Episode 13: Thom Mayer, MD

Dr. Thom Mayer joins Emerald Coast Medical Mastery for a wide-ranging conversation on leadership, medicine, resilience, service, and the lessons that shape a life of impact.

Transcript

SPEAKER_00 0:14

Well, hello again, and welcome to the Medical Mastery Podcast, the podcast of the Emerald Coast Medical Association. I am your Amoranthine host, Don Davis, and I am here with an incredibly special guest that we are delighted to have with us here, Dr. Tom Mayer. Many in our audience may know who you are, and they will certainly find out more about you here. But uh I think your CV might be one of the most impressive that I've ever seen, and I've seen quite a few. So uh, Dr. Mayer, before we get into um all your different uh titles and leadership opportunities, um thank you very much for being here today.

SPEAKER_02 0:49

Oh, it's an honor. Thanks for having me on. I I know it's the Medical Mastery Podcast, but I appreciate you making an exception in my case, uh and having me on. So that's greatly appreciated.

SPEAKER_00 1:01

Well, you and I are not going to get along very well at all. I can just tell you, just straight from the get-go. Okay. So um now, um, just as an initial start off here, um, one of your titles is the lead physician for the NFL Players Association. Is that correct?

SPEAKER_02 1:16

Is that is that the title that you have to do as a technical title as medical director for the NFL Players Association, and I've had that uh honor and privilege for the last 25 years.

SPEAKER_00 1:26

Yeah, um, and so you know, there's gonna be a lot of burgeoning questions that fall into everybody's mind as soon as we talk about that. But before we get into that incredibly interesting and fertile ground, why don't you tell me where are you from?

SPEAKER_02 1:38

Well, I'm actually from Anderson, Indiana, uh, a small town in the Midwest. And I was sharing with Michelle that um my high school buddies and I, uh, if we got into a uh particularly festive mood uh on the weekends, would drive down to Panama City uh State Park and uh camp on the uh the pristine white sand beaches there.

SPEAKER_00 2:01

So just a two or three short hour drive away, huh?

SPEAKER_02 2:04

Is that yeah, something like that. And and uh let's just uh say I got to know the constabulary in Panama City quite well because of our reveries.

SPEAKER_00 2:15

Uh indeed. Okay, so so you're not entirely unfamiliar with our Emerald Coast here. Uh that's that's great to hear.

SPEAKER_02 2:21

I love it, love it, love it. I was in Pensacola recently talking to the Institute for Human and Machine Cognition. Um, so no, I love that area. There's historical roots there, and it is a pristine and incredible area. But the thing that impressed me the most is the people. It's always the people.

SPEAKER_00 2:40

Yeah, the people kind of lead everything around um here and kind of in other parts too. And I I I'm I'm excited to hear about some of the people that you get to work with as well. But um now uh tell me about um where did you go to undergraduate?

SPEAKER_02 2:54

I played uh football, I was a linebacker uh at Hanover College in southern Indiana, overlooking uh the Ohio River. So uh linebacker job description blow things up, destroy the hopes and dreams. Get in there, mix it up. 11 guys on the other side of the field and the and the moronic uh coaches that thought they could outscheme us. Um and and loved it. Loved every minute of it.

SPEAKER_00 3:20

Now, uh Tom, I'm not trying to date you at any point in time here, but why don't you tell me about it?

SPEAKER_02 3:24

I don't I'm I don't have an age, I'm carbon dated.

SPEAKER_00 3:27

Oh, okay. We'll see if we can get that. Um Chris can help us with this dating, just in case. Okay. Now um tell me about what size were you as a linebacker playing?

SPEAKER_02 3:38

Well, I was undersized. I played at uh I played middle linebacker, mic linebacker. Um I went to Hanover because I like the the not all that bright person I am. Uh, three days before I was supposed to go to an NC2A school that I had committed to, I realized that in those days you had to play freshman football. You could not play varsity football in the NC2A. And I thought I I can start as as a freshman. And so I went to Hanover, which at the time was an N-A-I-A school. Um, and I uh I was uh about 195 uh and I'm uh 5'11 in that uh so kind of Teddy Bruskey size, but with uh with one difference talent, talent. I I don't have Teddy Brewski's talent.

SPEAKER_00 4:29

Other than that, it's just the exact same. I I can understand. Um but uh you know, if you're gonna play college football undersized, um that usually implies that you've got some determination and that um perhaps you wouldn't be told no. Is that a fair thing to say about that?

SPEAKER_02 4:46

Yeah, I tell you a quick story that when I was um when I was getting ready to go to medical school, I went to Duke. But before I went, um, I got a couple of invitations to go to for what are what at the time were called free agent camps, meaning you hadn't been drafted. And so I went to the Bears and the Vikings, and uh and they told me, uh, aside from size, speed, strength, and talent, that I would have been a great middle linebacker. Um and but they did tell me something that I I've treasured ever since. Both the the Vikings and the Bears said, you know, they called me Doc because they knew I was already in medical school. They said, Doc, you know, you may not make it on the club, but uh, but you got one hell of a motor. And so it it takes a certain motor uh to be undersized and and and under talented and yet still succeed.

SPEAKER_00 5:42

Well, I mean, look, that's impressive just to get a tryout in and of itself. Um, I do want to kind of double-click a little bit on um do you remember fondly your college playing days?

SPEAKER_02 5:52

Oh, yeah, the longer ago I played, the better I was. So I've actually got um the professor who videoed our games, uh, Dr. Stan Taunton, the geology professor, uh and it sent me all the film, and it was film at that time. And I had NFL films converted uh to discs so I could watch it and start and stop and break down the film and and all that kind of stuff.

SPEAKER_00 6:20

So it's uh the frozen tundra of Hanover Field and uh Yeah, it's different.

SPEAKER_02 6:26

It's completely different.

SPEAKER_00 6:27

Uh that's awesome. Now, um, you know, um, if you're anything like me in playing sports nowadays, um, I can play so much better up here than I can actually win my my feet into that. I wonder if that had been your experience at the time where in your brain you were really doing things that that were a level above.

SPEAKER_02 6:45

Yeah, you know, I think particularly uh as a uh middle mic linebacker, we played a essentially what would now be called a Tampa 2. That was long before Tony Dungey came up with that term uh when he was the head coach at Tampa. But uh basically a 4-3 so that everything funnels to the middle linebacker, which means you know, you you got an opportunity on almost every play. Uh, but it also means that you know you better not mess it up because all eyes are on you. And so the the mental part of the game, I think what people miss about college or about uh pro football players is how incredibly intelligent they are, how incredibly intelligent they have to be to understand even the the uh offensive or defensive calls that go out. I'll give you an example. Um, famously in the Super Bowl several years ago, when the the Chiefs were playing the 49ers, it was at Hard Rock Stadium in Miami, they're down 20 to 10. Uh Joe Buck says uh the Chiefs need some Mahomes magic. And it wasn't because Patrick wasn't playing well, it was that Patrick wasn't playing well because he was being accosted on every play by a very, very talented and very well-schemed uh 49ers defense. So Patrick goes to the sideline and says to Andy Reid, Big Red, as we call him, and Eric Bienemy, the the uh offensive coordinator, then, and he's now back with them. Do we have time to run WASP? Well, there's seven minutes and 13 seconds. It seems like that's plenty of time. No, he's talking about football time because WASP is a play that takes a full five seconds to develop, and so he's he needs protection to do it. So he goes in the huddle, and and the the call is verbatim. Gun, tray right, two, three, jet chip, wasp, why funnel. Now, you'd say, I have no idea what they're talking about. But not only do they know, every person knows what his job is, but every person knows what everyone else's job is in gun, tray right, two, three, jet chip, wasp, why funnel. And and what's the analogy? Well, you know, if you and I say, you know, Mrs. Smith in room six has a ventricular tachy dysrhythmia, an unstable hemodynamics, we know we have a gestalt of exactly what she looks like. And so it's a taxonomy, it's a way of speaking, and and that mental aspect of it is uh as true in my practice of emergency and sports medicine as it is for those players who've got to decipher what does that all mean. Then they get transferred to or traded or free agent with another club, and there's a whole new lingo they got to learn.

unknown 9:36

Right.

SPEAKER_00 9:36

Right. Well no, uh well, I mean, what a wonderful example, what a wonderful testimonial um to how these players can think and speak a different language and um how valuable a team is. And honestly, you know, there's a vibe check to being a team that you have to feel yourself over time. You have to get used to these kind of things and kind of knowing where your teammates are gonna be. Sure, you're speaking the same language, but you know, I'll say all the time, there's nothing better than a good tech when you're in a procedure that knows exactly where your hands are gonna be and just knows to hand you the right thing at the right time.

SPEAKER_02 10:07

Yeah, it's I mean, they know before you know. You don't even have to ask. They're handing it to you ahead of time. And and one of the great things about teams, and I don't mean just the sport teams, right, is you know, the ability to have played on a team. And a team could be, in my case, football, baseball, wrestling. Uh, in in others, you know, it's a different sport. It could be tennis, it could be golf, but it could also be chess, it can be debate society, it can be band, it can be uh, you know, madrigals or or orchestra. That's a team of people. And, you know, I find that that the best uh leaders uh in medicine, but anywhere in life, are people who've been on teams. Because if you think about it, Don, we don't, those medical students you were referencing, we don't choose them because they play in the sandbox well. We choose them for medical school because they're able to get higher grades, crawl over the backs of other students to get higher grades, better references, better MCAT scores, and then we put them through medical school and and residency, and then they come out and we say, Oh, by the way, you have to lead teams. You have to be able to work across boundaries within teams. And you know, some of them uh have gotten that in the course of medical school and residency, and some of them haven't, and we have to teach it to them.

