Podcasts about catholic medical center

 In this episode, Scott Becker is joined by Alan Condon, Editor-in-Chief at Becker's Healthcare, to discuss key developments in healthcare. They dive into the potential Medicaid cuts under the Trump administration, HCA Healthcare's strategic acquisition of Catholic Medical Center, and what these changes mean for hospitals, health systems, and patient care.

Gov. Kelly Ayotte officially took office this week and gave her first inaugural address. She touched on many different issues in her speech – from the state budget, to education and housing. We discuss her message to Granite Staters. And state officials have approved the acquisition of Catholic Medical Center by HCA Healthcare. We hear what this means for the state of the healthcare industry in New Hampshire on this edition of the NH News Recap with reporters Ethan DeWitt and Paul Cuno-Booth.

In this episode, Alan Condon, Editor-in-Chief at Becker's Healthcare, joins Scott Becker to discuss major developments in healthcare finance, including HCA Healthcare's acquisition of Catholic Medical Center and the creation of one of the nation's largest nonprofit systems through the Sanford Health and Marshfield Clinic merger.

Join us for an insightful episode of "Restful Recovery," where we explore the crucial interplay between sleep and cancer with Dr. Daniel Barone, a leading expert in sleep medicine. Dr. Barone, the Associate Medical Director at the Weill Cornell Center for Sleep Medicine, shares his extensive knowledge and experience in the field, offering valuable guidance on how sleep impacts cancer treatment and recovery. Dr. Barone's illustrious career began with his summa cum laude graduation from Fordham University, followed by his medical degree from New York Medical College. His path included an internship in Internal Medicine at Saint Vincent's Catholic Medical Center, and subsequent Neurology training, where he was named Chief Resident. He completed his Neurology residency at Beth Israel Medical Center and a fellowship in Sleep Disorders at Stony Brook University Medical Center. As an Associate Professor of Clinical Neurology at Weill Cornell Medical College and an Attending Neurologist at NewYork-Presbyterian/Weill Cornell Medical Center, Dr. Barone specializes in managing various sleep disorders, including sleep apnea, insomnia, and restless legs syndrome. His certifications and affiliations, including those with the American Academy of Neurology and the American Academy of Sleep Medicine, underscore his expertise. In this episode, Dr. Barone discusses how sleep affects cancer patients, strategies for improving sleep during treatment, and the latest research findings. His insights are drawn from his peer-reviewed publications, media appearances, and his books, "Let's Talk About Sleep" and "The Story of Sleep: From A to Zzz." Tune in to learn how better sleep can be a powerful ally in cancer care and recovery, and gain practical tips for improving your sleep health during challenging times. --- Support this podcast: https://podcasters.spotify.com/pod/show/aimatmelanoma/support

After two years of anticipation, we've finally had the pleasure of sitting down with the incredible Kristine DiFiore, Chief HR Officer at Catholic Medical Center. Kristine shares her invaluable insights from the conference, her perspective on the current challenges in healthcare HR, and some heartfelt (and hilarious) stories from her professional journey. Here's a sneak peek into what you can expect: Highlights:- Conference Recap: Kristine's experiences and key takeaways from ASHHRA24. Spoiler: It's all about networking and learning from each other!- HR Wisdom: Innovative recruitment initiatives and the significance of employee development for retention.- Funny & Awkward HR Tales: The most unique interview scenario Kristine has ever encountered – trust us, you don't want to miss this!- Vision for the Future: Kristine's thoughts on evolving dress codes, blending comfort with professional attire and how it influences workplace culture.- ASHHRA25 Teaser: Gear up for the next big event in Albuquerque, New Mexico! Tune In Now!Thank you for being a part of our incredible community. We're excited to continue bringing you insightful conversations and inspiring HR stories.Warm regards,Bo and LukeHosts of The ASHHRA PodcastThis episode is sponsored by RxBenefits... Unlock Pharmacy Plan Potential!Your employees expect top-tier medical benefits, like comprehensive care access. But how can you balance these expectations against rising costs, across your full benefits portfolio? Find savings and opportunities in your most highly utilized benefit - your pharmacy plan. Did you know that hospital employees fill 25% more prescriptions each year than other industries? How can you tell if all those prescriptions were needed, or if you could have had significant cost savings by filling at your own hospital pharmacies?Contact RxBenefits today to learn more: https://rxbene.fit/48n8VS8Support the Show.

It can be difficult to find VBAC support with gestational diabetes and most who are supportive of VBAC highly recommend a 39-week induction. Heidi's first pregnancy/birth included gestational diabetes with daily insulin injections, a 39-week induction, Penicillin during labor for GBS, pushing for five hours, and a C-section for arrest of descent due to OP presentation. Heidi wasn't sure if she wanted to go through another birth after her first traumatic experience, but she found a very supportive practice that made her feel safe to go for it again. Though many practices would have risked her out of going for a VBAC due to her age and subsequent gestational diabetes diagnosis, her new practice was so reassuring, calm, and supportive of how Heidi wanted to birth. Heidi knew she wanted to go into spontaneous labor and try for an unmedicated VBAC. With the safety and support of her team, she was able to do just that. At just over 40 weeks, Heidi went into labor spontaneously and labored beautifully. Instead of pushing for over five hours, Heidi only pushed for 30 minutes! It was exactly the dreamy birth she hoped it would be. ThrombocytopeniaReal Food for Gestational Diabetes by Lily NicholsInformed Pregnancy Plus Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details 05:50 Review of the Week08:04 Heidi's first pregnancy with gestational diabetes12:05 Taking insulin18:08 39-week induction 20:59 Pushing 24:29 Arrest of descent and opting for a C-section27:06 Researching providers before second pregnancy38:04 Discussions around induction41:45 NSTs twice a week47:10 Testing for preeclampsia54:53 Spontaneous labor57:43 Going to the hospital1:02:03 Laboring in the tub1:06:22 Pushing for 30 minutesMeagan: Hello, Women of Strength. It is Meagan and we have a friend from New Hampshire. Her name is Heidi. Hello, how are you? Heidi: I'm doing great. How are you?Meagan: I am so great. I'm excited to record this story today because there are so many times in The VBAC Link Community on Facebook where we see people commenting about gestational diabetes and for a really long time on the podcast, we didn't have any stories about gestational diabetes. Just recently, this year really, we've had some gestational diabetes stories. I just love it because I think a lot of the time in the system, there is doubt placed with the ability to give birth with gestational diabetes or there is the whole will induce or won't induce type thing, and with gestational diabetes, you have to have a baby by 39 weeks if they won't induce you and it just goes. So I love hearing these stories and Heidi's story today– she actually had gestational diabetes with both so with her C-section and with her VBAC. It was controlled. It was amazing. That's another thing that I love hearing is that it is possible to control. We love Lily Nichols and the book about gestational diabetes and pregnancy. We will make sure to have it in the link, but it is so good to know that it doesn't have to be a big, overwhelming thing. It can be controlled and it doesn't have to be too crazy. Right? Did you find that along the way? Heidi: Yes. Yes, definitely. The first one was pretty scary, but then the second one, you know what you are doing and you can control it and you can keep advocating for yourself. Meagan: Absolutely. And then in addition to gestational diabetes, she had advanced maternal age barely with her second, but that is something that also gets thrown out. A lot of the time, we have providers saying, “We shouldn't have a vaginal birth. We should have a C-section by this time,” so that's another thing. If you are an advanced-maternal-age mama, listen up because here is another story for you as well. We don't have a lot of those on the podcast. We are so excited to welcome Heidi to the show. 05:50 Review of the WeekMeagan: Of course, we are going to do a Review of the Week and then we will dive right in. This was from stephaniet and it says, “Inspiring and Educational.” It says, “As a mother currently in her third trimester preparing for a VBAC, I was so happy to find this podcast. The stories shared are so encouraging and it is so comforting to know that I am not alone in feeling that once a Cesarean, always a Cesarean.” 