Rev Left Radio - All Too Human: Dr. John Ukadike on his Experiences in Emergency Medicine

Episode Date: June 9, 2026

In this installment of our All Too Human interview series, Breht and Dave welcome Dr. John Ukadike, a physician and emergency medicine specialist, into the Shoeless Shed to have a fascinating conversation about his experiences as an ER doctor, his treatment of many patients who struggle with addiction in various forms, his personal relationship with religion and death, his understanding of and approach to general health, the challenges of informing family members that a loved one has passed away, his critiques of the for-profit American healthcare system, and so much more!  Check out John's articles on a wide range of topics here: https://pubmed.ncbi.nlm.nih.gov/?term=john+ukadike Follow John on IG HERE ------------------------------ Contact us, support us, follow us, or learn more about the show here: https://www.shoelessinsouthdakota.com Learn More about Rev Left Radio here: https://revleftradio.com/   Outro music: Millionth Time - Spinitch https://spinitch.bandcamp.com/album/run-for-the-arts-spinstrumentals  

Welcome back, everybody, to our All Two Human series. And today we have a different kind of guess that I'm really excited about as far as the perspective from a non-addicted person. But that is very much for what they do in the world and actually so much in the far end of the world. This is a person who works in the ER and really see sometimes the tail end, the hardest point. parts of people's stories and sometimes the parts they live over and over and over again. And so it's a great perspective and I just want to welcome here, John. Yeah, yeah, I appreciate it. And I'm John Yucata Kay.

I'm board certified in family medicine and I'm also finishing a emergency medicine residency. So I'm board eligible. So we'll be board certified here in the next few months, hopefully, in emergency medicine and family medicine. So I appreciate you guys having me here. Yeah, absolutely. It's a pleasure. I guess the way to start here is maybe talking about your backstory, specifically what got you into medicine and kind of your path to where you are now. Yeah, you know, it's probably run on the mill.

Really loved working with people, being around people. I really loved understanding how things worked. Always thought I was going to be an engineer. Ended up taking calculus one and was like, whoa, I'm terrible at math. It's not for me. And, you know, switching over to something more science-based. and, you know, kind of the rest of history. College, grad school,

med school, kind of did the whole, the whole gamut of education, been in school forever. So this is, I guess, 10 years now since I started med school. And then went to residency, wasn't a big fan of the clinic life and really wanted a little bit more of that kind of high-acuity, kind of dangerous, scary things, you know, like you see on TV, which is rarely,

is it like that in the ER? But sometimes it is. And it ended up doing a second. residency after graduating from family medicine residency. So kind of seen the whole gambit as far as the day-to-day, come get your blood pressure checked kind of things to, I've been shot, et cetera, and we need trauma, resuscitations, kind of thing. So I think I have a unique perspective in that regard, and I hope that I can at least give some of those thoughts and opinions today. Your shift from family medicine to emergency stuff, is that just the motivation being that you

wanted to have a different experience. You wanted to kind of, like, how would you articulate that? Yeah, you know, I worked in the ER for years as a scribe, you know, before AI and things. I would be the no taker for the physicians. So I was there for years. And I really love that model of really being there for you at your lowest point. No one wants to be the ER. And it kind of sucks to be there. But there's also a lot of really great takeaways. And you can have a really big impact on people on the data. day and I wanted to do emergency medicine for a long time ended up in family medicine had a great time there but still felt that itch for that higher acuity and ended up just doing a second residency you can work in the ER as a

family medicine doc there's a lot that do do so in Arkansas where I'm from we we have a great need for ER docs but family medicine and like nurse practitioners advanced practice nurses do a lot of that kind of in the rural areas which I'm very grateful for. But I wanted a little bit more of the training. So I ended up, ended up doing a second residency, like an additional three years. Just at a pure curiosity, did you grow up in Arkansas? Yeah, yeah. Born and raised from Litter Rock, Arkansas. My whole life, I lived there for, you know, almost, I guess, 30 years until I moved to Nebraska. And I've been here the last few years. And it's been awesome, just a little colder and windier. Yeah, what's, I'm curious,

because Little Rock is kind of like a mid-sized city and it's in the south, but it's kind of resident with Omaha? What are the differences between Omaha and? Yeah. You know, I would call Litter Rock. Like the deep south, you know, Central High Nine is there. There's a lot of deep-rooted southern history in Litterok. It's maybe 200,000 people, I think, and the Metro here is, what, a million almost. So this is the biggest city I've ever lived in. It's, uh, it's been a kind of life-altering with how much there is to do. And, um, this city's been very welcoming to me. And I've been very grateful to be here and have had a great time.

I used to live in Bentonville for, oh, yeah. Yeah. I went to college and Fayetteville. Did you ever go to Crystal Bridges? Oh yeah. It's phenomenal. The Walton's are really helping billions of dollars into Fayetteville. Really? You know, I could be wrong. I'm pretty sure they're opening a med school this year

that is free for the first class or two or something along those lines. So, yeah, a lot of really cool opportunity in Arkansas if you ever want to travel down there. Fayetteville is a great place to go. That's where the Walton's come from? Yeah, it's where Walmart. Walmart is invented in Bentonville, I think, or Rogers, yeah.

Both my parents worked at Walmart at them. Yeah. By the way, FYI, if you don't know, Crystal Ridges is the art museum that is founded by the Walmart and named after a porn charm. Is that true? I don't know. I don't know that. Fact check that one.

Yeah. Yeah, the Walton's are up there doing good things for the community. Interesting. Interesting. All right. So, yeah, Dave, you want to take us into a specific question? Yeah. So one thing of that, I'm just curious about working in the field and the specific sort of

field is what is kind of the day in the life of ER? I know it's probably like every day is different, but like because the way I imagine it, maybe it's just me, but it seems like is it just literally one thing after the other where you get done with the patient and it's like, all right, onto the next emergency, like just putting out fires. Is there an actual like structure? Is it more structured? What's it kind of like?

Yeah, I think really it depends on where you work. You know, so if you work at a major level one trauma center, which is kind of the high acuity. That's like the pit, basically, where everyone goes, the gunshots, the traumas, et cetera, et cetera. Yeah, it's a lot of fires and a lot of lower acuity things that probably need to be addressed. So I think a great example is if you work, I don't know, 12, 14 shifts a month, you go in, it's six in the morning and it depends on the day. So if it's Monday morning, it's probably going to be pretty chill. People are going to work kind of hanging out doing their thing. As the day progresses, Mondays tend to get slammed. That's when you, you're like, man,

you know what, I didn't, I didn't have any of my meds, or I went on a bender over the weekend, or my chest is really bothering me and people start trickling in that mid-afternoon, Monday morning, at least anecdotally for me, is usually a rush of, that's when the ambulance to start coming in. That's when grandma wakes up, you know, 10, 11 o'clock is not acting right today. And it could be as simple as I've had a cold for a few days, and I don't know what to do, and I couldn't get a hold of my PCP. So I came here because it's just, it's easy to just go to the ER and get some help, which is fine. to so-and-so is in a car wreck going to get lunch,

and they're getting CPR on the way in, and we need to do something about it right now. So it really just depends on the day. So some days are insane, and other days are, you know, somewhat chill. It just depends on where you're at and kind of how big of a community that you're in. Okay, and one thing I was always very curious about. As far as so, like, there's obviously there's like tears to the emergency. So if it's crowded, you know, there's just a bunch of people in there.

What is the process of how you choose, like, the hierarchy of emergency? Like, what, you know, there's a person that just like, my feet have hurt for four days. And then they come in right before gunshot victim. Or maybe there's one more severe. Like, do you have, like, a council of cloaked people that, like, are like, thumbs down, he goes in front? Or is it like a golf leaderboard where you move, like, an app, no, hard attack goes above the feet hurt?

Yeah, you know, it's funny. It does change. And it depends on where you're at. Some people have physicians in the lobby that, triage you. Some places have nurses that triage you. But basically it says, why are you here? What is the problem? And then what is the acuity of that? So if you're having crushing chest pain that started an hour ago, you're going to be seen before the four-day foot pain. And the goal is to treat the sickest people first who may die sooner. And that's the point of the ER is we don't

want you to die today. We are hoping to intervene to stop that from happening. And that's kind of the the unintended consequence of when you go to the ER for things that are lower acuity, you don't know that. I don't expect you to know that. You're not a physician. It's not your job to triage yourself in that sense. But it is hard when someone's sitting there. It's like,

I've been here five hours and all these people keep getting called in. He may just come on a day where there's a lot of sick people, man. Or if the ER, the waiting room sometimes gets crushed and no one's moving, well, you didn't see the 10 car pile up that came into the back door. And now we've seen no one for the last thing. hours because the entire team is now, you know, in the trauma day resuscitating. So it's,

it really is that ebb and flow. And you have to try and switch that off of, wow, someone just died, let me go talk to the foot pain, which is fine. You still need care. I still want to help you. But sometimes you have to remember that if you're really mad at me for how long you've been there, it's a good thing in my opinion if you've been waiting for a long time in the waiting room, because it means that we don't think that you're going to die right now. So it's silver lining, I guess. No one wants to wait. I get it. They just pull the wheel out. like a bucket of dirt in here, just rub this. Because I remember specifically one time I was in the ER because I was going through withdrawals

and they were starting to scare me as far as like a seizure coming on. Things were very shaky and my vision was actually blurry, not from intoxication, but it was like, uh-oh. And I remember sitting there, I've been waiting there forever and I was like, okay, hopefully I think I'm going to be next. And then right as I think I was ready to go, this dude is like wheeled in who's like bleeding all over his head and like, I was like, damn it. Like, all right, never mind, whip out the mobile phone again and start playing some games because it's going to be a while.

Yeah. So I have a question. My, like I had a family member that went into the ER for a stroke. The cause of the stroke for me knowing the background information, you know, this person is an alcoholic. They don't eat well. They're malnourished. They don't take care of their body. They'll actually, and a lot of alcoholics do this where they drink all the time, but they eat very, very little.

So they're getting poison, but they're not getting any of the nutrients that their body needs. Yeah. In the ER, that person was stabilized, was taken care of. But there was no discussion whatsoever about these background conditions. And I was kind of like wounded by that a little bit because I want a professional to tell this person, the reason this is happening is because you're drinking too damn much and you need to stop. But then I kind of understood, like, maybe the goal of the ER is to stabilize and get off. And if they have a general practitioner, a general doctor, that's the person that has that conversation. So with that in mind, can you help me understand that?

And what is the main goal when you see somebody come in from the perspective of an ER doctor compared to, perhaps, their general physician? Yeah, for sure. Well, you know, it's hard to, it depends on how many people that are waiting on you as well. But the main goal, my job is for you to not to die today. That's the goal. And that's just, that's the reality of the emergency room. That is the emergency that we are treating is that you should not die today. And hopefully not in the next couple of days.

