The Chris Voss Show - The Chris Voss Show Podcast – White Hot Light: Twenty-Five Years in Emergency Medicine by Frank Huyler

Episode Date: September 1, 2020

White Hot Light: Twenty-Five Years in Emergency Medicine by Frank Huyler Emed.unm.edu Another “pitch-perfect book of short essays” (New York Times Book Review) from the acclaimed author of Blood of Strangers, this one exploring the contemporary practice of medicine from the perspective of a doctor with 25 years of experience in the ER. In the late 1990s, a young physician in Albuquerque, New Mexico, published a stunning memoir of his experiences in the highly charged world of the ER. Presented in a series of powerful, poetic vignettes, The Blood of Strangers became an instant classic. Now, over two decades later, Dr. Frank Huyler delivers another dispatch from the trenches—this time from the perspective of middle age. In portraits visceral, haunting, sometimes surreal, Huyler reveals the gritty reality of medicine practiced on the razor’s edge between life and death. From the doomed, like the Iraq vet with a brain full of shrapnel, to the self-destructive, like the young woman who inserts a sewing needle into her heart, to the transcendent, like the homeless Navajo artist whose sketches charm the nurses, Huyler assembles a profound mosaic of human suffering and grace, complemented by episodes from his personal life: the hail that fell the night his wife gave birth, his drive through a snowstorm to see his father in a Colorado ER, the beautiful wedding of his childhood friend with terminal cancer. Melding hard-earned wisdom with a poet’s crystalline vision, Huyler evokes the awesome burden of responsibility, the exhaustion, the relief of a costume disco nurse party, and those rare occasions when the confluence of luck and science yield, in the author’s words, “moments of breathtaking greatness.” White Hot Light offers an unforgettable portrait of a field that illuminates society at its most vulnerable, and its most elemental. Frank Huyler is an emergency physician in Albuquerque, New Mexico, and the author of the The Blood of Strangers, The Laws of Invisible Things, and Right of Thirst. His poetry has appeared in The Atlantic Monthly, The Georgia Review, and Poetry, among others.

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. Get ready, get ready, strap yourself in. Keep your hands, arms and legs inside the vehicle at all times. Because you're about to go on a monster education roller coaster with your brain. Now, here's your host, Chris Voss. Hi, folks. Chris Voss here from thechrisvossshow.com, thechrisvossshow.com. Hey, we're coming to you with another great podcast.

We certainly appreciate you guys tuning in. Be sure to see the video version of this uh broadcast uh you can go to youtube.com fortress chris voss hit that bell notification you can find out everything you need to know about the show and see what's going on there refer your friends to the cvpn.com chris voss podcast network.com there's uh nine podcasts are over there. You can also now go to an Amazon page that we've set up, an Amazon shop. It's amazon.com forward slash shop forward slash Chris Voss. And it features all the great authors that we've had on the show, kind of some review blurbs on them. And so you can see that.

If you just want to go there and be like, I want to see all the authors that have been on the Chris Voss show, you can actually go there and see their books and, of course, the links to buy them, which I'm sure the authors would certainly approve of you doing. So be sure to check that out as well. You can go to the new book club we just launched at patreon.com for just Chris Voss. Getting to the most interesting author that we have today, this gentleman is Frank Heiler. He has written the book White Hot Light, and he's actually written several different books, which we'll get into and talk about. Frank is an emergency physician in Albuquerque, New Mexico, and the author of Blood of Strangers, The Laws of Invisible Things, The Rite of Thirst, and his poetry has been featured in The Atlantic, The Georgia Review, and Poetry, among other things.

Welcome to the show. How are you, Frank? I'm well, thank you. Thanks for having me. Awesome sauce. So I got a chance to go through your book here, and this is an extraordinary, not only human, but a really interesting look into what goes on.

Give us some plugs on where people can find you on the interwebs and everything else. Sure. Well, the book is available in most bookstores, I think, now. Barnes & Noble, certainly, and on Amazon always at this time, this era particularly, their Amazon page. And it's, I think, pretty widely around the country at the moment. Awesome sauce. So what was the reason that you wrote this book and what motivated you? Sure. So I, a little bit of a, I should probably back up a little bit. I'm a, I'm a physician. I'm an emergency physician working in an emergency room. And I've been doing this for quite a long time now, about almost 25 years, about 25 years. And when I was young, right out of my residency, I wrote a book called The Blood of Strangers,

which was sort of a young person's take on the medical world, the world of emergency medicine particularly. And after that, I kind of moved away a little bit from writing directly about medicine and wrote some fiction, some novels, and other things. And then at this point, 20 years later, kind of in midlife, I realized that it might be time to sort of revisit those same kinds of questions and issues that I was trying to sort of wrestle with as a young person from the position of someone being older. And so really this second, this book now, White Hot Light, is in many ways sort of a midlife sequel of that first book. And it's been vaunted by the New York Times Book Review, another pitch-perfect book of short essays, stories that are very interesting,