100%. That is 100% true. You are not alone here. And once a Cesarean is not always a Cesarean. It says, “This does not have to be my story. Thanks, Meagan and Julie, for providing the support and education to women who are fighting for a chance to have a natural childbirth. I would love to encourage anyone wanting to learn more about VBAC to listen to this podcast.” Thank you, stephaniet. This was quite a few years ago, actually. This was in 2019. We still have some reviews in 2019 that weren't read. It's 2024, so that's really awesome and as usual, if you have a moment, we would love your reviews. Your reviews truly are what help more Women of Strength find these stories. We want these stories to be heard so leave us a review if you can on Apple Podcasts and Google. You can email us a review or whatever, but definitely if you listen to the podcast on a platform, leave a review and that would help. 08:04 Heidi's first pregnancy with gestational diabetesMeagan: All right, Ms. Heidi. Welcome to the show and thank you for being with us. Heidi: Thanks for having me. This is awesome. Meagan: Well, let's talk about it. Share your story with us with your C-section. Heidi: Yeah. We were planning for a child and we just decided. We were like, “Okay. Let's shoot for an April birthdate.” We just thought that we could just have a child, but we got lucky and we did on the first try. Meagan: Amazing. Heidi: We went to our local hospital that was about five minutes away for care and it just seemed good enough. At the time, I thought you just go to the hospital. You get care. You can trust the provider and you don't really need to do anything other than a hospital birth class for prepping. We just went along that journey. They assured me, “This will be a normal pregnancy. Everything is great.” The pregnancy was uneventful until about 20 weeks when I found out my baby was missing a kidney during a routine ultrasound. That sent us down Google rabbit holes and all kinds of fun things. Meagan: I'm sure, yeah. Heidi: Yeah. So at that point, we were assigned a Maternal-fetal medicine OB. I was offered an amniocentesis if we wanted to check and see what else was wrong and things like that. That was a major curveball. Meagan: Did you end up participating in the amnio? Heidi: No, we didn't. We had a couple of detailed ultrasounds after that. At first, they didn't actually tell me what they were looking for. I had three ultrasounds in a row that were not the more detailed ones. Meagan: Oh, okay. Heidi: I was like, “Why am I having all of these ultrasounds? Nobody is saying anything.” I finally got a phone call telling me that my daughter was missing a kidney so that's what they were looking for. I was like, “Okay. Good to know.” Meagan: Yeah. You would have thought some communication before then would have happened though. Heidi: Yeah. It was pretty scary. So what seemed pretty uneventful–Meagan: Got eventful. Heidi: Yeah, it did. So right around 28-30 weeks when they do the gestational diabetes check, I went in for my check and found that I would need to start tracking my blood sugar and diabetes does tend to kind of run in my family even though everybody is very healthy. I was wondering if it would come up and also being older, sometimes they say there is a link but it still took me by surprise because I'm a very active person and I eat really healthy. I felt like a failure basically. Meagan: I'm so sorry Heidi: Yeah. All of a sudden, I'm meeting with a nutritionist. They give me this whole package of a finger pricker. Yeah, exactly. All of a sudden, I'm submitting logs four times a day checking blood sugar, and the fasting numbers for me just weren't coming down so it was about one week of that, and then all of a sudden, they were saying, “Okay. You probably need insulin.” 12:05 Taking insulinHeidi: It came on so fast, so strong. Meagan: Wow. Heidi: It was really scary so then I found myself going to the pharmacy. I am a very healthy person so it was just all really weird going to the pharmacy buying insulin and learning all about insulin and learning almost how little the medical field understands about gestational diabetes. That was something bouncing in my head bouncing off the wall trying to understand the plan there. Meagan: Yeah. Heidi: Yeah, so after that, then I got phone calls from the nurses. They said, “You know, now you are on insulin. Now, you are going to have twice weekly NSTs required at 35 weeks.” I'm thinking, “Well, I'm working full time. How am I going to do all of this?” There is just so much sick time and it was really, really difficult to hear all of that. Meagan: Yeah. How do I have time for all of that? Plus just being pregnant. Heidi: Yeah. Yeah. Insulin and just for anyone that doesn't know, basically you inject yourself. I was injecting myself every night with an insulin pen and it was all just very weird because you're also thinking, “Well, I'm pregnant. I've never been on this medication. What is it going to do to me? What is it doing to my baby?” Very nervewracking. It's all normal to feel that way. Meagan: Yeah. I think sometimes when we get these diagnoses, we want to either recluse because it's so overwhelming, and sometimes then, our numbers can get a little wonky, or we dive in so much that it consumes us and we forget that we are still human and we don't have to do that. Heidi: Yeah. Now that you say that, I definitely did a little bit of both. Meagan: Did you? Heidi: I did a little bit of denial and then I did a little bit of obsessive researching. Meagan: Yeah, because you want to know. You want to be informed and that's super good, but sometimes it can control us. Heidi: Yes. Absolutely. You're watching every single thing that goes into your body. I probably didn't look at food normally until my second pregnancy to be honest with you. Meagan: Really? Heidi: Yeah. Meagan: Yeah. Yeah. So it was working. Things were being managed. Heidi: Yes. I was honestly very grateful for the insulin. Obviously, it took a little while to feel that way, but it was very well-managed. My numbers were right in range. My blood sugars were always normal throughout the day. I never had to do anything during the day. I just checked my blood sugars. Then the other thing that came as an alarm, they told me about the NSTs which are non-stress tests. They also mentioned that I would need an induction in the 39th week because–Meagan: 39 to be suggested, I should say. Heidi: Yeah. It wasn't explained to me that with that provider, it was a choice. It wasn't a suggestion. It was like, “You have to do this or you might have a stillbirth.” It was really scary. Meagan: Oh. Heidi: I didn't know I had a choice. Being a first-time mom and not knowing about evidence-based birth, this podcast, or all of it. I had no idea. So I was told I could schedule it anytime after my 36th week and for every appointment that I had as I started getting closer, I felt a lot of pressure from the providers to schedule the induction. They cited the ARRIVE trial. Meagan: Yes. Another thing I roll my eyes at. I don't hate all things. I just don't like when people call people old and when they tell people they have to do something because of a trial that really wasn't that great. But, okay. Heidi: Yep. Yeah. I mean, they didn't explain the details of it either. They just said, “Oh, it's the ARRIVE trial,” so I go and Google and try to make sense of it. They just say, “Stillbirth risk increases.” They say, “If you are induced at the 39th week, there is no increase and chance of a C-section,” so I thought, “Oh, okay. Sure.” Meagan: Right. Right, yeah. Heidi: I finally gave in near the end and I scheduled my induction for the 39th week and 6th day. Meagan: Okay, so almost 41. Heidi: Yep. So then I worked right up to the night before my induction. I was admitted to the hospital at 7:00 AM. I was planning for an unmedicated, uncomplicated delivery and an induction using a Cook balloon because my provider had checked me in the office the day before and they found that I was 1 centimeter dilated so they said they could probably get the balloon. I'm thinking, “Oh, it's going to be a mechanical induction. There's going to be no IV. It's going to be really as natural as possible.” 18:08 39-week induction Heidi: I get into triage and immediately, they start putting an IV in my right arm. I am right-handed. Meagan: Why do they do that? If you are listening and you are getting an IV, don't hesitate to say, “Hey, that's my dominant hand. Can we put it in the other one?” Also, don't hesitate to say, “Don't put it in my wrist where I'm going to try and be bending and breastfeeding a baby in the end. Put it in the hand or put it up in the arm.” Heidi: That's really good advice. I didn't know that the first time. Meagan: I didn't either. Heidi: I knew enough to say, “Whoa, whoa, whoa. Put it in my left hand.” They ended up putting it in my forearm. So here I am. I was hooked up to Penicillin. I was GBS positive. I feel like I had all of the things. Meagan: Yes. We've got gestational diabetes, GBS, maternal age, and now we've got an induction. Heidi: Yeah. Oh yeah. So yeah. They put in Penicillin, Pitocin, and saline, and then they showed me how to move around while wheeling an IV pole. Meagan: Mmm, yeah. Fun.Heidi: Yeah. We felt a little gutted at that point. We are in the hospital and sorry, when I say we, it's my husband and I. Yeah. The midwife had trouble getting the Cook balloon in. We just sat around on Pitocin that first day. The OB finally got it in around 10:00 PM that night. It was her first visit to see us actually. She probably could have gotten it in earlier had she come earlier. It sped up the labor overnight as soon as the Cook balloon went in. It was a bit painful. They stopped the Pitocin the next morning. My water broke on its own. They were talking about coming in to break my water and I think my body probably heard them, so it broke on its own. Yeah. I was just laying in the bed and it happened. Then labor began to pick up, but the contractions were still not regular. Pitocin was increased and then the contractions got really intense, but still irregular until around 4:00 PM that day at which point, I just couldn't take it. I asked for the epidural. Meagan: That's a lot. That's a lot. Heidi: Yeah. It was intense. 20:59 Pushing Heidi: The shift changed and a new nurse had a student with her. So I consented to the student being there thinking, “Oh yeah. Come on. Come observe my awesome labor. This is going to be amazing. It's going to be a vaginal delivery and everything,” so I'm like, “Yeah, sure. Let them learn.” I achieved 10 centimeters dilation and full effacement around 9:00 PM that night so it was really exciting. Meagan: That's actually pretty fast. 10:00 is when the Cook was planned the night before. 