SPEAKER_00 11:27

So exactly right that we have to um it's not just about being smart. A lot of people are smart out there. You have to be able to be smart, you have to be able to be determined, and honestly, you have to be able to take failure in some cases, and you have to be able to build upon that. That's uh that's one of the greatest uh teachers that you can ever have in some cases, is failure and and bad outcomes. Uh, you know, if you don't learn from those, then you're not learning from anything. And that happens hard to do that.

SPEAKER_02 11:54

The paradox of teens, and that is in this day and age, we can assure our patients that they're going to be taken care of by a team of experts, smart people who know what they're well educated and know what they're doing. But in my experience, at least, that is not remotely the same as being taken care of by an expert team. That's a different set of skills, that's a different set of knowledge of uh the art, the science, and the business of being able to be an expert team so that, frankly, the scenes of the team aren't exposed, so that when the tech hands off, doesn't risk offense. And and as you say, failure, a chapter in a recent book that I did, making failure your fuel. We have to be able to do that, not just in medicine and healthcare writ large, but in life. And simple story for that. You know, in the 2000 uh draft, the 199th player taken in that draft was also the seventh quarterback taken in that draft. Now, he could have made that, you know, oh poor me, or I barely made it, and all that. But he made failure his fuel. He analyzed, you know, why he was there and how he had dropped as far as he had. And I'm sure you're guessing and your audience probably is as well.

SPEAKER_00 13:15

I think everybody knows it.

SPEAKER_02 13:16

Yeah, he won seven Super Bowls and uh and five MVPs. So Tom Brady did okay, but he did okay. He's the first one to say, and I know Tom very well, he's the first one to say, I didn't set out to be the greatest quarterback that ever lived. I set out to be the best quarterback I could be. And that's all we can do.

SPEAKER_00 13:38

And if I've heard um the stories correctly, and they may be apocryphal, but um I I believe he would he held that draft status in him quite a bit. And whenever he would go and play against coaches that didn't draft him, he he was ready there. That was a formative experience for him, and he was going to show you what you missed out on.

SPEAKER_02 13:55

Oh, I I first time I met him, first of all, he spent three and a half hours with us. Uh I was with the executive director of the NFL PA. I tested him on it. And I'm not making this up, Don. I tested him on it. I say, name the six. And he knew exactly what I was talking about. He named the player, the quarterback, the coach, the offensive coordinator, and the date he first kicked their butts because he played against all of them and he kicked all of their notes.

SPEAKER_00 14:24

All their butts repeatedly. There wasn't very many that he didn't.

SPEAKER_02 14:26

Yeah, so that's a true story. That's a true and I that was completely spontaneous in in the course of our conversation.

SPEAKER_00 14:33

Yeah, and you know, um I I like this too because you know, there's a lot of different um avenues you can go in in medicine right now. There's there's the hospital-based healthcare industry, um, there is uh governmental VA. Um you can go into private practice. What I what I try and tell everybody that I can is that I'm fighting against me. I want to be the kind of doctor that I want to go see. That's my greatest competition is to try and and um I'm not competing against hospitals or anything like that. I'm trying to be the best practice that I want patients to see every single time.

SPEAKER_02 15:06

And so No, I think that's exactly right. I uh two quick stories. One is is um when my boys were younger, we have my beautiful and brilliant wife, Maureen, and I have three boys, now young men. Uh but when they were younger, and I happened to be in town, because I've always had to travel in my various jobs, when I was in town, I drove them to school every day and dropped them off on the way to work, and I said precisely the same thing to them, which is one more step in the journey of discovering where your deep joy intersects the world's deep needs. I swear I said this to them. They they prefer to take the bus, as you might guess. But to to the point you just made, you got to figure out your deep joy. That's right. Because, you know, doctor is generic, nurse is generic, you know, tech hospital administrator, uh, which I hate that term to begin with, for reasons we get into if you want. But you have to figure out you know, for what is my deep joy? What brings joy to my life in terms of how I serve my patients? And there's a lot of different ways to do it. You know, yours in cardiology, mine in emergency medicine and sports medicine. Man, you stick me in a cat lab. Well, I've been in a cath lab, but I was horizontal when I was in the cat lab.

SPEAKER_00 16:20

Had less clothes on.

SPEAKER_02 16:21

Yeah, you stick me in a cath lab and expect me to perform. I don't know what I'm doing. You know, I'm guessing when you go to the emergency department, they gotta guide you around. You know, here's your patient.

SPEAKER_00 16:32

Absolutely. All that's I've said before, if if something's happening on a plane, you much rather would prefer an emergency department decision than you would ever to have me around.

SPEAKER_02 16:41

So you you take their radial pulse to figure out whether you can cast their radio. Exactly.

SPEAKER_00 16:50

Now, look, if you had an angiography machine there, I could help. Okay. That's something that we can do.

SPEAKER_02 16:55

We'd be all sent and be able to handle it.

SPEAKER_00 16:58

Well, I can't wait to make uh my wife and uh my daughters uh listen to that portion of the podcast again and again on repeat for for several years to come. Um now look again, obviously we could go off on several different tangents, but I do want to come back to your education at some point because so w what did you finish your undergraduate degree in?

SPEAKER_02 17:17

Well, I started with the first of all, I'm three months into being a linebacker. I just played a really good game at the risk of hubris, at the considerable risk of hubris. Uh 14 and four, 14 tackles, four assists, two interceptions. And I and the coach wants to see me. It's like, wants to see me? I mean, what did I do wrong now? I mean, that was a pretty good game, is what I was thinking when I went in. And he says, you know, mayor, you got to pick a major. And I said, a major what? And he said, No, a major. You got to have a major field of study. It's like, I thought I was majoring in football. You didn't say anything about major when you were recruiting me and took me three days to go before the start of the uh summer practices. So I chose theology. And why? You know, I was always interested in you know why things happen, why do people behave the way they do, what are their belief systems, how does that guide, what they say, what they do, and and all that goes with it. And I mean, just to be honest, Don, you didn't have to take tests. You wrote papers, and I thought, first of all, I'm not even paying for my education because I'm on a football scholarship. Now I'm gonna get a degree, and I don't even have to take tests. Well, fast forward to I I'm now a junior theology major, you know, all American linebacker, and two of my professors call me aside, uh, my theology advisor and um and a biology professor whose name was Dr. Prey. I mean, this sounds like some kind of allegorical stepbreaker.

SPEAKER_00 18:45

It's unbelievable. I'm sorry, Tom. You don't believe it, okay? No, I know.

SPEAKER_02 18:48

It sounds made up. And they said, uh, has it ever occurred to you you might have more impact on people if you became a doctor instead of being a theology major? You know, I restrained myself from saying, well, I'm gonna be a middle linebacker for the Bears, but uh, you know, I said that I trusted these guys, so I thought here we go. Yeah, so I mean, I start as a junior, I start taking the pre-med courses that freshmen are at. You know, they're looking at me like, what's this guy doing? Is he on the remedial track or something? He's already flunked all these courses. But uh, so I ended up uh only because I had to take so much chemistry and biology that I ended up being a theology, biology, and chemistry major.

SPEAKER_00 19:30

So uh in the annals of academic history, I'm not certain that those three had gotten together to make uh triple major, but um congratulations for you for doing something and and striking new graphs.

SPEAKER_02 19:44

If you just think about linebacker blow things up, theology, you know, that's some kind of demonic combination right there because, you know, theology integrate, pull together, develop meaning out of chaos, kacoping, and confusion. But that was kind of my job as a linebacker as well, is to develop meaning out of all those things.

SPEAKER_00 20:04

Well, it strikes me too, Tom, that these are um, in the words of Stephen Jay Gould, uh non-overlapping magisteria. Um you have some some reason, logic, um, sort of start with some assumptions and then from there you can extrapolate the rest on a more scientific basis. And then theology, which certainly can have a scientific bent to it, but it's is almost a study of how we are what we are. And so um those two seem to provide you with a significant portion uh or capability for leadership in the future if you could really master those two fields.

SPEAKER_02 20:39

I think that's exactly right. I think it it helps you develop uh magic uh uh uh uh the observational talents, the ability to look and see and and think why, why not? You know, as an emergency physician, uh on the one hand, you know, I don't know what's coming through the door. On the other hand, I know exactly what's coming through the door. Um but I know that behind it is not just a clinical diagnosis, but a person, a customer service diagnosis, as you know, we call it patient experience now. And I've written books on that and talked about that a lot. But being able to make the distinction between what's the matter with you, find it, fix it, great part of emergency medicine and cardiology, I might say. But that's different than saying to the patient what matters to you. Because that's different. It's not the same thing. Now, there's some someone comes into chest pain in my emergency department. There's some similarities to both what's the matter with you and what matters to you. But um But you take my point. I mean, you're a humanist at at heart and and bring that to your practice every day.

SPEAKER_00 21:47

Um I have been preaching from the high horse. Uh, regular listeners of this podcast will hear me say again and again that I believe we've lost sight in medicine, that this is a customer service business. So I feel like you're in my head right now, and that's not a safe place. For you to be. So I really appreciate you saying these things that that I I'm I'm trying to promulgate on a big scale. This really is it. We don't make iPhones here. We're not widgets, people are not widgets. We have to not only figure out what's going on with them, which also, by the way, I think we can figure out relatively quickly, get a pretty good differential about what's going on with somebody. But then the rest of the time is getting buy-in, is getting you to believe that I know what I'm talking about, and us kind of carrying on here to make sure that we're taking care of the what matters to you.