We want you to be able to get along until you can see your primary care physician. When you come in and you're drinking and you're withdrawing and we stabilize you, the question really becomes is, do you have a history of withdrawal seizures? That's a big thing that I really care about. Because if you go home and you quit drinking because you're trying to cut back, you seize and you die, no one sees you. You're alone. That's a problem. Versus, yeah, you know, I go through withdrawal. I get a little shaky.

I've never had a seizure. After a few days I get through it. It really sucks. Then we can help you outpatient or we can send you to the local rehab or whatever. whatever it is, whatever in the city that you have. Here we have a lot of places that we can actually transfer you to where they can screen you and decide do you need outpatient meds and we'll just give you like adaband or whatever to get you through this for the next few days until you can see your primary versus, yeah,

ICs on day two 100% of the time. Then the question becomes, do you want to quit drinking today? And a lot of people say no. And if that's, and that's fine, tell me that. Because we'll let you leave. You should go now because you should go drink. because you're going to have a problem. I see it.

Versus, yeah, I really, I'm ready to try and stop. All right, come on in. We'll get you admitted. We're going to get you the meds. We're going to get you through the seizure, which is the thing that will kill you and then stabilize you. With the hope of now that you're through this, the hard part really begins is you have to now avoid drinking forever.

And that's that kind of vicious cycle is I can help you in for a couple of days. No problem. Can you say no repeatedly for the next several months? months to get yourself out of that and then hopefully keep saying no moving forward. Now, do you have people come in who are obviously dealing with addictive issues who are not up front with themselves or others about that? But you know that this is obviously a consequence of addiction, but this person is unable to even face the fact that they're struggling with addiction? Yeah, absolutely. I think it's hard if you're not ready to hear it. And that's those

stages, you know, of acceptance and denial, et cetera, et cetera. And I'm very blunt with people. I think It's just part of my personality. So it may be useful, maybe not. It depends on how you respond to people talking to you. At least for me, I'd say it's like, hey, man, you're drinking too much. You keep coming back here. The reason you are here is because you were intoxicated. And we try and link those things, at least for me,

and say, look, every time that you get drunk, you meet me. And you shouldn't see. We shouldn't know each other by name. And we do. And so maybe you have a problem. If no one's told you, let me be the first person to tell you. And I tell people that all the time. And you can see.

the relief on family members faces when I say things like that. I was like, they made yell at you and it's annoying. I do not care. I'm just here to tell you that you're drinking too much. So you need to do something about this and we can help you if you want it. And if you don't want it, that's okay. If you change your mind, you don't know what to do, come back. We're open 24-7. Come back here. We'll help you. Doesn't mean we're always going to be super thrilled to see you, but we will always help you and try and give you the care that you need. Yeah. Because I knew there's regulars just from talking with people in you know, in rehab when they get there,

they'll talk about how, like, the past year or the past six months, they were like, yeah, I was in the emergency room nine times, you know, like, just in that past, and it, um, one thing with, uh, addiction, especially with, like, with drinking is that a lot of people hit this point where functional, fine, fine, kind of functional stuff like that, no real thing. And then they start hitting a problem and then that problem just keeps happening

quicker and quicker and quicker to where it's like I never had seizures before. Or I never like, something as simple as like I never threw a bile. Now every single time now I'm throwing it up. And it's like it breaks like a seal on something to the body's like, okay, we're doing, this is now this problem we're going to have every single time. And I really think, I don't know, maybe there is something like this where people working in the ER, it was supposed to give them a little seminar or something. Like, here's the deal. Maybe you've seen like the movies where there's the person that's the alcoholic and then they triumphantly, you know, make it through because there's a motivational speech.

or something or be prepared to see people just absolutely destroying their lives insane, super in denial that almost borderlines like insanity. And yeah, this is what's going to happen. You're going to be, because, you know, that was what I thought was interesting about your perspective is seeing like the true craziness from the perspective of not even knowing, like, the way I do or even working in the field intimately knowing that, yeah, some of these lives are just like unbelievable in the. in the way that they just keep they shoot themselves in the foot reload shoot themselves in the other foot yeah yeah

yeah it's you know it's hard at least at least for me i again i don't struggle with addiction i don't understand what it's like to to need that um but i can understand that no one ever woke up and goes today is a day that i drink for the rest of my life you know because i'll drink occasionally it's fun i have a good time it's no you know no big deal but then some people i've gone out with before they drink and you know that they're going to be on the floor and they will not stop And I was like, dude, you got to chill. Like, you can't. And so you start to distance yourself from those people because you don't want to be associated

with just the insanity of like, man, every time I hang out with you, the cops get called, you know, or something happens. You're punching walls. It's like, well, I don't want to. I can't, you know, I don't want to be around that. But in the ER, they come in. People come in really drunk. And that's when staff gets assaulted and they're hitting people or they're being arrested

multiple times. And the cops are like, well, you're just drunk. You just need sober up. We're going to take it to the ER for like a medical clearance kind of thing. So it's, it becomes a. safety issue both for the staff police and for us. You know, I've seen a lot of nurses and people get, get injured trying to stop someone from hurting themselves because they're so intoxicated, they don't understand what they're doing. And there's no redirection other than we are going to

basically drug you into a coma to stop you from hurting yourself for others. Then you wake up in 10 hours like, what happened? I'm like, man, you know, it happens frequently. But, you know, you try to remember that no one chooses to do that. You would never look at yourself in the future. Oh, yeah, I'm super proud of who that person is. But for whatever reason, you started drinking, you couldn't stop. And at least from my perspective, it's an accident. You didn't choose to do that. So how can we help you get out of that if we can? When you speak, it's very clear to me that you seem deeply motivated or perhaps just part of your personality that, you know, and maybe this is true of most, doctors and nurses, that you have this compassion towards people.

Um, is that something that has animated you on this path throughout your life? Did you get into this? I mean, it gets great money professionally. It's well respected. You do have some sense of status. But I wonder, like, is the, is there a core motivation to help other human beings? And if so, where does, where do you think that comes from in your life? Yeah, you know, I think a lot of it comes from my parents and my mentors.

I was, I had a really, like, nice childhood. And I, both my parents are so married. I went to private schools. Like, I had all the opportunity. world to be successful. So I don't think that I did anything that was to be commended because if you put most people in a situation with good finances and good education, you're going to be okay, I think. You know, that's just my personal anecdote. But, you know, my mom and dad grew up absolutely impoverished. My dad's from Africa, like middle of nowhere, no running water, no streets, no nothing.

My mom grew up in the middle of nowhere, Arkansas, like in a trailer with water dripping on her bed at night, you know, from the roof kind of thing. So they worked really, really hard to put me in a situation to do well. And I think the mentors I had and working in the ER, they showed me that compassion matters more than anything, in my opinion. And most people who come to you for help, especially in the ER, they are in pain or they are scared. So if you treat pain and fear and you don't know what you're doing or you don't solve their problem, you'll still be a great physician, in my opinion. And I've had a lot of mentors.

Dr. Wendell Paul's was a big mentor mine. He taught me that. And I think that really stuck with me when I was not in medicine, that most people just are scared or they're hurting. And if you can help those things, it'll make a big difference. And I think that really helped me along through medical school. And now seeing people get better,

you're coming to me because you're scared. I don't know. I'm going to withdraw. I have a problem. And if I can help you with that, man, it's it's it can really change your life and then people have kids and other you know what I mean it's and I don't I hope that everyone else gets better around you because you're doing a little bit better and that's to me a big takeaway so it's not always altruistic I'm not some altruistic guy you know

it's not all like sunshine and rainbows um but that's the goal I try and go into um each shift and not well always but that's at least the takeaway is look I'm here you're here let's figure something mental man. It has to be rewarding to calm somebody down to help them alleviate their fear, to take away their pain for a moment, to solve a problem for somebody and see them walk out the door feeling much better about themselves. But also you're a human being, so you've got to also wake up some days, pissed off or in a bad mood, and have to go and have those hard conversations. And it's a hard to switch on super compassionate doctor guy all the time. Absolutely. It's really difficult, especially from an alcohol perspective, if you were coming in drunk all the time, you open their

chart for our EMR or like our record keeping if it's red it's an ER visit and it's just a wall of red and it's like man you know like what am I going to do different for you today that we didn't do the last 100 times when you were here and I think the hard part is it becomes dangerous because are you sick today or not and that is the biggest fear I think at least from an ER perspective is there's been drunk guys I've taken care of, drunk women I've taken care of who come in all the time. I'm talking about the same day. Like, I will come in the morning, you will leave. And before I leave my ship, you were back hammered again.

You know, but this time you had a head bleed. Right. And it's like, well, shoot, I didn't CT scan this person. Should I have scanned this person's head? Because they're acting a little bit different than normal when they're drunk. And it becomes this risk benefit of, do I just CT scan everyone that's coming and walk in the door? because you're altered, are you altered because you're drunk, or did you fall down and hit your head?

Right. And it's hard to know because those are the people who really get sick super quick because they don't take care of themselves at baseline. Right, right. Yeah. I have a, sorry, there's probably going to be a bunch of maybe kind of random, but specific questions. Sure.

I wonder about when it comes to this stuff, protocol and discretion. So let's say with people that come into the ER, maybe there's a case where someone takes them. Like a family member takes more likely that the wife or the husband and they're usually with their with them a lot. And you can kind of maybe tell it's a, you know, a house of denial or the person's denying it. And it seems like over their history, they seem to be getting worse. Is it like against rules? Is it just up to your own discretion or is loud or I don't know?

Is it, if this person is super in denial, would you ever or could you ever say something to the? family member about like look they're they got to they got to get help like and again not talking to them because maybe they're just a brick wall or they just they don't care but you ever have the conversation with even the person that brought them if they're like family or loved ones yeah yeah absolutely usually what i'll do is if you're in the room uh i would say hey it's okay if i talk in front of your family and i like yeah well that is now permission for us to speak about your medical record um like with that person because some people like no i don't want them have them step out or i don't tell my wife or don't tell my partner whoever um so yeah people who come in family members are so lucky and i i

really try and stress uh in those moments that you have someone here who loves you and who cares enough about you to come into this shit show with you into the er wait for however many hours you're in this room you know you're drunk and they're they're still here cherish that and let's try and lean in and have them help you figure out how can we do this for you. Because they clearly are invested in helping you. And I love when family members, they'll kind of wave at you to be like, hey, can you talk to me out in the hall kind of thing. It's like, hey, here's what we're doing.

What can I do? What are the resources? And it's so helpful. Versus, when you come in alone, I just got to wait for you to sober up because I don't know, because I can't trust you. I don't know. I don't know. And it's not that I can't trust you because you're a liar.

I can't trust you because you're drunk. So I have no clue if you know what you're saying is true. I don't know if the story's true. I don't know if you're injured. And that's why we end up doing so many CTs in labs and all this stuff. And it's like, oh, everything's always normal. You do nothing for me. And it's like, well, yeah, I mean, we made sure that you weren't dying.

