Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Ambulances

Episode Date: March 10, 2018

Dr. Sydnee and Justin have talked about when you get sick at your house and when you're treated at the hospital, but isn't there a missing link? Isn't there something between those two things? What are Dr. Sydnee and Justin hiding? Well, nothing, they just have never talked about ambulances before. So here we go. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. Hello everybody and welcome to Saul Bones, a marital tour of Miss Guide Medicine. I'm your co-host Justin McElroy.

And I'm Sydney McElroy. And we have a new co-host on the show. That's right. Welcome to the first time, for the first time to Saul Bones, Cooper McElroy. Our plan is that she will be a silent participant. Silent participant. Third co-host, but that may not work out. Yes, but we will do our best to limit the amount of contribution because she doesn't know

anything. That's the thing. She'll just start bloviating and it's like, you don't know what you're talking about. You've only been outside four times. But she really fancies herself in experts. That's the problem. That's the thing. That's the problem.

That confidence. She has all the confidence of Justin, but none of the knowledge of Sydney. So she's you? I guess she's me. I guess she's just you. She poops your pants. More. Okay.

Well, that has nothing to do with what we're going to talk about this week. No, but we just thought we'd warn you. Yeah. Justin, I thought we should talk about ambulances. I got no other lead in them. Yeah, well, it's a part where we've talked about a lot of parts of the medical experience. You get sick at home. You go to the hospital, get treated.

What's in between there? What are you skipping? Well, and the thing is, we've had a lot of people request this, and then the other thing is I started to wonder, when did we decide, you know, there was a moment where there were house calls that doctors made? But when did we start taking sick people to doctors? When did, I guess the question is when did you get too lazy to go to people's houses? That's really what it is. That's really was although you do that sometimes right?

All right, so now we're back if you there was a brief moment there where our you probably heard our daughter Pooper pants and I left it in there just to let you know sort of what our day today is like. The sound, not the poop. The poop we did not leave. No, we did not leave it in there. So you were saying, said, I'm so sorry to have interrupted. Do you ask me, do I do home visits? Yes, I have done home visits.

I do that on occasion. But I think the difference is home visits used to be, in part, because, and we'll get into this more, the stuff that a doctor could bring to your house was like not necessarily any less effective or helpful than the stuff they had in the hospital. Because there wasn't a lot of stuff. You know what I mean? There weren't a lot of interventions that could be done.

So you didn't lose anything by having the doctor come to your house. Now, obviously, there's a lot more that can be done for you in a hospital. Right. So let's get into the history of ambulances. Okay. Thank you, Eric Richard Ruth and Sarah for mentioning this. And I should go ahead and preface a lot of other people have asked for the history of EMTs and, you know, EMS workers. That's a whole other story. And we will do an episode on that, but I'm not going to get into that because there get into that because that's a whole story unto itself. Okay.

So just a preface, I'm not ignoring that history, I just think, you know, it's a whole other episode. All right, got it. So we have had some sort of medical transport device since ancient times. Since the first time somebody got injured or wounded, it usually on the battlefield would be the first good example of that.

And everybody went, whoa, how do we get them out of here? Right. We want them. We've got other things to do. We can't have them lying around bleeding. We're going to get them out of here. Somebody kept to come up with something. So the Greeks and the Romans would use chariots, you know, if you managed to survive or

if you were wounded or injured or something, in another accident, not battle. In 900 CE wagons with hammocks between them were introduced. That is terrifying. Yes, it was not great because as you can imagine taking a big curve or going downhill. And they would have to go the same speed, I guess. So this was a bad solution. That's a bad solution. Wow's a bad solution. Yes. Wow, that's spectacularly bad.

It's weird how you see these kinds of devices that, well, obviously just tossing somebody in a chariot that was really made for sitting or standing and then laying down is not really what it's for, but you could repurpose it. But like turning it into a stunt. That's still better than doing it. Then turn it into a stunt. Yeah. To an evil, con evil style. Death, death, temptor.