SPEAKER_02 22:32

Yeah, it and we talked about this before we recorded. Every patient in every branch of medicine walks into the office or the emergency department carrying their own personal physician whose name is Dr. ChatGPT. So they've looked that up already. They feet have what they think is uh if anything, encyclopedic knowledge. Now, I can react to that a couple ways, to be binary. One, well, you know, where'd your phone go to medical school? Where'd the residency and all that? You know, and I've I've thought it. I just don't I was gonna say I've kept it up here, but let's yeah, my wife says there should be a filter between my brain and my mouth, which apparently never got installed as far as I know. But I don't say it. What I say is, wow, that's interesting. What have you learned so far? You know, what just so I know, because I need to know what their expectations are. If I can uh understand their expectations just by asking them, what are your expectations? What would make this? I ask every patient, what would make this an excellent emergency department visit? You know, and the chest pain patient says, Tell me I don't have a heart attack, or I do have a heart attack, and I need to do, need to go to the cath lab because of my STEMI. Uh, if it's abdominal pain, they're probably worried about either appendicitis if they're young or cancer if they're not. Of course. Of course. Getting them to tell me does wonders. That's why we have whiteboards, so we can write on the whiteboard what's the excellent, what's excellent. And it comes down to personalized precision care. Now, that's as true as you measure, uh as you manage lipids. One person responds incredibly well to lipitor, and another one, you got to put them on resubastatin uh to get any lowering whatsoever. And then others, you need to put them on ZDIA because it comes down, but you got to get the reabsorption of statins from their GI tract. But it's you know, it's fun. It's such a privilege to be a physician.

SPEAKER_00 24:27

It is, and it's so humbling, but at the same time, you have to kind of keep that in mind. The the idea of I understand this disease process, I understand the pharmacology behind what we're gonna how we're gonna intervene, but I'm willing to be wrong. I'm willing to say, hey, this thing didn't work, let's reiterate, let's start again, let's find something that's gonna make you better. I I I don't care what's gonna make you better as long as you get better. That's my main thing.

SPEAKER_02 24:52

So well, I wish I wish I was one of your medical students. I it sounds like I would have learned a tremendous amount from you.

SPEAKER_00 24:58

You probably learned a lot more than I could teach. So uh um now uh so so you have a triple major, you have finally um graduated from undergrad at Hanover, is that correct? And then um so so you you had some prospects of going to go play professional football, but how did you determine um that you wanted to apply for medical school after that? Because that's a that's a different process.

SPEAKER_02 25:23

Yeah, and it and it was um a humbling process is you know, uh we're working through all those things. I mean, one of the requirements, you may uh you're probably too young, but uh one of the requirements when I went through is you had to take physics. Now, why you had to take physics is completely beyond me. And and as you cram you know, four years of work into the two years that I had as a junior and senior, I one of the pro the the prerequisites for medical school was was uh physics. One of the prerequisites for taking physics, at least at Hanover, was taking calculus. Well, I couldn't take calculus, I couldn't fit it in. So I took physics without taking calculus.

unknown 26:00

Wow.

SPEAKER_02 26:01

That's not a lot of fun. I mean, teaching yourself calculus while you're trying to teach yourself physics is uh but to me, it was just you know, the whole journey was was great. I mean, the applying to medical school was uh, you know, it was really just an enjoyable uh thing because I didn't care if somebody told me no. They said, you know, what theology, football? I mean, are you out of your mind? It would be like, fine, you know, there's other medical schools. Somebody'll uh will take me in. If not, I'll just go back to the theology route and see how that goes.

SPEAKER_00 26:35

You know, something strikes me, which is that um being the Mike linebacker, which um for those that are not huge sports fan, the Mike linebacker is perhaps the quarterback of the defensive side. Is that a fair point?

SPEAKER_02 26:48

Yeah, that means that you're calling the signals.

SPEAKER_00 26:50

You're calling the signals, you're you're figuring out the plays, you're changing your audible lane, you're you're kind of um the the guy in charge on the defensive side of the ball. Um that probably gave you, especially as an all-American, a phenomenal amount of confidence that you can figure yourself out of situations if you need to. If something's gonna change, if there's gonna be adversity, you can you can move around it.

SPEAKER_02 27:10

Yeah, it's it's you know, I I wrote a um, as you know, there's an epidemic of burnout in healthcare right now. And I wrote a book called Battling Healthcare Burnout. Uh, and you know, make sure I get your mailing address and I'll send you these books.

SPEAKER_00 27:23

Oh man, stop that.

SPEAKER_02 27:24

That's amazing. My books sell tens of copies. They are incredibly uh popular.

SPEAKER_00 27:29

Tens of copies more than any of my books have sold.

SPEAKER_02 27:30

So uh so when I thought about burnout, I thought, you know, it's really just a simple ratio of job stressors, and job stressors are astronomically higher than they've ever been. And what most people would put below that is resiliency. I don't love that term, and I'll tell you why. Because if I say to you, Don, the reason you're burned out is you're not resilient enough. I didn't say it, but you're already thinking to yourself, I'm the problem. Right, I'm the are you serious? So it goes back to a football story. I I prefer the term adaptive capacity. So if I want to lower burnout, I lower job stressors, increase adaptive capacity, or preferably do both. So before, true story, before my first game, uh, we were doing the walkthrough, and you could tell that the defensive coordinator and the head coach were nervous about starting a freshman at Mike. Usually it's juniors or seniors to get enough experience to call the signals and all that. So, right in the middle of the walkthrough, he stops, the defensive coordinator stops, and he comes out and he points at me and he says, Mayor, my linebackers are agile, mobile, and hostile. Is that you? And I said, Oh, coach, that's me. I'm agile, mobile, and hostile. But I'm the Mike, I'm the middle linebacker. I gotta read and react. I gotta have my head on a swivel. I gotta adapt, adapt, adapt all game long. And he paused for a second and said, Um, my linebackers are agile, mobile, hostile, and adaptile. And that's, you know, to get through medical school, you gotta be adaptile. To get through residency, you gotta be adaptile. You know, in in your fellowship, I'm sure you had to adapt to the different attendings and their say quirks and foibles and different ways of.

SPEAKER_00 29:19

Idiosyncrasies, sure. Um Well, and you also have to learn how to um redouble your efforts, apply for things. I mean, look, there's not really uh a handbook on how to go through and get into residency. Yes, you have people that can guide you, but you really just have to kind of put your head down and figure it out and start to do the things. And there is some confidence to know that, well, it's been done before, and so I'm not traveling to Mars, so I I I can do this. Other people have done it before, and over time with successes, that that breeds the confidence that, yeah, you know, I can do this. I may not know exactly how to do it, but I'll figure it out.

SPEAKER_02 29:57

Oh, yeah. I mean, that first day, as you know, out of a residency or fellowship, you know, you walk in and and you're it. You know, when the STEMy comes into the emergency department, you're the one taking under the cath lab. And you know, you got partners and all that, but the fact of the matter is, you know, it's uh it's always a bit unsettling, those that first little bit, and yet having the confidence to be able to say, I got this. I got this.

SPEAKER_00 30:23

Tom, I I uh point oftentimes to one of the more humbling experiences that I had was um in uh my first year of fellowship in cardiology, where I had, you know, I I'd finished my residency and done fine, and um and was a board certified internal medicine doctor and felt pretty high on myself, and I didn't know the first thing about cardiology. You get humbled very quickly, and and that's a great experience for you in the long term because you know those humbling experiences are gonna make uh better patient outcomes at the end of the day.

SPEAKER_02 30:54

So a hundred percent. You know, uh we as you say, a good internal medicine resident, you know, got uh got your boards, but you know, when you step into a cardiology fellowship, you're among the best of the best. I mean, that is a a uh it's not easy to get into a fellowship, it's not easy to be in a fellowship. And so there is that kind of a the gulp where you think, wow, how did I get here? And then you start to say, well, okay, I deserve to be here. You know, I'm I'm among my my fellows. Harry Truman, I'm big on history and quotes. Harry Truman, great story. I mean, I could spend hours just talking about Harry Truman.

SPEAKER_01 31:30

Yes.

SPEAKER_02 31:30

But, you know, here's this guy from Missouri, highly experienced, uh, you know, World War I artillery officer. A lot of people don't know that. Gets into the Senate, is treated as a hack politician from Pendergast, which was uh the the guy who got him in that role in the first place. But the great thing that he said is is that he got advice from a senator from Illinois who said, Harry, you're gonna spend the first six months here wondering how you ever got here. Then you're gonna spend the rest of your life wondering how the rest of us ever got here. You know, once that epiphany comes, then it you know everything's gonna be okay.

SPEAKER_00 32:09

Well, I think Harry Truman is honestly it's a it's a good example here for those that may not know so much about him. He was um pretty ruthlessly principled. He was gonna stand by his principles uh no matter what, even if he took flack for it, um truly earning the buck stops here. Um kind of because, you know, if if if I recall correctly, he was somewhat reluctant to get into the presidency. It wasn't something that he had dreamed of doing his entire life. Um and I think a reluctant politician is probably some of the best that you can ever have.

SPEAKER_02 32:42

Well, there's a great story, I'm sure you know it, but you're some of your listeners may not, that that we when he was um he was about the fourth choice to become uh FDR's fourth uh firm vice president. And he said he bluntly said, No, I have no desire, I have no talent, I'm not gonna do that. And and FDR had to call him and beg him. Essentially, you can imagine FDR begging anybody about anything. You know, he said, Well, you know, if you you're you stubborn Missouri mule want to ruin the country in the midst of a war, I suppose that you and the war thing triggered with him because he was not just a veteran, but a combat veteran.