But I can't ever tell if you're dying or not because you can't tell me. So the family members there, like, love it so much so. But it gets rare and rare, I feel like as people come back more and more. Right. I've experienced that where they drop off. And again, it's not in this way where you're like resentful of this. Maybe some people are, but you're like, yeah, I mean, why at this point should I waste my time? You're like believing in you when you don't believe in you.

You don't even want it, you know, like you can't. It help comes to those not who need it, but who want it. And there's, you know, over time those ER visits get old. And you also weirdly get used to those chaotic moments where, you know, like I could imagine the first time someone went, you know, to the ER where they're like, oh my God, we're in here. there's like still, it's like the six times they're like, all right, yeah, the vending machine's down there and it's like, you know, like, I remember the first time I went to the psych world, I was like, this is such a big moment

with my lights crashing down. Then like the fifth time, I was like, yeah, I remember not to bring a belt. I remember that. And I wonder, do you have coworkers that ever show signs or, it's totally human, it would be expected, that get a particular fatigue with alcoholics or addicts, probably mainly like alcoholics again because of their drunken behavior and a bit and again because like

the idea of it being avoidable like you're doing this to yourself these people this person was hit by a car they couldn't avoid you keep doing this to yourself yeah you know i i think everyone has fatigue uh for things that are avoidable but we chose to be there too um and i i i had uh one of our mentors recently told us that when you start to hate your patients that is what we call big B burnout like you're really starting to burn out and they had felt that at at some point we're like man like why are you here this is so stupid like stop coming in for these things and you know sometimes I feel that way too it's like come on man like just take two seconds and realize that you could have done you could have made a better decision but in the reality of it is is you're scared or you're in pain

And it always comes back to those two things. And if you can remember, you're here and I'm here, let's just try and figure something out. That really made a big difference, have made a big difference for me. The mentality that you have to go into it. You can be exhausted and like, not again.

But at the end of the day, you're here and I'm here. You need some help. And I have the tools to help you. And I need to remember that. It's like, I've been in school for 10 plus years for medicine. You have not. And it doesn't mean that I'm God and I know everything. but I know a whole heck of a lot more about this than you do.

So let me try and help you figure out a plan. And it sounds so silly and so simple, but it is exhausting, but you can continue to help and even just making sure that you're safe today. You know, I don't mean not to sit down and talk to you about your family for the next 30 minutes again, but at least that you're safe today.

I can do that. Yeah. You know. That's fascinating, the resentment towards your own patience that could possibly build up just as you're under exhaustive pressure all the time and then you start seeing these same people come in

for the same reasons or self-destructive and sabotaging behavior. It's fascinating. We've talked about alcoholics quite a bit. I'm wondering what other substance abuse do you see the most? What people come in for the most outside of alcohol? Because I just assume statistically alcohol is legal. Most people are going to be engaging with that. They're engaging with substances in that hardcore, addictive way.

But what else do you see? And how do different patients under the influence of different substances need to be treated? like somebody coming in took too much LSD or something like that compared to somebody coming in on a fentanyl overdose yeah yeah you know it's all anecdotal right i guess it depends on where you are in the country uh i feel like i see a lot of cratum uh and a lot of what is it is it double o seven double o h or something yeah like 708 7 oh8 yeah and it's it's super addictive and you it's just it's gas station heroin is what we kind of jokingly call it right and it's you end up you end up going through really bad withdrawals and come to the ER.

Like, I'm freaking out. I have to go to the gas station every four hours where I'm going to withdraw. And there's, you know, we see people who do those things because they're trying to get off drugs. And then you end up doing cratum and you end up going to work, going at the gas station, going to work, going to go and that's all you do. You do nothing else except to get cratum.

And so it really depends on the substance you're doing. You know, people do meth and heroin and, you know, all the, all the things. It just depends on are you violent or not is the big thing. I didn't really realize until I started working in the ER that people who seem to be insanely unreasonable, like there's nothing you can do to talk them out of a situation. I was like, oh, you're intoxicated. And those were things I used to think about, you know, where it's like, oh, why would you,

you're at the airport and you're punching the, what are you doing? That's nuts, right? No one would do that. But it's like, oh, you're just drunk or you're high, whatever it is. So, yeah, we see a lot of intoxication things. I really care about alcohol because it'll kill you. Right? If you seize, you're going to die. Some of the other drugs that you do are, you're going to feel really bad, but you're not going to die.

You might feel like it. And you should come to the ER, like, we'll help you get through it. But from a risk of death scenario, alcohol is the one that's like really a big killer. No obvious is an issue to quit breathing. And that's the hard part is you don't know what drugs you're getting if you're just buying them off the street kind of thing. Oh, absolutely. Yeah, that's a crazy aspect. I'm wondering if you ever see like people coming in too high on marijuana or people on psychedelics that are flipping out but you know they're they're completely safe they're

physically fine yeah but mentally your your role now is to calm them down yeah yeah yeah a little bit too much of the fun stuff and you freak out but the answer is uh we'll put you on a monitor man we'll give some fluids we'll hang out we're just going to let you sober up for a while totally you know and if you need to be redirected we can and i hate doing that i don't ever want to like chemically restrain someone what do you mean redirected uh yeah like with meds right if you're violent if you're just if you're thrashing around, if you end up in a room that has a garage door in it, like, you're a threat. Yeah.

You know, that's not, that's not, if you're in a room where there's nothing that you can grab onto, we are worried about you, you know, and if, if there's cops standing outside the room, you should reassess what you're doing, you know, the cops shouldn't be hanging out around you. But yeah, it's, we can call it chemically restraining. We can give you meds to stop you from doing things if you won't verbally de-escalate. Most people want a sandwich, you know, and that's okay. We'll give you a sandwich. we'll kind of be like, you know, Bill, stop it.

Sit down, Bill, you know. And most people do fine. But if not, we can get as aggressive as you want us to get. But that's never the goal. I don't ever want to do those things. Sure. But it becomes safety at that point. Absolutely.

I have another weird question. This is kind of particular to me a little bit. But I've struggled with hypochondria, health anxiety, OCD. So there's been many times, not to the ER necessarily, but many times where I've convinced myself I have some horrific thing. And, you know, I've been working on that overall. and relatedly I have a friend whose wife is a ER nurse and I said oh it would be so nice I have hypochondri

it would be so nice to have like a doctor or nurse in my family because I would always be tapping them like can you just make sure this is but then he said he laughed he said actually no it's the exact opposite she's around people all the time and and she thinks the human body is so robust that she's actually dismissive she's dismissive of my like concerns which kind of she should be yeah yeah yeah so I'm wondering if a two-part question how robust is the human body? And also relatedly, people coming in with psychosomatic hypochondria,

basically fundamentally mental things that they're convinced are physical and you have to work through that. Yeah. Yeah, the human body is nuts, man. You can live through a lot. You know, and you can drink for years and years and years and years. And if you quit, you tend to get better. You know, most like it's like you may not get back to your baseline.

Yeah, you're normal. Sure. But yeah, you probably, you probably be okay. You may have knocked a few years off your life. But yeah, if you quit drinking, your liver gets happier, your blood counts get happier, you feel better. Like, you start to lose all that water weight in your legs. You know, it's kind of, it's kind of wild how much you can heal despite just trashing yourself for a decade. And quickly.

Yeah. Like, it's, it's wild. You know, and that's, that's the hard part, too. If you drink again, then you spiral right back down. So, I think that to answer the second part is that's why you need a primary care doc. Yeah. We beg you to go see your primary. I understand it's hard and it's not as easy as, oh, yeah, let me call them to get in.

It might be a couple of weeks. And then you're in that situation. I'm like, why I feel like I want to be helped right now? And it may not be an emergency. And that's why you end up sitting in the ER for five or six or seven hours. Because, yeah, like, we can address this problem. But it's better solved with your primary who knows you, who can give you meds, et cetera. For depression, if you want to hurt yourself, come to the ER.

If you're depressed, I'm not going to prescribe you an antidepressant out of the ER because I'm not going to see you again. Those first couple of weeks are high risk for people who are depressed on new meds, right? So you need short follow-up. You need to help. You need someone to see what we're doing for you kind of long term. But you're always welcome to come to the ER. If you're depressed, you don't know what to do. Come in, man.

I'll get you plugged in. I'll tell you exactly what to do, how to do it. But it's sometimes the mental health things that you need, I can't address today. or I can't, let me say, I can't solve today. I can absolutely help you through whatever you're going through, but I definitely not going to be able to solve it right now. Have you had people come in who are convinced they have a physical ailment that you know they do not?

Absolutely. Yeah, it happens quite a bit. Absolutely. And the answer is usually get some imaging of it and try and show them that there isn't any. And if they don't believe you, then we can try and address the underlying causes of why do you feel that way? But at the end of the day, it's not my job to do. then you don't have parasites in your bowel. I've proven that there aren't.

I can plug you back in to get some help if you want it. That's an interesting one, yeah. Happens a lot. I was wondering. Happens a lot. Yeah, how much that does happen. More than you would think. A lot of, like, I have snakes in my bottom or, you know, like, or I have flies coming

out of my, out of my mouth kind of thing. I'm like, you don't, but we'll prove it. And then when you don't believe me, we'll talk about, hey, like, did you do meth today? did you do a drug today? That's beside the point. You know, like, because sometimes that's the obvious. Everybody goes to that. That's better, right?

Sometimes that's what's happening. But we will roll it out. Yes. And then I'll be like, hey, what else? Tell me about the drugs you use today. But there's been instances where there's no drugs involved and it is just a mental thing. Sometimes. I mean, sometimes you could have something that it's where you were having some type of,

what I call like a, I guess a hallucination where you need to have something corrected. Yeah. And maybe that's an electrolyte problem. It's a thyroid thing. Maybe you just need to be on an antidepressant or antipsychotic, sure. But we'll make sure that it's not actually happening. And then at that point, we're back to that. You need a primary care doctor.

Do you think, just in your own opinion, I mean, I don't think there's a way you have any studies or way to look at it. But just from what you'd guesstimate, do you think that more people go to the ER these days because of like the web, Eb-M-D effect because so many people, because that's what I was thinking of, like, the non-otoxicated or drug people going. Like, why would they? Because there are some people that look something up and they're like, it's cancer. Like, everything says it's the worst-case scenario. And if you spend too much time doing that, you could, even if you don't have like, you know, OCD or anything, you could just, you look up too much. You go around a rabbit hole and you're like, and then you're like, because every once in a while, you'll get a weird pain or like, you're like, did my heart do that?

Yeah, dude. You know, if you're healthy and it's like nothing else, then it's just like, you're like, whatever. But if you were to look it up and then you just start going and, you know, some Reddit board's like, it will kill you, dude. My uncle in Alaska that you never met and died from it. And like, do you think more people are like quicker to reach out for emergency help because of that? Or is it just like, I don't know, people have always been doing that. You know, I think all roads lead to cancer, right? If you Google something, eventually it will say that you will die of cancer.