They just really wanted you to earn it. So like you survived your battlefield wound. Now can you survive the transport back? Back. We don't have any real medicine to give you anyway. So... Spoiler alert. In 1100, the Normans introduced the horse litter,

which was just a bed suspended between two horses. So, Norm and Lear, Norm and Reed have got together and they were like, listen, we've been doing this so poorly. Well, I don't know that it's too much better between two horses. It's between two horses. Between two wagons. Yeah, I guess. I mean, it might be a little more manageable to keep two horses in pace. That'd be a rocky ride. Yeah, be very bouncy I would think in the 1400s we see the first Concept of what we think of as like of where the word ambulance came from. Now these weren't actually Vehicles or modes of transport Necessarily an ambulance or an ambulance, ambulance-ia?

Ambulance-ia? They were basically like tents with surgical and medical supplies in them. Almost kind of like a mash kind of thing. So it wasn't actually a mobile, I mean you could move it, but it wasn't for moving people. It was like, no, it was not a transport, but that was the first use

of the term ambulance. Okay. That's where it is derived from now. They were first used in 1487 during the siege of Malaga in Spain, but they had these like tents closer so that you had like medical equipment, basically, it was just a way of getting medical equipment closer to the wounded people as opposed to far away.

But they didn't actually move any of the wounded until after the battle was over. So it's kind of the question of if you're bringing the hospital to the patient or bringing the patient to the hospital. Right. More the former. And this was sort of like an in-between measure because it wasn't, you didn't bring the medical care all the way to the patient. The patient still had to make their way to the tent. And there was no defined method for doing that at the time. And they didn't do it till the battle was over, which if a battle could go on for days, you better hope you were wounded the last day.

Some big improvements were made with the French surgeon Dominique Jean-Lauree. We've talked about him before. He was Napoleon's doctor. He saw that there was an opportunity to probably save more lives on the battlefield. A lot of this is military history because as you can imagine, that's where the urgent need for ambulances and some sort of medical transport first arose. But he saw that there were people on the battlefield who would be wounded and if you could get the medical care faster, probably would survive. But as a result of

having no defined method to transfer them from the battlefield or to bring medical care to them people were dying. So he thought we could improve survival if we could get these people who are wounded off the battlefield and two doctors faster. Agreed. So he developed these little carts with two wheels that were light and easy to transport on and off the battlefield quickly.

And you could run them out there, load up a patient and run them back off the battlefield. So like a wheelbarrow. I mean, I mean, I mean a wheelbarrow. I mean, they could also be pulled by horses. Right. Or you'll lose your camels depending on where you were. Yeah, anything that pulls stuff, it's still a wheelbarrow.

You could also bring the surgeons to the wound did this way. Okay. So you could say hop on, drop. Get on the board, I bet. Well, do you all do that with that helicopter? Is that the helicopters bring the doctors to this patient or are they all a doctor? There are both.

Okay. Both can happen. And in transport, there's always, whether or not there's an actual physician, there's always somebody, like there are transport nurses whose job it is just to like stabilize and provide medical care for patients in flight. They're flight nurses. We often will refer to them.

And then there are all these nurses would be cooler if you're looking for a cooler one. That would be cool. And also EMTs obviously provide this So there are a lot of medical personnel that aren't Physicians who can provide this care and and I think I've said this before on the show, but I should reinforce It's not because well you're in an ambulance or a helicopter So we're not gonna give you a doctor a lot of the, the things you might need in that sort of emergent situation, EMTs, and people who are trained specifically,

like flight nurses, transporniases, and things, are specifically, that is what they do all day, is stabilize emergent trauma patients and people who are outside of the hospital, pre-hospital patients, they do that constantly. They're really good at it. So when you, well, you don't need me in that situation, I mean, I manage blood pressure and diabetes most of my day.