SPEAKER_00 33:23

And and I mean, uh, you know, it's hard to do um counterfactuals um in some cases, but it certainly seems like we um got the better of that as the American people um because of his leadership. Um 100%.

SPEAKER_02 33:37

And and and by the way, I love counterfactual historical counterfactuals or you know, really, really interesting to be able because I think it makes you be innovative, creative, and and really think about a whole lot of not just why, but why not, and what and what if, what if that's right it had been Alvin Barclay uh who was president, you know, where we're moving now, of course.

SPEAKER_00 33:58

Well, would the same things have happened? I I doubt it. Um now uh so so you are in medical school at this time. Now, how did you do you know, oftentimes we have to decide in our world um whether or not it's gonna be medicine or surgery that's the clarion call to us that kind of drags us um into our vocations, many of us liking both, but kind of deciding one kind of fits the personality more than the other. Um you chose emergency medicine.

SPEAKER_02 34:24

Tell me about that decision point for your Yeah, so that it started with I I was drawn almost immediately to um the sickest of the sick. You know, I I don't want people to be in in the you know the operating room in the cath lab in the ICU, but if they're going to be, I want to be the doc taken care of. And the sicker the better. Uh I was also drawn to pediatrics uh for a lot of different reasons. But um so I thought I was going to end up being a pediatric cardiac surgeon. And um David Sabeston, who was my mentor at Duke, uh for some reason took a liking to me early and really mentored me along. And and at the time, emergency medicine as a specialty didn't exist. At Duke, there were five different emergency departments, you know, medicine, surgery, OBGYN, pediatrics, and psychiatry, interestingly enough. Now, obviously, all of those are one, but so thinking about emergency medicine hadn't occurred to me. But um, I had a commitment to the public health service, the Indian Health Service. And so I did a year of pediatrics because Dr. Sabeston said, you're gonna be taking care of surgical patients the rest of your life. You're if you're interested in PEDs, learn how to take care of sick kids. And so I went to the University of Utah, uh, great residency. I loved it. But two months in, they called me in the office. Another, you know, you're getting called in the office. Oh God, what did I do now? And they said, you know, you don't belong in our first year residency class. And I thought, well, you know, my imposter syndrome and all that. Um, the chairman said, uh, you belong in the second year. We're promoting you to the second year. This is my third month of being a uh a doctor. Uh so wow, yeah, it just and I I was able to spend a lot of time with uh sick folks. And as it turned out, you know, I gravitated more toward towards emergency medicine uh because I had a commitment that I had to make with the Indian Health Service. And uh plus we had been moonlighting as surgical residents uh in in local emergency departments in uh in Idaho and around uh Wyoming and places like that. So it's just you know, it's funny, it's the serendipity, the role that serendipity plays in your life. And and you know, um I don't know if I would have been a good pediatric cardiac surgeon to begin with, but I'm grateful that I became an emergency physician.

SPEAKER_00 36:46

Yeah, well, look, that's extraordinary, first of all, that you got promoted like that. I I'm not sure that I've ever heard of anybody ever saying, like, you're too qualified for this, you need to be advanced. So that says a lot towards uh your character and and perspicacity right there in and of itself. Um But so so you go on from there. Um now at some point, um sports medicine had to have called your name here because that's a separate fellowship that can be fallen into from a few different territories. How did you find yourself going leaning towards that?

SPEAKER_02 37:17

Well, a couple of things. Being an athlete, um, and and you know, I always tell my players I have responsibility not just for the current 2,500 current dues-paying members of the union, but increasingly for the former players. And and I always tell my players when it comes to transition, you're gonna be a former player a lot longer than you're a player, even if you're Tom Brady or Drew Brees or Lamar Jackson who plays 20 years. Um so getting ready for that becomes very important. Number one. Number two, as an emergency physician, you see sports medicine all the time. Where that's where concussions go, that's where heat illness goes, that's where cardiac arrests go, that's where you know uh the player with the bills was resuscitated on the field by three emergency physicians, friends of mine. Um, and I all plus my kids were all athletes, and so I was always on the sidelines of their games, whether it was football, cross, whatever sport that they were in at the time. And so the the people, you're gonna ask me, or somebody's gonna ask me, hey doc, how did you get your how do you how do I build my resume to get a job like yours as the medical director of the NFL Players Association? So I got that job on August 1, 2001. Corey Stringer, a tackle for the Vikings, died of heat stroke on the practice field. On the practice field. Inconceivable. I got a phone call from uh Gene Upshaw, best left guard in the history of the game in the Hall of Fame, but also the executive director at that time of the NFL Players Association, and he said, Doc, you got to step up to the plate. You're gonna become our medical director. And Gene didn't ask these things, he told you. You know, there was no option.

SPEAKER_00 38:59

Hey honey, guess what I'm doing?

SPEAKER_02 39:01

Yeah, so you know, did he uh flip through a stack of resumes? No. Did he get a search firm? No. He certainly didn't consult Chat GPT because it didn't exist at that time. He he told me I was gonna do that job because he trusted me. And he trusted me because we were best friends. You know, his youngest and my youngest were best friends. Uh, we had been on the sidelines of countless football games. We coached T-Ball, uh, a game my father invented in Anderson, Indiana. Um that's why he called me. And and my answer, interestingly enough, so when people say, How do I build my resume? My answer is don't build resumes, build relationships. And I'm gonna guess that that if you think back to the mentors in your life, it was the relationship, not the resume that mattered.

SPEAKER_00 39:51

That's exactly it. It's gonna be much more formative to that. Um, well, so so there there seems to be a time period there between as you are out in practice and you're practicing emergency medicine, which is a burgeoning field at the time, and then you get to that point in August of 2001. So, so take me through that time period. What were you doing?

SPEAKER_02 40:12

You know, you when you first started, first of all, there'd never been a medical director for the NFL Players Association before. Um, you know, the first meeting we go to was at NFL headquarters. It's Gene and I, and the president of our union, and we walk in and there's 32 team physicians. The commissioner at that time was Paul uh Tagliaboo, uh, three owners, and they're all looking at us. And I'll never forget we walk in, and Jean looks around the room and says, We may be outnumbered, but we'll never be outmanned. You know, when you got a boss like that, you kind of feel like, you know. Uh shortly after, uh we had a very complex issue. And again, nobody's ever done this job before. So I took the unusual step of making an appointment at Gene's office downtown because we live in Virginia. The offices are in downtown DC. I was smart enough to know you don't walk in and say, What do you want me to do? I said, here's the issue. Right. There's three ways we can go one, two, and three. I said, What do you want me to do? And he looked at me and he said, Just go be Tom Mayer. That's why you are Tom Mayor. That's why I hired Tom Mayer. And I walked out and I called Maureen and she said, What did Gene say? And I said, I don't have a clue. I have no idea. He just empowered me to do something. Exactly, but it was it was that the trust that that matters. It was like, you know, that's why I hired you because I trust you to be able to do it. But of course, Gene had that, you know, almost truculent way of saying something like that. And and I think that's what we do in healthcare. We were talking about, you know, reaching and the tech's going to put it in your hand. You trust that they'll do the right thing. You don't have to ask all the time. You know, that they know from experience because they've learned from experience. And I would say that they probably a little bit have made failure their fuel by, you know, you give them the wrong size catheter and and in your nice and and gentle way and tell them no, you know, we need the different one. And but they learn from that.

SPEAKER_00 42:15

That's right. Well, it had to have been a dream come true for you just to walk into that building and that association and then have all the eyes turn onto you. I mean, as a football player, I mean, that's that's kind of a a dream organization to have, and now all of a sudden, in a sense, you're responsible and you're you're leading them, and you've got all these different responsibilities with regards to it. Probably makes Mike linebacker seem easy.

SPEAKER_02 42:40

Yeah, and all those, I mean, the the Mike linebacker, the the theology, biology, chemistry, it all came together. I can give you an example. When I started, uh, if you had a concussion, by NFL policy, you could go back into the same game.

unknown 42:55

Yeah.

SPEAKER_02 42:56

Number one. Number two, they had no guidelines on on both either diagnosing or treating concussions. The original so-called NFL guidelines, I wrote, Sean Sanseveri, my legal partner with the NFL PA, and I wrote the original guidelines. And frankly, they weren't well accepted to begin with. We don't need guidelines, you know, our doctors are the best doctors, they do a great job, and all that. And my answer was show me the data that shows me that they're the best doctors. Show me the data that says it's okay to put a player back into the same game. You know, you say that uh these days, and you think, what? That can't be. Of course. But in 2001, uh, you know, that was the case. So I mean, it took a certain modicum of courage uh to be able to say, I'm gonna do the best thing for the players, period. Full stop, end of story. And and if you think about it, that's what you do, you know, and the colleagues you trust the most in whatever hospital or healthcare system you work in are the people who say, we're gonna do the best thing for the patient. It may be inconvenient for us, but we're gonna do the best thing for the patient.

SPEAKER_00 44:00

Well, Tom, you know, something strikes me about your particular position is that in some sense, you have to serve a couple of different masters. Um of course your top priority is player safety. I I don't think anybody would say you compromise on that at all. But the NFL does have to put out an entertaining product. And that is something that I'm sure certain, you know, in private meetings and behind closed doors, they talk about it. Sometimes they talk about it up front. They want to make this entertaining, they want people's eyeballs, they want people to have a good time watching it and bring family around and and celebrate around this. So so you you know, I mean the safest thing would be don't anybody ever play ever. But also these athletes, this is their raison dietra. This is this is their meaning in life. And you, you know, for for me, I want to facilitate patients doing the things that they find most meaningful, even if it's dangerous. You want it to be as safe as possible uh according to that. So I wonder how how do you reconcile those two different ends between wanting to make sure that this is a very entertaining product, but also uh safety is paramount.