I, you know, I don't know if it makes you go to the ER more. But I do like it when people are like, hey, like I looked online. I was kind of worried about these things. That's totally reasonable. You know, I want you to advocate for yourself and go look for the answers. Most times, it's probably okay. But, you know, every now and it's like, you know, some didn't feel right now. I think I have a blood clot in my lung.

I was like, oh, okay. And then you look at, oh, shoot, you do. You know, like those things happen too. So if you want to look up things, just know that you may end up in a rabbit hole and think you're going to die of cancer. And if you are afraid of that, come on in, man. we'll talk about it. There's an interesting tech shift too because before like AI, WebMD or Reddit where your main goes and those are always escalatory and catastrophizing.

Whereas I think these AI models are increasingly more prone to calm you down. It's like, well, hold on. I don't think you have, they're more like kind of reasonable in that way. So perhaps people are shifting away. In the depths of my hypochondria before I knew that I had this OCD thing, it was Reddit that I would constantly be going on and it was, yeah, worst case scenario every time. Now if I try to seek reassurance through a chat GPT or something, it will tend towards calming me down and saying the odds that you have this particular thing are so statistically low.

You know, kind of calm you down a bit. And the one thing, too, just with that, like if it is AI and has like this professional design, or if it comes from something like that, you're probably more willing to give it merit than like a Reddit board because someone could be telling you good information, but their username is like 420 boobmasters. So you're like, okay, I'll take that for what it's worth. But like the AI, it could be just as dumb, but it has like the sheen and the guise of like, I am an intelligent robot guy. True.

And yes, you should cut your arm off. Like, it will just tell you nonsense. Absolutely. Related question, kind of. Is you're studying health, you're helping people with their own health issues all the time. You look obviously like a very healthy guy. How has your experience being a doctor shifted your understanding of health and to a general population? What would you personally recommend is like things that any.

anybody can do actionable items that meaningfully increase their overall health. Yeah. You know, drinking less is always a great answer. Like I lived to before, I used to go out, you know, two or three times a week. Like we go hang out, left across the street from the bar. It wasn't a big deal. But my health was definitely worse. I was definitely heavier.

I craved going out to restaurants. I would order DoorDash all the time because I was like, I'm too tired. I'm not going to do anything. I didn't work out for three or four weeks in a row, et cetera, et cetera. Whereas now it's like, you know, if I drink, it's pretty rare. I may have had a drink in the last six months or something. And it's not because I'm worried about drinking too much. I just, I feel bad the next day after I drink.

And so it really made it easy for me to be like, I'm just going to quit doing stuff that makes me feel bad. Absolutely. I think easy things to do, which is the common trope is eat less, move more. But go for, like, yeah, right. But like go for, like, literally go for a walk. It's free. Go walk outside if you can.

If you live in a dangerous neighborhood, go to a, local mall and walk around and shop right just it doesn't have to be some rigorous whatever yeah just move a little bit more and instead of getting a double cheeseburger get a single patty you know just little like you don't have to hate yourself and do this grind and you want to be a david gagins like we're not all built that way exactly some of us take care of our kids yeah so you know i i think just just little easy things you know people aren't food deserts people don't have access people don't have cars you know or you have to choose uh do i pay five bucks for gas today or do I eat tonight kind of thing.

So, yeah, I think everyone's in their own unique situation. But if you're trying to be healthier, weighing less and moving more is going to make your life a lot better, just in general. Yeah, see, the thing about like any chemical dependency issues is that it's all super exponential. You know, we were talking about like if you're drinking all the time, you eat like one meal a day or you're like your sleep habits are terrible, which then make your food habits terrible. And also you're not working out. And like, so they all work in tandem to like get worse. Like it's harder to work out if you're hungover. Your sleep bars are.

Like it makes everything bad. Like I knew one guy who, he wasn't an alcoholic by any means. You know, he would just get drunk every once in a while. But he stopped doing that. Not because of hangovers, but it was just because he ate so poorly when he was drunk. Totally. He's like, get out. I guess I have to do with this.

Just for the calories. Like not. Yeah. But, yeah, everything rolls. It just spirals. You know, you have a 3,000 calorie meal for, dinner and you wake up and you're hungry. Yeah, it's like, weird.

Dang. That was a waste of 40 bucks. Absolutely. I'm wondering if you kind of hinted at it a bit ago, but the class divided in society, social outcomes, education, health, etc. They're obviously run along hardcore class lines. I'm sharing Little Rock as well as in Omaha, I mean, anywhere in the U.S. in the world, really, you see this class divide manifest.

How do you experience the difference in class when it comes to what you do? That's a big question. question a broad one. Yeah, you know, first of all, I think everyone gets drunk. That's what I, I think everyone doesn't matter if you're rich or broke. Everyone's drinking and party and doing stuff. And it's just a matter of the access and like, what brand of vodka are you drinking today versus, you know, did your vodka freeze in the freezer? It's like, well, probably shouldn't have. It's probably pretty cheap. But yeah, I don't, at least for me, I don't think that the amount of money that you have matters from a drinking perspective. I have met, uh, you know,

people who are like physicians lawyers doing like really fancy stuff who are hammered and are like do i'm barely hanging on can you help me stop um and then the guy who just at the gas station you know with a 40 you know uh and a paper bag asks you for money it doesn't matter it's you know it's it's it's all about did the alcohol hit you in a way that you can now not stop um and like you talked about earlier you can be functional until you're not right and then at that at that finally you hit that tipping point, that's when people start to lose their job. You end up homeless. You end up with your fourth DUI or third DUI is a felony now. You know, it just, it makes things are a lot harder for you in your day to day. So I don't think money changes things. I think it makes it easier.

And you could say, what was it? Who is it? Whitney Houston. She said, oh, I don't do crack. That's for poor people. Yeah. I do cocaine. Yeah. And so it's, at the end of the day, it's, you're still doing the same things. So maybe you put your pinky up. when you drink, but, you know, alcohol is alcohol. But beyond the substance use, I just mean like the access to health care, people coming in that might not have access to a general, you know, physician that come in because ER is the only thing they can rely on. Yeah.

Yeah. Yeah, it's horrible. There's a lot of people who are uninsured and that's tough. And we can help you try and do that through the ER, but it does require a little bit of effort on your part because you have to call somebody. I can give you all the numbers and things, but you still got to call the Medicaid office or whatever office it is to get the insurance that you need. And it requires time and effort. And those two things you don't have a lot of usually when you're hungover. I don't have the time

to do that. I want to go to sleep. And I'm not calling and waiting on hold to give you my social security number and bring all this stuff. And then wait for the paperwork to get mailed. And I wait three more weeks. And then finally I have insurance. Now I'm going to get wait three more weeks ago to my primary care doc. Oh, and the ER just sent me a $50,000 bill because they trauma scanned me from head to toe because I fell out of a, you know, fell off a ladder when I was hammered and they didn't know if I was injured or not. You know, it's just, I could see how it could become a problem very quickly. I don't know how much health care cost in the ER, but I know it, it is a lot. When I activate a trauma, it is tens of thousands of dollars for me to pick up the phone.

For a trauma surgeon to come down with a team, for my team to get ready, for the nurses to get ready for the trauma day to get ready. We have blood at bedside. We have flu. We have everything is tens of thousands of dollars and you haven't even rolled in the door yet. And that's not even including the cost of the ambulance who picked you up and whatever they did to you too. So it's just you know, the cost is astronomical and it's that goes back to that do I CT scan you or not. Are you actually sick or are you just drunk? And I think that at least is some of that burnout we were talking about. I cannot tell you how many people talking with addicts, alcoholics in those scenarios where it's literally the insurance question is always ever present

where they're like, I might have a seizure and die. Well, let's wait until it's a little bit worse. I don't really have, you know, like it's one of those things where you go to the ER, you're like, look, I need you to save my life, but not, don't try too hard. No, my stepdad had a stroke once, and as his face was drooping and his language was increasingly incoherent, he begged my mom and sister not to call an ambulance

because he didn't want because he's like too expensive. Yeah, that is a failure of the system, my friend. And that's what I kind of, maybe that's a good doorway into this question. I'm obviously a critic of the profit motive inherent in the medical system and the health insurance extraction of billions of dollars of profit from people and getting between the doctor and the patient. That's from just an outside political perspective. You might disagree with that completely, which is fine. But from an inside the medical system perspective, what would you say are the biggest problems with the American health care system? and how do you think about the role that health insurance plays from your position as a doctor having to deal with that?

Yeah, I mean, there's a lot, right? I don't know if there's a right answer, first of all. I think it's all opinions, and I don't have all the information on the back end of what's actually happening. The health care system is incredibly expensive. It could probably be run better. I don't know if I know the answer to that, but I don't think that a reason for you not to seek care should be it's too expensive. of this ambulance isn't covered. I think that's part of why Imtala exists,

which is the rule that says if you go to an ER, you have to be medically screened by some type of physician, nurse practitioner, advanced practice provider, regardless on your ability to pay. And that's why that ER ends up being the safety net for all hospitals is, I have to see you legally. And it doesn't matter if you ever pay me back or not. I don't know what it costs for you to come to the ER.

It doesn't matter to me. because I'm here to help you. I'm not here to get money from you. I get paid the same, at least here. I get paid the same if no one comes in or if everyone comes in. So to me, it doesn't matter. It's not about the finances. You know, we do want to be paid. I don't know how many people actually pay for their ER visits. I'm sure there's metrics and things you can look for each hospital. The prices seem to be made up depending on what hospital you're at. There's things called charge masters at hospitals that tend to just charge you based off of something that I can't talk about. I don't know what that is.

Ambulances aren't covered under the No Surprise Billing Act. Helicopters are, which is kind of crazy. So you can get a helicopter ride cover, but an ambulance may maybe not. So there's a lot of logistics that go into it. I think at the end of the day, the reality is healthcare should be affordable and readily available. and I don't know how we get past some of the divisive nature that we have

about oh well I believe this and you believe this at the end of the day I don't care man how can we help someone get in but it shouldn't in my opinion it shouldn't cost you five grand for an ambulance ride right and but the ambulance people should also make a little bit of a profit I think you should be able to charge

for the services that you provide so I don't know I don't know how we fix that but it sounds like it has to be from a governmental level which you know I don't know how great it's going right now. Totally. Not good. But yeah, totally, totally agree. A lot of other countries, you know, America is uniquely large and perhaps complex. A lot of other countries, particularly throughout Europe, but even Cuba and now Mexico, they're figuring out ways to provide universal

health care, while doctors that, you know, went through years of education should also still be completely fairly compensated. And yeah, at the end of the day, there is being a genuinely high-skilled service being provided. I just know that, like, the U.S., for example, we pay more per capita for health care and get increasingly worse results. And that's not because the doctors are bad. We have some of the best doctors in the best medical institutions in the world, but it's because of the problems with the administrative bloat and all these other issues. When you were in family medicine in particular, because I bet there's a difference there, the ER doctor versus the family medicine doctor engaging with the health care system, what was your direct experience

with them? Like, as a family medicine practitioner, are you calling health insurance companies? Yeah, unfortunately. Okay. Yeah. Yeah. We would deal with that a lot. Inpatient medicine, we did a lot of in-clinic. On the in-patient side, you know, again, anecdotal.