that are both human and, what's the right word? They're in an ER situation of desperation and emergency, and you guys are saving lives. Share with us some of the stuff out of the book that you'd like to. Sure. The way the book is structured is people have asked me if I took notes, and I didn't take notes. And I also took – I was very careful to protect patient confidentiality and issues like that. So basically, what I did is I would think, I thought back, I had a fellowship at a writer's

colony, the McDowell colony, during a sabbatical. And I just basically sat there and thought back of the events and stories that I'd been part of and seen over the last 20 or so years, and sort of let my memory serve as a filtering device in a way. The stories that I remembered most powerfully came back to me. It was really interesting to sit there in a cabin and thinking back on your life. And I think that's true for everyone, if you had to do that. So the stories tend to be short. They tend to be fairly easily read. I mean, they're not long. They're, I would say, a little more than vignettes, but very short kind of stories. And my point in writing about medicine was not simply to write about medicine, not simply to write about emergency medicine, but really to kind of explore

some larger questions that a novelist might explore, how the medical world reveals truths about our own lives, regardless of where we are or what kind of jobs we have. So I don't, I don't, I'm hoping that, that readers will, will see that it's not entirely about sort of true stories from the ER, that the intention is really to, to use those kinds of events, which tend to be very, very striking and powerful, to also look beyond them at some of the questions that we all face all the time in our lives. So you talked about how you faced questions when you were young, and I imagine that was as a doctor, I suppose?

Yeah, as a resident physician, meaning during medical school and residency and then shortly afterwards. And this is like when you're first getting into seeing what you're going to see in an ER situation of trauma and everything else and trying to probably either relate to it or try and put it in its place as to what you're dealing with. Cause I imagine the first time that you're, you're starting to really experience that that's kind of a, you have to somehow put that in your mind in a place that, that you can deal with it, I guess. Yeah. There's, there's a very strong sort of apprenticeship process where you start, you go to medical school and you're like, and you get this,

you get suddenly exposed particularly during your go to medical school and you get this, you get suddenly exposed, particularly during your residency, to these cases and events and pressure and having to make quick decisions and all of that, that's really a new world. And the human response to that initially is to get very detached and distant or start making like dark jokes, black humor, that kind of thing. And it's a very predictable pattern. And so and it happens quickly. And everyone kind of goes through that. And then, and then you find that, you know, as time passes, you want to try to recapture some of the,

I guess, not maybe not humanity, but at least the emotional accessibility that you quickly learn to some barriers as a human being because because you know you there there's the part of you have to protect and you're trying to do uh this beautiful thing to save humans and save human life and and uh you know be a protector but but then again i mean the shock and horror of it all i mean there's lots of stories in the book i believe believe there's one story about a veteran who's kind of brain filled with shrapnel. You know, there's lots of stuff that you have to deal with. And I know the hours are long for doctors and what they have to go through. What were some of the stories in the book that maybe you want to share that stood out to you or maybe changed you from a human level? I think there's a lot of stories like that in the book, ranging from really dramatic events. Like somebody, the beginning, the first story in the book is about a boy who was shot.

And he's about exactly the same age as my son. And they didn't look alike. But nonetheless, I mean, the first reaction you have as a parent when you see a boy shot is you think of your own, your own family, your own life. That's just one, one of many examples. Another, another example is somebody that I worked with in a story called the sunflower, who was a physician's assistant, who I realized after he, he had some, he basically had a tragic event occur to him.

Um, and I, even though I worked with him for years, I never really knew him until after he was gone. And I realized that he had been a photographer and he had traveled around the state on his motorcycle, taking really beautiful photographs. It was a, it was a, uh, a private, um, life that he had that I didn't see, and no one else knew about it either. So there's a lot of stories like that in the book that my intention about it was not to write about medicine from a technical perspective, but to write about the stories that we't, we don't often always associate

with hospitals or medicine. Typically, the way that hospital stories are presented, it's always, you know, heroic doctors doing heroic thing, that kind of stuff, right? Or there might be some salacious thing, you know. And I was more interested in, in not just doctors, but also everyone else in the hospital, nurses, the, the, the support staff, the techs, their sort of role and humanity and all of this. And also, and my own evolution, I guess, as you age, and I, and you and I, I think are probably about the same age or close to it and i'm sure that you know if you think back on your life uh you'll have a different perspective than you did when you were starting um yeah i i now nowadays i've got i mean you at 50 i'm 52 now

and and you have a pattern of life that you can look back on where you can see the wreckage you can see you can see the patterns right you can go wow that really i should have went this i wouldn't i should have seen a psychologist or that was a mistake wasn't it yeah i mean you can see the body stream behind you for 50 years and you're just like and then and then it becomes more obvious. Yeah, I should have done something different with that. But, you know, I mean, there's what's hindsight's 2020. It's interesting to me, you know, I've always looked up to what doctors do.

