like you might live with your parents until you're 30, you know, and that's normal. Yes, yes. You know, and that's normal. It's not ex- I mean, it's not normal, but it's normal.

SPEAKER_02 5:12

No, no, no, no, it's not necessarily seen as conspicuous if you're doing something like that. Yeah.

SPEAKER_00 5:17

Um whereas here it's you're kind of encouraged to go out on your own and do your own thing and find your own way and forge your own way. And I like that too. That's a that's the pioneer spirit of America. So, you know.

SPEAKER_02 5:28

Yeah, it is, it's uh it's kind of uh a different outlook. Well well, interestingly enough for that, how did your parents find themselves over from Lebanon over to the East Coast?

SPEAKER_00 5:38

Yeah, so they uh they grew up during the Lebanese Civil War. Yes. And um my dad you know met my mom, basically fell in love, and they were teenagers, they were kids. And his mom basically told him, You have to have a job if you want to get married. So he went first to the Emirates, you know, went to uh Abu Dhabi, UAE, and uh got a job there, saved up some money, went back, married my mom, and they were actually doing really well uh in the in the Emirates, and then he was he told me once, he was like, I fully intended on staying here, you know. And then the Gulf War happened. And uh the first Gulf War. And the prices skyrocketed, he couldn't afford to stay there, the rent you know got too expensive, and uh the company benefits were cut. So my mom's brothers had moved here and they attended college at UNC uh Charlotte. And so my mom was like, well, maybe we can go, and they got a visa, traveled here, started working on getting their papers done, and I was born here during that time, and you know, before you know it, uh like settled in Charlotte, grew up in Charlotte. It's it's so funny. I still think of Charlotte as my home. You know, like that's that's like uh when I when I say I want to go back home, I go back to Charlotte, even though I haven't lived in Charlotte since 2012.

SPEAKER_02 7:05

You know, like it's been a long time. Yes, yeah, yeah. Your home kind of stays your home. Yeah. Um you know, I I've I've spoken one of my um favorite uh fellowship professors uh was from Lebanon, and he would occasionally tell stories about the Lebanese Civil War and um just the pure atrocities that happen there. And um, you know, I don't think um there's there's several men and women that live in our society that have gone off to war for sure, and that could be uh incredibly traumatic. We are incredibly thankful for those men and women that um allow us to do the things that we do. But I don't think very many of us are um that close to people that have lived through a civil war and how um atrocious that can be forced.

SPEAKER_00 7:47

It was horrible, yeah. I mean it's uh it was horrible. People did horrendous things to each other, to their brothers, to their neighbors, you know, like i i a civil war is really a horrific thing. And my dad came here because he said, I wanted to give you guys a life where you would never ever have to go through what we went through and deal with what we had to deal with. Um, and and i i he worked very hard. Like he started off uh you know working at a gas station, yeah, but because of his work ethic, because of his honesty, he was eventually promoted, became manager, and then he was managing three gas stations, and then he like said, I want to do my own thing, opened up a mechanic shop, then had a car dealership. And you know, my dad's just a hustler. And I and I kind of I'm lucky because I got to learn that from him, you know. Of course. Um, you know, so he eventually got out of all those businesses and now he has just got real estate and he's retired and he's making a good income. He's very living his life, he's he he loves it, and it's all because of the opportunity that this country provided, and more so than that, he wanted to make sure that opportunity was available to us as kids. Because he was like, Yeah, even if I wasn't well off and I didn't do well and all that, I would still make sure that I gave you guys everything so that you could be, because the opportunity is here. That's like one thing that uh, you know, America is a land of opportunity, it truly is. Yes, yeah.

SPEAKER_02 9:22

Um, you know, I say this um not to pull off old scabs or anything like that, but to say that there is very little worse than civil war. And this is not to get political here in our own country, but we should do everything we can to avoid that. I agree a hundred percent it is just absolutely atrocious beyond what your mind can comprehend. So any way that we can start to compromise would be better for us.

SPEAKER_00 9:49

I think people who talk about war and you know, wanting to wanting to go to war, wanting to, you know, civil war, revolution, these words, I mean, they take them lightly. I don't think they realize the gravity of what they're saying. And you know, life as we know it would not exist. Like it would it would not be the same. And the violence, it would change people, it would scar people, uh many will die, people you care about will die, you know, like you're not gonna leave untouched. You know, it doesn't matter. Civil war is horrible. Like it's you should really it should absolutely be avoided at all costs. And open discussion and dialogue is the best way to do that. You know, I don't I don't understand why people can't have conversations these days.

SPEAKER_02 10:32

Absolutely. Yeah, and that's exactly what we're here to do. Now, um so so uh so moving on from that. Now tell me about so you turn 18, you go off to college?

SPEAKER_00 10:42

Yes.

SPEAKER_02 10:42

Okay, tell me where you go.

SPEAKER_00 10:43

So right? Uh ECU, East Carolina University. Yeah, I was a pirate. You know, purple building. Um Yeah, it was uh a heck of an experience. So it's like you know, every kid dreams of going off to college and uh you know getting away from your parents. And yeah, like I said, my parents are a little bit more traditional, more conservative, so they're a little stricter on me. So I got to, you know, I get to ECU and I get to kind of spread my wings a bit, you know. And um, you know, I uh ended up uh doing a major in chemistry. Um did a lot of research in chemistry and whatnot. And you know, for the longest time, uh uh it's interesting. I actually wanted to be a chemist. I didn't want to do medicine. I was I was gonna do chemistry. And then I actually started doing lab work. How terrible this is it was so boring.

SPEAKER_02 11:32

Yes, it's it's really awful.

SPEAKER_00 11:34

It's boring. It's very tedious, you know, and and um but the concepts in chemistry always fascinated me, you know.

SPEAKER_02 11:41

Yeah, so so um do you think it was kind of the you can understand some basic concepts and you can extrapolate out from there that was really great about chemistry that made sense to you?

SPEAKER_00 11:52

Yeah, yeah, yeah. It was it was cool. Like you you understand the basic concepts, and then once you know uh it's a very logical field of science. Put it that way, right? So if you if you do uh uh if if you like math, I was always very good at math.

SPEAKER_02 12:06

Turns out I do like math. Okay, good. So we're on the same.

SPEAKER_00 12:09

You know, it math for me just made sense. I never had an issue not comprehending mathematics because it's just logical, it just makes sense.

SPEAKER_01 12:16

Yes.

SPEAKER_00 12:17

And so that part of my brain, I think is what like chemistry. Um now before chemistry, you know, I've always had an interest in medicine as well. And so, you know, I think once I realized that I didn't want to do chemistry and I didn't want to pursue that, I went and I took my MCAT, I got a decent score, and then I went ahead and applied for medical school and ended up uh moving on.

SPEAKER_02 12:46

And well, I I think um, you know, our community certainly got the better of that equation if you're not doing chemistry there. But I think this also kind of testifies to um, you know, science is often thought of as facts that are kind of disjoint. And the truth is that science is a process. Oh, yeah. Science science is is deductive reasoning where you never get to the answer, you get closer and closer precisely to uh what we think is ultimately the truth. And then we use that to predict other things, and those things turn out to be okay. Now, where the rubber meets the road, how you make the sausage in science in terms of doing lab work is a little bit far more disjoint than the actual things of learning all the things that we know.

SPEAKER_00 13:31

Aaron Ross Powell Well, yeah, I still remember like having to wait on these NMR machines to you know analyze the amount of carbon atoms inside this chemical structure that we're trying to synthesize. Yeah, it was uh it was uh uh very it's just very tedious, you know. It's very tedious. One small thing can throw everything off. You've got to go back and look, you know, where the error was made, try to correct it, try to make sure that everything's consistent over and over and over again. Because like with consistency, you can get repetition, and then once you have reproducibility, you can extrapolate from there that maybe we're closer to the truth on it.

SPEAKER_02 14:06

If you've ever seen an NMR readout, you'll understand there's a lot of fuzziness there. This is not just like, oh, you've got 13 carbon atoms here. No, no, no, no. It's it's gonna be a graph that's gonna look a lot different. And you have to interpret it. You have to be able to utilize deductive reasoning to say, you know, well, uh how should we view this? How should we interpret this thing?

SPEAKER_00 14:25

Right, right, right, right. Yeah. And it was uh it was it's challenging mentally. And I I've always liked topics that do that. I like things that challenge me and like let me. I like to think deeper about things, you know. I like to really kind of get into the minutiae and think deeper. I don't like repetition.

SPEAKER_02 14:45

Yes, I don't like repetition. Yes, yes. Uh so so uh, you know, uh, I oftentimes in this podcast will drag it back to the way that I try and influence the medical students that I I get my hands on. And one of the things that I tell them is the biggest question you can ever ask is why? Yeah. Things should make sense. If you're seeing a patient and they just uh they're breathing 30 times a minute and you can't figure out, you need to be able to figure out why that is happening. That's abnormal. Why is this? And so I think that kind of deductive reasoning for me started way back in college too, where I started to think about, oh, why is this thing this way? Um so it seems like we're on some kind of similar path there. Now, now you go to medical school. Where'd you go to medical school?

SPEAKER_00 15:30

So um I had missed the application deadline for for med schools. Okay. So I when I was I was looking at my alternatives and I was like, okay, well, I can always just apply to a Caribbean school.

SPEAKER_02 15:41

Yes.

SPEAKER_00 15:42

And that's what I did. So I applied to St. Matthews University. Um it's a Caribbean school in Grand Cayman. Okay. And uh very smaller, it's a smaller program, but very high attrition rate. Like I rem I think we started off with like 50 in my initial class, and then by the time we got just through the first half of the med school, like this is before clinical rotations, through your basic sciences portions, which is two, three semesters. Sorry, five semesters. But it wasn't really a semester, it's really a trimester, because you had three semesters a year. Yes, yes. So we you know at the end of your second year, uh if you haven't repeated a class, if you repeat a class twice, they fail you out. Yeah. Right? And if you uh drop a class twice, they also fail you out. So it's not even like repeating or you know, you you get one of the things. You don't have a lot of leeway. You don't have to do that. You have one chance. You get one chance to redo, and then if you have too many redoos, they'll they'll they'll fill you out. So by the time I got to the end of my second year, it was me and like seven other students out of 50 who hadn't been weeded out by that point.