9:00 PM, so hey, that's pretty good. Heidi: Yeah. I was happy about that. I was so excited to push. I couldn't feel a lot because I was on the epidural, but it really took the pain away and it helped a lot in the moment. So let's see, I was mostly on my back. I was tired. I was just really tired at this point. There was, the nurse that I had was pretty new. She had been there for I think 6 months and then she was also trying to juggle the student nurse. She didn't have a lot of knowledge of positioning. I thought going into it that all nurses were trained in Spinning Babies and all nurses had the knowledge of baby positioning and things like that, but I was wrong. Meagan: Yeah, unfortunately, they are not all. I don't think a lot of them have it actually. Most of them don't. Heidi: Yeah. I pushed mostly on my back and when the OB came in around 11:00, she noticed my pushing was not effective at 11:00 PM. Meagan: So two hours in. Heidi: Yes. My position needed to be changed. She got me up on the squat bar and then she left again, but she showed me how to push and everything in the meantime. When she came back in, she explained to me that I would probably need a C-section soon. I don't exactly remember that sequence of events because it is so intense. I felt really defeated. I was like, “I just started. What do you mean I will probably need a C-section?” Meagan: So you were still wanting to keep going?Heidi: Oh yeah. Oh yeah. She also explained that meconium started to show in the amniotic fluid. The OB explained to me that the baby was probably in distress because of that. That was all that was said. Heidi: I spiked a fever. They gave me Tylenol and then the baby's heart rate began to slow a little bit, just for a little bit. The OB inserted a monitor on the top of her head. At this point, I felt like I was pushing for my life. I was like, “Oh my gosh. I need to get this baby out. How do I do this?” But I still felt like, “I can do this. I can do this. I know I can do this.” Meagan: Yeah. Heidi: But there were definitely questions at this point. 24:29 Arrest of descent and opting for a C-sectionHeidi: Yeah, so then around 2:30 in the morning, I was told by the OB to get on all fours and try one last position and I could opt for a C-section at that point or I could push until the OB came back in. I was like, “You know what? I'm going to give it all I have. I'm going to work so hard and the baby is going to come out in the next 45 minutes. She's got to.” So I did. Honestly, I was so grateful that I had that last 45 minutes. I feel like if I didn't, it would have been stolen from me. I feel I was defeated when she came back in because she was still not out and I was exhausted, but I was ready. The baby was not going to come out any other way at this point for whatever reason. That was going to be dissected months later, years later by me, but in the moment, yeah. She was at station 0. I was told she wasn't far enough down to do an assisted delivery, so they wheeled me into the OR for the C-section. I requested that the baby have skin-to-skin as well as delayed cord clamping. Unfortunately, none of this happened and I guess I should also note that once they put the monitor on her head, she did great. She still was not in distress. I was doing great too. The C-section was just really for arrest of descent. They just thought it was taking too long because I had been pushing for a little over 5 hours at that point. Meagan: Yeah. Heidi: Yeah. She was born via C-section at 3:20 in the morning. She weighed 7 pounds, 1 ounce and she was in the OP position. Meagan: I was just going to say, was there a positional issue here? I always wonder when there's patterns like yours where I'm like, “That sounds like a positional thing.” Okay, so OP. Occiput posterior for anyone who is listening or sunny-side up. Baby just needed rotation. Heidi: Yeah. Yeah. Yeah. That was that. Meagan: Yeah. So then did you end up when you got pregnant, did you end up staying with this provider? How did that journey begin? 27:06 Researching providers before second pregnancyHeidi: I went back– let's see. I'm trying to think. I went back for routine care almost a year later. I had care in between, but I had wanted to see that provider just to have closure. I asked her. At the time, I wasn't really sure that I wanted another child. My husband and I were just really thinking, “Is that what recovery is always like?” After the C-section, it was really hard. I asked her, “If I were to have another child, what would be my odds of delivering vaginally? Could I have another child that way instead of the C-section?” She said, “You probably would end up with another C-section if you even tried so you probably have about a 40% chance.” It was not based on anything. Meagan: Hmm. So she didn't even do the calculator, just gave you a percentage. Heidi: No. Just gave me a percentage. Meagan: Oh dear, okay. Heidi: So at the end of that appointment, again, I still had not really educated myself and knew that there were amazing resources out there, so I just said, “Okay. If I have another child, I'll have to have another C-section.” I went home and told my husband. I said, “If we have another child, we're going to have to have a C-section.” We were both like, “Okay, maybe we won't have another child.” Yeah, so then another year passed. We were beginning to get ready and slowly started to research other providers just for routine gynecological care. We ended up finding a hospital that was just about 25 minutes away just thinking, “Well, what if?” I had heard this hospital was well-known for VBACs and I had also started seeing a pelvic floor therapist prior to going to this hospital for care who was working at this hospital. It was kind of on my radar. Heidi: From there, I met the OB. I met the OB and then I was just really shocked at how supportive she was. In the past, you just go into the OB or gynecologist and they will put you in a gown and they do whatever they need to do, a pap smear or whatever. But this one, the nurse had said, “Don't get undressed. They want to meet you. They want to talk to you first.” Meagan: I love that so much. I love that. That's awesome. Heidi: It was so different. It was in a hospital, but it didn't feel like a medical office. The rooms were painted blues and greens. You could tell there was a lot of effort being made to make it feel like home. I began my journey. I had just met with her. This OB had talked to me about birth story processing. I had no idea what any of this was. I had no idea that I even had trauma from my last pregnancy at this point until I had just met with her and was talking with her. She said, “There is no pressure if you don't want to have another child.” I was just there to meet with her and have a check-up. I think I want to say a couple of months passed and actually, that night, I went home to see my husband. I was like, “You know if we do have another child, it's going to be here.” Yeah, so a couple of months went by and we did decide to have another child. Again, the baby was conceived right away. No complications. This time, we started working with a doula. I began birth story medicine at the same time. I did that for a couple of months in addition to my therapist to process the birth trauma and just everything. I was tested for gestational diabetes early during this pregnancy. I started insulin at 11 weeks and I was just kind of ready this time. It wasn't as scary honestly the second time. It's a lot of work. I would say that it was annoying, but it wasn't scary. Meagan: Well, and you're like, “I've done this before. I did a really good job last time. I learned a lot,” because you did go pretty deep into it, so you're like, “I can do this. I've got this.” Duh, this kind of sucks, but you know. You got it. No problem. Heidi: Right. My first baby was born at a really great weight and there were no complications at all. Meagan: Good. Did they already start talking about induction and things like that from the get-go? Did they talk about extra testing? Because at this point, you for sure have it. Earlier or later, did they talk about that stuff? Heidi: With this provider, I went in and they told me I was old last time, the other provider. I'm really old. They looked at me and were like, “No, you're not.” Meagan: No, you're not. Heidi: Yeah. They're like, “You're 37. That's not old.” Meagan: Yeah. Heidi: I'm like, “What?” Meagan: The other clinic, would they have wanted to do NSTs because of age and gestational diabetes? Heidi: I don't know. Meagan: Okay. But these guys were like, “No, we're good. We don't need to do any extra testing because of an early diagnosis of gestational diabetes and now you're 37.” Heidi: Yeah. They said what they do consider older but it's still not impossible was, I believe, over 40. Meagan: So you didn't even have that pressure from the get-go? Heidi: No, no. Meagan: What an amazing way to start. Heidi: Yeah. It was amazing. They also weren't concerned with the fact that I was on insulin. We did talk about NSTs because I asked because I knew it would come up and they had said, “You can have once a week as long as your sugars are in control, we are comfortable with that.” I felt so relieved. Yeah. It was such a holistic, relaxed approach. They trusted me to manage my body and to know what I needed and that was so empowering, the whole journey whereas before, I felt like I had a really short leash and they were basically managing everything for me as if they knew what was right for me and my body. Meagan: I was just looking. I'm just looking because I'm sure people are like where is this person? Where is this provider? Was it at the CMC? Is that where it was? Heidi: Yes. Yeah, Catholic Medical Center in Manchester. Meagan: Awesome. This is good. These are good vibes here with this provider. Heidi: Totally, yeah. Oh my gosh, yeah. 38:04 Discussions around inductionHeidi: So let's see. Once I'm diagnosed with gestational diabetes, I have maternal-fetal medicine ultrasounds, but that also was true because my first daughter was born missing a kidney. Again, she's