I don't know if this is true for all the things. They would wait until roughly 4.30 p.m. on a Friday to send in, like, basically an authorization form for whatever it is that we were trying to do in the hospital. Or if I'm trying to send you to a nursing home or a rehab for like physical therapy kind of things for a short stay, they would send that in at 4.30. 30 on a Friday, knowing that most of us will leave and no one who is going to do anything about it will see it until Monday morning. So I'm sitting there on the weekend with a form that I have done and ready, but I can't do anything because the manager who does it for me or does all the things is not until Monday. And then you call Monday morning like, oh, you had to answer within 48 hours.

It's been more than 48 hours. So we're going to decline that. You can resubmit if you want or you can call and you end up having all these peer to peers and you're yelling at people who don't care, their only motive is to make the insurance company money. Exactly. And so it feels sadistic. And, you know, maybe they're doing that on purpose.

I don't know. Maybe there's a rule that's saying, oh, well, we do it for safety, sure. But I never, I rarely encountered an insurance company who wanted to do the right thing, in my opinion, to help you. It was always no, you need to go do something else that's cheaper. never, oh yeah, that seems reasonable, we should help this person.

Absolutely. But that's anecdotal. Sure, sure. I don't know how true that is, but that was my own personal experience is I never called an insurance company and left thinking, man, that was a really good conversation. It might be anecdotal, but I've personally heard, yeah, many, many, many cases of doctors in various fields of medicine say very similar things to that. It's very frustrating.

Yeah. And it feels like there's this middleman being imposed between the doctor and the patient, restricting what the doctor can do in many instances. And as you say, the motivation is clear. It's about making money for these companies. They don't give a fuck about the well-being of the patients or the ease of efficiency, the work of the doctor. And that seems to be a huge fucking problem.

I would feel better about it if you weren't making billions in record profit. Exactly. Even if you made a billion dollars, cool. You shouldn't expect to make a billion and a half the next quarter. Exactly. Right. It is at some point, you cannot continue to make profit and more profit and more profit every single quarter every single year. And if you don't, they fire the CEO. You should make a profit. I think you should be paid for what you do. I don't think that if you're making record billions, that the next year you should make more billions. Just stick with a billion. Just stick with that. That's fine. But that's the structural problem, right? Because if a CEO and one of those companies said, hey, I think we're good at a billion. Like, we're not going to grow our profit base. We're going to have a healthy profit. We're just, going to stop here. We're going to start giving better care. That CEO would be fired by the board

and replaced my work. Probably. But you know, you have to pay for your boat and boats are expensive. Yeah, I'm cool. The real victims and all this. One thing I wanted to jump on before I forget, going back to money and resources as far as

care and treating addiction is that the one thing that I think is very, like, contrary to most of life, is that there are many instances where actually the the abundance of resources and money and sort of privilege in addiction works against you. Because, yeah, there's a lot of people out there that just need resources to be able to treat addiction.

But, you know, what I've seen a lot, what I've seen personally and what I have in the kind of recovery community that, you know, I'm in with a mutual friend, there's this way that being well off for having money and even support, can enable your addiction. Like, you know, going back to the idea of there's a person that's coming in with you. There's a person that's holding your hand, you know, like they're scared for you and they really care about you, which is natural and good, right? But it's weird because it's not set in stone, but like enabling is not just giving the addict money or giving the alcoholic beer or anything like that.

It's what it really is, it's just whatever it is that you're helping them avoid consequences, which is totally understandable because if you love it. this person, especially if you're a parent, you don't want to see them be hit with the consequences. And you don't know if the consequence will kill them, too. But there's a lot of people that at a certain point, they need to start going to the ER alone, so to speak, like they need to have people drop off. They need to, and it's not just about having the worst rock bottom, but it's finding out that no one's going to help you, no one's going to do this. Like, people will help you, but you have to do it for yourself. You're not going to be able to just, you know, have to,

a cozy, cozy ER stays for the rest of your life while you try to be functional. Like there's like a, you have to kind of hit a wall of some sort and the further that the wall gets pushed out. Like truly with drugs, it kills a lot of people. Like at, you know, at this nicer private treatment institution, I've just known more people that die. I've talked to people that have worked at other treatment centers and they're like, by far this one people die more. And it's actually usually the more well-off patients that were there. It's the more the people that have because they kind of were able to just kind of keep doing a very dangerous and risky lifestyle. Because whether it was the money they had, whether it was the backing, whether they kept, they were able to keep dusting themselves off and going back to drugs and alcohol until, you know, they needed to like be faced with like homelessness or abandonment.

And, you know, but again, at the same time, it's just like, well, that sounds awful for them too. because if you're abandoned, you have nothing, then you're like, fuck it, who cares then? But it's weird. Sometimes you do see this where the help that you get actually hinders you from being able to come to the conclusion of, okay, I have to stop now. That makes sense.

Accountability. Yes, yeah. Which I think is another great plug for primary care because I will hold you accountable. If you come see me, I will tell you the truth. I do not care if you don't like me. I'm not here to be your friend. We can be friends, but I'm not here to be a friend.

I'm here to make sure that you understand this is a problem. You know, I had a guy in clinic several years ago who was drinking heavily. Ended up going to the hospital, got put on a whole bunch of meds, you know, heart failure, all these things where it's like, well, I was healthy until I came to the doctor. And now I'm on 15 meds. So this is BS. And so he can't see me in clinic after being diagnosed all these things. And I was like, yeah, man, like you do have all these things.

It's like, well, I was always healthy. I was like, you weren't healthy, you were slowly dying, and then you got screened, and we caught all the things, and you need a lot of meds now. And he goes, well, how do I get off the meds? I was like, quit drinking, take the meds. You should start to get better. If you get better, we'll pull you off all the meds you don't need.

And he's like, I don't have a drinking problem. I was like, if everyone around you was drunk, that's what you're going to think, because everyone's drunk. You have a drinking problem, and it's the same old, I always say this, if I'm the first person to tell you, you have a drinking problem. you need to remember this. If no one else will, I will.

And he was really angry, and he left. And I was like, well, I'll never see that guy again. I remember telling my colleague. But I scheduled him short follow up. Like, come see him in a week, man. And let's just talk about it. And he showed up, and I couldn't believe it. And he goes, I went home and I realized everyone that I went home to was hammered.

And he was sitting there with a beer in my hand. And I was thinking, why did this guy who doesn't know me tell me that I am surrounding myself with people who were going to push me into the wrong direction. And I'm sitting here with a bag full of pills. He's like, I'm going to prove you wrong that I can't stop and that I don't have a problem. So he quit drinking. And over, I guess, the next six, seven months, whatever it was, that he came to see me, heart started getting better.

Liver enzyme started getting better. Work was easier to get up to go to. He wasn't missing anymore because he wasn't hung over. And we were slowly pulling meds off and decreasing doses to the point of where I think, you know, he's on maybe one med or something. And he went from a bag full to like a pill or two a day. Amazing. And he's just like, I told you I could do it.

I was like, I knew you could. But he's like, I needed someone to tell me that I had a problem because everyone else was like, oh, screw that doctor. He's an idiot. Don't listen. If you want to drink, man, go drink. But the reality of it is, is if someone who doesn't have an invested interest in you is like, I think you have a problem, you should probably listen. I mean, it's one of those, like, medical things can be like, like, good eye-openeres and good interventions

strictly for the fact that I've known a lot of people like that too and I think even I thought to myself where I was like, it wasn't healthy but things were going fine. Like things, nothing super bad was going on until like this thing happened and it's like, well no, that

it's not like that screwed everything up. That just revealed where things were. Like one, yeah, you probably didn't feel that bad because you were drunk all the time. So it was you were only feeling bad if you had a hangover and going to withdrawals. But you know, it's kind of like like someone hops in the car with you and they go wait a second and they wipe off

all this black paint on your dashboard and then there's a check engine light just all this shit and be like, who the fuck did you do that for it? It's like no this car is going to like give out on the interstate and then you're going to like one thing I've always said is that I got a D-Y I had a tail light out

or something like that and I remember I honestly thought to myself like you know if it wasn't for that fucking tail light And it's like, dude, you blow a point three eight. And you were driving drunk every day. Your life didn't come crashing down because your taillight went out. It just revealed where your life was at. And it was just you were always on thin ice.

Now, one thing I do want to ask, too, as far as like medical stuff revealing things, I think what shocks a lot of people, especially if you've been drinking for a while and you've never gotten a treatment, you've never really done anything that tolerance bills. And then even the alcoholics themselves are shocked when they, because you're not sitting around breathlizing yourself, right? You lose track of what it may be. And then alcoholics and their family members, if they are with them, are shocked to see their BAC.

Because I remember one time I went with my dad and I forgot what it was, but I was cogent. I was walking around fine. And I blew, not fine, but like functional. And I blew like a 0.38 something. And I remember my dad thought it was. It was like, okay, so 0.38. So you're like, well, that's like halfway to the legal limit. I was like, you got to move the decimal.

And you was shocked. Like, you stupefied because of what it was. And I even was like, whoa, because you're not sitting around breathalizing yourself. So my question is, I don't know if you could even say what this is, but I can imagine you've seen crazy things as far as like doing the blood alcohol test. I don't know if you can say this, but you don't have to say the name or anything. What is the highest one that you saw? living it's got to be in like the high 400s probably that's point four something point four yeah sorry yeah uh yeah like you're not doing well

yeah i don't know if i've ever seen a five because i was always taught point four it's considered lethal that's what yeah i was like in the 400s for sure or the point fours sorry we like the lab values of 400 but uh yeah and how are they presenting when they're at that level uh some people are around but they're stumbling you know they're it's like oh yeah guys drunk but yeah you're you're up talking i got to go to the bathroom but i feel like at that point you usually punching people you know like you're you're you're not what you're you're kind of a zombie at that point but 300's all the time people walk around you know doing their thing and you know you have some buddies that used to drink a whole bunch like that and they're like dude i'd wake up i'd so shaky in the

morning i'd have to down you know three or four shots with breakfast just to be sober quote unquote enough to drive to the liquor store to get liquor to go to work you know so like it's it's yeah it's it's impressive the tolerance if you know if i had if i drank two shots right now i'd i might like need to lay down like i my tolerance is so low you know but yeah it's just some of these guys man the amount of money it costs is crazy i always joke it's like dude you're going to save yourself thousands of dollars if you quit drinking seriously yeah yeah yeah i thought yeah i mean that even bartons went up but I was like, that's when I saw that, I was like, you know, changes need to happen. But, no, I really, I thought this thought before, it's because it's so insane to think about,

but that waking up in the morning and like going to the gash, especially if it's too early, like, fuck, it doesn't open until six. But I thought, dude, I got sober up. I got to get a drink. And I really thought that because of how people have blown above the legal limit, twice above the legal limit, when they have the shakes. That means they are starting to withdraw and they're at it. My God.