SPEAKER_01 16:50

Yes.

SPEAKER_00 16:51

Yeah, and I am you know, knock on wood, I never had to repeat any courses, you know. But like uh was that easy? No, because there's a lot of distractions on the island, you know, like you got these beautiful beaches and food and talking. Do we have drinks there?

SPEAKER_02 17:04

I don't know that. Uh that's weird. So uh so now I'm I'm just gonna talk maybe to the lay public for just a second here because there's a perception in some sense that Caribbean medical schools are just for all the people that can't get into the quote unquote domestic normal medical schools. And I would like to say that some of the most talented and amazing physicians that you would want to see have gone to Caribbean medical schools. I mean, these are incredibly smart people, so so that notion is not the same as it once was.

SPEAKER_00 17:36

Aaron Ross Powell Well, I think what it what it is is uh is that they might be slightly laxer in their admissions process to get you in. Sure. But getting through the program itself, I think is significantly uh more strenuous. Yes. It's not I'm not saying that the knowledge is Well, the knowledge is the knowledge. But the knowledge is the knowledge. Yeah, yeah. And in fact, if you're standing, being realistic, like how much of basic science do we actually use, like your histology? Like, do I you know? But I mean like What does that word mean?

SPEAKER_02 18:11

So is that something that I should know?

SPEAKER_00 18:13

Yeah, but you yeah, when you when you when do you live really start learning medicines when you get into residency and when you start uh seeing patients, putting hands on patients and you know the other thing that I talked to my medical students about is the Dunning Krueger effect.

SPEAKER_02 18:24

Going into residency from Yeah, I mean you're officially a doctor after you graduated medical school. You don't know the first thing about taking care of patients. You don't know the first thing about it, and that's okay. It's impossible for you to know until you kind of get deep into internship, and that's where you start to learn. Right. Um, but anyway, so so you're doing well in medical school at the time. Now you go to your first half is more didactic, your second half is clinically oriented.

SPEAKER_00 18:52

Clinical rotations. So yeah, we and and I got the opportunities because um we could pick where we wanted to do our rotations, and me in my mind was like, I just want to finish as fast as possible. That was like, I just want to be done with med school, get on with my life.

SPEAKER_01 19:09

Yeah.

SPEAKER_00 19:10

So I picked the first available opportunity, which was in Baltimore. Okay. Right. And I got to practice, I got to do internal medicine and surgery rotations in Baltimore, and I did a bunch of electives there as well. And it was between St. Agnes Hospital and Harbor Hospital. One of them was Johns Hopkins affiliated, so we had speakers coming in from Johns Hopkins to teach us, and you know, they have their own residency programs as well. So it was it was really nice. Um, and then I did some rotations in Chicago, uh, one rotation in Northern Virginia. That was my psych rotation. Hated that. Me too. Forensic psychiatry is you don't want to know the things those guys do. You have to be a really unique individual to handle that, you know, like and good on them. Like the people who pursue that career, get for them. We need them, yeah. Yes, but it's it's not for me. It ain't me. Um and so I did OBGYN in Chicago, and then I did uh uh family practice down in Orlando, and that's my first taste of Florida. I liked it. And I was like, well, since I'm in Florida, there's a Peeds rotation in Niceville. And so I came out to Niceville, Florida, and I did my peads rotation, and that was my first stay on the Emerald Coast. Yes. And I loved it. I thought, man, these people are so nice. Like I could see myself living here one of these days. And uh yeah, it's uh I never actually pictured it. I always thought I'd go back to Charlotte. You know, I always thought I would go back to be closer to my family and whatnot. But you know, when I finished fellowship and I was looking for job opportunities, one popped up here and did an interview and it worked out well.

SPEAKER_02 20:52

We're gonna get to that. Um, because you know, there's always that that that pull back home whenever after you finish training, about is this ultimately because you know it's where I grew up. And then you'll find other opportunities along the way that may even be better for you. And I'm glad that the Emerald Coast passed the vibe check for you and said, like, no, I I I like this. But but after that, so so you do a peripatetic uh rotational schedule through your third and fourth year where you're doing a lot of different uh rotations in different places. The other thing is not only is that training so intense, but like it can be expensive too. You gotta find places to stay.

SPEAKER_00 21:25

It is, it was, and it was expensive. It was it was very expensive. And you know, um I'm lucky uh because my father told me, he's like, Listen, I'm not gonna buy you a house, but I'll pay for your med school. Oh so I'm you know, I'm thankful for that. But that was one of those things he made sure that I didn't have any student loans, and I and I know how crippling that could be these days. Absolutely.

SPEAKER_02 21:50

What what a gift. Yeah, what a gift. So um, well, a testament to to his character and his faith in you as well. So so good on you. Um now, so so do Doing the rotation look, doing rotations is hard enough. You've never worked that hard up to that point. Right. I mean, you're you're learning this thing on the fly. You had previously been in didactic teaching, and so now all of a sudden you're on the wards and you're getting your hands on patients and you're doing things. I mean, it's it's a whole new experience. And you're having to live in other places. Absolutely. It's gotta be a little chaos.

SPEAKER_00 22:19

And it was not like the most organized. I will say this. You know, I wish uh um there are other schools where they kind of do like they have it organized to where you do all your rotations in the same place for one year. I kind of jumped around to get done as fast as possible, but I didn't have room and board arranged at every place I went. So, for example, I finished in northern Virginia and I drove up to Chicago, and that was I had 24 hours, you know, to get from Northern Virginia to Chicago. I get there, and it's the last day that the Grateful Dead is playing a concert in in Chicago, and this was like their final concert ever in Chicago. So all the hotels are sold out. Of course. Of course. Why wouldn't though? Here I am in my car, and I'm just like, what am I gonna do? Well, I happen to have a gym membership, thankfully, and uh and there was the same gym uh in Chicago as there was in Northern Virginia where I was staying in Fairfax. And so I found the parking lot, I slept in the parking lot, woke up in the morning, went to the gym, took a shower, brushed my teeth, went to the hospital. This is my orientation.

SPEAKER_02 23:23

This is what your physicians in training have to go through sometimes in order to get to their lifelong vocation. So so good on you for doing that.

SPEAKER_00 23:31

Yeah, I mean there's sometimes you go through things and you just gotta okay, you gotta figure out a way to kind of keep going.

SPEAKER_02 23:36

This is this is something that um I think your PhD that you really do whenever you go through medical training is of not really overcoming adversity, though it's that it's being given more tasks and saying, Oh, geez, I guess I've got to do this. And it's a lot of hoops that you have to jump through. Oh, you've got to do this application, oh you've got to take this board exam. And you just have to figure out how to do it. Now, occasionally there's some guidance along the way, but otherwise you just figure yourself through it. Yes. And because many times you say, Well, somebody's done it before. I I'll do it here now and I'll just figure it out. And so so I think there's a lot of resiliency that's built into the system. So by the time you come out of it, you're like, Well, yeah, I've been through a gauntlet here.

SPEAKER_00 24:19

I'll just do the next thing. Just do the next thing, exactly. Yeah. All right.

SPEAKER_02 24:23

So tell me about internship. Where do you go from there?

SPEAKER_00 24:25

All right. So um, well, this is kind of I initially really wanted to do surgery. Okay. So my first round, I applied for surgery and I didn't apply for any backups. And I kind of uh didn't, I didn't I matched in a prelim program which was notorious for abusing their residence. And if there's anything I can say to any students out there, be very like careful about the prelim programs you go to, because uh they will make you repeat your prelim year two, three times. Yes. You know, certain certain some of them, certain ones. So I decided, you know what, maybe that's not for me. Uh so I took a year hiatus, actually. I I went on, I you know, I took a year off, I studied, uh prepared for step three, and I went to Lebanon to visit my grandparents, you know, while they were still alive. So great. Uh I wanted to make sure that I got a chance to see them and um uh happened to meet my fiance or my my my wife, my wife, sorry, now but like you know, we've got seven years ago.

SPEAKER_01 25:28

We'll edit that out. That's all right.

SPEAKER_00 25:29

That's yeah. So I happened to meet her while I was there and um, you know, got into a long distance relationship. Before you know it, we're engaged by the end of the year. I'm applying for um new the new match, and I get a bunch of interviews this time as I did mostly internal medicine, and I got you know 20 or 30 interviews, and I'm going around from town to town to town to town and you know, traveling to all these places to do these interviews, and I get to New York City and uh Jamaica Hospital, New York City in Queens. They actually I finished the interview with them, and they're just like, Well, listen, you know, we like you. Uh you don't have to go through the match if you sign here. And and I was like, Can I think about it? He's like, Yeah, but you know, we don't want you taking advantage of us. So yeah. Well, they gave me they gave me a few hours. They was like, you you take a few hours, you think about it if you wanna if you wanna do it, you can and this is you gotta keep in mind, I just spent a year not doing what I wanted to be doing. And I was like, I'm not gonna risk losing that again.

SPEAKER_01 26:36

Yes.

SPEAKER_00 26:36

So I went ahead and I signed. I I I signed the paper and I uh I joined the residency program at Jamaica Hospital, and honestly, probably one of the best decisions I ever made because it is a very, very, very strong program. Like uh it's not an academic program, right? It's not. But what it is is a program that exposes you to so much like variety of diseases, and uh you have to learn to manage things that you wouldn't see really anywhere else. You know, so so and so for internal medicine as a base, just a hands-on experience, and and by the way, that's that's how I learn. I I'm a much more hands-on, get my hands dirty. That's how I learn. Try it, figure it out. Um, but I'm not uh I I I I'm not I don't not a big bookworm, you know? Yeah, which is weird coming from an ID guy. I know we'll get to that too. Uh so um, you know, Jamaica Hospital, just for for reference, is like right off the Van Wick in New York City. So that's very close to the airport, to JFK Airport. So there are cases where people would be dying in Africa, somehow get themselves well enough to get on the plane. Yes, they land at the airport, they come off, and then they pass out. And they this is intentional, by the way. They they because they they're seeking better medical care. Of course, of course. And that's what so they pass out, the hospital uh ambulance comes in, picks him up, takes them to our hospital, and now you get this like you know, this is a 75-year-old lady from Africa with uh, you know, who've syncopized and they've got they had rheumatic fever, they've got severe modular senosis, they've got tertiary syphilis, like all the things.