I'm one of those people that if you try and take my blood, and you probably know these people, I will almost pass out. i have to eat like a big meal before i take my blood if i see too much blood on a movie screen i'll pass out so i have a lot of respect for what you guys do because you guys save lives and if i came across some of the scenes that you guys have to deal with every day i'd just be i'd probably just pass out and i or i'd just be like, I'm, I don't know what to do here. I don't, I'm out. Um, and, uh, uh, and so what you guys do is astounding and beautiful, but the humanity of it is something I've always wondered about because, um, you know, you guys are human too. I mean, you guys, you guys aren't above this sort of thing. And you guys see some of the stories in the book are quite

extraordinary, especially when, uh, the attempt there is to really try and save life when it almost seems like it's not worth saving. Not that it's not worth saving, but the guy's gone, right? Right. And you guys are still in there trying to find a miracle if you can, and sometimes you do and sometimes you don't. Yeah. I think there's a lot of, um, people want to believe that we save lots of lives. And of course, you know, statistically that sure people's apply, you do say occasionally say

people, um, not as often, I hate to say it as, as, uh, most people want to think, you know, most of the time when people are going to die, they're going to die. And when they're going to get better, they're going to get better. And there's only a pretty small window where modern medicine really makes a difference. And the whole enterprise is really designed for that relatively small percentage of people that you can make a difference for. So the majority of the time, we're not saving lives. You know, we're, we're trying to see people, we're trying to pick people out of the, of the crowd who, who we might be able to help. It's not as, it's not nearly as dramatic in the, in the traditional way that, that society views medicine as that. There are different,

there are lots of different challenges associated with it. But most of the people we see will either get worse or better on their own. Yeah. And in terms of your first point, which was that, you know, you see blood and you get, you get faint,

you'd be surprised. You see blood a few times and you'd be just fine. You know, I mean, people have a very great essential toughness and resilience, and anyone who goes through this process will emerge from it just fine. So the doctors and nurses are not any different from anyone else. Do you feel that shows like ER or House over-glorify and maybe give a wrongful perception to your industry and what you guys do? Of course. Completely.

Hollywood. Yeah. Yeah, exactly. People want to see that. They want to believe everything. There's like a magic answer. And if you're smart enough like House or Sherlock Holmes, you can reason your way to the answer that no one else can find. And that's just not the truth. I mean, really, most of the time, you're trying to check the box. You're gathering the same information that anyone else would gather. There's no terrible insight or great or remarkable intellect that applies to almost everything in medicine.

There's other qualities like diligence, like being thorough and careful. And there are certainly judgments that you make. But we like to think that this world is elegant and orderly, and if you're smart enough, you can find the answer. And the world is not elegant and not orderly, and it's chaotic. And half the time we don't know what we're talking about, and that's the truth. Well, a lot of times you guys are presented with situations that are that are uh you know you don't have a lot of time to sit around and go well what should we do with

this i mean you guys are in the er you guys are i mean the situation is immediate uh you know you don't you have a lot of time to you know but well we should have a meeting and see what we should do about this you know you guys are you guys are on of it. It's life or death and seconds matter. And I remember, uh, years ago we owned a career company and we used to do, um, uh, blood and urine sample, basically body fluid samples. Um, and we would have to, we did the stat service. We'd have to go to the ER, pick up whatever blood, you know, whatever the body samples were that they needed tests on because they had some guy in the ER and they're like, we've got to figure out why this guy has a problem. And we had to race it to a company like ARUP.

And then they had to get it done. It had to be done very fast because lives were on the line. And there were times where we were picking up blood and bringing it back to the hospital from ARUP because they had a patient on the table who was bleeding internally and they couldn't figure out where he was bleeding internally. And I remember there was one time, it seemed like we did four to five runs for blood for just one guy. That may be too much, but it was like at least three i think where we did a blood run

and then like yeah he's still on the table we still haven't figured out where where the uh the bleeding out and just the level of of uh expertise and that has to go into that but extraordinary performance as a human being and being able to deal with it but then you have the humanity side of it which you deal with in the book as well you know, how you process it and some of the experiences that you have that, that balance that out. If you want to expand a little bit on those. Yeah, sure. Um, the, when people think about emergency rooms, emergency medicine, they think of lights and sirens and people getting shot and everyone running around and yelling stat and stuff like that. And yeah, yeah. And, uh, and sure. There's a small percentage of it where it really,

it is a question of minutes and it does happen. Um, and it happens fair, you know, not, not uncommonly, but almost every, most of what you do is not about that. It's an, it's an older, it's an old, old lady with abdominal pain in the middle of the night, or it's a kid with an earache, or somebody with a heart attack that may not be so clear that they have a heart attack. Those are the sorts of things. And then every once in a while, you've got all the drama and the adrenaline running around. And the fact is that most of the time, you know what to do. It's not very, it's not terribly complicated. These highly dramatic moments, when people are in a car wreck or shot or something, what needs to be done is quite clear. It's just a question of doing it fast enough and efficiently enough.

Is one of the biggest challenges is, you know, you said there's a small percentage of people that you can actually save. Is it just one of the factors that by the time they get to you, I mean, obviously they've been through some sort of trauma, and they have to wait for an ambulance to show up, and then it shows up, and the paramedics do everything they can. But, I mean, I don't know. Maybe sometimes it's the time of it. Yeah, I think a lot of what I meant by that is that the world gives us, there's illnesses like someone who has, let's say, advanced cancer, for example.