You don't want me, you want the EMT. You want that transport. And do you like, is there a doctor in the house? Should they be asking for an EMT? If there's an EMT, a lot of time, they're gonna be probably better suited. I mean, if there's some sort of intense diagnostic process, I don't wanna short sell what we can do as doctors, like I can assess people and I have some training in global

health and wilderness medicine. So I'm probably a little better suited than the average bear. But that being said, if I see a car crash on the side of the road and EMTs are there, they don't need me. All I'll do is interfere. I'm not pulling it. If I see a bear there, They don't need me. All I'll do is interfere. I'm not pulling over. If I see a bear there, I'm going to tell them that is unacceptable. That is just not, it's just not cricket.

They do this kind of stuff all the time. They're more suitable. Bears? No, not bears. Okay. If there's a bear there, I'm probably an average bear. An average bear.

Situational awareness. If there's a bear there, I am not safe. How can I help stabilize the patient? Thank you. Yes So anyway, these were called flying ambulances by the way Okay, these carts these wheelbarrows Okay, that would either bring you a doctor or bring you to a doctor Uh

You would be protected of course if you did stop by the good subaritan law Really do you feel better now? No. At the start of the American Civil War, our situation for wounded on the battlefield was still not great. We had these developments throughout history of methods, or even the concept. The wheelbarrow isn't really the key development here. It's the idea that you should remove wounded from the battlefield as quickly as possible. That was the concept that was revolutionary and safe lives. At most of history there had to be a certain fatalism here that like what why like it's probably like right We can't do much because you're probably gonna to get gangrene. You're probably going to get an infection.

You're probably going to die. And we want to focus on the soldiers who are well and able to whatever wounds they may have sustained, they're able to easily return from the battlefield. Those are the ones we want to focus on as opposed to put a lot of time and energy into people when we don't know how to fix them anyway. And at the beginning of the Civil War, that's kind of the attitude you see. This is, when I read this, it made sense, I guess, as I think about it, but then I thought, like, by the day standards, this is crazy. Wounded were left on the battlefield.

If you were injured and you couldn't leave, you were left there. That's rough. That's a rough idea. That's a terrible, right. That's a terrible thought, but they didn't, they didn't really have a good mechanism for removing people. They would assign certain people in the unit to go collect the wounded, but they were usually either like the company musicians. Or like soldiers that were thought of as like weak

or not as, you know, like, well, they don't really do much. So we'll just give them this job. And a lot of the time the people who were assigned this job wouldn't do it because they were running into the line of fire, right, and putting their lives in danger. I send up to play a fight. Exactly. I mean, that's like the, like the, the drummer, the five player, like, good. I'm telling that like, they don't have a gun and you're telling them to run out there and... My five, like, I'm great at five. So, they don't wanna lose that. So, they weren't, this wasn't always performed. And so, a lot of people were just wounded

and left on the battlefield unless they could get themselves off, unless they could crawl back or somehow, you know, get themselves off the battlefield. After the battle of Bull Run, some soldiers walked 27 miles from the battlefield to Washington to receive treatment. The lucky ones who were well enough to do so. Dr. Jonathan Letterman was the first one to revolutionize the system in 1862 with a

really simple idea. Why don't we assign soldiers to be what kind of would be considered medics? They weren't called that necessarily, but here's some basic things you can do in the field to stabilize people. Your job is a stretcher bearer. Your job is just to walk out with these soldiers, put people on stretchers and carry them back. And then he also helped to establish, again,

these sort of hospital-like units up at the front where you could get these patients to quickly, stabilize them, and then hopefully by an ambulance train or boat, you could transfer them to a bigger, you know, medical center. If that made sense. This was like the beginnings of what we see echoed in, you know, war situations today. In 1864, Congress passed the Ambulance Core Act. This was also called an Act to establish a uniform system of ambulances in the armies of the U.S. So this was just

kind of codifying what Letterman had already started doing, which was we need ambulances, we need ways to transport wounded off the battlefield routinely. We need a system for this. This is going to save lives and we need places for them to go initially to be stabilized and then bigger hospitals for them to go to after that. And at this point, all these ambulances fell under military jurisdiction, basically. So this was the beginning of the ambulance. It was just a military vehicle. Okay.