Because I remember in high school, you remember our buddy AJ. I remember he got busted at like a football game for being drunk. He was plaited, like barely able to stand. And it was like a point one, like points or whatever. You know, we were just like, whoa, you're above the legal limit. And it's just like, oh, David, you'll learn. The legal limit is not very, it's not very high. It doesn't take very much to bump up that high.

Yeah. It's even less for pilots, I think. you point out too maybe? I think you technically have a little inner system. Quote me on it. Don't quote me on that, but I was... You swigs of beer. Yeah, I'm going to be one of the few people out there as a lobbyist protesting to raise the legal...

Raise it for pilots, yeah. Okay, now, shifting back over to my fixation. No, so let, you know, we're talking about the healthcare system a little bit. And you mentioned antidepressants earlier. And there's like a lot of controversy sometimes around antidepressants. Some people say that they're overprescribed. Some people say that there's a pharmaceutical economic incentive and that doctors get kickbacks for prescribing them right away. There's always these stories of I went in saying I was sad and the first thing they did is put me on these meds.

What is what is your, based on your experience, what's your understanding of antidepressants, what role they should play? Should they be a long-term thing and whether or not the pharmaceutical kickback thing is a real thing or just a conspiracy? Yeah, so I think it depends on if you should be on a long-term. So to answer that first, I prescribed no antidepressants anymore. Being the ER, it's not our place. We don't see you. It's unsafe. In clinic, I would do it all the time.

I had zero financial kickback. I still, to this day, have not made a dollar off Big Pharma. I wish Big Pharma would pay me. They do not pay me. I make no money from this. You know, I drive a Kia. I think it's really in a clinic setting, are you depressed? and do you need something to help bridge you to get out of this?

And then we can reassess in three months. And I really use it as a tool to say, and you're doing really bad. Like you're doing bad from a mental health standpoint. It's affecting your life. You're here asking for help. We can send you to a psychiatrist and therapy on all things. But we can also give you this as a tool to bridge you over the next three months.

And let's see how things go. Some people are like, great, let's do that. Other people feel it's like it's a moral failing or that it's made up or, you know, there's a lot of different cultures that I've interacted with like, oh, you're weak if you do that. You know, and so we don't do that here kind of thing. And it sucks because you have to overcome that sometimes. A lot of time I give it to you for three months. And if you feel better, great.

Let's just keep doing it, man. It's working. And if you want to try it for three months, you get out of this rut and you want to stop. Okay. Let's stop and see how it goes. And if you get depressed again, then let's just, I think you should take it moving forward. You know, a lot of these drugs are generic. Eric, you know, they're four bucks or whatever it is a month.

Insurance may be billing more than that on the back end, you know, and that goes back to how long should you have a patent and is your return on investment billions of dollars? Probably shouldn't be, you know, or if you change, I know they'll change drugs, they'll add Tylenol into something or, you know, another medication or add an extended release coat and they'll put a patent on it and charge you 50 bucks. Just to extend the patent? But it's the same thing. Yeah.

You know, so, so it, I'm not a fan of that. I don't think that that's reasonable. I think you should make money if you invent something. I do think there should be a reasonable amount of time that you can make money back. If you cure Parkinson's disease, I shouldn't charge you $500,000 a month for that drug. Yeah. I think that's ridiculous. Totally.

But, you know, I don't make the rules. And that's, that's lobbying for you. Of course, yeah. But overall, just going back to the antidepressants, you feel like, They are often very useful. I think they're helpful. If you're doing it with your practitioner and if you are following up, there is a risk, right? If you're depressed and I give you an antidepressant, there's that middle ground,

or these the phytocin, it's that middle ground to where you start to have more energy and you are feeling a little bit better, but you are still depressed and have now enough energy to act on those suicidal thoughts that you were having, right? And that's why I say, if you're suicidal, come to the ER, man. Like now we will help you. come here to the ER, we will help you. And people hate doing that, I think, because they say, well, I'm just going to go to the psych ward. Well, sure.

If you want to call it the psych ward, we call it psychiatric emergency services. Where you need help now and we will help you. And that might mean we put you with other people who are having some mental health issues for a day or two until we get some things straightened out. And then we let you go. I don't want to imprison you. I don't ever want to do that. I also don't want you to jump off a building.

So it's a middle ground of you need help and you need it now from an emergency standpoint. But from a clinic standpoint, if you have good follow-up, antidepressants work, man. Like a lot. And we use them for things off-label too, like to treat chronic pain. It helps some people with smoking. Like there's a lot of helpful side effects to these things. But there's always downsides. And that's what you have to have that kind of risk-benefit discussion about anything that you put into your body.

Everything doesn't work perfectly. There are side effects. And that's why we should monitor you. When you're in family medicine, do you ever find yourself recommending to some people low-level cases? This is not super severe or maybe in tandem with antidepressants, lifestyle changes? Lifestyle is always, always the best answer. Doing things to help yourself naturally is always the best answer. But that's the hardest thing to do.

It's really hard to do when you feel like crap. I don't want to go outside and look at the rabbits and the grass. I don't care. I don't want to do that. You know, I have a crappy job. and my girlfriend's mad at me and all, you know, all the things. So it's hard to do that. And if you have the willpower and the effort to do it, great.

David Goggins your way out of this. But if you don't, which a lot of us just need a little bit of a boost, then let's have a little bit of a boost for a while. It's not a big deal. And then we'll help you. It's kind of like GLP's. You know, it's like if you need a little bit of help with wave loss, then let's get you some meds to help you lose some weight.

And now you feel better and it's way easier when you're 200 pounds and not 400 pounds. And it just makes life easier. and we can bridge you in the meantime. I don't think that that's a failure. I think that that's a miracle of modern medicine. Yeah, absolutely. Amen. Yeah, the GLP-1 inhibitors and stuff. Do you are, is there ever any like discussion about the possibility since there's such

new drugs, the, the possibility of like long-term consequences and concerns around that? Yeah, we don't know. Yeah, exactly. It's a big question. Smoking used to be awesome, you know. You used to. You know, you know, smoking makes you skinny and like, you know, you know, all the, you know, all the cool people do it and like, that's smoke on a plane, you know, those kind of things, right?

And then it's like, oh, shoot, everyone has cancer now. Like, what's happening? So I'm not saying that I think it's going to happen. But yeah, we don't have a lot of long-term data. But GOPs aren't something that's new necessarily. There's tons of research on the background. Kind of like with different vaccines and things, there's decades of research that doesn't mean that we are actively putting out to the public. But we are looking up these things and kind of studying them in the future.

background so it may be new in this new breakthrough but yeah the data and the evidence on these things have been long going for a long time and we are just now introducing it to the public and haven't in case of g lps haven't they been used in diabetes for a while yeah i mean i used to prescribe uh you know what was i don't remember the name now uh trillicity and some other kind of like similar acting drugs prior to everything switching over to like wilgovi and like the obesity uh FDA clearance right because I didn't have clearance. So there's a lot of people who I tried to do that for off label, and you couldn't do it because insurance would block you,

saying that, oh, they need to go to the gym first. And I was like, well, they are having trouble moving. So what, what now? Yeah. So, but then, and then they saw, oh, wow, we made a billion dollars this year. Let's get it at FDA, you know. Yeah, yeah. Let's push this through.

I just feel honestly, and maybe it's because I've just read too many books and watched too many movies about stuff like this, I feel I'm scared if there's ever a drug that comes out that is like a miracle drug because I'm a firm believer and there's like no biological free lunch. So with a lot of that stuff, I'm just like, oh, God, something bad has to happen. Like, this can't just be easy. There's always some, like, thing that's going to happen. That's my intuition as well.

Maybe. I mean, there's side effects. That just feels like that. That just, like, maybe it's cynical. There's side effects, right? There's always side effects. And you just need time and studies. But there's a lot of things that we didn't know, like, uh, like the,

polio vaccine, that wasn't a huge mass human trial. People were getting really sick and being paralyzed and on iron lungs and couldn't walk and ruining lives. And so they they pushed it out and was last time you saw eating with polio. Absolutely. It's true. Yeah, there's you have it. Right. So there's a lot of things that's like, oh, this is kind of scary because it's new, but it doesn't mean that it's bad. And what we need to do is as scientists continue to monitor those things. Now, if you start to take away monitoring and start doing things on feelings, which is what I think a lot of things I've been going to lately is I don't care about your feelings. I care about evidence.

And if there's evidence to say that this is safe and effective, then we should do that. And as that changes and as the information changes, then we should pivot with that. So it doesn't mean that we don't make mistakes. It means that we learn from them to get better. And that's how vaccines and other things have made a big difference in the U.S. and across the world. And I think I get scared, not of new meds, but because people are afraid to do the things that have worked, because they haven't seen the devastating effects of what it used to prevent. Yeah.

You don't, when the last time you saw measles, I've never seen measles as a clinician ever. But now we are having outbreaks in pockets across the U.S. And it's not because measles is this rampant thing. It's because we're no longer believing in the things at work. Because we've never seen it. And you're just, you're lying. It's a prophet or, you know, I should drink raw milk. Yeah, exactly.

No, you shouldn't. Yeah. There's some psychological fallacy where it's like the mind gets tricked or some do that you're not, you don't get to continue to see the really bad stuff that happens. So all you now know is the small group of the things that messed up. And that's all you get to look at. So you're like, we have to stop that. It's like, no, you don't get it. If we allowed them to do whatever, then there's going to be a whole army of measle people.

And like, you know, I. But that is the irony, right? We've gotten so good at some things that the side effects are more common. quote on, they're more common than the actual disease themselves. It's because we've eradicated the disease. But most people who get like vaccines or shots or other things like, it kind of hurts or I had a fever. But every now and then one person, like you might die, right?

Like that one person may have that catastrophic reaction, but the other 320 million people didn't. So at what point you say, well, yeah, it's really, it's like 0.000 something chance that you're going to be injured from this or a 99% chance that your child ends up in the hospital. And that's kind of that argument you have to balance. There's always risk with anything that you put in your body. That's what was so frustrating. And I'm sure you've experienced this during and after COVID.

It's like people would say like, you know, the vaccines harmed this subset of people. And they totally would never contrast that with the amount of harm done by the virus itself. You know, mytocard, what does it call when your heart? Markharditis. Yeah, yeah. Because sometimes the vaccine might cause that. But the virus itself caused it. at multiple levels higher than that.

But in the wake of COVID, there's been increasing skepticism, perhaps in our whole society of experts are at large, but specifically after COVID of medicine in particular. And you're obviously probably aware of that, and you're already kind of preemptively pushing back on some of that sloppy thinking around that. But yeah, have you noticed post-COVID in your patients a skepticism towards medicine writ large or towards specific forms of medicine? You know, I'm from Arkansas.