SPEAKER_02 28:30

All the things, yes.

SPEAKER_00 28:31

Everything that you would not normally see in an otherwise healthier population, you know.

SPEAKER_02 28:37

I love about this too, is because what you're really getting is not just pathology, but deep pathology. Again, untreated medical issues that have gone on for some significant time. You know, sharko feet that you're like that they've been walking on for ages that they've just got a stump ground down, um, you know, um in-stage infectious disease complications that we just don't see here because it just doesn't go untreated. And so um, so yeah, that's that's a great place to learn.

SPEAKER_00 29:07

It is, it absolutely is. And um there was obviously a hiccup. Like during my residency, it was uh um from 2019 to 2021. Did anything happen during that time?

SPEAKER_02 29:21

What about it? I wonder what happened. I'm hearing about this.

SPEAKER_00 29:23

This is crazy, yes. So uh, you know, there was the COVID pandemic happened to hit New York City at that time. Yes. And uh it was brutal. It was brutal. But uh what it also taught me was that you can handle really sick patients and you can handle really high volumes of patients, and you can handle it well. You know, like this is something that you that you need to do uh literally by learning by being in a pressure cooker, you know, like that's yes, you don't know you can do it until you do it, yeah.

SPEAKER_02 29:55

Then you say, Oh, I can do that. Yeah, yeah, yeah. So that's an incredibly intense environment to go through an international uh crisis like this. Oh yeah. Um it's and again, you're seeing you know, the stories, the statistics don't really tell the stories because when you're on the front line and you see these people that are dying and that it's scary, you're not entirely certain what is going on here, you're looking for advice from a lot of different places, and you're also putting yourself in the front line.

SPEAKER_00 30:26

I mean, look at everybody was terrified. I'm not gonna, you know. Of course. It was the hardest thing getting up in the morning, putting on my scrubs and going to work. Yes, very tough. I made sure I got some crocs that I would uh I would, you know, at the end of the day. I had two pairs of crocs, right? I had one pair that I left in the locker room over there, and one pair that I wore back and forth to the hospital, and then I had a bucket of bleach water sitting outside our house, and I'd take my shoes off, dump them in the bleach water, go straight in, shower to try and prevent the spread. Unfortunately, nothing nothing would have prevented the spread of this virus. That's right.

SPEAKER_02 30:55

Well, and you know, you've gotten some insight post hoc about uh a lot of that kind of stuff. Yeah. Um but but it was also, you know, it was pretty mentally taxing when you see, I mean, frankly, when you see a lot of patients die. Yeah, it was rough. I mean, that that's a hard thing because, you know, well, we we task ourselves with the idea of like, we're here to save people. And then when you see that the dye is cast in a lot of different ways on patients and there's not much you can do, that's a terrible place.

SPEAKER_00 31:20

I would say, and the hardest thing also was at that time they wouldn't let family come to the hospital. So you would have to call the family. Like I had to call a mother and explain to her that her you know 35-year-old son just died. And she's like telling me crying, telling me why. It was really sad. You know, I just Of course. And I broke I I I broke down in tears on the phone with her. You know, like it was it was really honestly a very depressing time in my life. Excuse me. The one good thing was um the birth of my daughter Naya. She was born in 2020. That was the only good thing that happened in 2020, as far as I'm concerned, you know. Um, but yeah.

SPEAKER_02 31:59

I I remember hearing a separate political commentary saying uh this is not talk about politics, but saying that 2016 sucks. And my whole thought was that's when my first daughter Avery was born. 2016 was great. I loved it. I love it. It was fantastic, it's one of the best years of my life. Um, anyhow, so um so this is a formative time where you're you're being emotionally dragged out, you're you're you're being uh put through the ringer, but you've also got to be around to help the next patient. Absolutely. And and that is that's another different resiliency that you're not taught during lectures of medical school.

SPEAKER_00 32:36

Right. And and you know what else? Um, you develop a certain brotherhood with your colleagues. Um, it's not just you're there to help the next patient, you're there to help your colleagues who are suffering just as much as you. Yep. But we're doing this, we're there hand in hand, and we're trying to do our best to help these people, you know, get through this pandemic.

SPEAKER_02 32:57

You know, and it's cuts across all religious, all creed, all gender, all every it cuts across all that. We're all working together on this task, we're in the fire together, I got your back, you got mine.

SPEAKER_00 33:10

Yeah, yeah, yeah. And and that was very nice to see that everybody kind of united.

SPEAKER_02 33:16

How else do you get through something like that? You have to.

SPEAKER_00 33:19

You have to. You have to rely. You can't look, I don't you could be Superman, but Superman still needs others. You still need people, you still need people to work with, you still need people to talk to. Um you know, everybody inside the hospital and outside the I mean I got I can't I can't tell you my wife like how amazing she was. Like without her support, there's no way I would have gotten through it, you know. Uh so inside the hospital, outside the hospital, my parents were calling and checking in on me. My mom like was telling me, I'm gonna come to New York. I was like, the hell you are. Stay away. Excuse my language, no. You're fucking stay away from this place.

SPEAKER_02 34:03

Away from this place. Yes, don't come to Jamaica. Uh uh Jamaica Hospital, yeah. Yeah.

SPEAKER_00 34:10

Yeah, do not come here. Uh and so they sent me, like they were super nice because they were running out of N95 masks, so they sent me the reusable respirators. Like they they would email them to us, and you know, we we we got a lot of support from outside the hospital and then also within the hospital. Within the hospital, um your residents, your chiefs, you know, you the like I was a second-year resident, so I had my interns that were relying on me to be there to support them and back them up. God, I remember at one point I had um there was like 14 or 15 uh critically ill ARDS ICU patients, and we just didn't have enough attendings to round on them. And they said, hey, you got these 14 patients, uh, these are two interns to help you figure it out. Keep them alive. Do your best. Yeah. And by God, I did. I mean, I tried, I did my best, you know. Now obviously, like it wasn't it it didn't work out the way we wanted, you know, like a lot of times.

SPEAKER_02 35:19

Well, and so this is something that um, you know, I'm not sure the lay public knows about this kind of thing, is that um for the most part, if you went into the ICU with ARDS, um so so so basically respiratory failure for for the lay public, okay? Um you're not gonna be able to oxygenate because you've got so much fluid inside your lungs. Um you've got a disease process that is gonna keep you from being able to get oxygen into your cells. Um if you went to the ICU and you required high dose oxygen, you were very likely gonna die.

SPEAKER_00 35:52

Absolutely. Yeah. I mean it's it's your mortality already is very high. It's irregardless of the disease process. Regardless whether it's COVID or or pneumonia. I mean, ARDS is a very high mortality.

SPEAKER_02 36:04

Yes. If you cannot oxygenate because you have some sort of process that is driving fluid into your lungs, you are in a bad place. Yes. And we need to work really hard to try and get you away from that. And this particular one seemed uh perhaps uh more mortal than others once you got to that point. Now, if we could keep you from that point, then then great, things were a little bit more sanguine. But that was that was a terrible thing whenever you started to admit patients and see them in consultation from my standpoint into the ICU. Right. Because you could start to see writing on the wall, and that's that's a depressing place to be in some ways. Absolutely. Yeah. So so a formative time for you to be a thought leader, to to kind of be thrown into the gauntlet, but boy, that steel is going to sharpen steel whenever you leave that.

SPEAKER_00 36:48

I'd like to think that. Yeah. So, you know, um I finished up and I didn't know what I wanted to do initially. I was looking at, you know, internal medicine, you can get into cardiology like yourself, infectious diseases. Hopefully you do something smarter than cardiology, but either way, that's you know, I I I really thought about GI quite hard because I initially wanted to be a surgeon. I figured that's the closest thing to surgery. In the end, I would say my experience with the pandemic is what led me to going down the road of ID. Yeah, that was uh that was the major reason. It was like I was because I've always had an interest in epidemiology and virology when I was actually all the way back to seventh grade, seventh grade, South Charlotte middle school.

SPEAKER_02 37:34

Shout out, South Charlotte.

SPEAKER_00 37:35

I am I am like in this middle school library, I'm looking around and I see a book. It's called The Hot Zone. Yes. I'm just like The Hot Zone by Richard Preston. Richard Preston, yes. Seventh grader, no idea what this is. Sounds interesting. Let's read it, you know, start reading through it, flipping through it. They're talking about the Ebola virus, the Marburg virus, the Lhasa virus. And they're giving these horrific descriptions.

SPEAKER_02 37:57

They are blood is pouring out of your eyes and other orphae, yes.

SPEAKER_00 38:00

Yes, and uh and I remember being so horrified, I was like, I need to I need to do something about this. This is like I'm gonna go into medicine to treat this. And this is a seventh grader, right? So what do I know? But I mean, sure enough, here I am. I'm I'm an infectious disease doctor. I treat viruses and bacteria for a living.

SPEAKER_02 38:22

Yeah, so so um ID, infectious disease doctor, um really um uh kind of treating and managing the um microbial um influence on our lives in a lot of different ways. Yes. Um and we're gonna get into some nitty-gritty about that, but let's just focus in on your training for a second. Where did you go to do your ID fellowship from there?

SPEAKER_00 38:43

So um after New York, I wanted well, after the pandemic, I uh look, New York City is a very nice city, it's a beautiful city. It's a great city to visit. I wanted to get the heck out of it. Okay. It's like after the pandemic, I was done. Yes you know, I was done with that city. Um so I applied for fellowships outside. I applied for I have some family in Georgia, in Augusta. I have some family in North Carolina, as you guys know in Charlotte. And I applied at my alma mater at ECU. And I went ahead and I did uh infectious disease at Augusta University uh medical center in Georgia. And they have a very, very good infectious disease program there. Um, I'm lucky. Uh happened to be close to family. You know, my aunt lived there, my dad's sister, and then my uh my my dad's brother was there as well, and several other family members. And one of my older mentors, actually, who I used to shadow, I would go to Augusta and I would shadow him and the ER, he's a pediatric ER doc. And uh he was a big influence on my relative into medicine as well. So it was nice kind of being around the community I knew. And fellowship, you know, brought with it a different set of challenges. Now you're actually kind of expected to be an expert of somewhat, you know. Like they're calling your consults, you know, you you gotta know what you're talking about. You gotta go in there and you know, they ask you, hey, how long do I give antibiotics for this osteomyelitis case? You know, like oh hey, we got an endocarditis, you know. Yes, and and so it used to be when you were doing your internal medicine rotations, just you know, consult ID, follow ID recommendations, put in the orders for ID if you need to, you know. Internal medicine was it's it's different. It's it's not like you're not managing specific processes. You're more like managing the whole picture. Yes, you know, so you're you're the general and you kind of call in the support, but when you're calling in the support, that support better be expert support.