And right now, we're talking about like a lot of medical advances as we have talked about. So after the Civil War, you had this concept of some sort of transport vehicle to take wounded or sick people to a hospital. But it had been under, you know, government military jurisdiction. So there were a lot of hospitals who were like, this is probably a good service to have in general. I would like to keep this. And so this started actually at what is now

Cincinnati general was the first place to have an ambulance, a private ambulance that would go pick you up and take you there. And this was to replace exactly what I talked about. The doctor who showed up at your house to make a house call with just their, you know, their black bag, the classic doctor, a little black bag thing, which would have had all the tools available to them in the day prior to, by now, in history, we have a lot more things we can do for people, a lot more medicines we can give and reasons to go to the hospital.

This was quickly followed by in New York, they had a really big, this was probably the biggest ambulance system at the time, Edward B. Dalton, who had been an Army surgeon. Like the bookseller? B. Dalton bookseller, that's a chain, probably not, probably a different cat. I have no idea. Maybe they're related. I don't know. chain, probably not, probably different. Kat. I have no idea. Maybe they're related. I don't know. Oh, we can look into that.

Just so you can Google that. Those may not. Justin will Google it. Go ahead, Sid. But he started an ambulance service at Bellevue. And so it started in 1869 and very, very quickly increased to a lot of calls, a lot of services being provided. The other hospitals in New York also started providing ambulance service. The New York kind of led the trail on this.

They would, at the time, assign doctors or surgeons to the ambulances to go with them. So at the time you did, you asked me, did doctors go out with it, what they did at the time. And the vehicles had like stretchers, they had handcuffs and straight jackets, because a lot of the early patients were psychiatric patients that people would call and say, help, I have someone with a psychiatric illness. I'm worried that they're a threat to themselves or to somebody else and I don't know what to do. And so that was a lot of the early ambulance calls. I have an update on on B Dalton bookseller. Okay. It was founded by a man named Bruce Dayton, who just changed the Y to an L because it

connotated the name B Dalton, connotated quality dependability and authority. I wonder if that's- I just changed it. I wonder if that's because of the ambulance guy. Me, I probably not. Probably not. Probably not. That would be quite a poll, honestly.

That's it. Well, does Dalton more dependable than Dayton? Apparently, yeah. Be Dayton is nothing. Be Dalton. Ooh. Dependable. Tell that to everybody who's in Dayton.

They would disagree with you. True. So, in the ambulance, in addition to the doctor, I thought it would be interesting to know, like, what would you have had if you had gotten an ambulance to your house in the 1890s. In addition to a doctor or surgeon, you and maybe a straight jacket and some handcuffs. You have a box with brandy, two turnikits, six bandages, sponges, splint material, and a small bottle of per sulfate of iron. And basically that was what they brought to you. And you would have a driver

who earned about $500 a year for doing this. Nice. Or not. I actually have no idea. And they even had like special harnesses that were easy to attach the horses to the vehicles because these were still horse drawn at the time. Very quickly. So you could get a call and instantly harness your horse to the carriage and go. And then you also, like your fewer or an ambulance driver, you got room and board because you needed to be there all the time. Sure.

The doctors who were initially assigned this job didn't like it because you didn't make a lot of money. So they started filling the job by making residents who were still in training do this as a rotation. So they had to do this for six months before they completed their training. Falling in the grand tradition of misusing resident labor. Exactly. Exactly. We can't we can't have doctors do it. So we'll force doctors, whether doctors, we'll force doctors in training.

Don't worry you're in charge of training. You know what I mean? We can't have attendings do it. So we'll force residents to do it because we don't want to do it. But The the the schedule and the salary offer though this sounds like Exactly like a resident situation. So you got $50 a month. You did 12 hour shifts and you got one day off every four weeks so That's all the residents would get That's yeah, that's rough the residents would get. That's rough.