I think we already, like, Arkansasans, in my opinion, already's like, I don't know. You know, we're a lot of like farmers and like kind of the, those guys don't come into the hospital. So there's a lot of people, I think, in a subset that don't interact with the medical community at baseline. And then getting, contrasting information from your leaders, I think, contributes to that fear of you don't know what you're talking about or you're lying to me. So if you're having people who are speaking on medicine who aren't clinicians or something, scientist or whatever, and you're just a dude who just got voted into power, I don't care about your opinion. I want to know the person who is dedicated their lives to this. What is the science saying? And I understand how if I tell you something and then I come back

a couple of weeks later, say, actually we were wrong, you may not want to believe me, but I think that that gives you credibility, that you're saying we are changing based off the evidence that we have. That's how science works. Not, I have a feeling. trust me. I don't want to trust me bro my way through through these things. But I think the joy of being an ER doc is no matter how you feel like politically, scientifically, whatever, at the end of the day, if you need help, man, we got you. And I've never met

anyone who doesn't believe, who doesn't believe in science, who is unwilling for me to give them chemicals that they don't understand to keep them alive. Right. You know, And that's the beauty of it, right? We don't have to have the same opinion. But at the end of the day, I want you to be here and you want to be here. Let's do this shit, man. You know, we can get through it.

And I take care of guys with swastak tattoos. And for people listening, I'm half black. I don't know if you all know that. I take it doesn't matter. Oh, wow. I don't care. Like, that's not the point. The point isn't that you think that I'm less than you.

The point is at the end of day, we're both humans. Let's just figure it out, dude. And if you want to go back to the rally or whatever you're doing, all right man like just but you remember a black guy saved your life right i take a little solace in that that's awesome very very cool i mean that's crazy i never thought about that seeing yeah seeing like tattoos of like swastikas on people and yeah being a black doctor and having yeah yeah yeah you know whatever like i said we're still being compassionate still we're here to you know whatever man it's that's not the point the point isn't that we have different beliefs the point

is you have a family and kids and things and i care about that too Dave has a swastika deta. It's the Hindu one. No, I would at least if I was, I would still mess with them a little bit, though. I would just be like, sir, you have a brain-eating bacteria, and it's starving. Nice. We got to help it. I have one major more question, which is around.

No, it's not normal, right? I have to say. I will not let me a rush. No, but I'm very curious. Your ER doctor, you face death. I can't imagine one like you're in professional mode and you have this sort of like perhaps desensitization to death, but on the same token, you have to talk to family members who don't have that desensitization. And I know some are better than others when it comes to speaking with patients, families in that regard.

So how have you dealt with that? And as a follow up, like how has perhaps your closeness with death altered your view of death? Yeah, you know, it's, you don't ever want to see anyone die. We, we see people die frequently. And it's, it's always sad. It's never, it's never good. I think there's different levels to it. If you're 90 something and you die, I am happy that you've had a good life.

You know, you're born in 1930. That's nuts. You know, I ask people all the time. I was like, you were alive when the car came out and like, the TV came out. And then like all these things happen in your life. And I love talking to people like that. Even when they're sick, I'm like, hey, like, I know, they're like, tell me, tell me about it. It's crazy, right?

Like, tell me something. And so that's cool. And I respect that. It gives me some hope that I can maybe make it that long. So I think that's nice. And most families are like, yeah, grandma, grandpally, you know, we gave them a chance. I think when they're younger, it hits hard, especially kids, especially kids, especially trauma kids from like, it's like car accident. Yeah, that's very sad. But things like, oh,

we think dad or mom is hurting the child. Wow. That really, that, that sucks. And then, you know, I think it's just trying to decide when to stop is hard. Stop trying to save them. Yes. And it's, it's hard when they're young and healthy enough to, it's like, we've been doing CPR for a while. They're not getting back. Things aren't getting better. And then the things, family is like, well, you know, I don't know. I feel for them because families get caught in this middle ground of we never talked about this. We didn't expect our 50 year old, whoever, to have a heart attack. And we never talked about what they wanted so that it's easy to say, oh, do everything.

And at this point, where it's now becoming futile, like, we're probably not going to save you. And if we do, I'm afraid that we may actually get you back and you are so brain dead. you now are comatose and have no brand activity and now it's months of the family trying to decide well do we stop do we keep going and there's a lot of things that really go into it that you think about while you're doing these things and it's it's scary because I want everyone to survive

but it's not like TV you don't just shock them they pop up like yeah it's great it's like I'm gonna we're gonna put a tube in your throat and you're gonna be like we're going to like chemically knock you out and hope that you come out of this okay over the coming weeks and this is going to be a really hard tough path so yeah I think that's hard in the ER because a lot of people don't have those conversations and I would I would encourage you to have conversations especially like I made my parents sign a will when I

started med school once I started seeing like doing rotations and things I was like guys how do you want to go do you want do you want me to shock you and do compression and break your rim do all stuff do you want to go in a nursing home or do you only just to say no stop they don't want this and if you die you die which is fine so i really i think the takeaway is i want to treat you with dignity and respect that you deserve and that also includes how do you want to be treated and it may not be how your family would act in those situations yeah yeah i mean those are hard conversations to have in general people don't like to talk about death so just just bringing up the topic at all let alone coming to conclusions about it but um but how do you so like in the case

of somebody that's that's young, that's not expected. That was something perhaps like a car crash. In the beginning of the day, they were totally fine and now they're gone. How do you, like, what is your approach? Do you have an approach when you walk out to talk to that family? Yeah. You know, I thought it would get easier and it doesn't. I'm always very sad.

And I try, I don't know if I like cry and I don't cry in front of families. I may, every now and then, I might, you know, tear up a little. but I think trying to be strong in that moment for them. And one of my mentors told me, don't impregnate the silence, meaning when I say, you know, so-and-so has died, just stop and sit there. And I don't need to speak anymore.

There's nothing left for me to tell you that matters. You don't care that they actually had a chance and that they had CPR. We did all these things. And it was, you know, we did all these things in the background. for the last two hours to save your son or your daughter, you don't care about that right now.

All you know is your life has changed forever. And in those moments, I've learned should just be and sit there. And I won't speak until you do. And so even if that, what feels like an eternity to me, it might just be at one or two minutes. Eventually, a family member will turn to me and be like, what do we do next? And I found that that's very, at least for me, has been well received.

it's just giving you an opportunity to grieve and then ask questions. We're lucky that I work in a place that we have a chaplain who comes in. It doesn't matter about your religion, but they're our chaplain and they're like, we will walk you through the process, we'll clean up the body and have you come see them.

So it's hard because you have to go right back into, let me go back to work. We do huddles or kind of timeouts or whatever afterwards where everyone in that code will meet in the hallway for about five minutes. and just debrief. How do you feel? What could have gone better?

What went well? And it gives people a chance to talk, especially, I think, for like our techs or people who are not medically trained, I've noticed that at least from my opinion, it hits them really hard because they may not have understood that we actually, like, this was not survivable to begin with. And it feels like, well, why did you give up so soon?

It's like, well, you don't, like, this is why. And it gives them a space that feel comfortable. And I think that doing those things and talking about it makes it easier for me to go into the next room. But yeah, if you need a minute, you have to take it. But yeah, it's hard sometimes. Sometimes multiple people die. And then you get yelled at and someone throws something at you. And he's like, dude, why am I here?

You know, and resetting the, you're here for pain and fear. And your mentality really matters. So take a moment. Because at the end of the day, everyone just needs help. As much as you try to handle it with that level of professionalism and, you know, metabolize it and then move on. have there been cases that have followed you home. Oh, yeah, absolutely. And you see it on the news, right?

Like, it's crazy to have a job where you go home and you watch. Like, oh, take it to a local hospital or follow. I was like, yeah, that was me. It's crazy. It's crazy, right? And, you know, I've cried in my car before after work. I've been sad. You know, I, but I've also had some joy in seeing that some people who have injured people.

I was like, oh, so-and-so went to prison for 50s and things. Nice, right? Like, that's like, it's, like, it's, So there is some closure in that too. But I think just being a part of that family, the ER community, we lift each other up and we talk a lot of shit. And, you know, our humor may be pretty vulgar. Gallows humor. Yeah, you know, but I think if this is going to happen anyways, I would love to be a part of trying to help you in that moment if I can.

And by encouraging people like do CPR training or classes and things to help, because you can make a difference. If you see someone pass out and they don't have a pulse, start doing chest compressions. You know, like something that simple could actually save their life. It actually changes our trauma algorithms if they have CPR in the field versus they're just laying on the ground and nothing's happening. I've kind of thought about that. Like, just to make myself slightly more useful of going and getting training in that level just so that if anything were to happen around me, I can't help somebody. Staying alive. Takes one hour.

Yeah. If you, if someone falls down and is not breathing and you feel and they do not have a pulse, if you do compressions, that is not the wrong answer. Because if you're wrong, they'll wake up. Uh-huh. Yeah, yeah. Yeah, true, true. Ah, stop.

So this might be, you don't have to answer this if this is too vulnerable, but do you have a religious outlook? Are you an atheist, or do you have a religion? And has that changed as you've been so intimate with death? I would consider myself a Christian. I grew up in a Catholic school, like my whole life. First public school everyone who was in college. I ironically think that being in medicine has made me a stronger believer in God, seeing some of the things that have gone on and the things that people have survived or gone through.

And it's hard for me to believe that this is just just happens spontaneously. That's nuts. And maybe I'm dumb and maybe, you know, whatever. But there's no atheists in a foxhole, as they say. And I feel like most scientists, it seems like they go further to the godless aspect. of things and I think that I've actually come closer to that from being from being in health care. And you seem to bridge that pretty well. Like if you have this religious faith, but also you have a scientific mind, your mind is, you know, seemingly very logical and scientific at the same time.

I try. You know, I'm not perfect. I have plenty of fallacies and I mess up all the time. And that's the cool thing about being an ER dog. I say, hey, I've been wrong before. Come on back if it gets worse. Yeah, yeah. It is funny because it's funny that you said, like if you're an atheist, if you went with that one first. Like, I've learned a lot that kind of counterintuitively, or at least seemingly so, these fields where there's not just death, but suffering, like being in child welfare or that,

I remember at the human trafficking shelter, you would think, all right, these were the agnostic, like, you know, because they see the real, like, they were more than normal religious, like, maybe not, like, in a super orthodox way, but, and I feel like to do a job like that, if you truly were like, yeah, there's nothing, there's whatever, it would almost be too hard to subject yourself to that if you didn't think,

like, there is something behind this, like there's a reason to do this, like, you know, in a certain way. And I, yeah, because I would think the same thing, because that was one of my questions. I was thinking about asking, so I'm glad you did, about how to affect it existential things, like how you think about the world now from the things that you're exposed to. Because it's one of those things where we know it happens, but it's way different seeing it, watching it play out in front of you.