totally healthy and totally great, but they wanted to make sure that nothing weird was going on, yeah. That was at about 32 weeks. They were also checking the baby's growth and baby's size at that point. Baby was measuring very average. She had two kidneys. Little things that we take for granted, we were so grateful for. Yeah. That went really well. The pregnancy was just progressing really well. In my third trimester, I was struggling with all of the extra appointments and the trauma that I was processing though from my last birth because I knew and my gut told me, “You need to work through this because if you don't, you have to be really strong to have a VBAC. You have to really work through a lot of mental blocks and things that come your way.” So I just started getting really stressed between work and the appointments will all the different therapies so I decided to take a couple of months away from work prior to the delivery in order to process everything and prepare myself. That was a really hard decision but it was probably one of the best decisions that I could make. Meagan: Good for you. Heidi: Yeah. At around 36 weeks, it was suggested to me by my provider that I could consider a 39-week induction, but it was delivered so differently. Meagan: Good. Heidi: Reasoning basically says that ACOG has a suggestion for insulin-controlled gestational diabetes. They basically told me the data. They told me why they are suggesting this, but ultimately it is my choice. It was a discussion that I just found to be so incredible and weird in a really good way. Meagan: Which in my opinion is so sad that these things happen that are good conversations have to feel weird to us because that should just be normal, but it's not a lot of the time, right? Heidi: Yeah. I was working with my doula at the time and she was a really big proponent of expectant management and letting everything happen naturally and honestly, that's all I ever wanted. I think that's what most people want. So I just explained, “I am not interested in induction. I want to do expectant management as long as everything progresses the way that it's going and it goes well. That's what I want to do.” They said, “Okay. We can do that.” Meagan: I love that. That's great. Heidi: It was amazing. It was really empowering. 41:45 NSTs twice a weekHeidi: So let's see. They suggested that I have a 36-week ultrasound to check my baby's size again. Actually, no sorry. They suggested it. I was actually able to negotiate my way out of it. I said, “You know, I just had one at 32 weeks. Is it really necessary to have another in 4 weeks?” I talked to the OB and she was like, “You know what? No. You don't have to do that.” Yeah. Meagan: Things are just getting better and better. Heidi: Oh, so good. Yeah. So right around then, the NSTs began. I'll just say also, I walk into– so NSTs were really awkward during my first pregnancy. I sat on the hospital bed so uncomfortable and sitting up with all of these things attached to me. At this provider, I go in. There is an NST room and it's painted blue and it's really common. There is a reclining chair and for me, it just really felt like they were normalizing the fact that NSTs do happen and it's okay and it's normal. Here's a special space for it. Meagan: Well, and almost like they are setting you up for success in those NSTs because in NSTs, when we are really uncomfortable and tense, overall, that's not going to be good for us or our babies. That's going to potentially give us readings that we don't want but when we are comfortable and we are feeling welcomed and we are like, “Yeah, we're not happy that we are here taking this test,” or sometimes we are, but when we are comfortable and we are feeling the beautiful colors and the nice, soft recliner, it's a very different situation to set you up for very different results. Heidi: Yes. Absolutely. Yeah, so then my journey just kept going. My NSTs were beautiful every week. It was really interesting how they set them up because they had the NSTs after the doctor's appointments because they weren't expecting. If they can get a good reading, I think the minimum is 20 minutes whereas I had the NSTs before so it was like they were looking for a problem then I had the doctor's appointment so I ended up being there for 2 hours during my first pregnancy. But these ones, I never sat more than 20 minutes.The nurses usually saw what they needed within 5 minutes and they said, “Your baby is doing great. You're out of here as soon as the time is up.” Meagan: That is amazing. Oh my gosh, 2 hours. That is a long time. Heidi: Yes. Yes. This pregnancy was really odd, but I'll take it. I stopped needing insulin during the last two weeks. Usually, there is a peak near the end of pregnancy, and then the need for insulin goes down in the last two weeks I want to say. For me, it actually just kept going down, down, down, and then all of a sudden, it was gone. That didn't happen last time. They were a little nervous about that because it didn't really happen. I explained to them, “I think it's honestly probably lack of stress,” because I wasn't working at my job at the time and I was moving a lot more too, so who knows? Meagan: Really interesting. Heidi: It did make them a little nervous because they said there is very limited data, but sometimes it can indicate an issue with the baby. Meagan: Oh, the placenta. Heidi: Sorry, I'm nervous so I'm forgetting. Meagan: There are times when it can be the placenta being affected. Is that what they were saying?Heidi: Yes, thank you. They said, “We could offer an induction at this point,” because I was at 39 weeks when they brought that up. I said, “I don't think so. I really want to stay the course. I want to do expectant management.” They said, “Okay, would you be open to twice-weekly NSTs?” I said, “Yes. If that lets me keep doing what I'm doing, we can do that and it's probably not a bad idea, because you never know.” 47:10 Testing for preeclampsiaHeidi: I woke up one morning at week 40 and thought my water was trickling out. I texted my doula and she was getting home from another birth and was going to rest, so I worked with my backup doula for that day which was a little scary. I didn't know what was going to happen from there. Around 6:00 PM that night, my husband and I arranged for my mom to watch our daughter because we needed to get to the hospital to get the amniotic fluid checked. We probably should have gone a little earlier, but the backup doula had suggested it might not be amniotic fluid. It might just be discharge. Meagan: Is there much going on labor-wise? Heidi: Not really. It was pretty quiet. Then I actually had an NST the day before that and there really wasn't much going on. I felt little Braxton Hicks-type things, but nothing much. We packed our bags, got ready, and got my mom. We arrived in triage. I had slightly elevated blood pressure which was just a routine check, but that basically led to them testing me for preeclampsia and then a urine test. Meagan: Hmm, a slight increase? Oh, man. Heidi: Yeah. It was slightly increased. You know, like a lot of people, hospitals make me nervous. Meagan: Yep. Yeah. They jumped right in and started going the moment you got there. Heidi: Yes. Yeah. It's different. It's still in the hospital, but it's separate. Labor and delivery is separate. They just had a very different mindset at the moment. I was sure that I didn't have preeclampsia. They asked me all of the questions and I'm like, “I really don't think that's what this is.” They were saying, “You're also post-date with gestational diabetes.” Meagan: Post-date by one? Heidi: Yes. Meagan: Or by 40 weeks. Heidi: Yeah. Yeah, so I would need an induction if I get preeclampsia and all of this. Who let this girl go this long? What the heck kind of thing? Meagan: Not helping your blood pressure, that's for sure. Heidi: I definitely started feeling PTSD. I was just like, “This again? Oh no. I feel like I'm in prison.” That's the way it felt last time. I knew I needed to get out of there fast. It wasn't good. The OB came in and lectured me. This was a different OB. She lectured me about preeclampsia and how I should really stay in the hospital. They were going to send for bloodwork even if it came back okay, I should stay the night. They drew the blood and I'm just beside myself at this point. I was like, “Well, when are they going to get the results back?” They said, “Probably about an hour or so.” You know how backed up the lab is. They were like, “Are you really going to drive home and come back?” I was like, “If I have to come back, which I really don't think I will, then yes, I will.” The blood was taken. The nurse ran back within– I want to say it was 10 minutes. It was really fast. She said, “You guys should really consider staying. Your platelets are low.” I said, “Okay.” Meagan: The labs came back that fast? Heidi: They came back really fast. Meagan: Because you were saying that you were maybe going to go back home? That's interesting. Heidi: Yeah. I said, “Okay. That's thrombocytopenia.” My provider had said I had that. We talked about it and I also had it during my last pregnancy. Meagan: Wait, what did you just call that? Heidi: Thrombocytopenia. Meagan: Thrombocytopenia. I've heard low platelets. I've never heard it called that. Heidi: Thrombocytopenia. I actually listened to a podcast oddly enough with Nr. Nathan Fox. Meagan: We love him. Heidi: Yeah, he's awesome. He was basically saying that it's common and it's generally not a big deal. Meagan: I just Googled it. Yeah, it says it's a condition where the platelets are low. It can result in bleeding problems. Yeah. Okay, all right. Keep going. Heidi: Yeah. It was interesting because he had said, “Within range,” and I was within that range, but I also talked to my provider about it months before and she said, “Oh yeah. This is common. We are not concerned with your levels.” Luckily, I was like, “Oh my gosh. I know enough.” I was like, “Nope. I know what that is. We are okay and we are going home. They can