And this, by the way, in this continued as late as 1935 in some places. They were still getting like 50 bucks a month in 1935. The same salary they were getting in like 1869. That's ludicrous. Yeah, if you can believe that. Now, Sid, I love horses much as the next guy who does a podcast, and it's largelyicrous. Yeah, if you can believe that. Now, I love horses, much as the next guy who does a podcast, and it's largely about horses.

But I wanna hear about the motorized ones, like the ones we have today. Well, we're gonna get into that Justin, but first let's head to the Billing Department. Let's go. Let's go. Let's go. Let's go.

Let's go. Let's go. Let's go. So you were gonna tell me about horseless ambulances, Sydney. That's right. So the- Which is a wild distinction if you think about it.

We don't really think about horseless. There's lots of things that are horseless, really. Hahaha. Yeah, well, that- Sad is that may be. What else, Justin? What else is, do you wanna make a list of horseless things? Well, okay.

My computer is kind of a horse list adding machine. That's true. Is that what you use your computer for? Adding. It's a horse list adding machine. Mike, our coffee maker is a horse list coffee maker. The shower is a horse list shower. It's a horse list shower if you can believe that.

It would be less effective if there was a horse in it. Friends, start throwing horse list on to the beginning of objects that don't have horses involved and see if they don't sound pretty impressive. Then see what your friends think of that, too. Go ahead and use the horseless speaking device in front of you, Sydney, and continue. So the first horseless ambulance was introduced actually in Chicago in 1899. And it's funny because New York got it like the year after. I'll just talk about New York and Dalton and Bellevue and everything and then

They're a year late. This became the norm and again a lot of the use was was military still so throughout world were one a Lot of different cars were tried like Model T ambulances and different things like they were expanding as the as the vehicle as the automobile Developed so too did the ambulance. That there was a thought this far back that, you know, maybe actually even before, I should say, before World War One, there was a thought as far back as 1870 that air transport might be better as an ambulance than ground transport.

Mm, I'm not so sure about that. So, but what were they using back then? It's 1870, what kind of? Zeppelines. Hot air balloons. Okay, oh, I wouldn't have far off. That's fun. A Dutchman named DeMoi came up with the idea

of a hot air balloon. You would suspend a giant stretcher under the balloon, and then to move it in the right direction, horses would pull it. And then you could get them evacuated faster. This actually was used. He got the idea during the siege of Paris and after that 160 French soldiers and citizens were transported this way in 1970. It was fun. Just because your hurt doesn't mean you can't have a little fun. Because your hurt doesn't mean you can't have a little fun. That's what I'm going to say.

So air transport was used surprisingly early. In World War One, airplanes were also introduced. So you actually had like, fly, like real flying ambulances services at that point. We didn't see helicopters come along until World War Two and classically, I think all of us are giant mash fans, right? Sure, of course.

So we know that helicopters were kind of the mainstay for a lot of quick air evacuations of wounded, you know, at once they were developing in Korea and in Vietnam as well. The use of ambulances by civilians was not really regulated and expanded until the late 60s and 70s. Oh, some a new idea, huh? Yeah, that recently. Because they really didn't have like a way of standardization of it until then.

The military had their methods, but as far as in civilian use, you know, for your communities, who was in charge of this service, who ran it? We didn't yet have the concept of an EMT. So, you know, what were the ambulances for? It was just a car that took you to the hospital. And so it could be run by your local police department. It could be run by your local fire department. And whoever ran it would also staff it. So you would have a police officer staffing the ambulance as well. So as you can imagine, they couldn't provide a lot of medical care. Right. Really. For a while, communities that could not afford ambulance services relied on the local funeral home.