Then there's nothing you're going to do that's going to help them. Or somebody has pneumonia or a kidney infection, you might give them some antibiotics, but they're going to get better. They're going to get better. They're going to get better. And, and the minority of, of, of cases, patients coming in are at the tipping point where a medical intervention will really, really help them. And particularly a quick one. Now, somebody getting shot, somebody in the car wreck is an example of that, you know, because that that's life saving. So the trauma surgeons take them to the operating room and they save them or not. So there are examples, certainly.

But a lot of what we see and most is patients who don't have anywhere else to go. You know, the emergency room, emergency departments around the country are in a lot of ways, um, uh, sort of like the canary in the coal mine for the country itself as a whole. Um, you see people who don't have doctors have no way of getting in to see the doctor who run out of their medications. You see the consequences of poverty. You see the consequences of substance abuse, uh, mental illness. Um, all of the social problems that confront us as a country and as a nation are revealed in the ER like few other places. Wow, that's extraordinary. I never thought of it that way. I know there's a lot of people who go to the ER and like you say, they can't reach

the doctor. I imagine you guys get dumped on with everything. Have you seen over the course of your career, have you seen an increase of that? We deal with a lot of different things with our society and it seems like a lot of things are in downgrade when it comes to people's incomes, people being poor. Have you seen that scale up or has it been a continuum? Absolutely. My anecdotal impression, I mean, of course, you know, I'm only one person working in one70, and that is an amount that they simply cannot come up with. These are illustrations over and over again.

People have nowhere to go. They're losing, you know, when you have hard economic times, they lose their jobs. They don't have access, don't have other places to go. And the mood seems in the country, at least in the Albuquerque area, certainly things are not getting better. I mean, particularly in the COVID pandemic, when so many are really struggling to make ends meet. So many jobs have been lost.

And so I think that the emergency medicine is a particularly good place to sort of take the temperature of society as a whole. Maybe we need to have more presidential candidates and congressional candidates or elected officials visit ERs and spend a day. That would be great. And, yeah, I mean, the ER is not really about the high drama and everyone running around. At least, probably 90% of it is about the other. Yeah, yeah.

How do you feel about, I don't know if you talk about this in the book. I didn't get fully through it. But how do you feel about, there's a gentleman who wrote a book called The Death of Expertise. I'm trying to get him on. It's a little bit older book, and so they stopped pushing the publicity. But it's been extraordinary over the years to see doctors maligned with this uh everybody knows it all sort of thing and it got worse with covid and you see people questioning doctors and you're just like you know especially with like uh what was it the uh anti-vaxxers and stuff

and you know you guys are professionals you spend years uh if not i don't know a decade or something like that in schooling and books and education and some guy reads a facebook post and and suddenly he thinks he knows more and you guys have to confront that like i want to punch those people in the face and i'm not a doctor but you guys have to deal with it and then you you have a situation where a patient's fighting you which i don't remember 20 years ago when I used to go see doctors that we used to fight with the doctor. We just went, okay, we'll take the pills and go home. You know, it's interesting.

There definitely is this, I think you said the death of expertise, the idea that when knowledge is disseminated on the Internet that everybody, everyone's opinion is as good as everyone else's in any area, not just medicine. That is potentially a dangerous view, I think, for society. The idea that, because there are people who know more than other people, and it's not necessarily by any means exclusive to medicine. Medicine is one of those tricky things because it's very hard for patients to know whether they're getting good medical care.

They really don't. It's very hard for anybody, no matter who they are, who is not that familiar with how medical decision-making is made, to know whether they're getting good care. So they tend to rely on secondary cues from the service industry. So were people nice to them? Did they get a blanket? are getting good care so they tend to rely on secondary cues from the service industry so are were people nice to them do they do they get a blanket you know did they have to wait a long time um i mean i'm not i'm not joking your yelp reviews basically yeah exactly like uh like you know hotel

management sort of thing they saved my life but i didn't get enough blankets. Well, maybe I waited so long. And so the corporate influence on medicine has taken full advantage of those things. And so a lot of times it's increasingly becoming a customer service-based field, which is a dangerous precedent to set because it's not the same as buying a product, selecting a car to buy or something like that. There's a fundamental difference between that contract between physician and patient than between retailer and consumer. Yeah, we saw kind of some of that through the crisis with the opioid epidemic,

didn't we? Epidemic where people were just like, hey, I want some drugs. And doctors started going, okay, whatever makes you happy, customer service. I don't know. A hundred percent. You're absolutely right. And what happened with the opioid crisis was that industry, pharmaceutical industry, basically came up with fictitious data that said that opioids should be used for chronic pain. And they marketed, sometimes fraudulently,

this idea around the country to physicians and also to patients. And then in part because of exactly what you said, keeping people happy, a lot of doctors started prescribing and were encouraged to prescribe opioids. And patients basically got very large numbers of people on opioids in that way, in a very cynical kind of way, driven by a quite predatory pharmaceutical industry. And also the fact that it's much easier to just write somebody a prescription for for percocet um and get them out of the office so that they don't you know complain or what have you and so it was kind of a perfect storm and a lot of people got um got uh

hooked on on oral opioids and then moved from there to um to heroin and iv forms and then heroin and fentanyl and these sorts of things have never been easier to get uh than they are now i mean the war on drugs you know it's it's unbelievable how uh how plentiful these things are yeah we'll throw we'll throw uh you know someone of color into prison because that's right what's going on um for you know, someone of color into prison because that's right. What's going on for, you know, an ounce of marijuana. And then, and, but, you know, Hey, go for the thing. It's interesting to me what you mentioned that, you know, Hey, we'll just give them a prescription. Otherwise they'll complain to management and tell them how horrible I am.

