Reply All - #2 The Secret, Gruesome Internet For Doctors

Episode Date: November 24, 2014

An app called Figure One wants to be Instagram, but for doctors. Why would doctors need their own Instagram? We spy on the secret & disgusting medical internet, plus we speak to one of its residents.�� Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello, I'm PJ Vote, and from Gimlet Media, this is Reply All, a show about the internet. And this week's episode is super gross and disturbing. I have 98 apps on my phone, and this week we are talking about the only one that I'm terrified of. That app is called Figure One, and it's billed as Instagram but for doctors. That means that it's a place where if you're a doctor at work and you see something that is really disturbing, like a particularly unusual kind of gunshot wound, figure one will let you. you take a picture of it, post it online, and have other doctors comment and favor it. Your first question about this app is probably how can this be legal? And actually, it's entirely

legal. The app forces a doctor to actually get consent from the patient that they're photographing. There's a built-in screen where the patient has to have the entire app explained to them and then sign their approval with their finger. And the app includes a bunch of rules about how the pictures have to be taken in a way that preserves the patient's anonymity. One of those rules is that you can't show someone's face really, which means as you scroll through the app, which actually does remarkably like Instagram, you just get close-ups of the broken parts of people's bodies.

Cuts, breaks, rashes. For most of the reporting of this story, I was relying on other people's description of the app because body stuff is the stuff that most squicks me out. But this week, I have finally decided to open it because, you know, journalism. And I decided to make my co-host, Alex Goldman, Open it too.

Because, frankly, he's spent a lot more time on the gross, gory parts of the internet. Forchhan, A.chan, A.chan, rotten.com. Places where people develop the kind of armor that lets them look at stuff like this without retching. Bring it on. I kind of just want you to scroll through and have the experience that I saw and tell me what you think. All right. We're beginning with a brain scan of someone who's been shot. I couldn't figure out that that was a brain scan.

Kind of hard to see. Hip fracture with femoral head. path specimen after arthroplasty. I was already having problems at the hip thing. I mean, there's like a gruesome thing, but it's, again, really hard to figure out of it was. You describe the gruesome thing? It looks like if you opened a tennis ball and there was just viscera inside it. Yeah, that's a really good description.

It's pretty gross. Any idea what this is? Patient family is unable to give us any ideas, and it's a chest x-ray with what looks like a USB key stuck in it. That got my eye, too. And then actually, one person does it's a USB key, and then like three people. identify it by name brand in the comments. So is it someone who swallowed a USB key? I think so.

I think it's probably a kid, right? No idea. Eight wisdom teeth. You keep going. Yeah. Right now, would you say you feel like it's just kind of boring? So far, it's a lot of, it's a lot of like, it's a lot of like cat scans and x-rays, so it doesn't have all the goo.

You know what I mean? You'll get to the goo. Let's see. More x-rays. Oh I take it back I take it back I just I just

scrolled up to the one That is doing it for me What is it? Male diabetic patient That was asleep at his home And woke up His toe being chewed off by a rat What

The patient did not feel it at first So the rat got most of the big toe I'm gonna go to the comments And then I'm done Oh I loaded it And I got the picture again To just try the picture to me It looks like a toe

It looks like a foot that has congealed into one gigantic bloody toe Basically I think I have to look at this Like because we're doing this I think I have to look at this All right hold on just a second Are you ready? Yep

Oh Yeah It's pretty gross I've been on the internet for my entire conscious life more or less And in that time, I have seen many things that I regret seeing. But my top 100 list of things I regret seeing is now populated, I'd say half by things I've seen on Figure 1.

The reason that we originally found out about this app was because John Herman, who edits the website The All, wrote a piece about it. John said that the part of Figure 1 that really gets to him isn't the pictures, it's the comments beneath them, left by other doctors. When you see a doctor talking about, like, a finger that's been punctured by a nail and making a joke about how the patient nailed it and then punctuating that joke with LOL. It's just, I mean, it's, I wouldn't say it's wrong.