call us with the results.” So we went home. Meagan: That is amazing. Did they make you sign an AMA or anything like that? Were they just like, “Fine. We were going to have you stay, but you are good to go.” Heidi: Yeah. There was no paperwork. Meagan: Okay. Good. Heidi: I was free. Yeah. I was actually amazed at how– I mean, I was very firm with them. I was just like, “We are going home now.”Meagan: That is hard. That is really, really hard to do, like really, really hard so good for you for following your gut. Heidi: Yeah. It felt really good. Yeah. We got home. I started to feel some mild, irregular contractions and the same thing I had been feeling. We sent my mom home because she was still at my house. Like, “Go ahead. We've probably got another day.” I was like, “I know something is going to be happening soon. I feel it.” So around 10:30 that night, I got the call from the OB– Meagan: Yours? Heidi: Sorry, the one in the hospital that was treating me. She had said, “All right. You don't have preeclampsia. You don't have to come back.” I said, “Okay. We did it.” Meagan: Yep. Yep. Yep. Can you imagine having to be there that whole time? Heidi: No. Yeah. I'm sure they would have found something else. Who knows? Meagan: You never know. 54:53 Spontaneous laborHeidi: Yeah, so when we were home, we unpacked our bags, ate some food and sent my mom home. I bounced on my birth ball. I was pumped. I was so excited. We were like, “Okay. Back on the normal track.” Then around midnight, some contractions started that I figured would stop once I laid down for bed. I didn't really know. I never really had normal, non-Pitocin-induced contractions before, so I didn't really know what they would feel like. I was in denial, to be honest. I was like, “There's no way. I'm not going into labor right now. What are these? These are nothing. It's just cause I'm nervous or something.” I laid down. My husband was already asleep at this point and they didn't stop. They just kept getting stronger. I was lying there thinking, “No. I can't go into labor right now. I don't want to see that OB. I can't. I can't. This is not happening.” I was just willing my body, wishing and willing my body to wait until 6:00 AM or 7:00 AM until the shift change. So then I was like, “Okay. I should probably start timing these because this is no joke.” I found a timer and started timing them. They were spaced at 5 minutes apart lasting a minute each. I was like, “This is early labor. This is it.” I finally woke my husband up and I was like, “Hey. I think we're going.” Meagan: This is going to happen. Heidi: Yeah. I called my doula. I had been texting her meanwhile the whole time and she was super supportive throughout, then I finally was like, “I need to call her.” She talked me through what I was experiencing because I had no idea. She was like, “You guys should probably leave soon because this is your second baby and it could happen really fast.” I noticed there was pink discharge. Meagan: And you had made it to 10 before. Heidi: Yes, exactly. She was like, “This could happen really fast.” I noticed some discharge and it was pink. Contractions started to be really regular and really painful. She was like, “That's probably your cervix dilating.” I was like, “Why am I dragging my feet? We need to go. We need to go now.” 57:43 Going to the hospitalHeidi: We called my mom to have her come back to our house. I think it was 1:00 in the morning at this point. She didn't answer immediately probably because she was exhausted. Meagan: Probably asleep, yeah. Heidi: When she did, it was finally 2:00 AM and there was a bit of an ice storm outside, just a little one but just enough to make the roads slippery because she had texted me when she was going back home and she was like, “It's kind of icy. I just want to let you know.” So then I was like, “Oh no. My mom's on her way, but it's going to take her a while to get back to the house.” Then it's going to take us a while to get to the hospital. It was really getting pretty scary, but we were just like, “Okay. Let's just pack our bags again,” because we had started unpacking them. My provider had actually said that they were comfortable with me going until at least 41 weeks so I was like, “I could go until 41 weeks and then who knows?” Meagan: Right. Heidi: Anyway, so we put everything back. It was a really good distraction and then every single contraction, we would stop and brace ourselves. My mom got to our house at 3:15. We got to the hospital around 4:00 AM. It was the longest car ride of my life. My doula was like, “The contractions might slow down in the car.” I was secretly praying that they didn't because so many people that I knew had prodromal labor and I was like, “I want this to come like a freight train. I don't want it to stop.” It is so painful, then a lot of people say you get nervous when you get in the hospital. Things will slow down. I was just so nervous about all of that. I got to the hospital. My doula arrived soon after. We spent almost two hours in triage even though we were already there filling out paperwork. The contractions didn't stop or slow down during this. I was beside myself. I was like, “Oh my gosh. My body is ready. We are doing this.” The nurse in triage, at the time, was a different nurse. I think she worked a half shift or something, but she was really skeptical of VBAC. I was not comfortable with her. She said I couldn't eat. She had obviously outdated info. I asked her, “Why can't I eat?” She said, “Well, the odds of you needing another C-section are higher.” I'm like, “Well, how do you know that?” It was just really frustrating. I requested a midwife to deliver my midwife because the same OBs were on staff. I was going to a midwife for my care, a midwife, and an OB team. I actually ended up seeing the midwife even more than the OB so I really was comfortable with requesting a midwife to deliver, but the nurse really pushed back. She said, “You're a VBAC. I don't think you can have a midwife.” Yeah. She went into the hall, made a phone call with the midwife and the midwife on staff actually said no supposedly because I was a VBAC. Meagan: What? They had never said anything like this in your prenatals. Heidi: No. No. I think again, it's a little different. They also use other hospital staff at this hospital so you never know who you're going to get, but my doula is there and that's what matters. That's why I had a doula because you don't know. Meagan: You don't always know, yeah. 1:02:03 Laboring in the tubHeidi: They asked to do a cervical check. I was hesitant, but they said, “We have to do this to admit you.” I was like, “I'm not leaving at this point. I'm clearly in labor.” I consented to it and they found I was 4 centimeters dilated so I stayed. I got to my room around 6:30 and actually, I think I was about 80% effaced at this point. I got to my room around 6:30 and I just began setting it up to distract myself. My doula started setting up the bath for me. I was like, “I want to go to the bath.” I got to the tub around 7:00 AM to deal with the contractions because I really wanted a natural birth this time. My water broke 5 minutes after that. Shift changed at 7:00 AM. I feel like my body was like, “Okay, hey. Shift change at 7:00,” and then my water broke. Meagan: You said we were in triage for two hours and I was like, “Your body was waiting for shift change intuitively.” There you go. Heidi: I got in the tub. My water broke. A new nurse came in around 7:15. She had a trainee, but this was a nurse who had a lot of experience and she was just training to be in labor and delivery so it was basically like an extra set of experienced hands. She was also a nurse who had run a training for us a couple of months before and I was like, “I hope I get this nurse. I really, really hope I get this nurse.” In she walked, and I couldn't believe it. She came down to me at the tub. She started asking me questions right away about my birth plan. It's like she studied it. It was the most amazing thing. I can't exactly remember what she was asking, but just clarification and she was like, “Yes. We can do this. We can do this and we will do that.” I was like, “Wow.” The first time, I had a birth plan, but I'm pretty sure they burned it. Meagan: Aww. Heidi: Then she just started talking about how the birth process would go and how I would be feeling mentally more than likely and she also said that she is well-versed in Spinning Babies. Meagan: What you wanted! Heidi: Yeah. Yeah. I was like, “This is heaven.” I also took a short course in it to prep for this labor and I really was trying to do all of the things. I couldn't do all of the things, but I think there is a lot of science to Spinning Babies, especially having an OP baby the first time. Initially, I was experiencing back labor. She asked me, “Where do you feel your pain?” I said, “In my back.” She said, “Get on all fours. The baby could be OP.” I was just like, “Oh my gosh. I will do anything to not have another OP baby.” She said, “We're going to spin her.” I stayed on all fours. I just did this. I started using the nitrous. This hospital provided nitrous. Meagan: Nitrous oxide?Heidi: Yeah. The other hospital did not have that, but I was so excited for that. It helped me just breathe through my contractions, really get in tune with my body, and gave me a focus. I was able to move around really freely. When I was in the tub, I started to feel the urge to push so we moved out into the bed. I still stayed on all fours. But I was also just, I don't remember this, but my doula was saying that I really was kind of dancing. I was moving in the ways that my body told me to do. It felt so incredible and obviously painful. 