And you probably do see people that come in the ER that, you know, I've heard some extraordinary stories where people actually break a finger or something just to get, you know, their fix. And you guys can probably really smell that when it comes in where you're like, I know this guy's an addict and he's just trying to hustle for stuff. Yeah, it's very, very easy. It's very transparent when that happens. It's happened less now because there's been a crackdown on it. Um, but it's very easy to see. And it's also kind of tragic. I mean, when people are reduced to that point, you know, when they're, when they, when they're feeling that bad that they have to come

to the ER and make up, make something up to get a short term shot of something. It's, it's really, um, it's fair. That's a pretty tragic person. You person you know i had in 2004 that's when i first found about oxycontin and my uh friend uh her sister had uh gotten uh really almost killed in a car accident and she was in a head rack with the whole thing and uh um and so she she lost everything because she'd been in an accident lost her job and so she ended up staying with her mom and they put her on oxycontin and i never heard of it before that but this is like 2004 and like they talk about how bad it got recently and you're like i started hearing about this stuff a long time ago and so she got hooked on that she would constantly use it for pain and you know it became a an

addiction and then once she got better she you know once she couldn't get it from doctors anymore she switched to heroin and then she started working the street and then she eventually died of an overdose um and that's when i went i'm never taking that crap ever yeah yeah that's a very sad story and it's a very enormously common one. I mean, that's a very common road. People get an injury, they get,

they get, they get hit on the oral opioids and then, uh, uh, and then either continued with oral opioids or, or moved on to street drugs. And that's, and,

um, it killed an enormous number of people. I mean, it was not, this, this was, uh, just an absolute, um, uh, travesty and the Sackler family, especially, um, Purdue Pharma, but not just them, others as well, um,

were, uh, very actively promoting opioid use at that time. Um, and, um, and still there has not been sort of a full reckoning of any of that. There's, there's class action lawsuits and so on going on. Um,

I mean, we'll, we'll, we'll, we'll go get old choppo and spend all the money for the drug war and put everyone in jail. But, uh, you look at the what they were dispensing in west virginia places like west virginia there were just like a drug cartel yeah it is it is very hard very hard honestly to distinguish between the drug cartels

and that sort of thing and and as you said, they put enormous numbers of people of color, African Americans in particular, during the crack epidemic, in prison for long periods of time for very mild or minor offenses, relatively speaking. We've done a lot of talking about that on the Chris Voss Show. We've had a lot of authors on them, and Black Lives Matter, of course, has been a theme through this. In your book, what's the biggest takeaway or some of the biggest takeaways you'd like for people to really

uh get when they read it or walk away with well you know i think that um one of the ways we sort of examine the life in our own lives and is through the through the context of stories of others so it was a an attempt to sort of make sense of my own life in in a way um to try to see the world um after 25 years of being exposed frequently to often very very dark stories and very dark events, not exclusively dark ones, though, but nonetheless. And so what does that reveal about the world we live in? How do you make sense of that? And ultimately, how do you find some sense of sort of peace, not only for yourself, but some perhaps some sort of wisdom in the face of, you know, what seems often very inexplicable

and deeply, deeply unsettling. And in some ways, it's almost a Buddhist kind of question. And so that was the intent behind this, for me, behind this book, not to make points about medicine specifically or the opioid epidemic or policy or anything like that. It was more to explore these larger questions that have to do with reconciling and hopefully synthesizing the experiences of our own lives, much like a novelist would do. So you hope people will take away from your experience, uh, maybe better lessons on life or contemplation of what their experience of life through your stories and, and through watching you, of course, go through your own, you know, sort of catharsis of how to deal with these things

and how to put things in peace, uh, with as much as you can. Yeah, I'm not, I don't presume to be instructing anyone. You know, I'm not trying to tell anybody what lessons to learn. More and more it was an attempt to sort of portray my own movement or my own attempt to find lessons. Yeah. my own attempt to find lessons and to, and to work through some of these, some of these questions. And that's the beauty of what we get through stories and books and movies and everything else. And why we collect stories is because we watch them and, and,

and it touches us or moves us or motivates us in some way where we look at, you know, just like you looked at the young boy on the table as your son, where you look at it and go, you reflect on your own life and you hopefully take lessons from it as well. Did you hope in the book that when people read this material in your prior books that they would hopefully maybe come away with a little bit more respect or understanding of what goes on in your industry and, and maybe, um, you know, just, just respect it more or have a better education of it, I guess. Yeah. Maybe not so much respect. I'm not, I'm not out there trying to, to get people to say doctors are great. Yeah,

no, no, it's not that it was more, it was more sort of, um, trying to offer a window into an often mischaracterized world. Uh, that I think you touched on a little bit with, uh, with sort of popular shows, you know? Yeah. There's more ER shows on TV than there are, I think just about anything else. Yeah. I wish, I wish we were all that smart and good looking is all I can say, you know? Um,

so, uh, um, just, just trying to sort of pull the curtain back a little bit toward what seemed to me more essential about, um, about this sort of work or anyone who does work like it.

And it's not simply doctors who do that. For me personally, I hope people would find the more respect for your guys's industry it was extraordinary to uh to watch this covid thing with the with the just the insanity of people going you know i i watched the doctors uh in in that were uh doing the videos going please god help us stop being stupid people um you know i i watched the doctors uh in in that were uh doing the videos going please god help us stop being stupid people um you know and they were talking about their experience and and they had people that just run around going i'll do whatever i want hold my beer and uh and you're just like these folks are trying to save everyone's lives they're overwhelmed to an extraordinary thing especially

like in new york and some cities now are spread around the nation and you're just like in their fit and then and then seeing the um i don't know if you want to talk about this but seeing the seeing some of the nurses go out and just get uh just get ridiculed and and treated like crap uh and all they're trying to do is save people's lives they're just like hey man we're just trying that just get ridiculed and treated like crap. And all they're trying to do is save people's lives. They're just like, hey, man, we're just trying to help you, help us help you. And it was an insane thing for me to watch. I couldn't imagine being on this side of it.

Yeah, our response, our national response to this has been really perplexing, to be honest. It's for many, it's still abstract. And because of its because of its abstraction, they can fools rush in, frankly, you know, the idea that the idea that that somehow wearing a face mask is a political statement um when really it's like this isn't during world war ii uh the united states was not saying um you know there weren't political divisions with the united states fighting fighting nazi germany right and this is not in the same way at any rate. And this is actually analogous to that. This is an enormous world event, arguably, certainly in 100 years, the greatest public health challenge that anyone has had. It should be a unifying force where we put aside some political divisions and say, okay, what's the practical way of controlling this thing? Not, not a, not a, not an opportunity to,

to sort of falsely confuse something like wearing a face mask, which is like, you know, wearing a helmet in battle with, with a political, with a political statement. I mean, it's ridiculous. And on the national level, I think our failures have been just extraordinary from the point of view of simply organizing a national response. We've left hospitals and states completely on their own, reinventing the wheel, doing the best they can. We have not created an adequate system of either testing or personal protective equipment or contact tracing or any of the basic things that the federal government

should have done. And really, in my lifetime, in previous, really all, you know, previous administrations, Republican or Democrat, I would think would have happened. I just, it's just mystifying to me that as a nation, we've responded to this in the way that we have. I think, I think the internet is part of, partly, you know, like, like we say, everyone's an expert now, and they read anything on the internet. But there, there has been a death of expertise. And I don't know if you ever saw the movie Idiocracy, but it seems like we say, everyone's an expert now, and they read anything on the Internet. But there has been a death of expertise. And I don't know if you ever saw the movie Idiocracy, but it seems like we're trying to make that. It seems like when I first saw it, I was like, this is the dumbest thing. I couldn't even barely watch it.

Now I watch it, and I go, this is a documentary. This isn't fiction anymore. I know. This is where we're headed. You know, I watched the videos, and the doctors and nurses were just extraordinary in how they would try and educate the public. And I would watch them suit up and put on all the PPE and stuff that they have to do. And you realize they wear that for like 12 to 18 hour days, just on probably normal shifts, let alone what a lot of them were going through and in the hellscape of of the overload of covid um and then you see these people like i have to put on a mask for five

minutes it it stops oxygen my brain i'll die you're like seriously yeah i mean you've seen a nurse suit up yeah no i know there's no it, it's really a shame because this could have been an opportunity for a collectivism, collective spirit and unity in this country. I thought I was hoping so too. And instead it seems to, so far it's been something that's put pressure on society. Um, and, uh, and our divisions have come up. I mean, uh, it's split, we've splintered along in the face of this pressure collectively instead of uniting, and that's a shame. Yeah, yeah, it really is. Hopefully, I don't know, I mean, COVID is just, COVID is such an extraordinary, I mean, if you could pick something that could just take us on and wipe us out, not only from an economic aspect, but from a health aspect, from being able to interact with each other aspect.

I've got two sisters in care centers right now, and COVID just stalks outside their door every day. In fact, they admitted one new resident recently, and fortunately, they quarantined him. They did everything right but uh guy had covid and if they hadn't done everything right that whole the whole care center wiped you know like we've been seeing so um you've got a few other books that you've written that are pretty interesting i don't know if you want to plug those as well sure well the first like i said the first book was the blood of strangers um which is similar to this, except again, written from a different point of view, I think. And then a couple of novels. The most recent one is a book called Rite of Thirst, which was about sort of international aid work set in the Middle East.

I spent time as a child overseas and in the Middle East particularly. So I would certainly that book is available on Amazon as well. But they're all published by HarperCollins. So the HarperCollins website should have both Right of Thirst and White Hot Light. And The Blood of Strangers is still in print. Yeah, it's a very popular book.

What were some of the things that you changed your mind on, maybe, between Blood of Strangers and this new book, White Hot Light? I think you become, I think you realize that you're part of a larger story a little bit better when you're older. When you're young, everything seems very individual. Your own individual ambitions, your own individual

hopes or whatever they may be. And as you get older and have a little more perspective, I think you realize that you're really just one of many, that you're all going, people tend to go through very similar events, that you're part of a larger, broader human experience, that it's not singular to you. That's, um, life is sort of rippling through, you know, you start from the beginning as a, as a kid and some of the stories in this book are talk about that. Some, uh,

some events, um, back when I was, you know, even very young. And then you're, you're, you're a son or a daughter, you move through life. You have a children of your own, and you can see that you're on a path that is very well trodden, that you're just one of many. And there's a certain, almost a certain comfort in that idea, which I don't know if that answers your question at all does it no that does that's great does when you say there's a certain comfort in that is is the comfort in finding that you don't have to carry the world and it's not your responsibility so uh or or that you're in a larger part of a map and and you realize that that is your contribution or yeah i think that the the your own individual

um we i mean america is a very isolated society it's full of it's a nation of individuals and we want and we value individualism um and there have been some benefits to that but also some great costs there's a lot of loneliness in america it's one of the things you see in emergency room a lot people alone uh people coming in toward the end of their lives with hardly anyone around them. And over and over again, you see that in this country. And I think you realize that as you age, and this is not some kind of great profound observation, but that the things that you do understand about this life tend to be one another from relationships you have with other people and your own sort of in

the context of your life, how it relates to others, whether they're your children or your family, that we're not truly in isolation. It's a mistake to think of ourselves that way. And to think of our own individual ambitions is so terribly important. You realize that you're not going to set the world on fire, you know. The world doesn't revolve around you. Yeah, exactly. That's exactly right. You know, you're a witness and you're part of it.

But you're not as important as you thought you were. Yeah. I think that's one of the things i've discovered as i get older i realize that there are millions of people that pass this way and i'm going to leave some footprints behind but probably the dust will blow them away very shortly um hopefully i'll make some impressions that will be lasting uh that would be my contribution but but when you look at the the grand scope of the names that are remembered and the people that are remembered, I mean, it's very few of the mass that do. But do you find a lot of people that read this book? Do they come from the medical community? Do you get a lot of feedback from young people that are going through school

wanting to be a doctor or a nurse in the medical field, and they read your books? Or is it a – I would say it's probably a good book for them to prepare, especially for this book, because they can see what you've done down the line and the experience of hopefully maybe what they learned from it without having to go through all the years learning it themselves, maybe? Well, to be answered your question, the book was published just a couple days ago. So I just don't know what people's responses are going to be to it. I hope that it would have some relevance to students. My first one, The Blood of Strangers, is still used in a lot of medical school and college

classes. Um, and I'm hoping that this someday will, will maybe take its, uh, be by its side in that. Um, so I, it, to answer your question, is this written for medical person of people? And the answer is no, it's written for a general audience and even more than medical people. It's written for people who know nothing about medicine or may not even be interested in medicine. Yeah, it's definitely eye-opening. I mean, I'm kind of familiar with what goes on in the ER, but this definitely goes into depth and gives a very sobering, visceral sort of exposure to it all. And what's interesting, too, is we see the stories through your eyes

and your experience with it and your experience of dealing with these cases and kind of your mental process as well. And I think that makes it even more interesting. There was another question I had for you. It was along the line of the medical students, but I think this is something that's important for people to read to see what's going on to, in my opinion, gain some better respect for what goes on in our mental community.

Oh, it was about, you probably see a lot of NER people that are people that are, you know, lonely, like you mentioned before, that are hypochondriacs that they're just looking for attention or, or whatever. And you mentioned the loneliness, and I thought that was kind of interesting. Yes, absolutely. I mean, loneliness is a big part of hypochondria. Yeah.

The wanting to be seen, wanting to be significant in some way in front of others. The longer I've done this, the more I realize just how much our sort of human psychology plays into symptoms. And we tend to sort of talk about these distinctions between, oh, it's all in your head, that kind of thing. And a lot of things are in our head. I mean, a lot of the reasons that people come to the ER have to do as much with their emotional state

or their psychological state than any physical ailment, than any traditionally physical ailment, I should say. Maybe you see a psychologist out front first as the first gatekeeper right well these are these are you know and they're and it also speaks to our heart i mean these are real problems these are not these are not they're not any less real than than physical problems but we see enormous amount of mental illness for example because as a society we basically said you're you're mentally ill, you have a severe mental illness, you're out on the street and you'll cover your meds.