SPEAKER_02 40:52

That's right.

SPEAKER_00 40:52

Right? So you know, you show up now, you're looked at as an expert. You're looked at uh as a fellow, is when I first actually started feeling like I was being respected among other physicians. You know, as a resident, you know, you're kind of like you're a resident. Of course, you're there. Yeah. So it was interesting, you know, it was an interesting uh feeling. And then as far as learning goes, God, we we did everything. You know, we we we had an HIV clinic, advanced uh HIV uh treatment, very we got to see the sickest of the sickest patients, you know, with AIDS, uh, which you don't see that often anymore. That's right. You know, but they're all being sent to us because we're a tertiary referral center.

SPEAKER_02 41:33

Well, it's it's one of the true uh success stories of medicine, I think, is that that this has become just a chronic long-term management disease, which is I would argue that HIV is easier to manage than diabetes.

SPEAKER_00 41:44

Yeah. Do you know you might be right?

SPEAKER_02 41:46

Yeah. It was just a pillow day. And and honestly, honestly, it's a tribute to our pharmaceutical industry too, to make these wonderful antiretroviral agents.

SPEAKER_00 41:53

It's it's incredibly impressive how far they've come, you know, with that. And uh it's only getting better. You know, it's only getting better. There's there's there's newer medications out now. There's like used to be triple drug therapy, antiretroviral therapy. Now now there's like a kind of a switch to two drug therapy, right? You've seen that more and more. Uh there's even long-term injectables for patients who have difficulty getting the pills and taking their pills for whatever reason.

SPEAKER_02 42:21

Long-term injectables to kind of prevent uh um Yeah, not taking your medications, which is one of the if if I remember correctly, uh which I don't, um if not taking your medications regularly for uh retroviruses is is incredibly deleterious. Because then you get mutations. Yeah, you get mutations very quickly, they become immune to the medications that you treat. So that's a that's a huge deal in the the HIV world. Um but I do I I want to double click on something that you had said there, which is which is really sage, which is coming into fellowship. I mean, you know, I'm a board certified internal medicine doctor at this point. Right. I'm coming into cardio, I've taken care of cardiovascular patients, I understand this whole thing. People are calling a cardiology consult. I'm ready, this is gonna be great. I didn't know the first thing about cardiology. Yes. I didn't know the first thing. I mean, you think you know, you don't know anything. And so it's a very humbling experience to all of a sudden realize, oh, you've got this accolage, you've got this societal praise that comes to you. Oh, you're a cardiology fellow. You don't know anything. And so you have to humble yourself and be like, well, geez, I need to learn this quick because people are gonna expect this of me. And so it's really nice to hear other people saying something similar.

SPEAKER_00 43:34

Yeah, yeah, absolutely. Uh you you gotta you gotta become an expert. You really do. Because uh you're gonna get asked questions and they're gonna expect you to have the answer.

SPEAKER_02 43:42

Yeah. And and and you feel like I owe it to the profession, I owe it to my colleagues that are asking for help, that I need to know what I'm talking about here, and I need to be able to get you out of a well, you know, if you come to me and you, you know, hey, uh what do I do about this uh, you know, endocarditis?

SPEAKER_00 43:58

It has this weird organism that's Growing and you know, do you think do we treat longer? Does it need surgery? Does it do I better be able to give you an answer? You know, I owe that to you. If you're coming, if you are giving me the respect of asking my expertise opinion, then I better be up to snuff. You know, like that's my that's my honest uh uh feeling towards that, you know. You can't not know what you're talking about and then give you some nothing answer because then I didn't give you the help that you wanted, you know, and I did a disservice to my field of medicine, you know.

SPEAKER_02 44:33

Um I th I think that esprit de corps, that that camaraderie that we have of like of, you know, if anybody calls and asks for help, I'm gonna come running. Like if you say, Look, I have no idea what's going on with this patient and they're getting sicker, can you help? We'll bring in the cavalry, we'll bring in every single subspecialist that's gonna come in and be like, geez, let's try and figure this out together. Now, if you've got a run-of-the-mill consult and you don't fully understand that for the medical students among us that is that are trying to call in consultations, well, yeah, I mean, we take some umbrage with that. But if you say, look, I have no idea what's going on here and I need some help, I'll drop everything and I'll come help. I mean, like that's that is that's the way that we really land on it.

SPEAKER_00 45:13

And that and that's I and I think that's um an important philosophy as well, is because when somebody's asking for help, this is I think our one of one of our main purposes, because when you say you're a doctor, right? A doctor is an expert in his field, he's a teacher, and he's a physician, right? So you're three things. You're not just and if somebody's asking your help, you know, one of your duties, one of your obligations is to go and help that person, whether it be a patient, whether it be a colleague, um, you know, whether it be a family member. You know, you you as that title should not be taken lightly. That's right. You know?

SPEAKER_02 45:56

I don't, and most of the good ones don't. That's that's the vast majority of us. So um now um my experience throughout residency and I think uh many others was that, you know, um you're gonna run into infectious issues all the time. I mean, that that is that is kind of the bread and butter of internal medicine in a lot of different ways, okay? Um so you're gonna have to understand some basics of that. Now, when it got to things like HIV, I really never really touched it because that immediately went to the infectious disease specialist who would who would dictate all of that. And we didn't really touch those kind of things. So it's the there are still these kind of interesting um silos that we kind of fall into where uh I can't tell you a whole lot about if somebody comes in with TB, uh I'm gonna I'm gonna ask for some big guns to come in and help me pretty quickly on things like that. Right. Yeah. And I would imagine uh when you were in training, you saw some pretty advanced TB cases.

SPEAKER_00 46:49

Uh oh yeah, yeah, yeah. We had uh several tuberculosis cases, uh one Potts disease, that's a tuberculosis of the spine, the spinal osteomolitis. Uh yeah, we we got to see quite a quite a wide variety. Um you know, even I even had like you don't see this very often, and it's on the rise, people, so be careful. But syphilis. Yes. Tertiary syphilis, I had a patient with tertiary syphilis, which is usually caught much earlier. Way earlier, yes. And treated. And so you don't really see it.

SPEAKER_02 47:20

Treated relatively easily if you catch it on the front end, yes. Um some some relatively um benign antibiotics. I don't know if that's right. But but it's penicillin. Yeah, penicillin, which is kind of our classic prototype. Yeah, exactly. Penicillin doesn't treat a whole lot, but syphilis is one of those things.

SPEAKER_00 47:36

Yeah.

SPEAKER_02 47:36

Right. Uh yeah, so that's incredibly interesting that we get to see this kind of advanced pathology manifestation.

SPEAKER_00 47:43

Very advanced pathology. And and what's crazy to me is that it was misdiagnosed for a while. You know, it was um it was the thought to be mycosis fungoides. So it's like uh a cutaneous T cell lymphoma for for anybody else that's a cancer of the skin that comes from the blood.

SPEAKER_02 47:59

Thank you. I could have said that, but I didn't, okay.

SPEAKER_00 48:03

I just want everybody to know that. So yeah, it's uh it was misdiagnosed, misdiagnosed, misdiagnosed, and then finally somebody decided to look at the pathology report under a dark field microscope and saw spirit kits. And then we get the referral and we look at it and we kind of go through it. I I wrote this up. It was a really good uh it was actually uh accepted as an abstract, and they I got to present it at a uh conference in Louisiana. But uh but yeah, it was it was it was neat uh just being part of that academic program, and you really get to see the more complicated cases, the stranger cases, things that you don't normally see. And you also learn your bread and butter ID. You know, that and you and you need to know that really well. That's you know bread and butter ID being your you know joint infections, bone infections, uh cardiac, you know, cardiovascular, you got device implant infections, you know, valve infections, cardiovascular valve infections, endocarditis, things like that. You know, those are kind of bread and butter, you see that a lot. HIV, you need to really know how to manage, you know. And then travel medicine. Yeah. Did a little bit of that. Not so much because there's not uh Augusta's not a big travel area. Yeah, yeah. But we did do a little bit of travel medicine and uh and you know, wound care. I started, I actually as an elective, I decided to learn wound care from one of my mentors. This is older gentleman, he was retiring. Um actually passed away. And now his name's not coming to me. That's right.

SPEAKER_02 49:37

You'll catch it in a second.

SPEAKER_00 49:39

But he um he had a wound care clinic and he was like and so I went and I started learning wound care from him and the basics of wound care and how important it is. Like managing the microbiological load in wound care is is an important part of it, right? So that's why it fits into ID, but also uh aside from managing infection, it's managing all the other comorbidities. Yes, and uh and really knowing your internal medicine and kind of applying what you learned in internal medicine in combination with ID to get optimal outcomes with wound care. And so it was kind of neat. I got to learn wound care from him, and he he always told me, he's like, you know, it's a very lucrative field for ID doctors. We don't make much, you don't ever make a buck off a gram stain, but you can make some money doing wound care. And so I I you know I I figured it'd be a good skill to have, and I you know, learned it.

SPEAKER_02 50:26

I think it's a great skill, yeah.

SPEAKER_00 50:27

Well, yeah, I mean it and it it served me, you know. I so uh uh ended up when I came here, you know, uh the ID doctor that hired me basically had a wound care clinic, an IV infusion clinic, and you know it just I fit I I you know fit right in. You know, it just uh yeah was easy uh to kind of pick it up and learn it quick. And obviously I had a lot of support because here's the thing you know, we talked about you don't know anything as a student until you start residency, you don't know anything as a resident until you do fellowships. Yes. Well, you don't know anything as an attending until your first couple years.