Oh, well, that's convenient because if it doesn't pan out, you're already in there. Exactly. Oh, God. I mean, I didn't mean to be ghoulish. So this, you might wonder, like, how in the world, and this was, this was very common. This is not like just a couple little places. There were a lot of places, and this happened all the way up until like the 70s in some very small isolated communities where the local funeral home would be who you would call if you had an emergency and needed transport to the hospital. There are probably people listening to this podcast who still remember this

The reason is an ambulance had to be big enough to accommodate a person lying down In most communities what is the only place that has vehicles built to accommodate someone lying down ice cream trucks Do you often lie down in an ice cream truck? You could. It's what I'm saying. Right, but it's not made for that, you know? Sure. Okay, fine. The way a horse is kind of made to accommodate a person who is permanently lying down. Got it.

Right. So anyway, the horse was a good fit. So funeral directors would offer ambulance services. And if you think about it, this was a good gimmick for them because you don't commonly have like, on your refrigerator on a list of important numbers, like nobody does that anymore, but we used to have like a list of emergency numbers on your refrigerator.

You wouldn't usually have a funeral home, right? That seems a little depressing. But if they were the ambulance, then you certainly would. And so it was a great gimmick for funeral directors to community engagement. You became relied on, you became valued members of community and not just like that thing you don't want to think about. Yeah, like decrypify. Yeah. The whole thing a little bit. Exactly. And they

should they again, or something again, to get back in the game with maybe like also cotton candy. Like also we do sell cotton candy. I don't, I don't. And batteries. A lot of times I need batteries. And it would just be super convenient if there's a place I could go get, cotton candy and batteries.

And something else sometimes at one point for the people that are not me ever. And that would be convenient. They were actually kind of reluctant to give up this because of the good, because of the good feelings that it generated in the community. And like you said, if things didn't work out in transport, they would just take you straight to the funeral home so it got your business.

I think there's any unscrupulous ones that kind of have the long way around. No, I'm stuck in traffic. No, there weren't that. But there was a letter cleaning. I got into this deep hole where I was reading about unscrupulous funeral home practices at the time, like back in like the mid-1900s and things. Anyway, so the thing is though, the Interstate Commerce Commission started regulating how ambulance drivers, like how, they started treating them like long haul truckers. It's certain hours that they could work and they had to be off and

they had standards for like the rest in between shifts and how well they were paid and all these different things. And that was very cumbersome for funeral homes. We're kind of just using like friends. Like once your kid was old enough to drive, let him be the the hers ambulance driver. Yeah. They weren't really standardizing this. They were just kind of doing it as a nice thing for the neighborhood. And then there was this big white paper report

from the National Academy of Sciences that came out in the 60s that said there was an increase in morbidity and mortality from inadequate ambulance services. Basically, we could be saving more lives if communities just had a decent ambulance instead of having to rely on whoever, not knocking the funeral homes, just acknowledging that this is not what they should be doing. After that white paper report, the EMTs became

a thing, emergency medical technician, the whole idea that we need people who are trained to do this came into being. Higher standards for what an ambulance could be. It was actually good for the funeral homes because they didn't want to disappoint and let down the communities that they promised to serve, but it became so cumbersome to do it that when they finally were told they couldn't anymore, it was like, well, if you insist, I guess. Yeah. Yeah.

But like I said, in some communities, the 70s, the 70s, they were still doing this. What followed along with this is obviously advances in what we could do in an ambulance There's no point in having an ambulance if you can't do I mean like if it's just a car to drive you the hospital But with the you know improvements in CPR and pre-hospital patient care and like the development of portable oxygen You know and all kinds of medications we can administer and fluids and everything we can do in the back of an ambulance all kinds of medications we can administer in fluids and everything we can do in the back of an ambulance, once we developed that, it made more sense to have vehicles that could accommodate it and personnel that could staff it. So medical care really necessitated, you know, once we could do these things, then we

necessitated the development of better ambulances. And now if you've been in the back of an ambulance, you know, it's like a mini hospital. Oh, yeah. Right. And you have to have people who know what they're doing to staff them. You couldn't just have anybody who had a car. What's interesting about this currently is that and then this would not replace the ambulance service. But car services like Uber and Lyft are getting into the medical transport business. You may have seen there's a big article about how Uber is doing this. This just came out a few weeks ago, I think.