But a lot of homelessness, a lot of substance abuse, a lot of things like that. Wow. A lot of people who have been sort of cast aside by American life. And you guys, I would imagine you guys have seen enough of the stories, you know, the timelines, like you can read the future, where you can see someone who comes in, especially maybe in that situation, where you know how it goes. And you know, you're going to see them again, more and more. And maybe there's going to be a downgrading of where they end up. Absolutely. You see a young

person, for example, who's withdrawing from alcohol, somebody in their twenties, who's just shaking and has DTs, you know, that that is a bad path that they're going down. Um, and then unless something changes that, that, that, you know, how that story will end. And so, yes, we see that a lot. We see a lot of those kinds of patterns that will end badly. You know that they will. So you try to do what you can to intervene, and you hope that you will maybe make someone change their mind along the way. When you go home at night, do you think about those stories?

Do you try and turn the switch? Because I imagine you can't spend your whole life in depth with that. You've got to find some peace or distraction or something. I would drink heavily. Yeah. No, you know, you get really good at turning it off. I mean, inevitably it spills out into how you look at the world and how you look into your personal life. It spills out into how you look at the world and how you look at,

you know, into your personal life. It spills out a little bit for sure. But, um, uh, you get pretty good at, at, uh, at leaving the hospital and putting it in the rear view mirror and not. So to answer your question, when I'm off work, do I, am I like thinking about cases? No, I'm not. Um, I think I probably was at one point more than I do now. But yeah, you get quite good at compartmentalizing regardless of what kind of work you do.

When people come home, their minds aren't always in the office, right? Fortunately, because who wants to live like that, you know? Yeah. That would be a tough thing to do for any of us. Yeah. And I remember, you know, I've had friends that they're, they're wives or girlfriends where they run to the ER every time the kid gets sniffles and, and you're like, that's quite extraordinary. You look at the burden on insurance and everything else. Um, I had one friend who was a hypochondriac and for 40 years they were dying of something at any given time, but somehow they lived 40 years. That's reassuring, isn't it?

That's good. Yeah. And they would go to the doctor and the doctor would say, there's literally nothing wrong with you and trying to apply to him that, you know, loneliness and anxiety and fear and, you know, maybe just to see a psychiatrist. And they would literally go get a second opinion. You know, most people, when they go to the doctor, if they go get a second opinion, it's because the doctor goes, you have cancer. And they're like, I'm getting a second opinion. This person, when they wouldn't get a second, you know, the doctor would say, there's nothing wrong with you.

They'd be like, I'm going to get a second opinion. I'm going to go find a doctor who tells me there's something wrong with me. I'm going to go to the Mayo Clinic. I'm going to go to the Mayo Clinic. There you go. Well, this has been an interesting discussion in depth and the beauty of humanity, doctors, ER, hospitals. I would hope more people would give you guys. I actually spent a little bit of time in the ER recently with my sister at a care center who got a lung infection. And they weren't sure if she had COVID, but she developed some sort of weird lung infection.

It was pretty bad. They drained her and everything. But we went into the ER, and it was crazy, some of the people that were in there. And it wasn't that they were bad people, but there was one guy in there with dementia who was uh swatting at nurses and wanting to throw fists uh and he was clearly demented so he he you know he felt sorry for him but he was he was starting to freak everybody out and he i mean and you guys have to deal with this on a daily basis and and uh i i just i just uh i i just think you guys are great in having to deal with it i mean i know you guys get paid for this and it's your job

and whatever people want to spend with it, but this really is a – to me, you guys are just really great human beings. That's my vote. Well, thank you. You know, I think that people are no different. I mean, it's easy to claim virtue, but really, I mean, there's nothing different about doctors. I don't know, Frank, I'd have a hard time dealing with it.

And I would go, I would go to the drink. I, you know, I owned businesses when I was 18. I drank a lot of vodka and that was over that stuff. I just, I find what you guys do extraordinary. So I think it's awesome. Anything more you want to tell us as we pass the book and pick that baby up on Amazon or local dealers? No, thank you. And I hope that your listeners will take a look at this.

I hope that it's not your typical kind of book about medicine. Definitely, definitely. And it's not the Hollywood ER shows that you see on TV. It's extraordinary how many of those are. I'm like, there's people who like a lot of er stuff on tv and there's people who are plotting to kill people with all the you know the the uh what is it uh i don't even watch tv anymore because i can't deal with it but all the uh you know murder murder stuff on tv you're like i i've seen enough of it to go i'm never killing anyone

because my dna i'll screw up the crime scene and that'll just happen so guys uh be sure to check it out it's uh frank hyler it's his white hot light 25 years in emergency medicine if you're not going to learn something from this gentleman after 25 years uh i don't know what to tell you um and it's really beautiful you can check out his other book, The Blood of Strangers, which has been hugely popular. He's a great author and I think you'll love the book. Thanks for spending some time with us, Frank. Thanks so much. I really enjoyed

talking to you. Awesome, Sauce. To my audience, be sure if you didn't get a chance to watch the video version, let's go to youtube.com forward slash Chris Voss. Hit that like button so you get all the different things we do. For the show, your friends, neighbors, relatives, go to thecbpm.com forward slash Chris Voss. Hit that like button so you get all the different things we do. Further, show your friends, neighbors, relatives. Go to thecbpm.com, and we'll see you guys next time.