SPEAKER_02 51:06

You really don't. Well, no, and so I see, you know, all the way back from the chemical interest in chemistry from before, the deductive reasoning that comes across, and you can reason, oh man, and now I need to use this appropriate antibiotic. What you start to realize once you start to practice is more the art. Yes. You know, just kind of when I'm I'm gonna go a little deeper into the business here, uh, when realistically you should use ceftriaxone as opposed to cefampine, even on the front end empirically, okay? Choosing different grades of antibiotics that are gonna come through just because look, I know what we're gonna see here, and I know the typical thing that this is gonna work for us. Right. And um high dose concentrations of um certain um antibiotics that will concentrate more in the bladder that otherwise, even though this bacteria is resistant to it, you understand the pathophysiology. Like those are kind of um arts of the trade a little bit that you have to pick up in practice.

SPEAKER_00 52:03

Yes, yes, absolutely, yeah. So yeah, you and that's just stuff that you learn as you do uh so for example, like you know, we we do a lot of um, we have an IV infusion clinic. And so a lot of our patients get IV infusions, and in fellowship, we didn't do an infusion clinic. We had patients on IV antibiotics, but we would send them home with them. The machine did that. I don't know. I don't know. I did put it in the order. I would get a Pedro Labs once a week, right? And I look at the labs and that would be it. And I would do clinic every four weeks, and if that's that's when I would follow up with them was four weeks. You get into the real world, right? You put these patients on these toxic antibiotics, right? Which let's face it, antibiotics are poisons. They're poisons. You know, they're poisons. They're just uh you're just poisoning the bacteria, but you know, you give it a colour.

SPEAKER_02 52:54

Hopefully more so than your anti cells, yeah.

SPEAKER_00 52:56

But you give high enough dose, you can poison you too. So um now I bring my patients back every week. So I'm like, you know, no, I'm gonna check your labs. You're on IV antibiotics, your kidneys could get shot, your potassium could shoot through the roof, um, you know, you could develop a myelosuppression. Who knows, right? Like, well, I mean, I would know because I give the bad advice. Yes, yes, but I'm checking, right? So I'm checking the labs once a week, I'm bringing the patients in, I'm checking with them, and I'm and I'm putting the. Putting eyes on the patient, yeah. I'm putting my eyes on the patient, I'm putting my eyes on their PIC line, I'm checking their PIC line, I'm making sure there's no PIC line infection, because that leads to endocarditis, you know. Uh I'm uh making sure that they are comfortable with the medications they're receiving, and you give a lot more personalized care. You get to know these patients quite well, actually, because they're usually on antibiotics for at least six weeks. And um, you know, I think it's better care for the patient that way. Yes. You know, as opposed to here's some IV bags, go home, you do the antibiotics yourself. You have any problems, call us, come and see us in four weeks. You're no longer a board question.

SPEAKER_02 54:05

Yes. You're now a person. You're now a person. And now we're talking about something totally different. And you've got a family and you want to go to their baseball games, and how are we really going to talk about getting this taken care of? And and I want the lay public to understand this. I mean, there are certain infectious disease processes that require six weeks of continuous infusion antibiotics. That's not something you want to keep a patient in the hospital for for six weeks. Absolutely not. In extraordinarily rare circumstances, would you ever do that? So we have to have some infrastructure to be able to get them the thing that they need, but they can still go home. They can still go out and do other things.

SPEAKER_00 54:38

No, and do other things just to keep a close eye on them, you know, make sure that they're doing all right. And um, absolutely. I mean, that's that's the benefit of being able to do antibiotics IV at home and having a specialty. Because most of your internal or internal medicine docs are not gonna try to manage that, you know, like that, because unfortunately we live in a very litigious they shouldn't do that, yes. And and unfortunately, we live in a very litigious society. So, like, you know, any medication mistake, you know, you can expect a lawsuit, and the first thing they're gonna ask is, well, why didn't you have ID on board? This is yes, you know? Um, so you know, everybody's specialty exists for a reason, you know? I do.

SPEAKER_02 55:19

Um and and in many cases, it's it's comfort with being able to say the buck stops here. You know, oftentimes we'll get pre-operative risk assessments, so-called clearance for surgeries and other things like that. And it's not because these physicians aren't capable of making that decision, it's that if God forbid anything were to go wrong or untoward in the patient, it would immediately be, why didn't you talk to cardiology about this beforehand? For the, you know, 95% of the time, they're gonna make the 100% right decision on whether or not this is a safe patient to operate on from a cardiovascular perspective. Absolutely. There's occasionally times.

SPEAKER_00 55:53

And and for the record, I uh can I just say this for the medical students who are listening to this? Please, please, please. Guys, med school is different than real world. Real world, you call a consultant, most consultants are happy to run, help, see, give advice, and and do whatever you need. Uh, so always, always, always be nice. You know, like that's a very important thing. Always be nice, yes. And then the number two is uh well, um what I was trying to get at was like in medical school, I don't know whether it's the students just tend to get grumpy, but you know, you call the student that's on that's doing the ID rotation at the time, and they're gonna give you some pushback. They might, oh, do you really need an ID consult for this UTI? Yes, you know, like they're they might say something like that. It's different in the real world. You know, you call your consultants, your consultants are always happy to help out, usually.

SPEAKER_02 56:48

Yes, they are they are thankful to be there.

SPEAKER_00 56:50

Thankful to be part of it.

SPEAKER_02 56:52

Yes. Um, and and that's why, in terms of your consultant for those that do end up going into subspecialty, um, your most important attribute is not your ability, it's your affability. Yes, it is you just saying, like, sure, I'd love to help. I can I come help? I mean, those kind of things are gonna go a lot further.

SPEAKER_00 57:10

I would say, and I would add to that availability. Availability. Availability and affability.

SPEAKER_02 57:14

Yes, yes, exactly.

SPEAKER_00 57:16

Um, you know, be available for your colleagues, you know, be there to help them because that's what they are. They are asking you for help. That's what we gotta like it's not because they don't know how to manage a UTI. Of course. They're asking your help. They're asking for you to come and give way in and give your opinion. That's a sign of respect.

SPEAKER_02 57:32

Indeed, it is.

SPEAKER_00 57:33

And that's how you should take that, and that's what you should do, is you should go and give them the respect that they gave you.

SPEAKER_02 57:38

Yeah, you know, the other thing that I try and clarify, and this is uh again a little bit of inside baseball, is that you know, we're often taught that our customers are, you know, I I've been preaching from a high horse for a while that I think medicine should be more of a customer service business, okay? Um, we're often taught, and it's intuitive, that patients are our customers, but also our our customers are the people who are consulting us. Yeah. Those are the people though because I can tell you, if you start to give attitude to people that are consulting you, they just won't consult you again. They'll stop calling you. Of course. And and who can blame them for that? Don't do that kind of thing ever. Okay. Um now I want to talk a little bit on a bigger scale here because um, so um, well, let's first say, so you moved after fellowship. Uh, how did you find yourself down here?

SPEAKER_00 58:25

You you uh yeah, so uh I was looking for jobs. Um again, you know, ID is not the most lucrative field in medicine, right? But uh I happened to find a good business opportunity here. Where uh I and it was Dr. Anastasio, Patrick Anastasio, he's out at Fort Walton Beach, um practiced there forever, and now he's uh basically president of the uh uh American Medical Group or uh you know Emerald Coast Infectious Disease. Shout out Dr. Anastasio, yeah. And great guy, you know, like first of all, super interesting dude. He's like a jiu-jitsu black belt. So we we immediately we click. I if you guys don't know this, I like jiu-jitsu. I like it's it's my form of exercise because I actually hate exercising. And I know I know what you said to make an exchange. Just do it. Okay. Just do it, okay?

SPEAKER_02 59:14

But uh but yeah, so Chris Joseph's about to come over here and put you in a hold. I just want that to be known.

SPEAKER_00 59:19

So it's um so you know he we immediately clicked on that point when we were interviewing. And then he basically told me, he's like, listen, I got a thing that I think that you can go out into this community, right? And you have a the personality to kind of make connections and meet people. Yeah, and uh and if it's business that you're after, you're gonna get business. And then also there's a need in this area for infectious disease. And that's where you're gonna find your success. You're gonna find your uh your niche, so to speak. And so um he kind of explained to me how he runs his business, and it was uh at the time he does uh he he he had a wound care center and an IV infusion center and you know regular ID clinic. And the IV infusion center, you know, he'd bring patients in for IV antibiotics, but on top of that, you know, he would also give specialty meds. So he made connections with all these uh other docs who needed like, for example, there's a new drug called um I I know of an infusion LecVio.

SPEAKER_02 1:00:30

LekVio, yes, yeah.

SPEAKER_00 1:00:32

We did LecVia for a long time.

SPEAKER_02 1:00:34

Uh we do a cholesterol medication that now is done in infusion centers, so yes.

SPEAKER_00 1:00:38

Yes. Um Good lord, why is it not coming to me? There's a neurology drug that Lakembi.

SPEAKER_01 1:00:45

Okay.

SPEAKER_00 1:00:45

So Lakembi is like a new infusion medication that we give for Alzheimer's. It's the first real medication that works against Alzheimer's, right? And as an infectious disease doctor, I would never get to prelate with this drug. I would never get to I would never get to treat a patient for the because Alzheimer's is not ID. No, it's not. But if you have an infusion center, right? Now I get to work with the neurologist, I get to treat these patients and help them with this medication, and it's on me to make sure that they're not having the infusion reactions and the complications. We keep close monitoring, you know, that's your job. But it's nice because you get to add on to your repertoire of uh of medical fields that you study and learn.

SPEAKER_02 1:01:27

You're cross-pollinating into other places where you can help out people, and that's great.

SPEAKER_00 1:01:30

And it feels good to help somebody, it feels good to know that you've made a difference in their life.

SPEAKER_02 1:01:35

Kind of how we got in the game in the first place, right? Is that that real difference maker?

SPEAKER_00 1:01:38

So so that's one thing I liked was that we could do specialty meds, and then on top of that, he's you he basically gave me the blueprint. He's like, you know, you keep a close eye on your patients, you make sure you do what's right by the patients, you know, uh patient always comes first, right? Even if they and and we've had situations where the patient couldn't pay or whatever, but if the patient needed care, the patient needed care, patient came first, you know. And that's just kind of he he kind of taught me his business philosophy. I've trained with him for a little bit, like I think it was two or three weeks over in Fort Walton. And then he basically said, Oh, by the way, I opened the clinic for you in Panama City. And so he uh he opened the clinic and I came in and I um started off just me and Megan, my office manager, and Crystal, our wound care nurse. Yeah. Uh nurse practitioner. And um we uh started just us three, and then before you know it, now the clinics growing quite a bit.