SPEAKER_02 45:04

Yeah, so uh that you're exactly right. It's uh typically astute question. So, number one, I don't set policy on health and safety for the NFLPA. I advise the executive director, the president, the the elected football player who becomes a president, the executive committee, and the board of player reps, one player rep for each team, we call them clubs. So I advise them and tell them this is uh the parameters, these are the consequences of that. And they make the decision. Now, they have never made a decision that I disagreed with. Never. They always do the right thing for the players and for the players' families and what needs to be done. Um but the fact of the matter is it's a violent game. Uh, we all even without my calculus, I I learned in physics force equals mass times acceleration. Well, the mass is higher than it's ever been, and the acceleration, they're faster than the thing I learned best, uh, other than the fact of the limits of my talent when I was with the Bears and the Vikings was how fast these people are. I mean, that was that's the difference between who makes it in the league and who doesn't. And someone would say, well, yeah, but that left tackle's 6'8 and 350. Yeah, but that's not what makes him a great left tackle. It's how fast does he get back, how fast does his foot come back? Because you've got an edge rusher who some people would say is arguably the most uh talented athlete on the field with one purpose, and that is to get around that person, and it's gonna take more than size. So force equals mass times acceleration, you know, it becomes a force mitigation equation. How do you how can we best protect them? The helmets, we now have helmet testing. The helmet I wore would is the you know, no, I and it wasn't leather, by the way. Just so you don't have to ask.

SPEAKER_00 46:53

I didn't say that, okay? I didn't say that.

SPEAKER_02 46:55

You were thinking it, but you didn't say it.

SPEAKER_00 46:57

Look, let's get out of my head, all right?

SPEAKER_02 46:59

You know, so that so the helmets are getting safer and safer and safer uh over time. Rules have changed, you know, our kickoff rules have changed.

SPEAKER_00 47:06

Kickoff rules, yes.

SPEAKER_02 47:07

Yeah, and and and yet, you know, what happened when when the rule changed that you know, if you drop it into the landing zone right in front of the goal line, you're gonna get a return. And if you get a return, concussion scope went back up when that happened. So they went down, but that's because there were fewer returns. And, you know, it's as as the great Robert Merton, not Thomas Merton, the Catholic Munt, but Robert Merton, the sociologist, said it's the law of unintended consequences. You know, you you do something with good intent, um fulsomely, and then realize, wow, that I didn't realize that was going to happen, or I didn't think all the way through. So, you know, it it our guys would want me to stress to you and to your audience the incredible benefits of playing football. You know, you have physical fitness, you play on a team, the camaraderie that goes with that, you get an education that for some of them would have been harder, hard to get or impossible to get in the first place. And no, I don't want them to have the consequences, but uh, but it you know, taking things on balance is the way our guys look at it.

SPEAKER_00 48:15

Yeah, uh, I think that's beautifully stated on your part. Um, you know, there's plenty of patients that, so for example, ultramarathoning. That's not healthy for you. It's not good for your body. You don't live longer when you do it. But the patients that do that, it's their raison dietra. That's what they are living to do. I want to try and facilitate you doing the thing. I don't want to tell you not to do the things that you really want to do. Skydiving is not safe. I mean, sure, it's relatively safe.

SPEAKER_02 48:43

How do you mitigate the consequences of doing that? You know, my so I'll tell you my my ultra marathon story. Oh I was at a sports medicine conference and and and I was uh having a beer with a bunch of ultramarathoners. And uh, and I said, you know, I did the Leadville 100.

SPEAKER_01 48:59

Oh, good.

SPEAKER_02 49:00

And looked at me, wow. They said, Doc, you did the Leadville 100? And as you know, obviously, it's a hundred-mile race. Leadville, Colorado, up in the mountains, I think base is like 9,000, and you gain and lose multiple thousands of feet during the course of the thing. So they're looking at me incredulously, saying, You did the Leadville 100? I said, Yeah, I went to the start, I was in Leadville. I went to the starting line, the gun went off, everybody took off running, and I went to a local bar and drank 100 beers and then came back and you know, watched them come back across the finish line.

SPEAKER_00 49:32

So not a beer more than 100, though. I just want to say I cut it off.

SPEAKER_02 49:36

Right at 100. Not 98, wasn't 102. Uh nothing in excess.

SPEAKER_00 49:42

I I'm proud of your restraint there. Um but um so so again, you know, these players are um I remember uh a high school teacher of mine talking about how much of a genius Michael Jordan was. And that's really what you're seeing, and you kind of alluded it to ear earlier. I mean, you know, um yes, Sequan Barkley is a freak athlete, an unbelievable freak athlete, but he's also a brilliant guy. I mean, just in terms of being able to navigate where the best position is gonna go, and these things happen quick. I mean, this is not like you've got 45 minutes to decide which route you're gonna take here. I mean, he's he's just doing this on the fly.

SPEAKER_02 50:18

And so let me tell you, let me tell you my genius story, because I just saw the person I'm gonna tell it about. Uh Joe Thizman, I saw him at the Super Bowl. Great, great guy and a good friend, and and very committed to to football players and transition from being a player to a former player and all that. But I was actually on uh the training camp uh with Joe, and it's when the uh Bill Walsh's um West Coast offense was first, you know, sort of coming out. Yes. And and this reporter, I'll never forget it, says to Joe, you know, to Bill Walsh, he's a genius. He's I mean an absolute genius to West Coast offense. And and Joe very thoughtfully looks at him and says, I I don't think you should call anybody in football a genius. I mean, because a genius is somebody like Norman Einstein. And I lost it, and the reporter lost it. I'm talking snot out the nose laughing because he didn't realize what he had said. Yeah, but he gives me permission to tell that story. He's he is a very smart guy. He just misspoke when uh he talked about Einstein.

SPEAKER_00 51:24

Well, Francis Newton would also have something to say about that. So that's um well, you know, you would talked about um kind of player size and momentum, and I and I do think you know there's something incredible about seeing a player like Derrick Henry, who is just an absolute beast at six three or four, two fifty, and who can squat a school bus. And I mean, that impact that he's gonna have for linemen and for linebackers. I mean, it it's a bit of a genetic arms race in pro football now to get more size and to be able to not just get bigger but be quicker and have all the constituent muscles and sinew and tissue and fast-acting fibers. I mean, it's just just incredible to see how this has evolved over the past few decades.

SPEAKER_02 52:14

It it is, and and you couple that with the discipline, the hard work, the you know, the reason he can squat a school bus is because he went through the pain of gradually getting that strong. I'll tell you a quick story. A couple years ago, when he was still with the Titans, uh, we try to go to a couple Thursday night games a year. I say we are my counterpart with the NFL and and I and our legal uh partners, you know, to fly the flag and to show the players and folks and coaches and trainers and docs that were there and you know we're watching and all that. And um and the Titans called this is when Mike Brable was there, basically called student body left. And here comes Derrick Henry running uh uh straight toward the sideline, and unfortunately, he was running straight towards me. And and I I mean, yeah, I played the game, but I I mean, not to get too graphic or schatological, but I thought I was gonna have to change my underwear. I mean, this was, and then all of a sudden it's an involuntary response. I mean, that's I never saw him plant his foot. The next thing, he wasn't there. He had essentially just changed 90 degrees, actually, it was it was more acute angles, more like 70 degrees because he cut back against the grain, and I never even saw it because he's that fast. So it's a you know, the great combination of force equals mass times acceleration, brain power in terms of knowing where the cutback lane would be in the first place. That comes from studying film, that comes from watching and seeing, you know what? I don't even remember what team they were playing, but they their backers did the second level did overpursue, and that's exactly what he saw. And uh yes, he went 60 yards on that play. I was crumpled on the sideline just from imagining contact.

SPEAKER_00 54:01

Uh I was crumpled on at my home watching it. So um, but but this also strikes me as um, you know, what is the first thing that you do in a code situation where you check your own pulse? Exactly. Because because then all of a sudden the training kicks in, and then you say, I know what to do here. We're gonna get airway, we're gonna get you're gonna start down the pathway, somebody check a pulse. And it's almost an out-of-body experience whenever you do that because it's it's it's something else that's kicking in, and you can almost watch from the sidelines as you do these things. And having been in a fair amount of codes, it's it's something that's um it's exciting. You know, I mean, obviously there's gravity to the moment, but there is something about oh boy, I get to use this training that you can see what frontline infantry soldiers could feel like when they say, oh, or or perhaps um Marines going uh Pacific Island to Pacific Island that that were having to absolutely deal with whores, but at the same time, this is what they had been trained to do.

SPEAKER_02 55:03

Yeah, it's it, you know, it it's a combination of training and trust, training and that you know what to do, and it's not just A, B, C, D, it's A through Z, and then double A through uh Triple Z to be able to walk through it and have a uh the confidence that there's an evidence-based or evidence-influenced uh approach. It's probably another podcast, but uh that interesting alone. Um but the trust in yourself and trust in the team around you, you know, one of the things I've always done, and it's funny you'll see it on on the uh the both ER, I was a script consultant for the first five years of the show ER.

SPEAKER_00 55:41

You might be the coolest person I've ever met. I'm just gonna say right now, okay? It's amazing.