It's just so strange to see it. Right. I caught myself feeling strange about this and then immediately thought, like, of course, this is how doctors talk. This is how I would talk. This is how anyone who faces anything like this would talk. There will be LOLs and LMAOs and ruffles and things like that.

And it's like there's, these are like the conversations that doctors would be having in a break room when they assume no one else was there. The combination of tone and subject matter is something that I've never quite seen anywhere else as a civilian, I guess. What do you most wish you could unsee of the things you've seen on it? For some reason, it's the late stage skin cancers. Those are pretty common, I guess you would say trope on here, because, it'll be someone who came in with undiagnosed melanoma, and clearly this person does not have long left. You're just seeing a cropped image of, like, a lower back

with this fatal growth on it. And then there's no sense that you're watching someone or that you're eavesdropping on this conversation about someone who has any sort of chance. All right, so we've established that figure one is a place where if for some reason you want to, you can get a doctor's view of the world. But what about the people who figure one is actually made for?

Doctors, nurses, other medical professionals. I mean, A, did anyone ask doctors if they needed their own Instagram? And also, like, if they're using it, how are they using it? Is it actually what it builds itself as, which is a useful medical tool? We'll find that out after the break. We will also find out how to talk to your husband about your exciting day at work when you spend that day at work chopping a corpse's penis off. Stick around.

I promise you've already heard the grossest part. But first, a word from our sponsors. You will always know when an ad is playing on our show because you will hear this ad music. This episode of Reply All is brought to you by Squarespace. In our last episode, we talked to Yasha Hoffman, a Squarespace user who wrote an album of songs based on obituaries. For example, he wrote a song about a guy who flew a balsa wood airplane across the Atlantic Ocean. And here, if I could pause the ad music for a minute, I'd like to play some of it for you. Skimming the lip of the ocean.

To the wet and windy Irish shore Little airplane taking a tailwind If you want to hear more of Yasha's album, you can find it at Afterneath.Squarespace.com To start your own website about obituaries, music, or anything else, go to Squarespace.com and use the offer code reply to get 10% off your purchase. This episode is sponsored by harries.com, and I'm about to confess a secret shame.

I'm just bad at shaving. Seriously, I've never learned how to do it without slicing up my face, and my wife Sarah is not a big fan of facial hair. But I got a $15 shave kit from Harries.com, which not only comes with a razor, three blades, and your choice of hairy shave cream or their new foaming shave gel,

it also comes with instructions on how to shave. It's like the father I never had. Pay attention to the way your hair grows. Which way does my hair grow? Looks like it grows down. What does the next instruction say? It's important that you shave with the grain and stay with it everywhere. I'm into it so far.

Go to harries.com right now, and Harries will give you $5 off if you type in the offer code reply with your first purchase. That's h-a-r-r-r-r-s.com and enter coupon code reply at checkout for $5 off and change the way you shave forever. Thank you for coming back to reply all. So I talked to John Herman, and for the next week, the thing he said that just stuck in my head was something that he kind of tossed off casually. This idea that figure one made him feel like a civilian. Overhearing doctors is like overhearing soldiers because you're listening to a group of people who are acquainted with death regularly and you're listening to them as someone who just isn't.

And that's why as much as an app can be traumatic, figure one is traumatic because you're getting a proxy experience of something that you don't have the training or the context to process. That was my highfalutin podcast journalist theory anyway. So I decided to test it. Hamilton automated attendance service. I called my friend Loren, who's a first year resident in an emergency room. So the first thing I learned was that, yes, Lauren and her friends do use figure one.

It's really popular, particularly among med students. And when I told her that John had used it and that he'd found it unsettling, she could not fathom that at all. Worst grossest things he's seen are like horrible images from the internet? Really? Yeah. Oh, weird. Most of it's not like gawk-worthy, I don't think.