SPEAKER_02 1:02:31

When you came over here, did you have to sleep at the gym first or did you there was a house? Okay, good. Um Well, look, uh, and so you know our community is really benefiting from having you here in a variety of different ways. So we're really thankful for that connection to be made and glad you guys are here. Um let's talk about on a big picture here for a second. Sure. Tell me how you think about our microbiome. Um, when you are doing your day-to-day life, are you are you really considering that, you know, the statistics seem hard to bear out, but 90% of our body mass may be made up of bacteria of different types? Oh, yeah. Um is that something that's going through your mind? Is it is it kind of permeating the backwards thoughts of everything that you're doing here?

SPEAKER_00 1:03:15

The the uh understanding of your microbiome and the organisms, uh uh we have a very limited understanding. You know, we have skin protects you against infection, skin breaks down, bacteria get it gets infected. Okay? Give antibiotics, kill the bacteria. Do we take into any consideration into what's happening into your gut when you get these antibiotics? You know? Um we have a symbiotic relationship with the majority of bacteria on our body. Right? So certain bacteria will help break down enzymes and nutrients and allow you to digest and absorb certain things that you're otherwise not going to be able to. So it's good, we're talking about long-term impacts on your health because of minor deficiencies. And then even there's been studies that I want to say acromensia mucinophilia? It's an acromensia. It's an acromensia species. Uh it's found in the guts of people who tend to be less obese. No figure, right? So it actually affects our weight. It affects the way we digest food. It affects it. They found that this bacteria, people who have higher levels of this bacteria have naturally higher levels of GLP1. Which in case anybody that that's the new weight loss drugs that everybody's getting injections for, they're injecting. Yes, yes, yes. That's all GLP1 analogs. And so people who have higher amounts of this bacteria in their gut have a higher natural amount of it. But also, it's been seen in patients with MS. Yes. So they've also correlated it to MS and chronic uh uh long-term neurological autoimmune conditions.

SPEAKER_02 1:05:01

So these are humongously and complexly interacting societies of organisms that are living within us. Right. And that relationship, that that society that they're making there affects our health in some way. Or is it representative of our health? It's sometimes hard for us to figure out chicken or egg.

SPEAKER_00 1:05:22

It's a very good, yeah. It's it's hard to say whether it's representative or it definitely affects our health. It definitely affects. I mean, the simplest one I can think of is you give somebody antibiotics and then they develop profound diarrhea. Yes. C. Dipcolitis, right? Classic exam.

SPEAKER_01 1:05:37

Yes.

SPEAKER_00 1:05:37

Classic, classic exam question, you know. And I've seen more than my fair share of cases, you know, but I obviously prescribe a lot of antibiotics.

SPEAKER_02 1:05:45

So so for the lay public here, let's think about the implications of this. Okay? So this this bacterium, Clostridium difficulae, is a it's ubiquitous, it is in our environment in a variety of different ways, but our own natural Natural gut kills that, keeps that in check to where it is not infectious, just not causing any sort of syndromic issues whatsoever. Our own natural keepers make sure to keep the peace that keep it suppressed until we take antibiotics that are trying to treat something ostensibly, at least some sort of lung infection or something like that, that will also kill other of those peacekeeper cells, those peacekeeper bacteria inside of our gut. And then all of a sudden the C. diff comes in and it says, Whoa, I've got rain of the roost now. I can come in. No competition. No competition. All the resources in the world.

unknown 1:06:35

Yes.

SPEAKER_02 1:06:36

Mafia takes over New York. Indeed. And this is a way to think about this. So this is a complex environment. And that's effectively what you're dealing with. So it's not just as simple as I've got an infection, I take an antibiotic. You, the smarter among us that are thinking about these kinds of things, have to keep into mind the entire organism here that we're really taking care of. Yes. Because if I make some decision here upstream, it's going to have downstream complications that we need to account for.

SPEAKER_00 1:07:02

And that's why it's important to limit your antibiotic durations to only what's necessary, you know? Um and that could be that that's again, we we talked about the art of the field. That could be tough. That could be really tough to figure that one out. You know, sometimes there's patients that have them on antibiotics for life. Yes. And there's patients that I say, oh, you know, we can get away with five days of antibiotics for pneumonia. That's the standard of, you know, but then there's patients who are like, I'm not gonna give five days. This guy's way sicker. You know, he's gonna need longer than five days.

SPEAKER_02 1:07:34

Right, right. You know, you're putting this into your own computer, and sometimes the output is something I'm not even fully cognizant of why I chose that. But there's something about you that caught my eye and said, hey, we need to do things a little bit more.

SPEAKER_00 1:07:47

Maybe this patient's a little bit sicker, maybe they have a a slightly worse comorbidities, maybe they you know, whatever it is, but you you you just kind of develop that feel for, you know, okay, yeah, this one can probably get the standard five days, no problem, it'll clear up, simple pneumonia. Whereas this one's you know, a little bit more complicated, a little bit more this. And you gotta take all that into account. You know, you gotta take it first of all, limiting the duration, narrowing the spectrum of antibiotic as much as possible so that you're targeting what you want to target. So that's another thing where it's like uh we give a lot of times pseudomonas coverage for diabetic foot infections. You don't need it. You don't need it. If you if you cover staph and strep, that's 95% of the time, 90, 97, 98% of the time it gets covered.

SPEAKER_02 1:08:36

So for those that are not familiar with this, pseudomonas, particularly bad actor whenever you get an infection with pseudomonas. And it usually requires some big gun antibiotics, oftentimes in combination. Right. So if you're gonna empirically, meaning just first out the gate, treat some of these things, you will try to cover pseudomonas because if that takes off, you're gonna get a lot worse clinically. However, it's often not the case, so you can use a little bit more clinical acumen to determine we're probably gonna cover if you end up if you start getting worse, yeah. Of course we'll change our strategy.

SPEAKER_00 1:09:08

Well, even even like like when I look at like some cases, right? Sometimes you get a patient who has a osteomyelitis, right? Bone infection. Bone infection. It's a bone infection. So a lot of times you can really wait before you treat those bone infections. You know what I mean? Like and unless the patient has a lot of swelling, pain, tenderness, and we we call that cellulitis around the bone infection, right? You can kind of ignore it for a little bit while you do a workup, figure out exactly what the organism is, and then you target it. You could target, you could instead of like carpet bombing, you're smart bombing. That's what I always tell my patients. You know, you don't want to carpet bomb everything because then you're killing things that you don't even be killing. If you target it, then you use targeted antibiotics. One, it's a neuro spectrum, and um two, it preserves those stronger antibiotics for when you really need them, as opposed to developing resistance to them early on.

unknown 1:10:12

Yes.

SPEAKER_00 1:10:13

Um, and that can happen. The bacteria that are in your gut will eventually, after multiple exposures to certain antibiotics, develop resistances. And then that's it's no wonder that you see these patients who are coming to you, like usually they're like a nursing home patient, and they come to you and they're like, I have this recurrent UTI, and they look at it and it's an extended spectrum, beta-lactamase resistant, you know, E. coli. That's that's a that's a bacteria that's very, very, very resistant to a lot of antibiotics, with the exception of certain very powerful ones. And uh, you know, it's because of all the exposure they've had. They've had multiple exposures to other antibiotics. Oh, you know, she looks like she's a little tired. Antibiotics, you know, like maybe she has a cough, antibiotics. Maybe there's no definitive diagnosis of pneumonia or anything. There's just they're treating with antibiotics empirically, so the patient feels better. And a lot of times we're not treating the patient you're treating yourself.

SPEAKER_02 1:11:08

So you know 100% yes. Oh, I say this, yes. Yes, I love this. Um, and and this also, this exact scenario that you gave elucidates such a huge scale on things because of the two greatest um, I would say most influential discoveries, I think, in health are the germ theory of disease and evolution by natural selection. Okay, so we have both of those at play here. First of all, you have infection from microorganisms are causing the badness inside your body. Okay, so we have to take care of that. Now, if you have this normal E. coli, I'll say, or or wild type E. coli, however you want to do that, they're going to be uh sensitive to many different antibiotics. If you kill those again and again and again with those antibiotics, then this other subpopulation of E. coli that is resistant to that will all of a sudden be in an environment where it can. There's no competition. There's no competition. And so then all of a sudden, now you've got, it's, it's, it's, you know, we say that it's developed this uh resistance to us, but in reality, you've just killed all the native ones that may have even kept that other one in check a little bit. And so now this guy can out compete. And that's so so we've utilized both the germ theory of disease and evolution by natural selection. We see it writ large, and it's these are two powerful concepts that we have, and you have to kind of keep in the forefront of your mind.

SPEAKER_00 1:12:27

Absolutely, absolutely. So, so you know, narrowing your antibiotic choice, narrowing your duration of antibiotics to prevent side effects, to prevent chronic issues. Yes. Um, you know, that's important too. And also resistance, because resistance does develop with long over a longer duration. Um, you know, those are the two major, major things. And then there's several benefits to that, right? So, like if I'm in the hospital and I the patient is came in with their septic, right? They have sepsis, they're very sick. Uh you're gonna give them broad spectrum, because you don't know what's going on, you're gonna give them everything, right? So you're gonna give them vancomycin and zocin, and these are two very expensive antibiotics. We're at emergency.

SPEAKER_02 1:13:09

Yes, yes.

SPEAKER_00 1:13:10

And I get in there and I say, well, you know, it looks like he's got a pneumonia, and uh, you know, uh don't necessarily, you know, we did a swab of his nose and it doesn't look like there's any MERSA. So we can get rid of this vancomycin, and you know, you don't really need anaerobic coverage, so you can get rid of the zocin and just put them on ceftriaxone. Well, the cost of ceftriaxone alone is pennies compared to the cost of a combination of vencomycin and zocin. And so you save money, and that's important too.

SPEAKER_02 1:13:38

Very important.