1:06:22 Pushing for 30 minutesHeidi: Then it was about 9:15 and I was really, really wanting to push at this point. I was told to wait for a cervical check though and I was like, “Why do I need a cervical check? I'm ready.” Meagan: My body is saying I'm ready, yeah. Heidi: Yeah. A midwife came in. She introduced herself and she was like, “I'm going to be delivering your baby.” I was like, “Okay.” I couldn't believe it. It was a different midwife and she was like, “I want to check you because you could have a lip if you're not fully effaced. Your pushing will be ineffective.” She found that I was 10 centimeters dilated, fully effaced so then we went on and pushed. My daughter came out at 9:46 AM so we pushed for a half hour. Meagan: Oh my gosh! So you got baby in a good position and isn't there such a difference between pushing? Heidi: Yes. Not having the epidural, I could feel everything. It was so real. She was 7 pounds, 3 ounces. She did have a compound presentation. She was head down, but yeah. She came out with her hand pressed against her head. Meagan: Yes, come out thinking. Heidi: Yeah. I had really no tearing, very, very minimal. I achieved the delayed cord clamping. My husband got to cut the cord. We didn't have to remind them of our wishes. They just knew. We had a golden hour which I never had before, but I was told I could take as long as I wanted, and yeah. It was just the most beautiful thing I have ever experienced in my life and I just couldn't believe I did it. Meagan: Yeah, what a journey. I am so happy for you. Heidi: Thank you. Meagan: Congratulations. And now, at this time of recording, how old is your baby? Heidi: She is 8 weeks.Meagan: 8 weeks. Brand new! How has the postpartum been? Heidi: Oh my gosh. It's been amazing. I mean, as amazing as it can be. Let's be real, but compared to what it was. Meagan: Good. I'm so happy for you. You know, when you finished your first, you were like, “My husband and I didn't even know if we would ever want another kid.” I can just see this joy on your face right now. Where are you at in that stage now? Are you two and done or are you like, “I could do this again”? Heidi: We are two and done. Meagan: Hey. Heidi: Yeah, I mean it's funny because the nurse and my OB were like, “You really should have another one.” Meagan: This is what I did. I went out with a bang. You went out with a bang. Heidi: You can't top this. Meagan: You got the birth you wanted and all the things. You know, you advocated for yourself in the birth room. You left and then still advocated for yourself in the birth room. I mean, how amazing. How amazing. Heidi: Yeah. I ended up with the most supportive team. You do never know what you're going to get, but the team that came in at 7:00 AM, oh my goodness. They treated me like I was just a normal, vaginal birth. There was no VBAC. There was no jargon. It was beautiful. Meagan: I love hearing that. That is truly how it is supposed to be and it's so often not. Then yeah, then we learned more about the correct diagnosis or term of low platelets. I totally Googled it really quickly and it just said that gestational thrombocytopenia, how do you say it? Heidi: Thrombocytopenia. Meagan: Thrombocytopenia is a diagnosis of exclusion. The condition is asymptomatic. It usually occurs in the second half of pregnancy in the absence of a history of thrombocytopenia. Heidi: You got it. Meagan: It said, “The pregnancy and the platelet counts spontaneously return to normal within the first two months of postpartum.” We will make sure to have a little bit more reading. It will go back into some things, but one of the things it does say is that it is not necessarily an indication for a Cesarean delivery which is also important to know because I mean, there can be low platelet levels that are more intense like HELLP syndrome and things like that, but this is a really good things to know because that would have easily been something if it hadn't been for Dr. Nathan Fox and if it hadn't been for them talking to you about this. It could have scared you like, “Oh, okay. Okay. Let's stay.” But you were fully educated in the situation and were able to make a good choice for you and advocate for yourself and say, “I feel good about this. You can call me when the preeclampsia levels come back, but I feel good about this decision. We're moving on.” Then the amazing, miraculous, no insulin need, that's another really cool thing about your story, but I also wanted to share Lily Nichols. I don't know if you've ever heard of her. Heidi: Yes. For my first pregnancy, I read both of her books. She's amazing. Meagan: She's amazing. We'll be sure to link her books and stuff in the show notes as well so you can make sure to check it out. If you were given a diagnosis of gestational diabetes or even actually just in general, her books are amazing. You can read and be really, really well educated. Okay, well thank you so much for sharing your beautiful stories. Heidi: Yeah. Thank you for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Dr. David John is a distinguished Trinidadian healthcare professional based in Brooklyn, NY. He is currently serving as Director of Occupational Health and HIV Services at Gotham Health. He has been recognized for his outstanding achievements in Adult Preventive Medicine, contributing to defining the overall business strategy and direction of the organization's eight main centers of operations. Dr. David John is a member of the American Academy of Family Physicians and has demonstrated leadership and inspiration to his medical colleagues throughout his career. His passion for providing the best medical care possible has led him to assist in the implementation of population health programs, including mental health and substance abuse screenings. After arriving in New York in 1980, Dr. John completed his residency at Catholic Medical Center and has been rated an average of 5.0 stars by his patients. He obtained his Bachelor of Science from the City University of New York and earned his Medical Degree from Weill Medical College of Cornell University. He then completed an Internal Medicine Internship in Northshore University Long Island and a Family Medicine Residency in Brooklyn. Dr. John is board-certified in Family Medicine by the American Board of Family Physicians and is also a certified physician in his home country with the Medical Board of Trinidad and Tobago. After working in New York for a few years, Dr. John decided to return to Trinidad in 1994 to contribute to his homeland. During his earlier years in Trinidad, his involvement as a faculty member in the Lutheran US-Caribbean HIV/AIDS Twinning Initiative, contributed to the success of this program. Dr. John volunteered as a medical professional at the Cyril Ross Nursery, a home and treatment center for HIV-infected babies who were neglected and abandoned by their parents. His focus at the Nursery was pain control and other comfort care, and he worked alongside fellow Trinidadian and Ms. Universe of 1998, Wendy Fitzwilliam, to bring anti-retroviral treatment to the children. Dr. John's dedication to providing care to HIV-infected children led him to become a board member of the Caribbean Women's Health Association, in 2009, working tirelessly to advocate, address: comprehensive education, healthcare disparities, improve healthcare access and promote better resources for women's health, in the Caribbean region, while continuing to assist patients with HIV screening, housing, and other social services. Dr. John's commitment and advocacy to improving healthcare outcomes for underserved communities, particularly immigrants from impoverished backgrounds, such as the Dominican Republic and West Africa, has earned him recognition, praise and honor, with a special proclamation from the Mayor of New York City for his contributions to healthcare, for his dedication, leadership and impact in the medical arena, in Brooklyn AND for his dedication to addressing critical health issues, providing the highest level of medical care, and promoting the health and wellness of the community he serves, was recognized by Continental Who's Who! --- Support this podcast: https://podcasters.spotify.com/pod/show/ozzie-show/support

In this episode of The ASHHRA Podcast, host Luke Carignan sits down with Theresa Mazzaro, Director of Talent Acquisition at Catholic Medical Center, to discuss her experience as a nurse and her journey into healthcare recruitment. Teresa shares how she found a community and support system in the National Association for Health Care Recruitment (NAHCR) when she transitioned from nursing to HR.Luke and Teresa also touch on the unique challenges faced by veterans transitioning into civilian life and the importance of maintaining a sense of community for them. They delve into the similarities between the military and healthcare recruitment in terms of teamwork and the focus on the collective rather than individual achievements.Additionally, Teresa shares valuable recruitment strategies and emphasizes the importance of believing in the product you are selling, which in this case, is the talented individuals that make up healthcare organizations.One of the highlights of the episode is Teresa's innovative approach to making job offers by sending personalized video notifications. She explains how this method not only adds a personal touch but also sets the stage for a memorable experience and enthusiasm for the candidates joining the organization.If you want to gain insights into effective recruitment strategies, the power of community, and how to create memorable experiences for candidates, then this episode is a must-listen.We hope you enjoy this episode and find it as informative and inspiring as we did. Don't forget to subscribe to The ASHHRA Podcast for future episodes featuring industry experts and thought leaders.Support the Show.

The conservative media organization PragerU won state approval last month to offer online classes to high school students in New Hampshire. Education Commissioner Frank Edelblut has publicly supported PragerU, but he's also been active behind the scenes. Catholic Medical Center in Manchester recently announced that they could become part of Tennessee-based hospital giant HCA Healthcare. What could this deal mean for patients. We talk about these stories and more with NHPR's Sarah Gibson and Paul Cuno-Booth.