SPEAKER_02 55:46

Means I'm carbon-dated. Um but they the the pit, the one that Noah Wiley was actually in both shows, uh, he actually uses the same line I always use, which is is does anybody want to try anything else? So that the team feels if you've got you know something that we haven't thought of, plus it's a team effort, and as as you may know if you've seen it, you take a a moment after if the code does not go successful to remember the person, to think of their family and all that goes with it. But you know, you take a no offense to your dermatological uh audience, you you take a dermatologist and put them in the cath lab or in my emergency department, they're you know, they're not gonna like it because that's not their thing. Now, I'm I'm about the world's worst with rashes, so you put me in their office, I'm gone. I'm you know, no, no, no, I wouldn't help at all.

SPEAKER_00 56:36

I wouldn't help yeah, Tom, it reminds me of uh um I had a a procedure where um we were we were doing a heart cath, and then uh in the middle of it the patient said, Ah, I'm feeling some tearing sensation in my back and it's spreading to my chest. Exactly. No, no. Um that certainly strikes your uh fancy, and it did mine, and it was one of those um eschatological moments as you had referred to before, where it was, oh man, this is gonna happen quickly. And and and so, you know, um for for those uh delay in the audience, um that usually implies that kind of sensation is very distinct and almost pathonomonic of an aortic dissection. And it's a true emergency where mortality is very high. Um anyhow, and so so we moved quickly, we got things taken care of, everything went well. Um but either way, in talking to my friends and my fellow um cardiology fellows about that afterwards, um, one of them said to me, said, uh, we're not practicing dermatology here. And that really that really lands on you that like, you know, things things can happen. Um the the biggest mistake is not to make mistakes, the biggest mistake is not to learn from mistakes.

SPEAKER_02 57:44

So yeah, you know, it's uh you know, it's uh uh Mark Twain said, you know, it ain't what you don't know, it's what you uh do know that ain't so that's gonna get you. And I will say there is a metaphor, and that is you know, in in your case, that patient with a dissecting aneurysm was in the safest place on the planet to have that happen, number one. And number two, when when we don't use players' names, but everyone remembers the player who went down with a cardiac arrest. Well, he happened to be on the safest place on Earth to have a cardiac arrest, which is an NFL field with three emergency physicians from University of Cincinnati within 20 yards of them.

SPEAKER_00 58:27

And hopefully with AEDs all the way around, um within arm's length, um, virtually everywhere in every stadium and practice facility, I would imagine that's ubiquitous.

SPEAKER_02 58:36

Um, I I talk to to high school teams, college teams all the time. I mean, if they if somebody invites me to speak to their their team, I'm gonna come because our you know, our young people are are the future. They're gonna be taking care of you and me one of these days.

SPEAKER_00 58:49

Absolutely, absolutely.

SPEAKER_02 58:50

Um and so I go and I there's two things I always say to them. The first thing out of my mouth, you know, guys, great to be here. Where's the AED? That is perfect. Nobody will I'll I'll say, Who's the captain here? The captain will raise his hand, go find it, go find the AED and bring it back. And then once they bring it back, uh you know, how do you use it? You know, because if if you if you think about that, uh you know, those guys, I mean most of them aren't gonna play in the National Football League, you know, uh but they could save a life. I mean, that knowledge could save a life. Now, the other thing I always tell them, uh, you know, I always you gotta be have a certain level of confidence to play football. And I look at them and I say, uh, you know, you're not playing for the name on the back of your jersey. You're playing for the name on the front of your jersey. You know, you're representing your school. And you better understand that whether it's on the football field or whether it's in the classroom or or whether it's Saturday night frivolities, you're representing your school and your team. And inevitably somebody will say, Yeah, but what about the name on the back of my jersey? And my a I it's like a setup. I always say, it's not your name, it's your parents' name. Your parents have loaned you that name, and they're just wondering, as I am, if you're gonna live up to it. Are you gonna live up to the name on the back of your jersey? Because it's not yours, it's your parents. And they I can't tell you how many kids have emailed me or texted me and said, you know, doc, that really helped me a lot.

SPEAKER_00 1:00:24

Tom, that is so beautifully said. I love awe moments where you are struck in awe, and that is just beautifully said. I might take that. So if you ever hear somebody come to you and say that, just just just let me provide my mayoculpa right here, because that's that's really brilliant. And asking about the AED is another really lovely thing to do. Um, uh look, I'm cognizant of our time, I'm cognizant of your time. Um, there were a couple things that I did want to cover here that I think would be um germane to our audience, and and I just want to get somebody's thoughts that that are um insightful and and kind of doing things on a big scale here. Um, how do you think AI is gonna integrate into your practice now and and with the NFL? Do you do you think about this at all?

SPEAKER_02 1:01:05

Oh, sure. I think about it a lot. I mean, I I always think about, I always say innovation, you have to think differently, we have to act within a week, because we don't act within a week of whatever we hear on this podcast, we're not gonna act at all. And the third is to innovate. And so think, act, and innovate. But innovation doesn't occur at the speed of genius, intelligence, or creativity, it occurs at the speed of trust. And so it when we I'm always anxious to see, okay, how can things be done differently, more positively, in a in an adaptile fashion, if you will. And and we're gonna have to adapt to AI. And and you know, I've had lots of conversations with you know world leaders in AI and healthcare, Harvard and Duke and other places. And you know, there's no question it's going to have an impact. And the question becomes, what what impact will it have?

SPEAKER_01 1:01:55

Yeah.

SPEAKER_02 1:01:56

I I would had the great honor of speaking at the Institute for Human and Machine Cognition in Pensacola, just this incredible secret place that is, I say secret, they are public lectures, but I I it's just amazing. And when you talk about the existing proposals for AI, the smart people will tell you there is not enough power on this planet to power all of those AI implementations. That's right. That's why you see, you know, all these Google Meta, everybody else is building plant plants, power plants, moving close to them. So it's gonna be it's gonna come down to uh, I always say data knowledge and wisdom, they're not the same thing. You know, we're choking on data. The AI experts tell me it not only can it not give you wisdom, it can't give give us knowledge, yeah. I am confident it will someday.

SPEAKER_01 1:02:48

Right.

SPEAKER_02 1:02:48

But having the wisdom to say, you know, simple things about what does it mean? What does it mean and how do we uh uh apply that? So uh no question, someday in in our cath labs, in our offices, in our emergency departments, uh there will be AI that helps us uh make the work easier because the only reason people ever change is if it makes your life easier, their job easier. Um and sure, you know, um there could be an AI suggestion, you know, uh I have this tearing sensation in the back of my chest. I mean, obviously you thought of it immediately, but what if someone didn't? And or what if it was in an emergency department? I think emergency physicians would get that. What if it was in a family practitioner's office? Maybe not quite front of mind and all that.

SPEAKER_01 1:03:38

Right.

SPEAKER_02 1:03:38

So I think it's gonna help us. They're quite, I always say, and I said in Pensacola, uh, you know, I'm I'm a little less interested in the AI than I am in the eye. You know, what's the intelligence that goes into that large language model? Because if I take a hundred lousy, uh poorly performing emergency physicians or cardiologists and surgeons or surgeons and put that together, I'm probably not going to get AI that's gonna be helpful. But if I take the folks like you in your practice that have the best results and start to aggregate that in a large language model, now we're starting to say, okay, we're at least getting to knowledge, if not all the way to wisdom.

SPEAKER_00 1:04:22

Right. And I think I think that wisdom is, you know, there's one of the my wife's a physician too, so so one of the best compliments that we can think of is you are a good doctor. Now that to me means that you are doing the right thing for the right patient at the right time, and you're not doing the wrong thing for the wrong patient at the wrong time. So, in other words, that that starts to bleed into the wisdom side, and you're very astute to note that um you know, we're gonna get we've got a lot of noise. Are we gonna get signal from that? Very likely. Are we gonna get signal that we use and implement? Time will tell. I I certainly hope so.

SPEAKER_02 1:04:59

So to g switch back to a metaphor, making failure our fuel. I mean, when it comes to AI, there's gonna be a whole bunch of uh quarterbacks taken ahead of that uh, you know, 199th one. And the question is, how did they miss it? And how can they we not miss that in the future? And so I think AI will help us in terms of uh not you know uh fatal mistakes, that yes, it'll help there, but some of the more subtle things that come down to what makes a great doctor. Plus, I I do think that um AI, I would say, how can we approach doing is documenting? So the very act of whether it's in the cath lab or the emergency department, you are observed to have done it, and therefore it is translated into a medical record that is accurate, reasonable, understandable, and frankly compensatable. There's nothing wrong with that.

SPEAKER_00 1:05:58

Tom, this is about the fourth. Time I think you've really been in my prefrontal prefrontal cortex here. This is amazing because I've said for some time, you know, what I really want AI to do, what I really want is for me to say, this patient needs a lysinoprol of 20 milligrams, and it just gets sent. Yes. It's just done. That's already done. I don't have to say anything more about it. I don't have to worry about sending this or checking or any, it's just gone, done, taken care of right then and there. And we can move on.

SPEAKER_02 1:06:24

Or even uh even a voice saying, uh, I'm sorry, Dr. Davis, did you say Esmalol 20 milligrams? No, less than a prel. And and so I I can see a thousand different ways it could help us. Um, but I think it's going to take a bit to get there. And we're going to have to be patient with the failures.

SPEAKER_00 1:06:42

We are. We are. Because you know, the documentation is not our work product. Our work product is is is interacting with the patient, is putting our insights onto what we think is going on. The documentation is for billing purposes, and that, you know, that starts with um you had spoken about this earlier in our conversation, but um something that I've heard called moral injury, where you just get more and more piled upon you and it just becomes omnipresent. And that really contributes to physician burnout. Physicians are not gonna get burned out with helping people and saving their lives and making their lives better. That's not something we will get burnt out on.