And so, yeah, the one thing I was going to ask is, yeah, speaking of the child welfare thing, I totally forgot that the most where they catch cases is from school, but the second most is medical stuff, like whether it's in the hospital or the trauma unit. And you had mentioned that's really tough to deal with. Have you dealt with that a lot? Is that something where you've had to report a good amount

or was it just very few times? We report and, you know, I tell families all the time, it's, there's, so there's accidents that happen all the time. And good parents, just being parents and maybe you're, you know, you're holding your baby and you trip and you fall and you hurt your kid on accident. And they're like three months old, whatever. Yeah, accidents happen. People fall down. Sometimes kids get hurt because you didn't mean to do anything. But we're going to look in, from a objective standpoint, is that story plausible?

Is what, are what you telling me actually, the mechanism matching, right? Those are, we're going to confirm that we agree that that could have happened. And then if it's kind of iffy, I'll tell people up front, like, hey, we're going to call CPS, like child protective services, but it's not because I think that you're harming your child. It's so that we make sure your baby is safe. And so make sure that you have what you need at the house. They'll follow up with you. They'll make sure that they agree that things are safe.

Make sure you have what you need. And most people are like, yeah, that's reasonable. Not a big deal. It's a fine when people are like, wait, what? And they start fighting you about it. It's like, okay, now I'm a little bit actually more suspicious. Because it's like, hey, I'm not trying to get you in trouble. I don't ever want a parent to lose their child.

That's not my aim. My goal is to make sure that your baby is safe and has what they need. So are you falling down a whole bunch? Because like, do you need medical attention? Are you hurt? Are you know, are you tripping because you have bath mats on the ground? You're, whatever. And you're like you're falling and causing an unsafe environment at home.

And you just need a little bit of help. Okay. Well, CPS can help you. Make sure that you have the things you need the house. So it's not, it's not meant to take your child away from you ever. That's never my goal. In most cases, they don't. I don't want that.

I don't want that. I just want them to make sure that you have what you need. But yeah, any trauma evaluation, really any kid that comes in that's under a certain age, I'm looking, we're looking under your diaper, we're looking at your mouth, looking at yours. Like, dude, I'm here for a cold. Why are you taking my diaper off? You know, I take my kid's diaper off? Well, it's like, is there an underlying infection or a rash or, oh, that's weird.

Where are these bruises from, you know? And the mechanisms, the irony is you don't know the physiology of a child. child as well as I do and things that should not and cannot physically happen by the mechanism that you're describing is now I'm like well that doesn't make sense you know my kid rolled off the bed your kid's two months old no it didn't you know so it's like we got a it's yeah we're here to protect you and your child but I don't want you to lose your kid I want you to raise your kid and have a good time but you've clearly seen cases where they should lose their kids and it was obvious it's not to me but I've seen cases where parents are hurting their children

and it's my job to protect that child. And so the state needs to determine if they feel that you are fit to be a parent. That's not my job. My job is to make sure their child is safe. I don't care about what's going on with you at the house other than your child is safe. And your child's safe. And then if the answer is yes, do you need help with resources at home? And I ask you all that all the time.

Like, hey, do you have food, water, electricity? Can you afford formula? Do you need information on how to sign it for WIC? Like, whatever. I'm here to help you. So please let me give you those things. Because I'm not here to judge you. I want your baby to be happy and healthy, just like you do.

Absolutely. Yeah, it's a fascinating aspect of the job that people don't often think about. Going kind of back to, we can wrap this up fairly quickly, an hour and a half here. Thank you for being generous with your time. This is kind of a weird one out of left field, but it made me think of it after we're talking about death. Have you ever had anybody wake up from technical death or close to death? and report anything like a near-death experience or anything like that. Yeah.

You know, I did that more in family medicine because we did a lot of inpatient. In the ER, we don't do as much inpatient medicine, like, through our training. We do some, but not nearly as much. I feel like there has been some people who have either died during surgery or in the ER. And, you know, they've said, oh, yeah, like, I could hear everything going on. I couldn't answer. I couldn't move, but I knew all these things were happening. I've had people say that they saw family members

or that they heard or felt this overwhelming joy and then woke up in the ICU or whatever it was and then overwhelming hell of the ICU. But yeah, I've had people talk about that. It's kind of wild. It gives you some hope that there's something. There's something worth going through all of this. And a lot of the stories that you hear online are stuff,

there seems to be these interesting patterns of seeing family, feeling overwhelming joy or love, comfort, some sort of bright light. Hard to make sense of it. You almost can't, but. Who knows. Who knows what's actually happening. It gives me some peace, some reprieve that, you know, hopefully that'll, I'll have some similar experience whenever it's my time.

Absolutely. Do you have, do you have children? No. Do you want them? Just me. Yeah, I would love to have a kid at some point in my life. That is on your list. Yeah.

I think that would be cool. Absolutely. But, you know, we'll see, we'll see how it goes. Do you have any other questions, Dave? God, I thought there was something. Nope. There's nothing on the paper. All those papers are blank.

I do want to plug one thing if that's okay. Actually, two things. As much as you want. One, I don't know this guy, but his YouTube handle is liver disease. He's phenomenal. I don't know this guy at all. I don't know if he's a good dude or not. He seems like it.

I watch a lot of his content on YouTube, and he literally just sits in his backyard and uploads a video a day. He was drinking heavily, like all day every day. and every day he uploads a video and just like hey man you know these are the things i'm going through this kind of sucked and it was talked about all these stories and it was for me very moving to see someone who actually got help because he was like on death door kind of thing like blood clots tips procedures all the like the really bad liver things where he was just dying and he bloated and you know fluid overloaded and uh was being a bad dad basically is how he explains it um and he's

been sober now for however long but uploads uploads a video day and i actually passed his YouTube channel along to a lot of guys who come to the ER. And it's like, hey, if you're bored and you just want to sit and watch a YouTube video, you should go watch that guy. He's actually really motivational. And he's not trying to give you this big speech. He's not screaming at you like, Goggins. He's like, dude, I was a drunk ass.

And, you know, I finally woke up and things are a little bit better. And it's kind of cool to see his ups and down. So I always encourage people to go check him out. From an alcohol standpoint, please come to the ER. If you don't know what to do, come in. Please go see your primary care doctor. They will help you more than I can in the long term.

I can help stabilize you. I can't help cure your alcoholism. But if you don't know what to do, come in. Even if it's a 10th time you come in today, come back. People may look annoyed or roll their eyes. We still will care for you. We will still help you. It doesn't mean we're always the kindness or the nicest.

We're still humans. We can be dick sometimes, but we will help you. If you don't know what to do, the ER is always a great starting point. And we can point you to the right direction. Don't not come in because you're afraid of a bill if you feel like you're going to seize or withdraw or you want help. I know that sometimes you may have a really bad experience at a hospital, and I'm sorry for that, but I hope that you can run into someone who is willing to listen or take just a few moments. I may not have time for your entire life story, but I do have time to make sure that you're okay.

And I want you to come see us because it really is cool. A lot of the buddies I work out with now, great guys, never knew them when they drank. I would have never, ever known. You know, they had a problem. And, you know, I don't know if you read that article, the, you're welcome here. The one that I had written about that guy who was basically withdrawing,

about the sees, going to the guy. It was a really, it was, I was so scared that he was going to, to seize and, and die. He was,

he was kind of circling their drain. Go to the ICU, never saw him again. Years go by. Some girl watched. between me in the gym and, you know, said, you know, Dr. You, is what I go by. Someone can pronounce my last name. You know, Dr. You. And I was like, oh, hey, what's up? You know, kind of look familiar. And she's like, you know,

thank you. You saved my family. I was like, man, you know, I have no idea who you are. And she called her husband over. She's like, do you remember he was in the ER? I was like, oh, my God, yeah. Like, I do remember that guy. And she's like, you're the first person who ever told him congratulations for being sober. And I try to deal with everyone. He's like, oh yeah, you know, I was sober for a couple years. I had some stress and I got super drunk and started drinking too much. I was like, oh, nice, man. Well, congrats on being sober.

That means you can do it again. So we'll get you through this and you can get you back to that point. So even if you've been sober for 12 hours, 24 hours, and that's it. That's as long as you've been sober for the last 10 years. Cool. You just proved to me that you can be sober. So let's start stringing those together. And over the next decade, yeah, maybe you'll be drunk for a few days of that.

Maybe a few weeks of that. but that's a pretty damn good run. And so I'm trying to remind people, it's okay if you fall off or you drink every now and then and you go on a bender and you end up back in the air. It's like, yeah, that sucks. That's not the goal. But we'll help you out of that

because if you can get nine and a half sober years and six months of that sprinkled in as you being drunk, to me that's a win. Totally. You know, I don't encourage you to do that, but if you do, that's okay because we can get you back to a good point. But it's cool to see that guy again

after several years. He looked great. He was in the gym with his wife, hanging out with his kid, like the whole bit. And that family got so much better. And I didn't do Jack for him. All the ICU docs, they did all the work. All I said was, dude, I'm proud of you for being sober. And that's really all it took for him to get out of that.

And I think that's really cool. That's amazing. It has to be deeply rewarding. Yeah, because that is, to think about it, you see, you see people sometimes on the most turmoil or significant day of their life. And then they go and you never like. Never see him again. So it was really cool.

And so that that helps me with the day to day. Because I, you know, I hope that there's some others kind of sprinkled around. It's like, oh, yeah, that one random dude helped me out that day. And, you know, I take solace and that's really cool. It reminds me of this one post where this woman was like, this doctor. It was like a review thing. This doctor literally saved my life. Such good care.

Great bedside manner. Like, saved my life. And she gave him like four and a half out of five stars. And the guy was like, how the fuck can you get five? Like saved your life? Five, not five? The weight was a long time. Yeah, I don't know.

He's a weird beard. That's funny. Well, thank you for coming on. This has been fascinating. I appreciate it. You mentioned that you have that article. You're welcome here. We'll link to it in the show notes.

Yeah, sure. People can check it out. Is there anywhere else that you might want to direct people who want to, if you have more articles or any personal socials? You don't have to. Yeah, PubMed. If you just type in John Yucateke on PubMed, it'll pull up all the articles. It's a lot of the things that I write about are more about being black eye medicine.

And it's not common for black male to be physicians, like 2 or 3% or something in the nation. So I talk a lot about those things, but I do have that article about, you know, my encounter with alcoholism. I think that's how we actually end up getting connected. I did actually read that article, though, that is fascinating. So, you know, just, yeah, check it out if you want. And, you know, people are always welcome to reach out to me. And, you know, if you just want to shoot the shit, I'm always here for it. Hell yeah. We will, I'll find that link for all your articles. I know our audience would, I think,

be very interested in that, you know, being a black doctor and that underrepresentation in the field. So we'll make sure to link to that. And yeah, thank you so much for being generous with your time and your knowledge. And I'm sure you probably hear this a lot, but, you know, you chose a very noble profession and you, you know, you help people. So I appreciate you guys. Thanks a lot of me here. Yeah, thank you, man.