SPEAKER_00 1:13:38

Because if you can't be efficient with how we're spending your money, healthcare costs are going to continue to rise for everybody, and hospitals are not gonna be able to stay open. You know, it's it's it's important that we we are efficient and and actually think about that, the economics of medicine as well. It's not my favorite way to it's I it shouldn't you shouldn't make a decision off of the economics of medicine alone, but it should factor in. Yes. If that makes sense, you know?

SPEAKER_02 1:14:05

Very well stated.

SPEAKER_00 1:14:06

Yeah. Uh because if a patient needs vancomycin and zocin, give them the vancomycin and zocin. That's not that's a no-brainer, right? But yeah.

SPEAKER_02 1:14:14

So we need to be effective stewards of medicine too while we're doing this. This this isn't just about treating patients with infinite resources, we have to create an economic engine in this world in order to be able to take care of as many patient patients as we can effectively. So so yeah, that's so that's that's a great policy. And I I've loved my infectious disease professionals throughout my life that have really inculcated that into me about how now the one thing that that you didn't say explicitly, but I just want to make clear. If a doctor or an infectious disease specialist says, take five days of antibiotics, take five days of antibiotics. Yes, don't just take two. Yes, yeah. And you start feeling better, you will feel better, take five. Take the whole amount of prescriptions that you were given. Okay, that's important as well. Um well, let's um let's shift some gears to talk about the future a little bit. Okay. What is the biggest issue that is facing your specialty in infectious disease for the future?

SPEAKER_00 1:15:08

Ooh, it's a very good question. You know, sometimes I'm scared that AI is just gonna take over my job. You're gonna you're gonna be able to plug in, you know, what the patient has, what their diagnosis is, and this is what the cultures grew, and it's gonna spit something out and tell them like exactly what I would tell them.

SPEAKER_01 1:15:27

Yes.

SPEAKER_00 1:15:28

Um I don't necessarily think that that's gonna happen now. Yeah and I and I uh I think that it's important for us to kind of get on board with AI right now and really kind of utilize it. Because if you don't if you don't use it now, you're just gonna fall behind. And that's just uh facts. You know, it's unfortunately. The other issue I would say is that we're not really developing new drugs, right? We're not really developing these newer antibiotics. There's not that many new antibiotics coming out these days. So the antibiotics that we have are what we have, and they're very good up to a certain extent, you know. Like yeah. You're gonna end up eventually with some sort of superbug that we're not gonna be able to treat, and that's gonna be a problem. Because there's only so many variations you can come up with for how to kill something that doesn't also kill you.

SPEAKER_02 1:16:25

Yes. You can only add a fluorine to so many different uh molecules in order to get it to kill something. Yeah. Uh no, that that's that's sage. Now, do you think somewhere along the line there's a totally different, there's a paradigmatic shift that we're gonna have about how we kill bacteria that we want to? In other words, we've been using poisons that oftentimes take apart their cell wall or interrupt their cellular transcription machinery or something along those lines. Is there a brand new method that we haven't even thought about that could be coming out?

SPEAKER_00 1:16:58

There are some interesting uh things. There's one uh for MERSA that was in trials while I was a fellow. For staph staph bacteriaemia, they were using it. It's basically a bacteriophage. So bacteriophage, in case you know, uh it's a virus that targets bacteria, right? And what they had done is they altered these bacteriophages to target staph. And so you could treat uh um and it was mainly used as an adjunct in patients who are refractory. That means they're not they're not getting better. Yes, bacteria. Despite the antibiotics we're using, they're not getting better. And we use that mainly on patients with like severe endocarditis kind of cases. Uh yeah, prosthetic valve endocarditis, things like that, but they're too sick to go to surgery, they got prosthetic valve, and then uh they just persistent bacteremia.

SPEAKER_02 1:17:52

Um that was uh that's one case where that's a fascinating idea to me. I mean, because now we're kind of using nature against itself. And and indeed, I mean, honestly, antibiotics are more um, they're they're usually before they're synthesized, they're plant derived or they're other substance derived that kind of you know you know what's interesting is I used to laugh off a lot of the stuff my mom would tell me.

SPEAKER_00 1:18:18

Like just like take some honey. I hate hearing how right my parents were. You know, the the little old traditional old school remedies, yes, uh, they work. You know, they work. There's there's wisdom in them.

SPEAKER_01 1:18:32

Yes, yes, yes.

SPEAKER_00 1:18:34

It's not just um, you know, there's a reason for it. Honey, for example, has been used in wound care for thousands and thousands of years. In fact, I still use it now. I have we we use medical-grade manuka honey, it's irradiated, there's no bacteria in it, but it's medical-grade manuka honey, and you put it on these chronic non-healing wounds, and I swear to you, sometimes it's just what the doctor, like, you know, like it's that's what they needed.

SPEAKER_02 1:18:58

Well, and it's counterintuitive because you'd think this sugar-filled substance would be a haven for bacteria to come in and make it worse.

SPEAKER_00 1:19:05

Yeah. So when I first heard of putting honey on wounds, I was like, yeah, come on, don't be silly. Don't be silly. Don't be. What are you talking about? What are you talking about here? You gotta feed the feed the bacteria? That's what I would have thought. So it works. Yeah. Um, and so things like that, like, there's a lot of uh uh we should pay attention to some of the older things. Acetic acid, vinegar, yes, household vinegar, you know, for surface bacteria, works amazingly. So pseudomonas, oftentimes you get a patient with like pseudomonas in the wound, and you know, whoever's been taking care of that wound might freak out. They say, Oh god, there's pseudomonas growing, but it's really only on the surface. And it's hard to get rid of because of the biofilm. That means that's a certain coating the bacteria create.

SPEAKER_01 1:19:47

Yes.

SPEAKER_00 1:19:48

Um so what do you do with that? You know, believe it or not, acetic acid, what to dry lead dressing changes, it it'll clear it up. What it does is it breaks down the biofilm and the acetic acid acts as an antibiotic and it actually kills the pseudomonas. And you don't need to take oral antibiotics and destroy your gut, you know. Now, obviously, this is only for surface surface bacteria, surface infection. Yes. If it's a deeper infection, or if there's surrounding redness, cellulitis, you know, um, if the infection is spreading beyond just the surface of the wound, it won't work. Yes, right? But yeah, that's uh it's uh there's some interesting little tricks you pick up, and it's old medicine.

SPEAKER_02 1:20:29

Yeah, this could go back to um the Roman Empire or or perhaps even Babylon, where they were utilizing these things uh because they had they had figured some of this stuff out. Yeah, yeah. No, that's really fascinating. So um all right. Um sorry, you were asking you're asking like new ways to treat bacteria.

SPEAKER_00 1:20:49

Oh, yes, yes. I think there's gonna be a resurgence in that. I think people are starting to get more and more in tune with that kind of stuff, and there should be I expect there to be a resurgence into some older, more holistic approaches to medicine. Yes. I don't necessarily think it should be used alone. I don't necessarily think that holistic medicine alone is the answer in combination with modern medicine.

SPEAKER_02 1:21:08

Yes, that synergy is probably where we're gonna get a lot of effects. The analogy that I typically use here is that you know, uh we we have chess computers that can beat all of our grandmasters relatively easily. Um, however, humans with chest computers can beat chest computers. So, in other words, that's that symbiosis is actually gonna be a lot better for us, I think, at the end of the day. Um so now um give us a fun fact about um bacterial or antibiotics or other things that we don't know about. Is there is there anything that you think is kind of just cute or glitchy or something that that we wouldn't think about?

SPEAKER_00 1:21:47

Hmm. All right. Well, there was a Vibrio scare here not too long ago. For those who live on the Emerald Coast, yeah. I don't know if you remember this.

SPEAKER_02 1:21:56

Thank you for bringing this up. Yes.

SPEAKER_00 1:21:57

Yeah, it's uh uh basically everybody was afraid to get in the water. You know, I think a lot of what you hear on the news can be overblown. Uh fun fact with Vibrio you're generally safe as long as you're not eating a like raw fish shellfish that is infected, right? Or you don't have an immunocompromising condition, such as like cirrhosis of the liver, like meaning your liver doesn't work, or you're on drugs that suppress your immune system, or you know, you have advanced HIV, that kind of thing. Those those are situations where I would be concerned. Or just a straight up open wound, you know? But don't allow these stories to ruin your summer fun. You it's you can go out and swim and be safe, just be careful, be cognizant of your body, you know. Your first layer of protection against any infection is your skin. Your skin. So if you have a breakdown of the skin, you should take that seriously. Don't get into dirty water with a broken skin, right? That's gonna get infected. But if uh, you know, and generally speaking, you know, I think a lot of this stuff is is is a little overgrown there.

SPEAKER_02 1:23:08

Yeah, you know, I I I have a saying in my clinic, which is if you feel good, you are good. Um the body has a way of telling us if things are not going exactly right. And so if you're feeling well, you're generally healthy, go out and enjoy the sun, go enjoy the beach, go enjoy brackish waters if you need to. Yes. Okay, yeah. Um, that's great. So um now uh do you have any recommendations to health professionals that are starting their career right now?

SPEAKER_00 1:23:33

Um to health professionals that are starting their career right now, get a mentor. Get a mentor, ask questions. Don't be afraid to ask questions, right? I was lucky in that Dr. Anastasio, even though he was over in Fort Walton, whenever I needed anything, I could call him up any time of day. It was a you know 10 o'clock at night, 12 o'clock in the morning. You know, sometimes I was at the hospital at 12 o'clock in the morning because I was that slow at the beginning, you know. I need doctors work late and they see a lot of patients. And I I I'd call him up and he would answer, you know. Um, my mentors from fellowship, you know, really complicated cases, I would call them up as well and they would answer and they would give me advice and tips. And so don't think that as like I've graduated now, I don't need anybody else. It's always okay to go back to the people who trained you and back to the people that you know and trust and you learn from and uh talk to them and get their advice, and then reach out into your local community as well. Join medical organizations like ECMA. I think this is a fantastic thing because what you know, you you you meet uh your colleagues, your people who who live in the community that are looking to serve the community, those are the people you want to get to know because if you need help, you talk to them, you know, and you need advice, you talk to them. And I'm talking all sorts of advice, you know, whether it's medical advice for patients or business advice or heck, even family advice. Sometimes, you know, our kids go to the same school together. Indeed, they do. So we we we run into each other often. You know, it's nice, yeah. You know, your conversations aren't always necessarily don't have to be medicine or medical related.