In the search for the special antibiotics to treat Margaret's MRSA, Martin has to travel to Manchester on short notice. Connie told him to talk with a Dr. Rowlett at the Elliot hospital. Dr. Rowlett is kurt and dismissive. The only place with those antibiotics is the Catholic Medical Center on the west side -- which is tightly controlled by the Kings gang. When Martin snarks about taking a boat across at night to avoid the gang sentries, Dr. Rowlett suddenly becomes helpful. They then hatch their plans for sneaking across the river that night.   Mic is asking his listeners how they feel about the ads that play during the episodes. He has a survey here.  Here are the links to Mic's Buy Me A Coffee page and his Patreon page.

In this episode, Norman Acker, Nora Becerra, and Katherine Rippey discuss the False Claims Act as it relates to Stark Law and the Anti-Kickback Statute. They analyze the Wheeling Hospital case and the Catholic Medical Center case and discuss key takeaways from the cases as they relate to the False Claims Act.  

In this second episode highlighting the SVS women's section, Wen (@WenKawaji) and Amanda (@AmandaFobare) are joined by Dr. Furey, Dr. Bunnell and Dr. Kumar to discuss important topics such as the needs of a young vascular surgeon and how to pick your optimal practice.  Show Guests: Dr. Bunnell @avi-bunnell: Private practice vascular Surgeon in Tampa Florida specializing in venous disease, PAD, and carotid revascularization Dr. Furey @drpfureymd: Chief of vascular surgery and president of medical staff at Catholic Medical Center in Manchester, NH. Associate director of surgical services for New England Heart and Vascular  Dr. Kumar @ShivaniKumarMD : Graduates of Mount Sinai Medical Center in 2021, currently a vascular surgeon at Tufts medical center. Show Resource: We have shared a list of questions recent graduates have generated for the job search process. Check it out! For those of you who are not familiar with the women's section, we have a great episode that was recently published in September (see link below). To learn more about the Women's Section, please visit the SVS Women's Section website below. https://www.audiblebleeding.com/svs-womens-section/ https://vascular.org/vascular-specialists/networking/svs-womens-section What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org. Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

The Boston Globe's Spotlight Team released an exposé unveiling how one decorated heart surgeon at Catholic Medical Center in Manchester, NH was able to work for decades despite 21 medical malpractice claims. Spotlight reporter Rebecca Ostriker joined Dan to share the Globe's story.

In this episode of Fireside Chat, we sit down with Dr. Joanne Conroy, President and CEO, Dartmouth-Hitchcock Health System to talk about the COVID-19 pandemic and how the crisis has changed several aspects of healthcare for the future. Please note: The number of COVID-19 cases and the situation referenced in this episode were based on reported data at the time of the interview and are subject to change. Transcription Joanne Conroy 0:04 If we continue to have a significant portion of our workforce working from home, then I have an opportunity to repurpose some of our space for activities that actually are growing and need more space. We were thinking about building an extra administrative building. And now that’s totally off the table. I wouldn’t even consider that. Gary Bisbee 0:27 That was Dr. Joanne Conroy, President, and CEO Dartmouth-Hitchcock health system, noting that lessons learned from treating COVID patients has led to the development of an approach that allows COVID and non-COVID patients to be treated at the same time. I’m Gary Bisbee. And this is Fireside Chat. Dr. Conroy has seen telemedicine visits grow from three visits a week pre-COVID to 2,000 visits a day post-COVID. Concern overexposure to Coronavirus drove the increase but Dartmouth Hitchcock found that many users embraced it and will continue to use it going forward. The caregivers quickly became facile with it, and Dr. Conway believes that they will become increasingly innovative in how to best work with patients. Joanne Conroy 0:44 COVID patients when they are admitted, actually Gary are quite sick. If you look at the CMI of most of their admissions are pretty high, and they’re very resource-intensive to care for them. But you don’t have to shut down the entire institution in order to provide that care. You just have to make sure it’s appropriately cohorted. Gary Bisbee 1:02 Dr. Conroy has concluded that Dartmouth-Hitchcock’s approach to the future will be substantially different. The new normal will include reconsideration of facilities incorporation of remote working and Dartmouth-Hitchcock’s human resources, strategy, and restructuring ambulatory care waiting rooms and patient flow. I’m delighted to welcome Dr. Joanne Conroy to the microphone. Well good morning, Joanne, and welcome. Joanne Conroy 2:02 Thanks, Gary. Glad to be here. Gary Bisbee 2:03 We’re pleased to have you at this microphone. We’ve learned that the surge is highly variable by region. What’s the status of the surgeon Dartmouth-Hitchcock’s primary service areas? Joanne Conroy 2:13 Well, it really depends on what model you look at. I would say that the Washington model had indicated that our surge occurred early in April. Our epidemiologists, however, are looking at the data, and they are actually predicting that we may have a more meaningful increase in volume in September. But nothing that would exceed the ability of our health system to manage those patients from an ICU. That perspective or ventilator perspective. Gary Bisbee 2:45 Well, as a chronic disease epidemiologist, I’m delighted to see that we’re all now including epidemiologists in our planning going forward. But the fall surge has been under discussion for some time and it sounds like your epidemiologists are thinking that that might be the case. Joanne Conroy 3:02 We had one of the first cases in New England up here. We had an employee that had traveled to Italy and came back at the end of February and was probably the first patient tested for COVID-19 in the state of New Hampshire. And that activated the entire state, we were on the front page of every single newspaper. And I also believe the globe and the New York Times covered it as well because the employee chose not to strictly adhere to quarantine and they went to a party. And that activated the entire community to be aware of the implications of COVID-19. And I would say that we had a diminished surge because people were social distancing, and staying at home from the first weekend in March, which was in advance of any order from the governor or in a blanket expectation across the state. But you could see that across the state. We canceled a very large fundraiser on the 14th of March. And we did that a week in advance. People weren’t happy with us. But when we look back, we can see that probably had a big impact on communities spread a virus. Gary Bisbee 4:13 Yeah, for sure. You definitely were early. What’s been the morale of the population? If I could ask it that way. Are people sticking with social distancing and staying at home and so on? Joanne Conroy 4:25 I would say shifting initially in early March, people were actually a little frightened and angry at the employee that had not adhered to quarantine. Then they moved into appreciating the impact of the virus and were very supportive of healthcare personnel in the hospital and you could just see the surge of support moved through the community. I would say now people are having a little bit of quarantine fatigue. And now that the days are warmer people are out. But most people up here are wearing masks, voluntarily any time they’re outside their homes, and are trying to adhere to social distancing. We have a pretty obedient population in the upper valley. Gary Bisbee 5:16 Well, I live in the New York area and there, you would not describe this group as obedient at all, but why don’t we go on to Dartmouth-Hitchcock Health System for those of us that may not be familiar or up to date. Joanne, could you please describe Dartmouth-Hitchcock health system for us? Joanne Conroy 5:35 Dartmouth Hitchcock is a health system that is about 2.8 billion a year consists of the academic medical center here in Lebanon, as well as a PPS Hospital in Keene, New Hampshire. We also have three critical access hospitals, and we have a nurse and hospice association that serves the upper valley of New Hampshire and Vermont. We also have 24 ambulatory practice sites and actually three very large multi-specialty group practices in Concord, Manchester, and Nashua. They serve anywhere between 20% to 35% of the people in those communities. So a robust ambulatory enterprise. Those ambulatory facilities actually are responsible for a lot of the inpatient volume at hospitals that we are not affiliated with in Manchester and Nashua and Concord. Gary Bisbee 6:41 So before COVID here, what were your top priorities? Joanne Conroy 6:45 Our top priority before COVID was consummating a combination agreement with Grant at One which is a Catholic Medical Center. And we have continued to work on consummating the combination agreement. But how we look at it and how we look at assets and how we look at our future has changed dramatically. And I don’t think things are going to go back to the way they were pre COVID. So we are moving through an evaluation of kind of what’s possible from a capital perspective as, as well as thinking about how the markets going to change in the future. Gary Bisbee 7:27 Are you thinking differently about scale? Now, you must be but is size more important? Do you think about going forward? Joanne Conroy 7:33 I think the size is much more important. In fact, our system members would say that they have seen the benefits of being part of a system through COVID-19. And I’ve actually received letters from a number of physicians that work at the other smaller facilities that they felt much better prepared, much more coordinated, and how we approached managing this surge. Much better supported from PPE and information perspective than they think they would have been if they had remained a standalone facility. So I actually think people will see the benefits of being a system. The things I think are going to change, though, will be certainly the ambulatory enterprise. Because there are things that we learned about telehealth, our ability to provide it, and the community’s willingness to embrace it through COVID-19. Gary Bisbee 8:32 Most of the health systems have seen a dramatic increase in tele-visits. That sounds like you have as well? Joanne Conroy 8:38 We went from about three telehealth visits a week to over 2000 a day in less than 10 days. So it was a dramatic