Uber is now offering to charge doctors offices to go get patients and bring them to their appointments. So it's free to the patient. The doctors pick up the tab. Exactly. And you might wonder why would they do that? Because it's cheaper to pay for an Uber ride than it is to lose that appointment slot.

The money that the office loses by having like a no show in that slot is way more than it would cost to just send the Uber driver out and get him. I like the no show, because it means that you could might have like 10 minutes to eat lunch. So that would be great.

That's true. Those no shows are how I eat breakfast and lunch. They're the only reason I ever get to drink coffee or pee. And also for those of us who have to pump at work, sometimes lunch breaks and no shows are the only times you get to... Because no show is coming. Folks, right now, I'm gonna put the appointment with your doctor. You do not keep it. No, I'm not advocating that. But actually my office manager would kill me for the, but sometimes that's the only chance. But anyway, and Lyft actually was already offering the service. All these articles about Uber,

I didn't realize Lyft had been doing this, but they're both getting into the business. And then the thought is like, you know, for a lot of communities like, for instance, in parts of our surrounding area, not in the city, but in the more rural parts of this area, you might wait 45 minutes for an ambulance. Yes, but in the more rural parts of this area, how much longer are you going to be waiting for an Uber?

Well, that's fair. I'm just saying there's an opportunity here for non-emergent patients who don't actually need an ambulance because you see that a lot. People who need to get to the hospital, but don't really need an ambulance, but don't have a way to get there and they can't wait till the next day. So they use an ambulance. There is an opening in here. There's a small opening for these people. And I mean, we've been doing this. We give patients taxi vouchers already. So this is an easy way, paperless, you know, way to do this. I should clarify we do have an Uber We have yeah on Uber and Uber flash lift Ted's Uber. He put a sign up on his car

It's an Uber and a lift Whatever you need. I think we have to we have to know I think we might have to know Okay, well you're covered because they can each work 12 of our ships all funny to Folks that's gonna do it for us. Thank you so much for listening. Thank you for your continued support of our program. We certainly do appreciate it very much. I wanted to mention we've got a, if you want to buy a Solbund's t-shirt, we've got a couple of them available and that's going to be in our new merch store. We should be going live on Monday. You can go to McElroyMarch.com and when that is working, that address will also be functional.

And I want to say thanks to the MaximeFund network for having us as part of their extended family. I want to tell you we've got a new, two new podcasts on the MaximeFund network. Everything's coming up Simpsons, Simpsons Podcasts, and Jonah Radio featuring my buddy, Jonah Ray. And both of those shows are going to be on the maximum fun network, maxfun.org. Of course, you can find them on iTunes or what have you.

So go go for it. And folks, that is going to do it for us for this week. So oh, actually, I did want to mention we got a few nice gifts in the PO box yesterday that I wanted to thank people for. In the meantime Cooper has pooped again, just in case she has pooped again in case you're tracking that on a spreadsheet. Thank you to Sam for the book Angie for the blankets and pillow monster scrappy Lynn for

the doll and booties. Haney sent plenty delicious plenty of Elder, which Sydney can drink again. Suzanne for a book called Jack's New Smile, which is about cleft palate. I'll proceed from that and actually go to help families affected by cleft palate. So check that book out. Leah sent mugs, Adam sent coffee,

Paul sent a book for Charlie, Kelsey sent booties and a hat and Catherine sent books. So thank you to y'all for the gifts. It's very nice. I guess we're a third Charlie as well. Yeah. And our third co-host has has started to get a little grouchy. So we're going to wrap it right there. So until next time, my name is Justin McRoy. I'm Sydney Mac. And as always, don't drill a hole in your head. Maximumfund.org Comedy and culture, artist owned Listener supported