But maybe I'm, I don't know, maybe I have lost more empathy than I thought of. know. Lauren said that for her figure one was not a useful educational tool that actually she was using it like John was using it as a thing on her phone to look at when she got in bored of looking at all the other things on her phone. I mean, I look at it kind of in the same way that I look at like Instagram. I'm not like I'm going to sit down and do some studying by looking at figure one. I'll be like I'm bored and it feels more like a useful waste of time to look at something that is at least like like tangentially related to medicine. If you were putting it on like the credibility scale with like Yahoo answers at the dumbest end of it and like, I don't know, like Mayo Clinic website at the highest end, like where

would it fall? Somewhere along the middle of the spectrum. Like it's like more knowledgeable idiots posting nonsense sort of. And there are other like websites out there that do a similar thing but with like less educational images. Like it'll be like, oh, look at this abdominal series of somebody who like has a beer bottle stuck in their butt or something. Wait, so there's like a whole doctor's gawking at patients' internet. Oh, God, yeah. Really? Yeah. I try not, like, I'm not trying to sound like a good person.

I try not to engage in it just because, I don't know, it's kind of mean-spirited. Yeah, but there's tons of that stuff. Wait, like, so what are the other places? Lots of, like, random message boardy things. Like, I don't, I don't know of any, like, apps that do the same thing, but there's, there's subredits where people post, like, for an object in, in, in, rectum kind of stuff. Loren's not the kind of person to surf the beer bottle in rectum doctor internet. But when her and I talk about her work, those are actually the kind of stories she tells me. Silly, quick anecdotes.

Like the time when she was working in an Israeli hospital and using her not-so-great Hebrew, tried to ask a patient to lean forward so she could listen to his heart. Instead, she asked him if he could lean forward so she could try to fuck him. She tells me those stories not because she's a cold, unfeeling person. She's the opposite. But she tells me those stories because they're funny, and they're the part of her day that she can tell me about. And I kind of know in the back of my head that actually there's this other thing going on, a thing that figure one shows. You probably don't look at people's wounds all day in your job.

Or like, you probably don't see people's genitalia regularly at your work. And like the questions that I have compelled to ask people as part of my job, it's like very personal stuff. Like what kind of stuff? Do you have gonorrhea? Are you sure you don't have gonorrhea? Do you for sure not have gonorrhea? Can we test you for gonorrhea? Or like, when you had blood in your stool, was it only on the outside, or was it like mixed in with the stool? Was there any mucus? Was it diarrhea? How many times? Questions that, I mean, I wouldn't be thrilled to answer if somebody asked me them. And are those the kinds of things that, like, if I say, like, how is today, you can't say you would, I didn't believe how much blood this guy had in his stool.

Yeah, and, like, I guess that's not an example of something that I find exciting, but, like, I don't know, let's say there's, like, a really interesting way that somebody died. I guess just even saying that makes me sort of recognize what the differences, because to most people, there's not, like, an interesting way to die. And I recognize, for sure that it's sad that someone has died, but there may be something that is, like, clinically or, like, physiologically. interesting about it. And same with the trauma, right? Like, you don't really care that somebody's foot was only held on by their Achilles tendon. Like, you don't really want to know more about that, probably. Like, the fact of these things happening are more commonplace. And so, there's less, like, processing time, I guess, involved. It's not like, oh, my God, first of all, I have to totally, like, unpacked and tell you that somebody's foot almost fell off. You just say that they have, like,

a partial amputation of their foot. And no one would be like, wait, what? You know? Yeah. Do you have a, like, a specific memory of talking to somebody you were close to who wasn't a doctor and just sort of realizing, like, halfway through the story that this was not going to work? Yeah.

I feel like pretty much every time I talk to Dave about anything that happens at work. Dave's Lauren's husband. I remember Dave was particularly horrified in med school when, we were doing dissections and we only had one male cadaver and we were dissecting the external giantelia and I was the one who removed the male cadaver's penis. Uh-huh. I feel like I hear it in your voice that you're terrified by that also. But yeah, that was something that I think stuck with Dave in a way that he wished it wouldn't.