increase. And it’s the fascinating part of that is that we really wanted to continue to care for our patients, but the insurance also paid for us and that removed one of the major obstacles to really expanding telehealth is that many payers didn’t acknowledge it. And it’s both commercial and government payers. I don’t think you could put that genie back in the bottle now. Gary Bisbee 9:13 Any lessons learned as you’ve gone to 2,000 visits a day that will allow you to adjust how you’re approaching tele-visits. Joanne Conroy 9:21 We have done a combination of video, when available, and telephone visits when a video is not available. So a couple lessons learned are in rural health care. A lot of the broadband access is inadequate to do really robust telehealth and I have to say that the governor of Vermont is investing a lot of money in increasing broadband capabilities across the state which will be really great for telehealth number one. Number two, I would say that patients do like it. It is convenient especially if they are afraid to leave their home are concerned about community transmission of the virus however it most of the older patients do say I am looking forward to seeing you to all of their primary care providers. So I don’t think our patients will go totally telehealth, but they will probably incorporate it as part of their relationship with us in the future. Gary Bisbee 10:23 Seems likely that as the physicians become more familiar with it, they might figure out ways to make the patients more comfortable with it. Do you see that happening? Joanne Conroy 10:33 Some of our providers are better than others in navigating through a telehealth visit. There are a couple things that we’ve started to look at. Number one, let’s understand really the infrastructure needs of telehealth. We have an MA, who actually calls the patients a day before starts to populate the record. Make sure that the technical capability of the patient allows for the video ad or telephone visit. So they actually do some work ahead of time so the provider can move through their list of visits, without a lot of technical things getting in the way of taking care of patients. So we need to really figure out what the cost is the infrastructure costs of telehealth, which will be less than face to face. But it is not just the cost of a provider on a computer. There is other costs that we’ve got to quantify and then figure out how we can actually create that type of infrastructure for everybody that is doing a data telehealth visit. Gary Bisbee 11:36 Well, that makes good sense. But as you say, it seems unlikely that at least around the country will put the genie back in the bottle on these tele-visits. So what’s been your policy for working remotely, how many of your staff are working remotely? Joanne Conroy 11:52 When we did an analysis of how many people were actually logging in remotely the vast majority before COVID-19, were providers or people working after hours after they got home. So logging in through VPN, or through our remote access. Within a week, however, when we decided to move all non-essential people off-campus, we went from basically a handful of people that were remote working to over 4,000. And I actually think that’s something else that’s gonna stay. I think there are some leaders institutions that are resistant to remote work, which I don’t agree with. I think remote work is something that allows you access to a national talent pool instead of just a local talent pool. Number one. I think that we have demonstrated that people are actually very productive when they work remotely, but we do have to train our leaders to actually lead remote workforces which is different then, sometimes leading a workforce that you’re face to face with a team, five days a week. I would say that a lot of our employees like it, and they feel that they save time on the commute. Some of our employees are commuting an hour and a half to get here. And they also are probably juggling some of their childcare and homeschooling issues now, as we have stay-at-home orders for all the schools, and they’re all online. And that actually helps those employees accommodate all those different demands on their daily working hours. It remains to be seen though, how many employees will say yes, I want to continue to work from home when their kids go back to school and the younger children maybe go to a local daycare. Now, I would say that it creates an opportunity for us to look at our space needs here. If we continue to have a significant portion of our workforce working from home, then I have an opportunity to repurpose some of our space for activities that actually are growing and need more space, we were thinking about building an extra administrative building. And now that’s totally off the table, I wouldn’t even consider that. The second thing is the parking. I have to say that there’s no problem with parking anymore here. And for most hospital CEOs, that is something they get an incredible number of complaints about, but when you don’t allow visitors in the institution, and your employees are remote working, all of a sudden, we have just scads of parking. And you know what, that’s a real investment. We were even thinking about building a parking garage and we’re not going to do that now. So I think there are a lot of advantages to leveraging a remote workforce. Gary Bisbee 14:53 We have a question later about the new normal, but you’ve just covered two points. One would be the tele-visits and the other is working remotely and what that means to the administrative expenses. Well, if we could go back to COVID communication with your community and with your caregivers is all-important. How have you thought about communicating with the community, Joanne? Joanne Conroy 15:17 Our communications team isn’t really a fabulous job. They have communications that come out from me every single day. And we have a flash report that identifies where we are in the surge and also key points for leaders to share with their teams. They also very early on created town halls and webinars for the community. So we could put our epidemiologists on camera, put our Chief Clinical Officer on camera and talk about what we were learning about the virus, what was available in terms of testing, whether or not people had questions. We do have a studio here in the hospital. And that’s been invaluable for really creating these 15-20 minute webinars that go out broadly on the community. We use Facebook, but I would say that the uptake in the community has really been tremendous. And people were actually waiting to see the webinars to get an update on our best understanding of what the community could expect. They had a lot of questions about testing, about symptoms, about quarantining, and we were able to address all of those. So I would say communication was critical for actually managing the concerns of the community number one, and it’s even going to be more critical as we try to get people to start to think about coming back to the facility for the appropriate care of their chronic diseases and or necessary procedures. Gary Bisbee 16:59 What about the community with your caregivers? Joanne Conroy 17:01 So we send out an email every single day to all of the caregivers. I would say, I receive lots of feedback that people feel very well informed about everything that’s going on. In terms of the adequacy of PPE, the understanding of the virus, the status of people in the hospital. Can we share with them the number of people that are in quarantine, answer questions about any employees that have turned positive. We’ve been very fortunate; we have had no employee turn positive. While there were using appropriate PPE with a COVID 19 patient. So our employees actually moved from being super anxious about dealing with this patient population to feel supported and protected. Gary Bisbee 17:49 How’s the morale been among the caregivers? Joanne Conroy 17:52 Pretty good. I toured in the COVID-19 ICU about 10 days ago. And there is a sense of confidence and definite competence, there is no panic. You know, they’re taking care of incredibly sick patients that have to be proned for 6 to 12 hours a day. And it’s just kind of part of their work and how they care for these patients. And at the same time, they’re training other providers throughout the institution. So if we have a surge and have to expand our COVID ICUs, that we have enough people that have that level of experience with COVID-19 patients so they know how to care for them with confidence. Gary Bisbee 18:37 What about testing? Have you had enough supplies to conduct the right level of tests? Joanne Conroy 18:44 Our lab has been fabulous. When we first started on this journey. there weren’t tests or reagents, etc. They very quickly got some virus to actually use as their quality control and then developed their own internal tests. You know, we have two of the Abbott machines here. So we can do 1000 tests a day. And they struggled a little bit with reagents and viral media, as everybody did across the country. They created their own viral media and validated it and used that. Then they also just figured out how to do dry nasal pharyngeal swab testing where you don’t need media and validated that. And now they’re working on a 90-minute bass test. So they’ve really been ahead of the curve. In fact, we did most of the tests for the state, because they were overwhelmed after about two to three weeks. And there was an incredible backlog it was like eight days to get a test back. So we work the backlog for the state so they could actually get to some level of testing that they could actually manage. We continue to be challenged in getting reagents and I think just like everybody else, that’s one of the limiting factors. We did actually contract with a supplier that did not make nasal pharyngeal swabs but created some nasal pharyngeal swabs that again that we validated so we have plenty of nasal pharyngeal swabs to actually test any patients that require it. You know, we’re testing symptomatic patients. We’re testing people in nursing homes, we’ll test first responders and healthcare workers that feel like they have been exposed. We are talking about testing patients that come in for elective procedures or semi-urgent procedures, and people that are coming in for bronchoscopies, endoscopies, and cardiac procedures. We’re also talking about testing patients that are admitted to the hospital, but we all know that the specificity of that test decreases if people don’t have any symptoms, so remains to be seen. It just has not been validated in people that don’t have any symptoms. Well thinking about the possibility of a September increase in a surge, what’s happening to try to find the right reagents and solve this testing capacity issue? