Toronto Mike'd: The Official Toronto Mike Podcast - Dr. Brian Goldman: Toronto Mike'd Podcast Episode 1878

Episode Date: April 9, 2026

In this 1878th episode of Toronto Mike'd, Mike chats with Dr. Brian Goldman, host of White Coat, Black Art and The Dose, about his latest book The Casino Shift and how Canada's emergency rooms compare to ER and The Pitt. Toronto Mike'd is proudly brought to you by Great Lakes Brewery, Palma Pasta, Ridley Funeral Home, Nick Ainis, and RecycleMyElectronics.ca. If you would like to support the show, we do have partner opportunities available. Please email Toronto Mike at [e-mail].

Hello, I'm Dr. Brian Goldman. I'm an emergency physician. I'm the host of CBC Radio's White Coat Blackguard and The Dose. I'm the author of the Canadian bestseller, The Casino Shift, and I'm thrilled to be making my first in-person, in-studio appearance on Toronto Mic. It's like you're a broadcaster or something.

That was perfect. Like I'm a broadcaster or something. I thought I recognized that voice. I'm in Toronto right. I want to get to city love. Donna Dingwall told me, taught me everything I know about broadcasting. I love you, Donna. Well, Donna's listening right now.

You better be listening. You and Dave better be listening. Well, it's funny. Dave came up in the Ed Keenan episode yesterday because that's how I got Ed's phone number. But let me get to this intro and tell everybody, welcome to episode 1,878 of Toronto Mike. an award-winning podcast proudly brought to you by Great Lakes Brewery. Order online at Great Lakes Beer.com for free local home delivery in the GTA.

Palma Pasta, enjoy the taste of fresh, homemade Italian pasta and entrees from Palmapasta in Mississauga and Oakville. Visit palma Pasta.com for more. Fusion Corpsoe Nikainis. He's the host of Building Toronto Skyline, and Mike and Nick, Nick. two podcasts that you ought to listen to. Recycle My Electronics.C.A. committing to our planet's future means properly recycling our electronics of the past. And Redley Funeral Home.

This man exists to keep clients away from Ridley Funeral Home, Pillars of the community since 1921, and joining me today making his in-person Toronto Mike debut. It's the author of The Casino Shift, Dr. Brian Goldman. This is the first time we met. Yes, it is. It is. The other times we're all virtual because of COVID. Well, let me tell you, Dr. Brian Goldman, I took a note on these two. So I'm actually right off the top going to tell the listenership where they can hear the first two episodes featuring Dr. Brian Goldman.

And then today will be like a whole different vibe because you're in person. You're in the studio. You made your way to South Atobico. I'm honored. You're here. I am honored to be here. I am freezing. Your basement is as cold. You're still, sorry. It's healthy, right.

You're the dog. You're right. It's healthy cold. It's healthy cold. And it's the best way to keep people awake when you're giving a speech and when you're doing an interview. So you're right. Yeah, I know what I'm doing around here.

Episode 1870. I don't want you to get too comfy. You fall asleep on me. I had a great guest. Mark Jordan. Do you know the name Mark Jordan? He's a singer, songwriter. He had a, he was like a yacht rocker back in the day, but he's a legend.

But he was here. And I watched him like he got really comfy. He started melting into the chair. I had to check for a pulse a couple of times. Okay. So that's when I said, no, we got to keep it cold down here. Keep these guys away. As opposed to keeping it cool.

Like a room full of Fonzie's. That's what I say. May 2020, that really is pandemic time, man. Oh, yeah, it was. Yeah. Episode 653. You've done 1,200 more since then. Oh, my God.

Well, it's been six years. But I'm going to read the description at the time. And while I read this description, I can make sure this is all accurate in 2026. But I wrote, Mike Chats with Dr. Brian Goldman, host of White Coat Black Art on CBC Radio. I'll pause to ask you, Dr. Brian Goldman, you're still the host of White Coat Black Art. I still am, yeah. The show that they didn't think was going to happen and they didn't think it was going to last. And who was ever going to create a show for Dr. Brian Goldman?

Answer, nobody. Well, I did. The answer is Dr. Brian Goldman. Yes, that helps. As you would know. And I told you back in May 2020, that's a great show. Thank you. Like, you're, we're going to get into the emergency room physician aspect of your life

and we're going to talk about the book. But you're a hell of a broadcaster. Thank you. I appreciate it. So are you. Well, listen, you nailed the intro, the cold intro, okay? I'm just impressed. I don't know.

You can string more than two words together. I'm impressed. But I also wrote. Because at the time it was a new podcast called The Dose, you're still producing episodes of The Dose. We are still doing that. And, you know, the DOS and White Coat are like Yen & Yang. White Coat Blackguard tells stories about health care providers, like people who work on the front lines and people who experience medicine on the front lines, patients and their families, and within the culture of modern medicine.

And so as long as we've got culture issues to talk about medicine, boy, do we sure do. these days, which is why I wrote the book. We'll get into that. We're going to get into that. The yang, though, is the dose. The dose is practical information about stuff that people are talking about in health care. The last few weeks alone. Did you know that young women, the teen girls and young women are more likely to tear their ACLs than the teen boys and young men?

I had no idea. You got to listen to the dose. You know what? I do periodically tune in, but you caught me a little behind there. I did not know that. But why is that? Why is that? Several reasons. First of all, the female pelvis is wider, which puts more stress on the ACL. Really strange things. Well, women have stronger quads than hamstrings. And what it means is that they tend to, when they land, they tend to land flat on their feet.

So flat-footed landing puts more stress on your ACLs. They think that maybe estrogen and lack of testosterone plays a role. and I mean, it's amazing. And I can tell you that 90% of the women who tear their ACLs have to have it repaired surgically. And, you know, it's an interesting thing. You injure, you know, you're a young woman. You injure your ACL playing soccer. It's usually playing soccer these days. Right.

They put you, you know, you get x-rayed. There's no fracture. You get a Zimmer splint. You get crutches. About four or five weeks later, you're feeling better. I want to go back to play. That's a bad mistake because you're going to injure it worse than. next time. You need to have it repaired surgically. You need to see an orthopedic surgeon. You need to get an

MRI. Okay, mine blows off the top. You're not holding back. I love it. Okay. So I finished up that description in May 2020 by saying that I asked you many COVID-19 questions. How did that go, COVID-19? Are we out of that pandemic now, Doc? You know what? I would get into serious trouble with people who are, who continue to be worried about COVID, you know, because of long COVID or because they are immunosuppressed, when I, you know, when I, when they think that I'm saying that the pandemic is over, I guess the WHO has basically said the pandemic is over, but it's not. We're still, you know, we still have new variants that are coming.

The latest one is known as, I love their nicknames, Cicada. That's the latest. Oh, they make that noise in the trees. Well, they seem to do a number on young people. And they're high, it's highly infectious. And in fact, I think, you know, my, my daughter. I hope you're listening, Kaylee. I hope she's listening to.

She was in Florida and came back from Florida with a raging virus that I'm quite sure was COVID. And we don't even have testing anymore, right? Like my wife was big on having tests in the house and now there's no, there's no tests. They're hard to get. They're hard to get. And it's so interesting. I mean, there may be political reasons for that because the less you test, the less you know and the less you worry about stuff. And they're trying, I feel like there's a push to like normalize it somehow.

Like, oh, there's flu. There's a few different things you might have as a stew out there, and this is just one ingredient in the stew. Yeah, it is one. Well, you know, that is sort of right because, you know, we have respiratory syncedural virus RSV. Yeah, that's the way. We have pretty bad, pretty nasty flu. That was early in the season. So November, December, that's kind of gone now.

And, you know, we're back to the kind of seasonal, like, what we don't have right now is the general population has never had this virus before. So a lot of them are going to get infected. A lot of them are going to get really sick in the absence of, of, you know, medications or vaccines, which was what we were into when we spoke. May 2020. In May 2020. Well, I'll never forget. It was a Friday the 13th in March 2020 when I picked up my kids at school because it was March break. And we didn't go back for quite some time, Doc. So I'll never forget that date. Yep. And what happened? Remember that the NBA shut down. Well, that was earlier.

I feel like that was the day before. I feel like in a shell, everything was going down on that Thursday. And then on the Fridays when kids were still in school, I know my daughter had a birthday party on the Saturday and we all got together. We all looked at each other at this like playground place.

And we all looked like, should we be doing this? I remember, that was like the last hurrah for my family anyways. But wow, I had a lot of questions in May 2020. And then I invited you back, another remote April 2020. So I gave it a couple of years, and here's what I wrote at the time.

In this 1,042nd episode of Toronto Mike, Mike is joined by Dr. Brian Goldman of White Coat Black Art and the Dose. As they discussed, we talked about music. Remind us, what are your jams? Oh. It just says here we talk about music, but I can't remember now. I'm guessing you're a metalhead. Oh, no.

No, my son's a metal head. Yeah, Sasha's a metal head. But, no, I'm not a metal head. What do I like? What did I like? Yacht Rock. I like... Steely Dan.

Yeah, yeah. Steely Dan definitely, yeah. Old Chicago. No. Peter Gabriel. I like foreigner. Okay. Yeah.

Warner tours, but there's no original members left. What are your thoughts on that? I know you're a medical doctor, but as a musicologist, which you are not. Like, are you a cover band now? Are you just, you're a cover band who licensed the name? There's no original members left. Yeah. But people go out to see foreigner because they have the brand.

Yeah. The power of the brand. It seems like a waste of money and time and ever. Just go see a cover band, you know, at your local beer fest or something, drink at Great Lakes. Well, and how many, I mean, how many people from that era, how many artists from that era can still play, can still sing and still hit the high note? I saw Roger Daltrey last summer, and somebody said maybe they were sweetening it. I don't want to, like, make any allegations here, but he sounded pretty damn good for an 80-something-year-old guy. So did Elton John, the last live appearance at the Rogers Center, two years ago, something like that.

And that was delayed by COVID. And then he eventually, yeah. And, you know, I said, he sounds great. And somebody kind of tapped me on the shoulder and said, autotune. They're sweetening it. You can't believe anything anymore, Doc. You must get a lot of this. Now, he married Torontoians.

Oh, that is true. I was going to say I'd get auto tuned on White Co. Black Heart. That's how I sounds. Well, I'm learning that now because right now you're unfiltered in my headphones. and I'm like, who is this guy? I don't recognize this voice at all. All right, to wrap this up, though, we talked about, oh, we talked about 1050 chum.

Yes. Oh, so you were a chum bug. Oh, I was a chumbug. Of course I was. Al-Baliska? Oh, my, that's really. I don't even know that word. That al-Baliska.

Oh, sorry. You thought I was talking about a disease. Or something. Yeah. Al-Beliska. Al-Beliska. He was a DJ at 10-50 chum. Prez, Brian Skinner.

Of course, Roger Rick and Maryland. but that's much more... Well, and that's also FM. Oh, that's FM. Yeah, that's 1.4.5. In the mid-80s, that starts up. But I'm gonna, let me help you. Roger Ashby was on 1050.

At some point, Tom Rivers is on 1050. That's right. And Jim Van Horn is there. And the greaser is there. I'm trying to remember his name. But yeah, Scott something, but... David Marsden. Well, that's also FM.

That's FM too. And what was his name before... But you're thinking of his 590. I'll help you. You ready? Dave Mick. Dave Mickey. And that was 590. Club 11 dance party.

Wow, my old. If you can keep up his pace, you'd be talking a lot faster there. Dave Mickey was just on some amphetamines or something. Okay, we talked more about COVID-19. We talked about the leaves because you're a big leaf fan. No, no, no, no, no. We won't do it today. No, please.

Well, you can't. I'll talk about them. Well, just briefly that I feel like the window has closed, and that's a damn shame because we had a pretty good, almost a decade of that window being open. go and it couldn't get out of the second round. It was fun and hopeful for a while. We were there. I was there with my family on that last playoff game in

2017 when they took Washington to seven, sorry to six games and how you know how Austin Matthews scored the tying goal, fired one off the stanchion and bounced off in front of the ice and then he fires it fires a puck into the net and it looked like he was a magician

he could do anything. Right. And the world was one It was fun, and we were all full of hope, and it kind of went steadily downhill after that, thanks to Boston Bruins and the Florida Panthers. You're right. As we speak, of course, not a playoff team. We're rooting against him, really.

And then there's a first round pick that's top five protected, I think. So it's like... Top five, yeah. And you know what? They have against everybody's better judgment with no plan. They can't even tank. Yeah, but they never could tank, right? Until they got Matthews.

That was the one time they figured I had to scorched the earth. But just wild That one year ago We went to game seven Against the Florida Panthers In the second round Like it really did look like Hey maybe last year was the year

And one year later it's like Burr it down Start again Well let's let's talk about that game Because I was there with my With my two kids Game 7 What was it 6 1

Whatever it was Oh yeah I don't even kind Like we all And And And to hear the crowd Booing Mitch Marner

Right And it was It was like I can tell you, like, there was a moment when it was 3-0 and Max Domi scores, and everybody got lifted out of their seats for like a moment. And then Florida goes back. There was a time when that team could come back from any deficit. And they did it against Columbus and the playoffs.

Anyway, you know, Florida skates down the ice and whiffs a softie past Joe Wall. Yeah. And that's it. And it was like 4-1, and then the Boeing started. it and it was like that was the end of it. But so that core, that window we talk about, and this is it. I don't want this to be very long because it upsets me to talk about this team.

But what was it about this team that was unable to put it together in the playoffs? I mean, a pretty damn good regular season team. We won the division last year. What, there was, the reason we're booing Mitch Marner is because of this lack of heart in the playoffs. Lack of heart. Yeah. Yeah. They, uh, they, they weren't hardwired to play that way, to play like, like your,

like you're ready to be injured. Well, that's called Truculence, I believe. Yeah, yeah. And it's interesting, interesting, Justin Boren had a good blog on Sportsnet, basically saying that you cannot bring in tough guys to complement the softy skill guys. They all have to have a little bit of all of it. And if they don't, then the team doesn't play, like, you know, the moment that Sam Bennett concussed Stolars,

last year. That was basically the end. He did it was in game two. 100%. Yeah. And and really, you know, the rest of the team could have crushed Sam Bennett and they didn't. Could have knocked him out of the playoffs at that point. Boy, I don't sound like an emerge position right now. I'm a goon. I sound like a goon. But so that, yeah. But that's the power of teamwork. That's the power of teamwork. That's right. And that's what else we discussed in April 2022. Your book, The Power of

Teamwork here. Is there any truth to the rumor, Dr. Brian Goldman? And how should I refer to you? Could I call you doc? We can call me whatever you want. That's well. You know, interesting thing, interesting thing, my colleagues. When I was just starting out, I wanted to be called Dr. Goldman. And they all called me Brian. And now I'm at the end of my career, and they all call me Dr. Goldman,

and I want to be called Brian. Well, that's funny. Well, I might call you a doc. I just think that's a cool, cool nickname for you. Call me whatever you want. That's okay. I'll call you a dog. But is there any truth to the rumor that you're considering suing the most of the

makers of the pit for stealing that idea from your book, The Night Shift. Don't get me started. Yeah. You know what? I've actually reconciled with that. So I wrote The Night Shift, which was a single shift. It was published in 2011 well before the Pit. But hey, let's, let's, and then the Pit came along.

Let's, first of all, I've got to thank the Pit today because the popularity of the pit has certainly raised the profile of the Casino Shift. So I have no complaints. And the other thing is there was a little TV series called 24. That had the same concept. That's a real-time show. Yeah, there's a real-time show, so it's not like I invented it. But, you know, ER real-time, you know, I'm just saying that you did write the book that was a real-time.

It was essentially one night, you know, 10 to 9 the next morning. You're describing the patients you'd see in that one shift. And that is essentially the premise of the pit. It is. And, you know, the concept that a patient who seems to be doing quite well, and hour two has a crisis in hour nine and crashes because that's real life. That does happen. And it has happened many times during a night shift.

And so, yeah, the concept was there. What's interesting, Mike, is that the night shift was optioned. And it went through two or three groups of writers. And the concept was there for them if they wanted to do it. They instead wanted to create a kind of an ongoing procedural show. where you have the, you know, here's, you've built a world, here's the cast of characters, and they go from one shift to another,

one year to another, instead of doing it as a single shift. But what changed things was the whole streaming concept, the whole streaming platform. That's what changed, that's what made the pit possible. Okay, but the night shift, we're going to talk about the casino shift,

which is your new book, and it's like a sequel of sorts, I suppose, to the night shift. It is a sequel. It is a sequel. It is a sequel of sorts. so much so that it is actually a sequel to the night shift. So the casino shift,

which has nothing to do with Mitch Marner playing for Vegas. Unbelievably, you'd think it would, but no. So I guess, I guess I'm wondering, like, you mentioned it was, what were the words, optioned? What are the term? What's the terminology? So, okay. So are you allowed to disclose?

Like, how close were we to having some kind of a series called the night shift based on your book? We were close. We were close. but not close enough. You know, there were, there were, I think there was a script. There was a pilot script. And, you know, what happened, like, most of these shows that get optioned don't get made into series. And there's a whole bunch of speed bumps along the way.

And this one had the typical, you know, one production executive, you know, one programmer leaves, another one comes. What is this? I didn't commission this. and they hire a bunch of new writers, you know, and then it eventually dies. That's it. And then when the pit comes out, whenever the first season dropped, I don't know, about a year ago or so, that kind of burns the idea right now. You can't do it because they're going to say you're copying the pit.

No, no, I'm not copying the pit. No, I know. I'm not saying you're talking to pit. No, actually, you know, you're kind of right. I mean, there's always... The perception will be that, oh, the pit was a hit, and now we have this, like, Canadian version or something. Well, they could.

There's nothing to stop. In fact, the latest I've heard as far as the pit is concerned is that they want to create a new show called the pit night shift. Oh, I heard that too. Yeah. So, hey, now maybe they're going to come knocking on my door. Well, that's really going to piss you off. That's really going to piss you off because they're not going to license your work. They're just going to do it.

They didn't even remember, there's a lawsuit already in play against the pit from the ER Crichton. Michael Crichton's estate. That's right. Right. Because of how similar. the pit is to ER. Yeah. Okay, lots to cover here.

Okay. I'm going to guess, and I don't, you don't have to, I mean, you can answer it. This is the home of real talk, but you're already in bed with CBC. Yes. So was it CBC gem or something to that effect that might have been looking at the night shift? I think we would rather keep that on the down low. I know, you don't have to answer. You know, I'm here to ask the tough questions, and we'll see if you give up any of the,

spill any of the tea here. I'm always curious in how the sausage gets made here. So am I. Which is why I like. If you can tell me how the sausage is made, I would love to hear. All I know is you don't want to see it. It's ugly, but damn, the sausage does taste good when it's, you know, in the bun of a little mustard here. Okay.

You, my friend, we're going to talk about the casino shift, but you started working in the emergency room way back in, is it possible? 1982? Yes. Yeah. Yeah, I worked at what it's now called, God, McKenzie Health. but back then was known as York Central Hospital, 10 Trench Street in Richmond Hill, and that was my first place.

I also worked at Northwestern General, which amalgamated with Humber River Regional Hospital, now was Humber River Hospital, back in 1982, yeah, and then I joined Sinai in 1984. So you're now at Mount Sinai working as an emergency room physician. Okay, before I ask you about, you know,

what the hell does the casino shift? And I know the answer, I read your book. I loved your book. I love your book. Thank you. It's because, you know, you look at... My wife loved my book. Well, ER, the pit.

These are like American things, right? You have a lot of Americanization going on there. I like to see, kind of get a glimpse at the emergency room here at home. I like the homegrown stuff. Show me a Toronto emergency room. Yeah. And that's what the, that's what the casino shift does. And, you know, I have colleagues that are saying, you know, you've really written well how the sausage is made.

and you know just do and that and that's the point the patients that come and go the real dilemmas that we deal with and they're very dramatic and and you know the characters that that come and go the people we work with you know that we love that I love working with not there they I would call them representations of the people I work with but they're not the people I work with you change the names to protect the innocent I did more than change the names. I created composites. I, you know, I, they, certainly some of the characters, some of the recurring characters, like there's basically there's two aspects to the casino shift. There, the spine of it is the hour by hour of me working with colleagues. And, and that's all, that's, those are all representations of people I've worked with over the decades, but they're not, they're not the people I've worked with. I don't want any of my colleagues to say, oh, God, you've really messed up on this, Brian.

So I didn't do that. So that's one aspect of the book. The other aspect of the book is that I interview colleagues right across the country. So I have a coast to coast to coast kind of. Oh, yeah, yeah. There's like interesting to see the problems in Alberta that I learned about in your book. Yeah, Alberta. And it's so interesting because, you know, Alberta has just taken off as, as unfortunately, a hotbed for major issues in the emergency department.

And that started up in just as the book was coming out, like January, February, you had, you had Prashent Sri Kumar in late December spending eight hours in the emergency department at Gray Nuns Hospital in Edmonton and dying within minutes, within moments of being finally brought through the sliding doors, brought into the emergency department. And he's not the only person who has died waiting to be, to be fully assessed by the emerged personnel. So that was happening, you know, on White Coat Black Art. We interviewed a couple of triage nurses from Edmonton from the Royal Alexandra Hospital who talked about, you know, that time when they had 120 patients waiting to be seen in the waiting room. I can't get that. That's 24 hours worth of patients all there at the same time. That's almost like a mass casualty incident.

And, you know, if 10% of the. are seriously ill. And you don't have a stretcher to bring them in. You can see the genesis of a major problem. So I write the casino shift. And what's in Chapter 1? Alberta. I didn't guess that that was going to happen.

I was just, I guess I was foretold it. I foretold it. You had the data that suggested, hey, we have a situation critical. Shout out to Platinum Blonde. And there is another reason for it. sadly, the problems that exist in emergency medicine today are only magnifications of what we've had for the last 40 years. You know, in Edmonton, you know, why don't they have enough stretchers to bring people

into the emergency department? Because they haven't built a hospital in 40 years. Is that because they don't have provincial tax? Well, they have a certain, certainly have a different set of priorities. What is interesting, Mike, is that Calgary, I went to the South Hospital in California. I'll go right beside this brand new. It's the largest, do you know, it's the largest YW, YMCA in the world? I had no idea.

You're full of the fun fact. It is gorgeous, and it's right next to this, like, steps from this brand new hospital. Well, how come Edmonton hasn't had a brand new hospital? What that about? Is it that one is more NDP leaning and the other one is more UCP leading? Well, maybe, maybe. You know, you're making a good point there, because as far as Alberta's concerned, yeah, you're more, you know, small Liberal in Edmonton. That's right. You are. Yeah.

Yeah. My wife is from Edmonton. I get my Edmonton knowledge thanks to my wife, being born and raised there. Okay. So since 1982, so I'm, here's what we're going to do. So we're diving into the casino shift now. I read it. I got some questions. I want to get you going on a lot of this. I know you have a gift for me. This might be an appropriate time to give me the gift because I have a couple of gifts for you. Thank you. And then it's going to be

casino shift the rest of the way. There is your gift. Oh my goodness. There's the moment. there's the moment. This book, it's the casino shift, stories from an ER on the edge. Well, I meant to ask you, do you watch the pit? Yeah, I do.

So are you up to date by any chance or a little behind? I'm a little bit behind. I did, hey, I, tonight's a new episode. Yeah, it is. I did a TikTok and it has 650,000 views. Three things that I think the pit gets right and three things that it gets wrong.

Well, hopefully I have just as many listeners because this is all what I want to talk about. So did you watch ER back in the day? Yeah, I do. Okay. So I'm going to set to make sure when I drop these references that you know what the hell I'm talking about. So I was a big fan of ER, although, and I won't spoil it. People can probably stream it on Crave right now. Spoil ER.

I know, I know, I know. But the first time I watched the ER, I watched it every week on NBC, 10 o'clock Thursdays, and then I stopped when a certain character died. It was at an end of the season, this major character died, and then I decided personally, and my wife agreed with me, my first wife, we agreed, we're done, we feel good, we're done. So I walked away, but then with the pit coming back, I revisited ER with my last wife, and with current wife,

I don't know the proper terminology, Dr. Brian Goldman, my wife. Latest wife. It sounds like it's one in a series, like I'm going to have a third and a fourth. I don't want to leave that impression. But anyway, we went back and watched ER together, and then we got to the point where I left, the first time, but we kept going. So we're way deeper than any, than I went the first time.

So I'm well versed in ER, and I'm completely up to date in the pit. I just want to make that clear before we dive in. And before we dive in, I'm going to let you know. And I don't, let me ask you the big question, Dr. Brian Goldman. You're here in person. Those two zooms, I didn't give you anything. You just zoomed with me. We had a nice chat.

I don't even consider. You gave me your time. I never even felt like this is a common discussion point. I didn't feel like I met. the great Dr. Brian Goldman. Did we meet? When you meet virtually, nah,

you know what, it's hard. Yeah, you've got to walk together. You got to talk. When I met you outside, you were on your way to the door. I said to you,

oh, it's nice to meet you. And I felt inside, like we were meeting for the first time. Okay, then that's fine. Then we were meeting for the first time. All right.

Well, some people think if you have a, you know, a 90-minute Zoom with somebody, you met them. And I do not believe we met. So we met today for the first time. So,

I'm honored to meet you, but I couldn't give you any gifts. So quickly, I'll do this quickly because it is all casino shift the rest of the way. I have upstairs in my freezer a large lasagna from palm of pasta. Do you enjoy lasagna? I love lasagna. You're going home with a lasagna. Wow. I also have in front of you.

Yes. Fresh craft beer from Great Lakes Brewery. Okay. So brewed right here in South of Tobacco. Delicious beer, you take that home. Thank you. Either enjoy it or give it to somebody you love. We will enjoy.

it. Okay. So you got your lasagna, you got your beer. Ridley Funeral Home. They're pillars of this community here since 1921. Giving me a gift. I'm giving you a measuring tape from Ridley Funeral Home.

Okay. You never know if you have to measure something. Maybe in the ER, maybe you'll need to measure something. You know what? And we do. We do. Although you can use your,

you can use an app on your phone. Why use an app when you have a wonderful measuring tape from Ridley Funeral home? And I love the color. Yes, the color is great. The color of money. Okay. I'm going to give you a quick tip here. If you have old cables, old electronics, old devices, doc, don't throw them in the garbage because those chemicals will end up in our landfill.

Go to recycle myelectronics.ca, put in your postal code, find out where you can drop that off to be properly recycled. Good tip. Good tip. I like that. And I want to give a shout out to Nick Iini's, the latest episode of Building Toronto Skyline features his conversation with Brad Bradford at a live event last week. So you can hear Brad, mayoral candidate Brad Brad Bradford, and Nick Aeney's chatting about affordable housing and the missing middle, and it was very interesting stuff.

So building Toronto Skyline from Nick Aeney's, check it out. Okay. Okay. The casino shift. Help just to get us started here. What does that mean? I read the book. I know what it means, but where does that name come from and what is the casino shift?

The casino shift comes from the casino industry, which like medicine, like emergency medicine, is 24-7. And they discovered in the casino industry that the workers who worked all night tended to nod off. They lost their attention span. They weren't concentrating. They weren't able to figure out who might be counting cards, et cetera. And so they developed the concept of a split night shift. So either you start at 9 or 10 p.m. and go to 3 or 4 a.m. or you start at 3 or 4 a.m. and you go until 9 or 10 a.m. And so you don't work the whole night. And I reckon that the first hospital to adopt casino shift was the QE2 Health Sciences Center in Halifax. And they love it. They loved it. And there's a number of reasons why it's better than a night shift. And I can tell you, I've done a lot of both.

Yeah. And, you know, back in the day I used to do, you know, and a number of us would do a string of night shifts where you do two, three, four night shifts. And you never felt as if you had slept. You never felt like, you know, you had some relief from sleep deprivation, but you never felt completely rested. And, you know, part of the problem was that you weren't sleeping in your bed at night under any hours.

You were sleeping during the daytime. And you weren't getting out in about during the daytime. the day. So now when you have a casino shift, even if you, you know, if you have to get up at 3 o'clock in the morning to be at work at 4, you know, you're still getting into bed. You're probably getting to bed at 9 p.m. or 8 p.m. or something like that. So you're sleeping in your own bed for part of your night. Same thing if you do a casino shift, the late, you know, the night casino shift and, you know, you get off at 4 in the morning. You know, I get into bed at 5 a.m. or 5.30, and it's not the same as finishing a night shift and, you know, getting into bed at 7 in the morning and not experiencing any daylight.

You sleep in either of those two kinds of shifts, casino shifts, you sleep several hours in your own bed at night, and you're out and about during the day when it's light. That is so important to synchronize your circadian rhythms, and I found and, and, you know, people who do casino shifts find that they don't have that perpetual fog, that mental or cognitive fog that comes from working straight nights. And, you know, the docs at QE2 Health Sciences Center, once they tried it, have not looked back. And I can tell you, it has preserved my ability to work at least part of the night. And I still do.

Yeah, because you can find time to sleep. Yeah. Find time to sleep. Your sleep quality is better. and you're more alert. And yeah, you know, you might be a bit sleep deprived, which, you know, I'm sure people listening to this are not happy about that, but it beats the mental fog.

Let me tell you. What I like about the casino shift is it really puts you there. Like, so I'm already in like ER mode. I mean, ER, the small ER, not like the show ER. Although that's why I'm in ER mode. So between the ER the show and the pit, I'm already kind of like, I feel like I'm in an emergency room every night, basically right now.

And what I like to put you there. For example, what I learned was, so you're talking about these six-hour shifts, these are the casino shifts, which is something new from the time you wrote the first book. These didn't exist when you wrote the night shift. That's right. When you put it in 2010 or whatever it was. And that's what makes it an interesting sequel. Like originally, when I was pitched, you know, Harper Collins asked me, do you want to write a sequel?

We would love to have another book in this series. And my first thought was, I don't want to do a sequel. Like, you know, there aren't a lot of good sequels. You know, let's Godfather 2 was good. loved it. Terminator 2 was good. Yeah, and the born supremacy. Yep. Yes, I think you're right about that too. And Toy Story

had, I thought, two and three. Actually, I liked all of the Toy Story Story. Okay, there you go. So there are some, and you know, I thought... X-Men 2 was good. It's better than the first one. Yeah, okay, okay. Spider-Man 2 was good. Spider-Man 2 was good. Okay, let's keep going. Well, you know, and they're of

a kind. But that's it. Like, we're done. You're talking about blockbusters. Some of them are better. Anyway, the I did not, at first blush, did not want to do a sequel. And then I started to think, wow, things have really changed. And so it gives me a chance to do two things. First of all, to talk about some of the amazing, you know, the technology that's different. And, you know, the ways that we do things, the way we diagnosed is different.

Good and bad. But also to talk about the crisis, you know, the crisis in emergency medicine, that fire hose of bad news of people waiting extraordinary amounts of time. for health care in the emergency department, people who don't have family doctors, who are coming to the womenage because they feel as if they've got no other option. I've traveled.

I've seen health care in Germany. I've seen health care in Denmark. And it gave me a chance to say, hey, come on, open, like open our eyes because there are solutions. There are things we could do better. And, you know, now I'm an old fart, and I can, you know, I can wag my finger

and I can say, this is what we need to do. So if you've been working in an emergency room since 1980, you must be eyeballing a date in the calendar when you're going to retire. Yeah, I am. Yeah, I am. What is that date? I need to know when we have your accident interview. You know what?

It's interesting that you're saying that. Just call me Jason Spetsa of... His dad just died. Oh, yeah. Yeah, it's true. Just throwing it out there. Our condolences. But he was, you know, he didn't.

He signed, you know, one-year contracts and basically kept his kind of horizon short. you know, I, if I get, you know, tap, I've got colleagues who I've said, you know, tap me on the shoulder and tell me it's time. Oh, if you slip, if you're slipping. Yeah. Because by all accounts, and this is in your book, but by all accounts, you still got it. Yeah, I have, you know, there are some things that my younger colleagues are way better at. You know, they are, they're much better at ultrasound, you know, pick it up a probe and using ultrasound as part of their physical exam because that's their training. technically they're better.

I'll tell you what I have. I have an ability, I have a lot of experience. I memorized my lessons. You know, I, there was a time they said that Brian Goldman would study for a blood test. I was a, I was a browner. I was a nerd and a geek. And I studied, studied, studied. So I put all of that into long-term memory.

So that's one thing. The second thing is, I have good situational awareness. And I think that is the worst. thing to lose. If you have, if you, if you can't read the tea leaves, you know, that your patient needs urgent attention right now, drop everything right now. This one requires, and that they're situation critical. They're, they're minutes away and because you don't want to be running to the resuscitation room to, to try to resuscitate them if, if an hour before you could have taken measures, taken steps to prevent that from happening. So there's that. You know, no question.

Dr. Google has been very good to me. You know, we, we joke about, you know, about Dr. Google being, you know, bad for doctor-patient relations. That's BS. You know, I think, I think if you intelligently search, if you're searching reputable websites, I'm all for it. And I don't, don't challenge me. Let's look together.

That's, that's my approach to Dr. Google. But I can tell you that Dr. Google has been very good to us because, you know, we have information at our fingertips. In five seconds, I can get up to speed on a new procedure, a new drug, a new drug interaction. You know, for instance, metatomidate is the sedative that's now being used to lace fentanyl. So people are smoking that, and not only are they getting the fentanyl opioid, but they're also getting metatomidate, which sedates them, can affect their blood pressure and their heart rate. And so I can get up to speed on this new development really quickly.

And thank you. Thank you very much for the Internet. So when you say, Dr. Google, though, are you using that as like a term for online searching of a trusted database? Yes. Oh, yeah. No, I'm not talking about. I'm just clarifying for the listenership. You mean, you mean, am I going to be listening to RFK Jr's new secretary, Secretary Kennedy's podcast?

Only to mock it. I heard about that. Oh, God. What a God. Part of, I mean, this is a quick aside, though, but it's disturbing for me as a man who trusts science and reading that he's made claims that the COVID vaccination is the most deadly vaccination in the history of medicine.

And to support that, they've been scrubbing some government health websites of data that says, oh, there's many benefits to the COVID vaccine. And not only that, they're suppressing a study right now that shows that. that the COVID vaccine administered to kids reduce their ER visits this past winter by 50%. Shame on them.

Shame on them. But this is going to cost lives. Yes, it is. Absolutely, it will. Yeah. This is criminal. Yeah. Not only that, but, you know,

they're taking advantage of the fact that, you know, by and large, we have kissed away those childhood infectious diseases like measles and whooping cough and polio. Right. And they're not all childhood. They're infectious diseases for which, for which there were childhood vaccinations. Right.

Inoculations. And inoculations, yeah. And meningitis, you know, there was a meningitis outbreak, meningitis B outbreak, men B in Kent, in Canterbury, UK. And we have the same meningitis B here in Canada. And what did the CDC recommend, like the current CDC, that a whole bunch of routine vaccinations be no longer routine, including meningitis vaccines,

which is, I mean, this is a disease. Yeah, it's rare, but if you get it, it's devastating. And this vaccine will all but prevent that from happening. And so you have these grifters who are selling stuff like lucavoren and snake oil. And taking advantage of the fact that we have a climate, we have a world in which these infectious diseases haven't popped up so that you can start to say, I wonder if they do more harm than good, because you can, you know, you can get away with that. You can't get away with that if you have iron lungs and people getting polio,

which is the next thing that's going to happen, God forbid. How did vaccinations get politicized to this extent? I'm fully vaxed. When the new COVID comes out, I get the flu shot and the COVID in the same trip, and I do it annually. It's just, I don't even, of course, I'm going to do this. How did it get so politicized? It was the, you know, it was partly the internet, the social media, and not, and not policing

it for, you know, for accuracy. You could make whatever comments you wanted. You could say whatever you wanted. You're not sued. People aren't, people are dispensed, people who have no business dispensing medical advice. They're not medical doctors. They're not medical doctors. Are telling you don't get vaccinated.