SPEAKER_02 1:07:18

So uh the the person who applied that or uh is is Wendy Dean. Wendy is a very good friend. I was on her podcast. I'm gonna introduce you by email. You should have her on.

SPEAKER_00 1:07:28

She's so that would be excellent. Thank you.

SPEAKER_02 1:07:30

Yeah, and our our middle son was a marine infantry officer with two highly kinetic tours. So that uh yeah, as you probably know, that came from John Shea, wrote Achilles in Vietnam, and it comes from uh typically infantry, but it could be any branch, uh, who are asked to do something that is morally against their beliefs and values. And and I give Wendy and Simon Talbot, her writing partner, full credit for applying that to healthcare. At first, I thought, well, I don't know. I mean, this is not a battlefield. And then the more I thought about it, uh yeah, it kind of is like a battlefield. But Wendy's great. You I'll I'll uh email her to Well, thank you.

SPEAKER_00 1:08:12

Um now just because I've got somebody that's so inside in the business, I really wanted to talk to you about a hot buzzword that I think everybody in the lay and the the medical field here would understand, which is CTE. Um and we had talked a little bit about that, but you know, um I I think CTE perhaps it's not as well known. I think it started from military circles, is that right? And then we kind of evolved to figure it out from contact sports.

SPEAKER_02 1:08:37

You know, like like most um great insights, it comes from several different places. Military was one, particularly um infantrymen, uh marine breachers who who use you know uh explosives to blow doors down all the time, uh, but also from from boxing. Uh it was uh the original description was dementia pugilistica. Yes, and and the journey has been fascinating. Uh my senior thesis was on the structure of scientific revolutions, a book written by Thomas Kuhn. Uh, the paradigm shift concept is what he came up with. And it's fascinating to trace that and see how, you know, when it was originally presented, there were there were certain people, football people, who denied it. These guys are liars, they're thieves, they're making stuff up. Um Bennett Amalu, uh famous pathologist, was requested by the NFL to retract a paper in the journal neurosurgery. I mean, can you I mean to retract a paper is incredible.

SPEAKER_00 1:09:43

Especially a legitimate paper that that was well founded.

SPEAKER_02 1:09:46

I mean was it inconvenient? Sure, it was inconvenient, but now we're to the place where there are NIH clear guidelines on how you diagnose this. You know, the the issue, Don, as you know, is it's strictly a post-mortem diagnosis. So the only way you get diagnosed by that is if you're dead, and your brain goes to a pathologist who looks it up and sees it. So the I I think the the um unintended consequence is you know, players age and they know they played football, their wives and families know they played football, and they develop uh signs of dementia, forgetfulness, you know, can't find my keys, can't remember stuff. Uh, they might use a different word than stuff, but we won't go there.

SPEAKER_00 1:10:33

Yeah, yeah. I'm familiar with that word.

SPEAKER_02 1:10:35

Scatological reasons and all that. Well, you know, if you look carefully, you find out that, well, there are incidents of hypertension, there are incidents of sleep apnea, there are incidents of chronic pain, uh, and and go on and on. All those are higher, and all of those are associated with dementia, but vascular dementia as opposed to the anatomic lesion of CTE. So, you know, so far there's no anti-mortem diagnosis for CTE. Uh, lots of folks working on it. Is there a way to have Tau? There's a group that we're funding at Harvard is looking at Tau um essentially vaccinating for Tau so that Tau antibodies could be could attach to Tau and take it out of the system instead of depositing it. Um amyloid, you know, for Alzheimer's, that would be great too. But indeed, you know, I would just say aren't we we're so lucky to live in the in the medical era we live in. Yes, yes, absolutely. Me, you can replace an aortic valve through a catheter, a mitral valve through a catheter. Are you kidding me? You know, there's roaming. Yeah, and in many um in many cities, there's roaming medic units with ECMO on board that to take patients in cardiac arrest and put them on ECMO before they even get to the emergency department.

unknown 1:12:00

Wow.

SPEAKER_00 1:12:01

Yes. Wow. Yes.

SPEAKER_02 1:12:03

So somebody will have an anti-mortem test and an anti-mortem treatment, I'm quite convinced for CTE.

SPEAKER_00 1:12:09

Yeah, you know, it it begs a lot of interesting physiologic questions. You know, is is Tao um the bad actor, or is that just a side effect of the hundred percent? You know, we we don't know that. Is this um is this uh microfracture of capillaries and therefore a release of inflammatory materials that destroys that portion of their brain creating lesions? I don't know. I'm just throwing out different things that that potentially that it could be that you know seem plausible, but I mean there's certain things that never would have seemed plausible, like you can't get cancer from infectious disease. That's not how it works, right? So it's it's you you don't get you don't get gastric ulcers from uh bacteria. That's just not how it would have been stopped.

SPEAKER_02 1:12:52

Okay, so um anyway, so of course that that encourages our our infectious disease brethren to say that all diseases are infectious.

SPEAKER_00 1:13:02

And they would say that, by the way. I think they're looking for the same thing with CTE right now. They're gonna look for the culprit or rather.

SPEAKER_02 1:13:08

When you and I went through medical school, appendicitis had one treatment, one treatment only, surgical. And the sooner the better. You know, are there going to be some normal appendices taken out? Sure, but you know, you're that that's the price of the disease. If you said, let's let's do a double-blind, well, couldn't do double blind, but a blind uh a study, randomized study on antibiotics versus surgery, you but you would have been laughed out of medical school, a residency. And now, I mean, so-called NOTA, non-operative treatment of appendicitis, is routine. That's not the only choice. It and it drives toward a patient-informed decision. Which would you prefer? These are the data.

SPEAKER_00 1:13:57

Yeah. We we uh patients' customers get the option now, and I think uh there's some very similitude with prostate cancer now, too.

SPEAKER_02 1:14:05

Yes, you have to do different options that um surgery, you want radiation, you want you know, pellets, you want, you know, you're very successful too.

SPEAKER_00 1:14:12

Yeah, yeah, my my wife is a breast radiologist, and so uh we talk a lot about um breast cancer in our house. And um, so you know, uh let's say 30 years ago, maybe a little bit more, breast cancer was considered a surgical disease, and that's it. That is it. You you weren't taking enough breast if you if they still died from breast cancer. And we've evolved our thinking to say, no, we've got some tools available, let's utilize those.

SPEAKER_02 1:14:41

Yeah, and you know, it's a separate podcast. You're probably gonna have a guest on to talk about it, but the whole HRT issue, hormone replacement therapy issue in menopausal or postmenopausal women, completely blowing apart the what was set thought to be I I always hate it when I hear the science is settled. So the science is never settled.

SPEAKER_00 1:15:00

That's not how science works. Okay, that is well, I'm glad you got the theological and the chemical background and biological. So you could kind of say that for sure. Um, Tom, what do you do for fun?

SPEAKER_02 1:15:12

Uh, you know, I my wife is the most wonderful person on the planet. Uh my son's second most wonderful.

SPEAKER_00 1:15:18

I've got a wife too here, okay. I just wanted to.

SPEAKER_02 1:15:21

You know, someone said once, you know, she's your better half, and I said, No, she's my better seven-eighths. Let's just be careful about that. We have a saying in the NFL uh that applies to me and I suspect to you, which is you you look at the guy and you look at the wife and you go, You outkicked your coverage. You seriously outkicked your coverage.

SPEAKER_00 1:15:39

I say it all this is the fifth time now you've been in my head, Tom. The fifth time, because I say it all the time.

SPEAKER_02 1:15:44

Yeah, so that you know, we have three boys, we have six grandchildren. We live in Wyoming. Um, we love the outdoors, we love every every bit about it. Uh a bright day, sunny day, rainy day, cloudy day in Wyoming. We say there's no such thing as bad weather, there's just the wrong gear. Um and our kids and grandkids have uh done that uh as well. We have a our family motto is always do the more aggressive thing. So that's what I do for fun, is is that. And you you might ask me after me saying, you know, what's my deep joy? My deep joy is helping other people find and fully embrace and explore their deep joy.

SPEAKER_01 1:16:20

That's right.

SPEAKER_02 1:16:21

So I'm honored that you would ask me to be on the podcast and share some contrarian crazy ideas that um your your uh guests are probably thinking, who cleared this guy to be on this podcast?

SPEAKER_00 1:16:34

Well, I think it speaks a lot to your character that you can be so compelling with these ideas, and that um one of the best things anybody can make you think of is why do I think that thing? Because if I can change your mind or if you can change mine, that's a really powerful thing. We just we don't, you know, it's it's the um you when you vote with your money, you vote a lot more truer to what you really believe about things, and to really change your beliefs is really impressive. Um now um I've got some rapid fire questions. I'm just gonna go with you here, just to end up um of an absolutely amazing uh podcast interview here. Okay, so now um who is the smartest person in history?

SPEAKER_02 1:17:16

This this sorry, there's a joke I can't tell, and I apologize about the U.S. I can't tell that joke.

SPEAKER_00 1:17:25

Um I've got a couple too that we'll share.

SPEAKER_02 1:17:28

I I would say the smartest person in history is the person who looked at E equals MC squared and said, it can't be that simple. It can't, I mean, it took us centuries, millennia to come to that. And it turns out it's not that simple because if you go to the Einstein's paper, 1905 paper, Special Theory of Relativity, uh E equals MC squared does not appear anywhere in that 23-page um uh uh paper. What does appear is E equals MC squared divided by one divided by one minus the square root of v squared minus c squared. Well, that's a little more complicated. And Einstein himself said simplify, simplify, but not too much.

SPEAKER_00 1:18:15

That's right. That's right. And and so you can see from that that uh as the velocity approaches the speed of light, based off that equation, that's how you get, it takes infinite energy to get there. Exactly. I and I I have uh read uh it's it's the um miraculous year uh his four papers that came out in in 1905. Yeah, I mean, just some of the most seminal achievements ever, and he came out with them all in the same year, and you're just awestruck at this incredible. I mean, don't get me wrong, general relativity is is absolutely amazing, but just to do all four of those papers in in 1905 is incredible.

SPEAKER_02 1:18:51

So yeah, I'll send you the uh the English translation of that paper. It's kind of a cool thing to have.

SPEAKER_00 1:18:56

Yeah, I absolutely love that. I remember deriving that in our physics class, and it was it was groundbreaking to me. So uh by the way, fantastic answer. I'm just gonna give that to you, okay? Um now if we can live to be a thousand years old, should we do it?

SPEAKER_02 1:19:12

The answer is it depends. And you know, you learn in both theology and linebacking that the answer to any intelligent question is it depends. So I spend a lot of time with my players and and my other patients talking about the distinction between lifespan, how long we live, can you live to be a thousand years, health span, how relatively healthy you stay during the course of the time that you live. And there's a big it depends in there. Um but but the thing that's missing, and actually we're working on both a paper and and a and a book, uh, joy span. You know, the joy you take from life while you are living your allotted years during the course of the health span that you have. And and you know, there's um there's eudaimonic joy, as Aristotle called it, the you know, the beauty of a flower, the beauty of seeing a uh a child, an infant, uh, you know, a puppy, whatever it might be. But there's also generative joy, the ability for you to to say, do, create things, uh, actions, behaviors, uh, emotions in and of themselves that create joy in others. So um, so yeah, boy, you give me joy span and I'll take a thousand years, but not without it.

SPEAKER_00 1:20:27

I have been using um lifespan and health span quite a bit, and I didn't put the words to joy span, so I am gonna steal that idea from you too. This this is super high yield for me in my practice, so my patients will thank you for that. No, that that is perfectly stated. That's exactly what we want to optimize. And and you know, it's also it's also part of what I talk about patients, is that look, uh now, the present, this here, our attention is the only thing that we have. It's the only thing we have.

SPEAKER_02 1:20:58

And think about how many times your patients, particularly you know, cardiac patients, mm, cu can focus on what they don't have, what they can't do. And you know, I always I l I I say, uh I got it, I understand that, but let's focus on what you can do. Because that's what's gonna take you where you want to go, not focusing on what you can't do.

SPEAKER_00 1:21:23

I you have no control over if you have cancer right now. You have zero control over that. You have zero control over your blood pressure, really, but you can control if you smoke. You can control if you're gonna get up and exercise, you can control if you're gonna get up and play with your kids. Those are the those are things that you can control.

SPEAKER_02 1:21:42

Yeah, and to to to go to that point, well I learned a lot of this from Victor Frankel, uh, man's search for meaning. Uh, and and for your audience, you know, this guy was a prisoner in a uh a prisoner of war camp, a concentration camp at World War II. Parents uh and family died, you know, he survived. And yet this guy says, I I realized in the midst of being in a concentration camp that I can never control what happened to me, but I could always control how I felt about it. And so he calls it, as you know, the last of the human freedoms, the ability to choose one's own way. And and I think that's just a magical, uh, you know, I I do a lot of coaching of executives of organizations, healthcare systems, and and CEOs of of uh large companies. And and when I send him a document, that quote of Frankl's is the first thing up front. Because if you don't understand and know that, then me coaching you is not going to help anything. That's right.

SPEAKER_00 1:22:43

It's an absolute superpower.

SPEAKER_02 1:22:45

Yes. Yes.

SPEAKER_00 1:22:47

Um, okay, so um, do you like it too cold or too hot at night?

SPEAKER_02 1:22:52

I like it too cold. Uh you know, my patients say to me all the time, you know, sleep, seven to nine hours of sleep. Uh, you know, as you know, the single biggest determinant of all cause mortality in every decade of life is VO2 max. And so we can influence that. And and probably the second most important thing is sleep, is getting seven to nine hours of sleep. Now, you and I, you know, we took it as a badge of honor when we were medical students, interns, residents, and fellows. You know, I get by on two hours sleep, four hours sleep. You know, it's like, well, you know, when did you become suicidal? When did you think that that was a good idea? But, you know, I my players always say to me, particularly the former players, you know, tell me about sleep, doc. And my answer is C and C. It's got to be cool and it's got to be calm. And what I mean by that is calm yourself by not getting, don't bring electrons into the bedroom. You know, don't frankly, don't let electrons come into the last couple hours of your day, period.

SPEAKER_01 1:23:52

Yes.

SPEAKER_02 1:23:53

But at any rate, it's it's uh can be C and C uh cool and calm.

SPEAKER_00 1:23:57

Yeah, um eat, drink, sleep, pee, and poop. A lot of things can be helped with those basic things. Uh many, many um clinical conditions can be helped a lot with that. So uh I mean, just the perfect answer right there. Um if you could go back in time to yourself as you started medical school, what's one thing you would tell yourself?

SPEAKER_02 1:24:17

Be kind, be kinder, be even more kind, um, be more thoughtful. You know, um think not of yourself, but of others even more than you did.

SPEAKER_00 1:24:32

It's hard for me to think that you would have to tell yourself to be kinder. Um what is one current medical treatment or therapy that we perform now that we're gonna shudder that we did 15 years from now?

SPEAKER_02 1:24:44

Oh, concussion evaluations. I mean, this is like medieval. That I get the SCAT five, I get the questions, you know, who scored last, you know, who did we play last week, and all that. Got it, understood. You know, I get the uh the neurologic exam that we do, and and we demand not just that the team physician do it, but our unaffiliated neurotrauma consultant be there. But you know, how we have failed to get a Bones McCoy tricorder to use the Star Trek analogy, to be able to say, you know, you have a brain injury or you don't. You know, we're getting there with with uh some blood tests that can then tell us, but you know, we're we're not we're not there yet. I think we'll look back and go, what were we thinking?

SPEAKER_00 1:25:29

Yeah, yeah, we put we put a lot of players at risk when and other people at risk, to be honest, when we shouldn't have. So I think that's a great answer. Um tell me about what is the best song of all time?

SPEAKER_02 1:25:43

Um Jimmy Buffett Havana Daydreaming.

SPEAKER_00 1:25:50

Perfect. We're down here on the Emerald Coast. We appreciate that. And then um finally tell me about what books you're reading right now. What books should we be reading too?

SPEAKER_02 1:25:59

Well, um the um the books I'm rereading, because I've learned to read about half as much as I used to, but to reread the good ones. Uh I and I you can't make this up. I'm rereading um Man's Search for Meaning. Uh I'm rereading um a lot of theological texts that I that I, you know, uh Reinhold Nieber, who as you probably know, he's the one who did the Serenity Prayer, not AA and the wisdom, uh wisdom behind that. You know, to me, great history, great biography, the lives of great men, great women uh are just uh phenomenal. I I'm rereading uh uh Catherine Graham's biography, one of the most courageous women of all time, to do what she did in the face of what she did and to stand up to it. Um and um and I'm reading uh my friend Walter Isaacson's got a very slim volume called The Greatest Sentence Ever Written, which is about uh not about the Declaration of Independence, but but one line in the Declaration of Independence.

SPEAKER_00 1:27:09

Um well sounds like I've got my reading list set up for me um over the next uh 12 months um proactively here. Um look, there are a ton of things that um we didn't get a chance to get to here today. I would love it if you would uh and join us again because uh this has been fascinating for me. This is uh it's just just incredible to see um, well, honestly, to see people that are hitting at such a high level and doing so many great things for our society because you're doing it at a very big level. Um we didn't even get a chance to talk about um your Hall of Fame nomination.

SPEAKER_02 1:27:43

And uh that'll never happen, that's for sure.

SPEAKER_00 1:27:46

But uh some other really, really incredible things here.

SPEAKER_02 1:27:50

Well, to the question uh come back, and when when when this thing rings and I don't know who it is because these are not in my contacts, I always answer the same way. This is Dr. Mayer, the Answer is yes. Now let's figure out what the question is.

SPEAKER_00 1:28:02

So let's find out what the question is. Yes.

SPEAKER_02 1:28:04

John, the answer is always yes for you and for the Emerald Coast. So you you uh you ask me, and I'll definitely do it. Look forward to it.

SPEAKER_00 1:28:12

Uh uh Tom, a really incredible conversation. I cannot wait for my family and my friends to hear all of this, much less our uh podcast listenership and our membership here. Um, thank you again for um helping our professional players do what they do um safer. Thank you for all your leadership, um your authorship, um, and being damn funny at the same time. Okay. Uh this is this is really great. Um I hate that I have to give Mark Noon credit here for introducing us together, but but seriously, I I cannot believe that we had a connection like this. Yeah, Mark, thank you so much for being here.

SPEAKER_02 1:28:46

Yeah, you really are. And we'll see you next time. And tell your tell your audience. I guess I'm telling them right now, if I can help reach out. I'll make sure that you've got my email, my text. Um, you feel free to share that with anybody who's listening to you, and if I can help them, I will.

SPEAKER_00 1:29:01

Tom, thank you so much. We appreciate you on being here on Medical Mastery Podcast, and thank you helping it for helping us make medicine better together.

SPEAKER_02 1:29:09

Absolutely. It's been an honor and it's been fun.