The same way, like people ask soldiers, they killed anybody. I know intellectually that when you're at work, sometimes people die. I bet the number of people who I think you've seen die is crazy low compared to the amount of people that you've seen die. And I don't think that's just because I don't know hospitals. I think it's because my brain starts shouting when I get close to that. Like, I would say, like, less than 10. And I bet it's not less than 10. Yeah, no.

I don't know. I mean, I think that there is some degree. of sort of, like you have to disengage a little bit, right? You can't feel everyone's pain as though they were your own or else you wouldn't get through the day. I remember the first time I saw like a code. Wait a code. What's a code is a CPR?

Like a resuscitation, CPR. Like a code blue is when somebody found them responsive typically. And, I mean, it's done actual cardiac arrest, then they'll do CPR. Yeah. And I remember the first time I saw that as a med student. It was like super traumatic. Like it was, I recognized intellectually that like what people were doing and that they were trying to do somebody's life.

But it's not gentle. It's not like it looks on TV. What's it like? Violent. You break ribs and you break people's sternum and like, like people always make jokes about like how bad TV CPR is. Like the TV CPR is. Like the TV CPR is too gentle?

Oh, yeah. Nobody would ever come back from that. Did the person die? Yeah. And I think that was even the weirder part, was when everyone was kind of like, okay, like, we've run this for a long time. Anybody have any other ideas?

Everybody was like, no. And then I stopped. And you're like, it's sort of this juxtaposition of this, like, really violent thing that you intellectually know is a good thing and that's what you should be doing, if that's what the person wants, and all of that stuff,

and then just like, and we're done. And everyone I've talked to the first time that they saw CPR, they felt the same way. But gradually, people who actually work in medicine learn to do what Loren learned to do. They learn how to feel enough that they're still human, but not to feel so much that they're overwhelmed and they can't help their patients.

They develop a way of talking about the world as they see it, and they mostly keep that language secret from the way. rest of us because we won't understand it and we don't want to understand it and then figure one stumbles into the whole thing I asked Lauren if it bothered to imagine civilians like me or John looking into her world I never really considered that like I never considered that it would be interesting to anyone other than people who look at images like that all day long when we were talking on the phone a few weeks ago and I was asking you if if like learning medicine was like being a soldier that you felt like you end up in this place where you're experiencing a world

that you can't totally explain to people on the other side of it. And then talking to John, I felt like he was like looking through a window at this world and like totally being traumatized by it. Yeah. Like it seems like you're just like, yeah, this is the world. Yeah. And I think maybe like I don't have a great sense anymore of what it's like to not see it the way that I see it. I can remember what I was doing it. It was somewhere in one of the senior residents was draining it like a perianal abscess or something. Like it was something that like understandably there was like some anxiety on the behalf of the patient. What's a perianal abscess?

It's when you have an abscess like right around your anus. Oh. Yeah. You have to drain them. But what the resident said was he was like, he was like, you know what? I know this is anxiety provoking for you, but this is just like this is what we do at work. The writer Paul Ford once said that the thing. about social networks was that they gave you a different kind of story. Unlike a book or a movie

where you get three acts, beginning, middle, and end, a lot of times the internet just gives you the middle of someone's life. And it gives you that middle over and over again. Figure one is that in the purest sense. A picture from somebody's day at the office, and we fill in what comes after, whether we're equipped to do that or not. The Friday before this episode went up, I got a text from Loren that was unlike any she'd ever sent me. She said she just wanted to let me know that she was really excited for work that day. She was going to get to see an organ harvesting. Ugh.

Reply All is Alex Goldman, Lena Maseezis, Caitlin Roberts, Alex Bloomberg, and Matt Lieber. Our theme song is by the Mysterious Breakmaster Cylinder. If you want more Reply All, go to our website, gimmelitmedia.com slash reply all. You can also follow us on Twitter,

on Instagram, I think on Facebook, too. Thanks for listening, and we'll see you next Wednesday.