It's a killer. That vaccine's a killer. It's just, and as if, and, well, the food and drug administration, they're bought and paid for, doctors are bought and paid for, you know, public health, all bought and paid for by karma. And, you know, some of this has the ring of truth. You know, when I say the ring of truth doesn't make it true, but it has the ring of truth. It's plausible. And, you know, in politics, you know, there are those who know how to. level a charge against somebody that has the ring of truth.

And if it has the ring of truth, a certain percentage of the population is going to believe it. That's the basis for conspiracy theories. And, you know, people who, their mindset is that once they decide something, they're certain. They don't like living with uncertainty. They don't like living with shades of gray. It's black and white.

It either has to be, this is good for you or it's very bad for you. And once they decide it's bad for you. So there was a lot. And, you know, frankly, in COVID, during COVID, I think the public health and I think messaging by people, including me, was probably too absolute. You know, I think I subscribe to the theory to the hypothesis that COVID was droplet only instead of being airborne.

And that was a mistake because there were people who felt betrayed that, hey, you know, maybe I should have been wearing a better mask. But, you know, at the same time, you know, I'm not taking all the blame for that because, I mean, there are people who thought let her rip, you know, let COVID just rip its way through society like Sweden did, that that will somehow, we'll all get immune and that will be the end of it. Yeah, like a herd immunity would occur. And that didn't happen because, because unfortunately, COVID kept mutating. Right. Right.

As the flu does. Yeah. Right. Jeez. I can only imagine the uptake by Canadians for the most recent COVID vaccine is very, very low. Like, I can only imagine that the most. people listening to us right now just took a pass. And flu,

influenza vaccine too. Oh yeah, but flu's always felt low. I mean, I... It's lower. I've had people I know and trust. I produce podcasts who kind of made fun of me that every single year I got a flu shot for as long as I can remember, but they kind of make fun of me for it.

Yeah, and you know, the thing about, and here's the plausibility factor, that the flu shot, you know, as such as it exists today, is not perfect, and it's never been perfect. It's never been perfect.

It's not 100%. It will, by and large, reduce your chances of being seriously ill, reduce your chances of requiring hospital, fertilization or ending up in an ICU, but, you know, it's not perfect. And that's why scientists are trying to develop a vaccine that would be universal and would be that would allow your antibodies to attack that part of the flu virus that never changes from year to year.

And so it would be universally effective from one year to the next. And I've always been aware it was like a guess on what the strains will be based on like possibly what they see in Australia. I'm guessing they see it before. You know your science. I know my science. So I always knew, depending on how accurate they are, it could be, it could be low, it could be 10%, it could be 60%, whatever.

But my thought on this is, oh, it's still the best game in town. Yeah, it's still the best game in town. I give us 10% coverage, oh, that's better than zero. Yeah. And it's probably a lot better than 10%. Right. You know, in the low number. In its best days, it's probably 50%, something of that ilk maybe, you know.

And on an average year, maybe 25, 30%, which will reduce. the severity of your illness, which is good, and reduce the risk of complications, which is very good. Now, I realize you're an easy man to talk to. It would be effortless to consume your entire afternoon. I bet you that's not in your calendar. But so a few hot spots about the book,

notes I took as I read that I wanted to ask you about. But one is about, there's a great elaboration. I really felt like I was there. Hallway medicine. Like, hey, like tell us about hallway medicine. medicine and the dangers of hallway medicine, which I feel like I've experienced myself. But also, like, how do we fix that?

Yeah, so why do we have hallway medicine? So the factors that lead to hallway medicine have not been fixed in most provinces, which is why they continue with it. Basically, we don't have enough hospital beds per capita. Right. And to take into account the fact that the population's older, we have more people living in Canada than we used to. and so, you know, building, you have to build more hospitals. And, you know, a C-change happened about 40 years ago or so where there was this notion, this belief that we could take hospital beds out of the system per capita through the miracle

of same-day surgery, keyhole surgeries, or people who, instead of spending a week in hospital after an appendectomy or gallbladder surgery, could go home almost the same day, and they can. we deinstitutionalized patients with mental health diagnoses. And the idea was that we were supposed to build up much better community resources. We were supposed to build up home care for seniors so that they could go home. We didn't do any of that or enough of that. And we didn't build enough beds for the population and for the complexity, you know, for an aging population.

So that's one factor. and the other factor is that, you know, 10, 20% of patients who are admitted to hospital don't need to be there, but they're waiting for a bed in a long-term care facility. And these are all, I mean, I sound like a broken record. Now, my colleagues, when we talk about this, sound like a broken record. So all of that lays the groundwork for this situation. You have a lot of inpatient hospital beds that are occupied, and for every bed that's occupied on the wards, that's one less person, one less soul who can be brought from a stretcher in the emergency department upstairs to the ward.

So you have lots of stretchers that are occupied. You know, I've met colleagues who will start their 6am shift with two stretchers available to seat patients. And that's an extreme version of what we're talking about. So hallway medicine, so what is hallway medicine? Hallway medicine is we better invent a space for these people. Sometimes they put patients in the photocopy room. Sometimes they put them in the kitchen. sometimes, you know, in the nurses' lounge.

And there was a hospital, what was it, Royal Columbian Hospital in BC, they put patients in the Tim Hortons. Wow. That was a temporary thing. And so a hallway is, by definition, a temporary space. And I can tell you, it's gotten worse now. Now we have waiting room patients, where you create stretcher spaces in the waiting room,

and you try to institutionalize that by having phlebotom. people who do blood work, because you can't have the triage nurses, keeping track of 60 or 70 patients in doing blood work and doing assessments on individual patients. It's just not possible to do that. And you have what they tried in Alberta, and they were supposed to do it again now, like everything old is new again, where they were going to have these triage liaison physicians, the physician liaison doctors who would go through the patients in the waiting room and assess who needs to be admitted, who maybe can go home with,

community resources, you know, with a home care assessment. And we just have, that's just an extreme version of what we have. Now, you asked a whole bunch of other questions. I guess the other question is, so what's wrong with hallway medicine? It's not private. There's no access to bathrooms. You're having intimate discussions about what's wrong about prognosis. You're telling somebody they have cancer in a hallway, for God's sakes.

But it's worse than that. Older patients who spend time in a hallway are more likely to die during that hospital. stay than if they're not in the hallway. When you came to the hospital, okay, that's the worst decision you could have made today. And a lot of patients feel that way. Okay, when you talk about, because I was going to ask you about this later,

because pit stop, I was reading about pit stop. Do you know what pit stop stands for? Oh, you tell me. Paramedic initiated treatment of sepsis targeting out-of-hospital patients. Oh, oh, this is seftriaxone. They can get seftriacin in the field of blood work. Yes, thank you.

Yeah, yeah, just, Yeah, good. Just taking notes over here. But hey, so two things that tiny. So this hallway medicine, which I read that whole chapter and it comes up often, it was following a chapter I had just read about Molly. Yeah. Molly is what you call, I mean, I don't think you use this term anymore,

but we used to call Molly a frequent flyer. Yeah, yeah. And that's an interesting point. So first of all, people who, like somebody who comes to the emergency department regularly, you know, there's, I wrote a book called The Secret Language of Doctors where, you know, I discussed, you know, a lot of cultural, you know, beliefs or beliefs in the culture of medicine as symbolized by slang. The problem with slang, even, and I can tell you that frequent flyer or bed blocker are slang terms we don't use these days, but they are, they're mild. They're mild forms of slang.

Right. But I can tell you, a lot of people who wouldn't be caught dead using slang had no problem. saying the phrase frequent flyer because they didn't think it was slang. And the problem with it is that it objectifies, it stereotypes behavior, you know, the fact that somebody comes to the emergency department frequently. Why do they come? Because they've got no other place to go to have stuff managed. And, you know, Andrew Buzari, Dr. Andrew Buzari at UHN found that, you know, a lot of people who have, we know this, a lot of people who come to the emergency department frequently,

live in precarious housing. They spend much of their time on the streets or in shelters, which are not safe, which are not the greatest place to be. And they come to the emergency department sometimes 100 times a year or 200 times a year. Well, what Buzari discovered is that if you give them a home, it's called Dunhouse, they take good care of them there. And it's not just that it's a house.

They also provide mental health supports and other kinds of medical supports. They have a clinic there. And they're less likely to come to the emergency department and they're in better shape. So our system, I mean, they are, it's like a canary in the coal mine. People who come frequently, like Molly, are, who come to the emergency department frequently, are, you know, it's symbolic of a system that's not taking proper care of them.

Yeah, so frequent, well, I'm using this antiquated term. And I think you hit it in the head, but like a term like frequent flyer, you would minimize the condition. Like it sort of like you disregard that they might actually. have something or that you dehumanize them because you're calling them, you're calling them by a behavior when it's like we learned not to call people with diabetes, diabetics, they're people with diabetes.

They're not diabetics. It's like, that suggests that the entire sum total of their lives can be summed up. The different species. Exactly. They're people who have, you know, have to deal with blood sugar issues and maybe they have to take insulin.

Maybe they have a Dexcom, you know, And, you know, they're taking medications, they're trying to lose weight. Maybe they're on Ozempic or one of the other medications, Jardy ants, etc. Now, you mentioned actually earlier that some people don't have a family doctor and you become their family doctor.

So I was interested in the book when you talked about Bill. And he basically, I think there's a quote, you have an exchange of a colleague. He's been coming here for seven months. It's like we become Bill's family doctor. And then the question's asked, how would you feel if you had a mystery pain like Bill's and didn't have a family doctor to turn to him?

to, you end up in the ER. Yes. And, you know, it's because, you know, what are your options if you don't have a family doctor? You can go to an urgent care center. You can't just go to an urgent care center if you've ever tried. You have to sign up. You have to call. And if they have space, great.

Is that right? Because it's one near Sherwey Gardens. Yeah. Trilium, I think it's called. They get, they don't see everybody no matter how long because they're not 24-7. They close their doors. So they have to be able to manage their patient volume. And so, you know, not surprisingly, you know, an hour or two into the day,

all of their appointment slots are full for the day, and that's all she wrote. And after that, your only other option is the emergency department. And, you know, think about, like, it's estimated that there's six million Canadians who don't have primary care, don't have a family doctor or a nurse practitioner. I would put to you that many more, many, millions more have someone who they seldom see because of lack of appointment slots, you know, you know, they can book an appointment in six weeks. Or geography, like I don't have a car and I don't know, maybe it's a town over.

You know, we talk from Toronto. We forget there's a lot of this country where you have less resources at your doorstep. And, you know, I talk about this at the end of the book, at the end of the casino shift, you know, Denmark or the Netherlands, they have like 99% of the population has primary care. When you arrive in the country and you have your landed immigrant status or your work visa and you are entitled to health care benefits, your social insurance card has the name of your doctor written right on it. And you didn't have to look for this person. You didn't have to dial up and phone a friend and ask your relatives.

Are they taking patients? And you have choice. If you don't like that physician, they'll find you another one or you can find another one. And that's because, you know, they have a system of mandatory enrollment. So just like your kids, your kids reach the age of five, you know, by December 31st or pre-kindergarten, you know, and they have a school. They have to provide you with a school in the same way they have to provide you with a physician. And not only that, but they have, you know, the way they're on salary, the way they organize their practices, they have appointment slots, open appointment slots.

they have to each day. So that means they have walk-ins, like their patients, have to be able to come in if it's urgent enough. And one more thing. When they sign out for the day, you don't hear a voicemail that says, go to the emergency department, right? If this is an emergency, you decide and you go.

No, you call the number of that primary care provider and you get connected with a call center. And that call center, you know, they take a triage history and then they put you in touch with the doctor and the doctor on call. and they do one of three things. Either they treat you, run in a prescription, or they send you back to your family doctor,

or if they think it's an emergency, they call the ambulance for you. You don't select the emergency department as your destination unless you've collapsed, and they call an ambulance for you because you've collapsed. Whereas in Canada, you can select the emergency department. Now, it's not the fault of the people who select the emergency department.

It's that they have no other place to go, whereas places like Denmark and the Netherlands have a place, have a place for you. That's why Bill's showing up in that ER, you know, he's got a, he's got a pain and he doesn't have a doctor to turn to, and you become his doctor. Yeah. Jeez, okay. But except you can't, you can't become their doctor because you don't know them like your

family, like their family doctor would know them. Well, that's not the purpose of the ER. Yeah, of course. I know that person experienced. I know what you're saying, but that's, but that's the misery. That's how this is not working for anybody. Well, that's right. Between the Mollies and the bills and then you, you know, we talked about the, the, the,

the symptom here being hallway medicine, and you talked about how hallway medicine kills. Yes, it does. It kills. And it's, you know, there's a risk of sharing, you know, sharing germs, sharing infections. But yeah, no, it's that you're not as well monitored in a hallway. Like in a hallway, you're not going to be placed on a monitor, for instance.

So cardiac monitor could be the difference between recognizing a cardiac arrest in time to to save the patient and not. You're not getting the same level of nursing care that you would get on a ward. And you're not comfortable. You're kind of on alert. Your body's kind of under stress. It's already under stress because you're in the hospital. And you can't sleep.

No, you can't sleep. I spent a night in a hallway fairly recently at an emergency room. Yeah. You can't sleep. You know, there's lots going on. There's a lot of noise.

And you have patients who are there who are not being quiet in the hallway. That's right. But that's actually an issue throughout the hospital. And there are, actually, there are hospitals. I remember the Ottawa Hospital instituted these silent alarms where if the noise level got to a certain level, they had noise meters that would register colors. And if I got into the red zone, too much noise. And so they actually, they were trying to monitor it.

And I think if you don't track it, then you can't do anything about it. Well, that'll make the noise lady happy. And the listeners know who I'm talking about. Shout out to the noise lady. So I mentioned to you, Doc, in this chat, we talked about Ridley Funeral Home because they're a sponsor of this program, but I also produce a podcast for the funeral director at Ridley Funeral Home. His name is Brad Jones. The podcast is called Life's Undertaking.

Brad was here yesterday. We recorded a new episode. And we chat every couple of weeks for Life's Undertaking. And, you know, having these conversations with Brad, I can see how he struggles somewhat, like, with what he sees in his day-to-day job. Like, he's absorbing. he's seen a lot of stuff. A lot of trauma he's seen. He takes it and he talks about coping mechanisms, et cetera.

So I can't imagine how you, Dr. Brian Goldman, how you cope when you see young people come in, they might have a pain. And at some point in their visit with you, you need to diagnose them with something possibly you may need to tell them they have cancer or something very serious. So how do you cope? You're a human being, right? Confirm or deny those allegations? Are you a human being?

I'm a human being and you took me right back to the last person, the last person I saw with cancer. I'm not going to give details of the patient, but this is somebody who's got a young family. And this is not good. This is a, and you talked about me. You know, I'm thinking about them. I'm thinking about my patients.

And I found that I, you know, as I'm well past 40, but somewhere around the time I turned 40 or I started to think more. about not hoping, you know, hoping that my patient doesn't have that diagnosis that I'm doing the CT scan to find, to rule out, like a mass in their abdomen that turns out to be cancer of the pancreas or something like that. So, like, how do we handle it? Well, because to build on that is that you're not their family doctor, right? Right. You don't have a rapport. You don't know their history and stuff.

But you're now, you know, looking at the, whatever you're looking at, the x-ray or the scan. It's the CT scan. The CT scan, okay? Yeah, or ultrasound or MRI. But you're now the person who needs to tell this person, regardless of their age or health. You need to tell this person that they have cancer. Yeah. So the first, I guess the first thing that, you know, I wrote this book, The Power of Kindness,

and it was really an exploration of empathy and whether I still had empathy. And that book came to me at a time when I was ready to ask that question, am I still a kind soul? And I think most of us are hardwired to be kind and empathic without which evolution favors people who can empathize. And that means that they have the brain cells, the neurons that allow them to be to be both the participant and the observer at the same time. So they can flip perspectives. And I can imagine what it's like to be you right now thinking I've got to juggle all these questions or have time to finish the interview. I've got to slip in a commercial. And so I can think about that.

And so when it comes to, you know, giving breaking bad news, early in my career, I was worried about how do I sound? Do I sound right? Do I sound bad? Am I, do I sound cold? Are they going to be mad at me for,

are they going to blame me for, for telling them what's wrong? And if they, if they started to get emotional, especially if you're talking about a death, you know, somebody who they didn't get a chance to say goodbye to, a loved one they didn't get a chance to say goodbye to,

that they would start, you know, having an extreme grief reaction. Then one day, you know, I flipped the script, and it was really the day that I saw the cardiologist who had looked after my dad for, what, five hours and then he just died kind of suddenly. He was having a heart attack. And I could see the discomfort on his face.

And I, and I, you know, not at that moment. At that moment I was grief-stricken. I didn't want to have to deal with his emotional. And I, and that's when the light went off that I was, I realized that I was, that, that I was bringing my emotional state into this conversation with this patient and that I'm breaking bad news to. and so, you know, it was, it was in that moment realizing that he was attending to his own discomfort that I thought, I'm going to relieve him of his discomfort.

And I said, thank you very much for looking after my dad. And he kind of, I could see him visibly relax. And he said, take all the time. And he withdrew. And I, and that, that hit home because I, I, I reflected back on all the times I had broken bad news. with patients, and I realized that I was much too attentive to my own discomfort. So what you have to do when you're breaking bad news is

get your shit out of the way. That means meditating, whatever. You five seconds, say, this is not about me. This is about you. This isn't about me. This is about you. And I'm talking about, I'm not saying, I don't say this to the patient.