SPEAKER_02 1:25:22

That's that's exactly right. Well, uh, you know, we did not hire you to put that plug in for the Emerald Coast Medical Association. Well, we appreciate that you're doing that. Many of the audience here will be.

SPEAKER_00 1:25:30

Because I I I honestly believe it's a it's a it's a good organization. I'm happy to be part of it.

SPEAKER_02 1:25:34

You know, so yeah, well, we're happy to have you here as a part. Um now uh tell me what you do for fun. What are your hobbies?

SPEAKER_00 1:25:40

All right, so I like um hunting. Okay, you know, that's probably I grew up hunting. Since I was six years old, I would go hunting with my dad. It's like father-son bonding thing. Yes. Uh fishing is obviously a big on the list. Um, I already mentioned I do a little jujitsu for exercise. I like to play soccer on occasion. You know, that's another thing. I grew up playing soccer. Um that's basically it. I mean, travel, you know, we we like to, I haven't had a chance to recently, to be honest with you. In the last couple of years, I haven't gotten to do much traveling, but I love international travel. You know, I love to go to other countries, experience other cultures, learn different languages, you know, try different foods. Um I can be kind of skittish about that sometimes, you know, on the foods. It depends. Yeah. I don't I don't condone street food guys. Like street food in general is it can cause trouble.

SPEAKER_02 1:26:31

Rule to live. You heard it from an infectious disease doctor here, okay? Perhaps these are things that can cause problems.

SPEAKER_00 1:26:36

But yes, but trying different foods, you know, experiencing different cultures, getting to know people outside of your immediate sphere, I think that's very important in life.

SPEAKER_02 1:26:45

You learn so much more about yourself and your own culture and your own things when you go and experience others and you realize, oh man, this is this is why some things are the way that they are. So that's great.

SPEAKER_00 1:26:56

So yeah, that's that's uh those would be, I would say my hobbies would be travel and then uh uh hunting, fishing, chess, jujitsu. Yes. I like chess, I like to play chess a lot.

SPEAKER_02 1:27:05

Good, good. Um can I ask what your ELO is? Are we are we gonna it's not great. That's okay. All right, so we'll we'll save that for another time because we we can talk about um well a lot of different things, chess. Um so um let me ask about your kids. You want to talk about them for a little bit?

SPEAKER_00 1:27:24

Yeah, I got uh two. Yes. Um Naya, my daughter, she's five years old. And then my son Mazan, we call him Zuzu, and he's uh he's three years old now. So he's uh gonna be starting pre-K next year. And then Naya's moving on to kindergarten. So great. Yeah.

SPEAKER_02 1:27:43

Um I don't know that there's too much better in life than that.

SPEAKER_00 1:27:46

Yeah, they're they're amazing. Look, they can be a handful sometimes. I'm not gonna lie to you. But I mean it's there's not nothing changes your outlook on life like having kids. It's unbelievable. Yeah.

SPEAKER_02 1:27:57

It's it's the days are long and the years are short. So it's amazing. And I I know that you've kind of uh worked to create a work-life balance for yourself that's appropriate to where you can interact with them and spend more time.

SPEAKER_00 1:28:10

I really do try. You know, one of the things um I do is I definitely I I told my wife, I was like, I will be the one to drop the kids off at school. I can push my clinic hours a little bit later. You know, it's fine. I don't need to start clinic at first thing in the morning. I can push it to nine, and then I let me have that morning time with the kids. Because sometimes, you know, especially in the beginning when I was really slow, I wasn't getting my work done as efficiently. Because I wanted to be thorough. Of course. But uh uh I wasn't efficient, and so I would stay out 10, 11 o'clock, you know, after you know, doing clinic notes and rounding at the hospitals, and you know, you pick that up, that efficiency picks up after I would say six months to a year. You know, you tend to start picking up that efficiency and and working a little faster, and you're not thinking as hard about the cases, you know, like you just know, like I know, I know this is what needs to be done.

SPEAKER_02 1:29:01

This is where I say where the infectious disease becomes the easy part.

SPEAKER_00 1:29:05

Right, yeah.

SPEAKER_02 1:29:05

Where that starts to just come naturally, my body just starts to answer the right thing.

SPEAKER_00 1:29:09

Right, yeah. And so that that that takes, I would say actually about a year to two years to really kind of get to that point.

SPEAKER_02 1:29:16

Took me a lot longer. So good on you. Um all right. Um thank you. We're gonna go to some rapid fire questions here, okay? Are you ready for this? Let's do it. Let's do it. Okay. Who is the smartest person in history?

SPEAKER_00 1:29:32

Oh man, Isaac Newton.

SPEAKER_02 1:29:34

Okay. Um, we've had some feedback from some friends and some family that have listened to this podcast and its different iterations because I asked these to the same people and they have confirmed that that's the right answer. So good on you for choosing that. Uh brilliant guy just decided to create calculus out of nowhere. So physics.

SPEAKER_00 1:29:52

I mean the guy, the guy like, what was it, saw an apple fall off a tree and then decides to figure out that no.

SPEAKER_02 1:29:57

They touch so many branches of physics too, and optics and other stuff. Yes, it is incredible. So um everybody go out and read the Principia Mathematica, okay? It's worth it. Um, all right. If we can live to be a thousand years old, should we do it?

SPEAKER_01 1:30:10

Ooh.

SPEAKER_00 1:30:20

If I could add a condition to that to where it would not like because obviously the problem is this if you live to be a thousand years old, then you're taking resources away from your generation, right? If there was plentiful enough resource or energy that it was infinite. Yeah, why not? Love it.

SPEAKER_02 1:30:45

Would you rather be too cold or too hot at night? Too cold. Yes, that's the right answer. Okay. Um if you could go back in time to when you started med school and tell yourself one thing, what would it be? Try harder. I think you did okay. Um what is one current medical treatment or therapy that we are gonna shudder that we use 15 years from now?

SPEAKER_00 1:31:15

So amputation. I think that's um that like patients who end up needing foot amputations and BKA's and things like that, and it's uh really sad and it's um a lot of times it can be preventable with aggressive intervention early on. And uh you have to you have to do it early. And I think that one for me, because uh we tried to initiate like a limb salvage program around here, it didn't quite work out the way we planned, but we still work closely with our colleagues, you know, uh you know, between our wound care center and other doctors in the area to to really kind of help these limb salvage uh patients, because that shouldn't need to happen. You know, that really shouldn't need we I I mean short of like you actually having a massive trauma accident Which happens? Yeah, then that happens. But like um, you know, if the patient is a smoker, they just need to stop smoking. If they you know I think there's things that we do to ourselves that we just need to we need to do better.

SPEAKER_02 1:32:23

You stop.

SPEAKER_00 1:32:23

You stop and do better.

SPEAKER_02 1:32:25

Well, yeah, so so wound infections where we end up amputating is a combination of poor vascular flow and um and and uh bacteria infection. I mean you can also include diabetes on that and the management of that, but but if but if we could work to re-establish that at earlier stages, then we can get a handle in this and keep patients with their independence.

SPEAKER_00 1:32:47

Um if you're if you're aggressive up front and re-establishing blood flow and managing all that, then the wound should heal and you shouldn't need to amputate, you know? Um but you gotta be very aggressive up front.

SPEAKER_02 1:33:00

You do. I really like that answer a lot, Goodwin. What is the best song of all time? Don't stop believing. Love it. Okay, and then what books are you reading right now?

SPEAKER_00 1:33:12

Oh, um honestly. I have a book. I haven't had a chance to start reading it yet. Okay. Like it's um I think it's you I buy the books and I don't read them. I'm putting you on the spot.

SPEAKER_02 1:33:28

Yeah, my to read list continues to increase.

SPEAKER_00 1:33:30

Honestly, I I I need to. I I need to get back into reading, but I uh nothing right now.

SPEAKER_02 1:33:35

Why don't we make a plug for everybody to go read The Hot Zone? Because it actually is a page turner. That is a great book. It's a really interesting, and his writing style is great, and it's you know, includes some personal stories in there that I think are really uh I I I like that book a lot.

SPEAKER_00 1:33:49

Yeah. And that was honestly a big influence on me, that book. I I I always I always hearken back to that because it's like, yeah, even in the seventh grade, I always knew I I initially wanted to be a virologist. Yes. Which I don't want to be a virologist. No, no, nobody wants to be a virologist, okay. So it's but that's that's what I thought I wanted, you know, and and it had a big influence on me that book. That's a very good book. I would I would definitely recommend that one. Um, you know. But yeah, it's uh that's there's not many. I've I was big into Tom Clancy books for some reasons. Like I used to read a lot of Tom Clancy stuff, like those little action thrillers.

SPEAKER_02 1:34:26

Page turners, yeah.

SPEAKER_00 1:34:27

You know, yeah, absolutely. Um but I haven't actually picked up a book and read a book in a while. You know, most of my information now comes from like podcasts and uh you know, which we are big fans of the podcasts here, yes.

SPEAKER_02 1:34:39

Everybody should be listening.

SPEAKER_00 1:34:40

So um yeah, yeah. And and and honestly, I need I think it's a lost thing. You know, we should go back, get back into reading more. Yeah, great. Absolutely.

SPEAKER_02 1:34:47

Well, look, uh Ray, thank you very much for being here on Medical Mastery Podcast. Um, thank you for what you do for our community. Um, thank you for being a friend. Thank you for um uh just discussing things randomly. Um thank you for being an olive oil distributor, which we will talk about on the side. Um and and thank you for making our community better, okay?

SPEAKER_00 1:35:09

No, thank you. Uh thank you for inviting me. Thank you for you know getting a chance to actually hang out. I like this. Yes. We need to do we need to do more hangouts.

SPEAKER_02 1:35:17

We'll get you yes, we'll we'll get you back more and then who knows? Maybe we'll record it, maybe we won't, okay? Uh, but thank you for being here. And thank you to the audience for being here and helping us make medicine better together.

SPEAKER_01 1:35:29

Absolutely.

unknown 1:35:29

All right.