No, no, no. I center myself. I clear myself. I sit. I don't stand over a patient. I instruct the ward secretary, hold my calls. I don't want to be called unless there's a cardiac arrest that I have to run to. I want them to feel as if I've got all the time in the world and they have all the time of the world.

Because for them, time stops. Right. At that moment, especially with a death, but with a devastating diagnosis like metastatic cancer, like stage four cancer, time is stopping for that. That was a moment in the book. and you mentioned that when you're delivering this news, it'll often result in tears from the person receiving the news, right? They're allowed to, they're allowed to scream, they're allowed to get angry, they're allowed to do all that.

But, Doc, I'm curious, how do you process that? Like, do you go, I know, do you go for a run or something? Like, do you meditate? You mentioned a brief meditation of a few seconds there, but, like, how do you cope with the fact that you just told a other one? As a 24-year-old that they have stage 4 cancer and need to speak to an oncologist, and they're maybe distraught over receiving this horrific news. Like, how do you cope with that?

What do you do? I talk to, most of what I do is I talk to Tamara. I talk to my wife, my partner, my life partner, will be married 30 years this December. And, you know, that's, I mean, she talked, we walk and talk. You know, she talks about her clients. retiring from the YWCA Employment Center. She helped a lot of people get jobs, dusted up their resumes, you know, helped them dress for success, help them process their, their files so that they could get into government

programs that would help pay for their education and, you know, her taught lots of seminars and her clients lover and her coworkers lover. But, yeah, you know, I have a confidant. I have a confidant. We talk. We talk. and you know and and and uh you have to have a confidant and uh you know that's otherwise you'll end up drinking or something yeah yeah or you'll or you'll bottle it up inside um right you'll and and you know

this is happening but it's not all it's not the only thing that we deal with you know we like everybody else we deal with microaggressions we deal with you know consultants who put us down You know, there's a time when I need, you know, I need help. And that happens a lot less lately. I have to say the residents that I work with are fantastic, you know, by and large. I think, and if they're not fantastic, they're having a bad day. They're just, they've, they've had too many consults. They've been kicked around by somebody.

And so I have to, like, you know, I can empathize with them. I can say, hey, what's going on? Are you okay? And, and, you know, so it's, so basically, I cope. by trying to connect as much as I can, you know, either it's co-workers or it's my partner, Tamara. And because you have to be able to, you have to be able to decompress.

You have to be able to talk about this stuff. The casino shift, your new book, which I highly recommend, especially if you enjoy the pit. You got to check out the casino shift. But I didn't even consider until I was reading in your book, what it's like for the technicians, right? Because the technicians will see it.

They won't say anything to the... The X-ray technicians. They're called MRTs, medical radiologic technicians, yeah. So they'll know before you know. Yeah. And then it's your job to convey this to the patient. Yeah, the MRT who has to keep a poker face. Yeah.

And, you know, a lot of us, if you've gotten bad news, you know, either a miscarriage, you know, obviously visible on an ultrasound or a CT scan, or in this case, you know, I told the story of a... of a technician, of a technologist, a medical radiographic technologist who could see the brain tumor on the five-year-old and had to keep a poker face. Yeah. And say, you have to talk to the doctor. And, you know, with mum looking, eyes welded on the technologist's face looking for any clue that they see something. It's heartbreaking even.

Yeah. And, and, but the point, what's really heartbreaking is. is that they often don't have the emotional support that I have. People expect me, people expect nurses to have to deal with trauma, but not MRTs. And, you know, they're burning out. And the other thing I talk about in the book is how CT scanning has changed.

It used to be that CTs were an event that took 45 minutes to an hour to do. Now they can get them in and out in 10 minutes. And so they expect the same technician to process five times as many CT scans in an hour. And it's not just that they don't have, you know, they can't process, but they don't even have the time to process. Another one and another one, another one, another one, and no wonder they're burning out. Jeez. Yeah, my goodness gracious here.

Okay, so this is, this conversation has been wonderful. Was that, by the way, was that on the pit? Were M.R.T's on the pit? No, in the pit, there's a guy named Duke. Yeah, but do they, like, like, you know. You don't, you don't, I mean, I can't think of that specifically, but you definitely see that they're, that this friend of Robbie, the main character, Noel Wiley.

He needs a to, what's it? A CAT scan, I guess. He needs something to that effect. And he keeps getting delayed by other people coming in and he's there all day. Like all shift. He's kind of there waiting. But at some point... That's the patient.

But not the MRT. And that's why I wrote the book. Because, you know what? Yeah, I never considered it. I see, exactly. And I wanted people, I wanted people to read the book and learn things. And I have colleagues, emergency colleagues,

who have never thought about the people who take CTs until I wrote the book and now they're thinking about them. Yeah, well, now I'm thinking about them. Now I can't not think about them. Yeah, well, they see it first, actually. And what is, this is a quick aside. I was thinking as I read your book, but what is it with all the colon cancer diagnoses

and young people lately? Yeah. Like, why is that on the rise? I did a TikTok on that recently. And so we don't know. It's not turbo cancer. anti-vaxxers, sorry, it's not turbo cancer. It's not because you've got COVID shots that you're that, if anything,

COVID itself might, by causing chronic inflammation, might actually predispose you to cancer. But, you know, is it diet? Is it gut microbiome? Is it obesity? Is it alcohol consumption? Because people are drinking more at a younger age than they used to? Those are all possibilities. You think with cannabis that they'd be drinking less?

Yeah. Just a, no, no, no, no, no. They'd be, some of their place. They're drinking more. drinking more alcohol. And so we don't know why. It's clearly not genetic because it wouldn't suddenly be happening. And it's tragic. And we are seeing people in their 20s and 30s with stage 4 cancer because they went to their primary care provider complaining of a change in bowel habits and maybe a little bit of blood. And they were told, you know, it's probably irritable bowel syndrome

couldn't possibly be cancer because you're too young. Right. And, you know, we've had a number of people in White Coat Black Art. I don't know if you remember, do you remember Bishop Burgante? Bishop Burgundy was in Orphan Black. He played a, you know, he was a major guest star, recurring guest star. And he died before the age of 50 of colorectal cancer,

had stage four cancer, and established a petition at the Ontario legislature to lower the age for screening to 45. I think he would have liked to have been even, even even younger. And then, of course, the former star of Dawson's Creek. James Vanderbeek. Yeah, that was big news.

You know, I recently turned the big five-o, so I went to see my doctor for my annual, and I'm like, okay, so what changes? And there was two things she mentioned was she said, okay, colonoscopy, which I did. Yep. And she recommended I pay for the shingles vaccination. Yes, you can, at 50, you have to pay for it at a pocket.

Shingricks, yeah. And we think it, reduces the risk of dementia. Well, I did it, Doc. Okay, both shots. Good for you. Done. Out of pocket there, okay.

And there's also, you know, there's also blood testing, and it's not all poop testing, you know, for blood, but also there's blood tests. At the moment, you have to pay for this stuff, but there's blood tests that can detect the genetic fingerprint of colorectal cancer. And so that's something that we're going to do, probably do more testing. of that kind in the years to come. When is your next shift? My next shift is Saturday.

It's casino shift, Saturday. Okay, and you did, in the book, you talk about how you can, if you're really busy, you can have a dog come in a couple hours early for that casino shift. Well, that's what I did, yeah. Like if they're real busy and they call you,

they call you in, yeah, you have to be prepared, you have to be prepared for our shifts. You know, we work with, we have wonderful, generous colleagues, and one of the things that we do is we are available to come in up to two hours before our scheduled shift. We don't do that with a night shift.

We're not going to ask a night shift doc to come in at 9 p.m. because they deserve to get their sleep and be ready to go. But we also have an on-call. We have an on-call doc. And we call the on-call dock for two reasons, either because somebody can't make a shift because they have an illness or a family emergency or to have to have. handle excess volume.

And we didn't have that until about 20 years ago. And we instituted that. Okay. Now, you talked about your TikTok account. What is your handle? I'm not on TikTok. I'll confess to you. I don't have a TikTok account.

But for the many people listening to you have TikTok, how can they follow you? I got to look it up. Is it? I guess it's not as simple as Dr. Brian Goldman. No. That would make too much. Night Shift MD?

Yeah, at Night Shift MD. I know my Twitter handle. That's my X handle. You still post it on X? Yeah, sure. Okay. Yeah, you know what? I abandoned ship at some point.

We have, well, you know, we switched over, a lot of us switched over to Blue Sky. That's where we Twitter refugees are hanging out. Yeah, so, you know, I have a Blue Sky account, and I've got like 13,000 followers. I still have 100,000 followers on X. And there's a lot of doctors who, I mean, there is a lot. The algorithm is nuts. And I don't get the engagement. to get. I get weird engagement.

And so there are moments when I feel as if I'm, you know, spitting into the Grand Canyon. I have no idea if people are actually... I miss pre-Elon Twitter. I miss that experience. Yes. Yeah, he kind of wrecked it. He wrecked it, all right. Because you mentioned a popular TikTok post of yours was about what the pit gets right and what the pit gets wrong.

When I initially thought of this episode, it was quite simply, pit, pit, pit, pit, let's talk about how the pit, like how realistic is a pit. But then as I read your book, I realize I actually don't want to do like the whole episode about the pit. I want to talk about this great book, the casino shift. But maybe on our way out here, if you're a game, could you tell us a little bit about what the pit gets right and what the pit gets wrong? Okay, so, now, secret weapon of the pit, they have partnered with the premier emergency

medicine podcast in the world. It's called EMRAP. So they have, they actually have the director, like one of the key doctors who's a consulting producer on the show. That's, first of all. So they get the medicine right. They get, and they don't just, you know, talk about fentanyl, which is kind of old news, but fentanyl laced with xylizine and metatomidine. And, you know, they, so that's one thing they get right.

They get the medicine right. It's spot on. They get the technology. right. So bedside ultrasounds, Pocus, and ECMO, extra corporeal membrane oxygenation, the artificial heart that can sustain people whose

hearts have been damaged by cocaine or by valvular heart disease or myocarditis, you know, infections. They get that right. They get the milieu right, waiting room medicine, hallway medicine.

They, you know, so they understand the issues and, you know, they're getting more into Medicare and, you know, that people are going to be thrown off Medicare and Medicaid benefits. They've got that for-profit hospitals and, you know, closing down hospitals, putting more pressure on urban emergency departments to stay open. So all that they get right. What do they get wrong? Have you noticed that Dr. Robbie never spends one nanosecond in front of a computer?

Oh, yeah, I have noticed that, yeah. And what this weird business of bopping from one room to another and kind of going there for like a star turn and then going to another, we don't do that. I spend five to ten minutes boning up on every patient in front of a computer terminal because every patient until proven otherwise is complex, meaning that, you know, they're not going to be able to tell me what's wrong. It's going to be some complication of a complication of a complication. Also, in your book you make an interesting point. I'm just going to throw it out there that often patients are lying to you. Yeah. Like, I mean,

yeah, yeah. I read it in your book, Doc, that sometimes patients will lie to you. Like, you have to know when they're lying to you. Yeah, and they don't.

throwing it out there, that I didn't consider that. You know, they, yeah, and, and, you know,

the fact is we, what is that? Okay. I'm trying to get my Twitter handle. My, I'm trying to get my TikTok. The doc has started doom scrolling on TikTok.

I'm doom scrolling. So, so, so, so, you know, to frame the purpose of the visit, we have to get up to speed and a hurry. And I can tell you that, you know, we need to

have AI in health care. And with all of the risks that are attendant in that, what I've been asking for for probably 20 years now is an app that can take a patient's discharge summaries and MRIs and ECGs and blood work, recent blood work, and turned it into a cheat sheet. Like one or two paragraphs that get me up to speed so I know exactly what's wrong with that patient.

What's happened up until the moment that they've come to the emergency department? It's not rocket science. It can be done. So it doesn't exist. Well, it does exist. It exists on Epic, you know, the EMR, the electronic medical record. Is that FirstNet? What's, because first? We used

Yeah, we use FirstNet, but there is Epic. And all the hospitals or many of the hospitals are transitioning to. I'm not a doctor. I just play one on podcasts. Right. No, you're doing well. So, so, so that's wrong. He doesn't, that's wrong.

Now, the second thing is this, this notion that I know, I know it's for dramatic effect, that the characters don't have a filter. They just say what they think. And the idea that, you know, I would, you know, Santos, uh, just saying what she thinks, said, like, and just, and just, I'm just kidding you. She'd be up before the human rights officer of the hospital and, and, and dealing with a major complaint in five seconds flat. She wouldn't do that.

She wouldn't do that after two shifts. She'd be, in fact, if she kept doing it after a second shift, they would say she has a characterological issue, and I'm not sure she's, she's cut out for that. Have you met people like this in your many years working emergency rooms? They stick out like a sore thumb. Like, do you ever see a colleague? Obviously, you won't identify this person. that. But you ever have a colleague where you're like, maybe emergency room medicine isn't for you.

There's other vocations. But I would never tell them that to their face. And, you know, there would be conversations about it, but it would take, actually, it would take a long time for the conversations to happen. It would be tolerated for a long period of time. The third thing is this leaning into the trope of, of the wounded healer. That we're all just wounded healers. We all, we're all, Well, they're all wounded this season. We're all seriously screwed up. And first of all, most of us wouldn't be caught dead, revealing that we're wounded healers. We would cover it up.

And we're all, you know, whatever it is that might make us screwed up, the last place we're going to show it is is where we work. So we're going to look, we're copers. We're going to look and sound like we cope right up to the point when we don't. We can't cope. And why? Because there's great stigma attached to being a wounded healer. There's great stigma, whether it is a medical ailment or, you know, more commonly an emotional ailment. It is, it's just not something that most of us care to reveal about ourselves.

We don't like looking and sounding vulnerable. And so, you know, we, you know, the characters on the pit where they're vulnerability on their sleeve. like they're vulnerable a lot, uh, or they have overcompensated aggressiveness that is in fact blocking or trying to to act as a shield against

their fear of being vulnerable. Yeah, there's a character, Dr. Mohan, I believe is her name this season who, um, like has, seems to be having the panic attacks and she's, she's leaving apparently. That's a, yes. She's leaving and she's moving on.

She's finally moving on. Good for Dr. Mohan. Okay. We don't know though, because there's, two episodes ago, you know, we don't know she's moving on. We just know she's not in season. There are no spoilers. Believe me, there are no spoilers here.

Nobody has seen this episode that airs tonight, the penultimate episode actually. But there is, you know, if you go to like a subreddit on the pit or something, there's some concern for some of these people that they might self-harm in some way before this series ends. We don't know anything. I'm just saying. I hope she moves on. I hope they don't. And I hope she moves on to work of geriatrics or something like that.

Exactly. Yeah, I think I heard geriatrics too. And there you go. Well, I think they... We're fishing in the same pond. We're fishing in the same pond. But I got to say, I feel like the first season was kind of like ER style, because I saw a lot of echoes of ER plot lines in the first season.

But the second season seems to be more focused on the healthcare workers. Isn't that? But isn't that the way these series always go? And that was the other thing I didn't like. The patients were kind of wheeled in and out like meat, like so much meat. The patient with the hard-to-diagnose problem that needs to be diagnosed in five seconds, flatter they're going to die. And, but they, and, yeah, I, I, I think the, the characters, you know, the recurring characters, the staff were written better.

They seem to be known better than the, than the patients, maybe because the patients come and go. So, good news on the live stream, live dot Toronto Mike.com, Moose Grumpy, who says, big thank you to you. Your social media was a savior during the pandemic. So Moose Grumpy loved. Oh, thank you. But also wants you to know your TikTok handle is Brian Goldman MD. Thank you. Thank you, Moose.

Thank you, Moose. Oh, and shout out to Andrew Ward, who says, this is gold. He says these points should be taught. He says, this is powerful. He says, wow. So you're already making, even before the podcast drops, you've made quite a impression here on the TMU, the Toronto Mike's Universe. What took us so long to get together in the flesh here? This was great.

We were just saving. it up. We're going to do this again at some point? Yeah, I'd love to. Unfortunately, the sets, the Star Trek sets have been struck. And some people seem very happy about that. I'm sad. I want more Star Trek. Yeah, I think my client and friend Dana Levinson had a guest appearance on that iteration of Star Trek that filmed here. But sorry to hear it goes. So I'm sorry about that. I'm sorry about the Leaps. You got your next shifts on Saturday. So how many shifts a week are you working? One or two a week. One or two a week. Okay. I hope you hang in there because you know what you can't teach.

You can't teach experience. You've seen some shit, Doc, and that's got to come in handy. So hopefully somebody taps you on the shoulder when you lose a step or two. But I don't think that'll happen for quite some time. Yeah, you know, the Vulcan, no, it's the Borghive mind. My collective, you know, I'm not going to enter the collective consciousness. That's the weird thing. You walk out the door and whatever was inside your head is gone.

Not from you, but from your not to be used. by your colleagues other than your words of wisdom, although I do have five books. Five books and counting. So every time you put out a book, you come by and talk about it. Okay. And that brings us to the end of our 1,8-78th show.

Go to TorontoMike.com for all your Toronto Mike needs and buy a ticket or two to see me make my Elmo combo debut on May 21st. Doc, you got to come see me at the Elmo, buddy. May 21st. Imagine I'm up there doing my one-man show when I see Dr. Brian Goldman in the audio. Wow, mine might be able to do that. May 21, go to Toronto Mike.com,

hit the link for Elmo gig. Get a ticket or two. Much love to all who made this possible. That is Great Lakes Brewery, palm pasta, don't leave about your lasagna. Nick Iienies, RecycleMyElectronics.ca and Ridley Funeral Home. See you all. Saturday.

It's toast with Rob Pruse and Bob Willett.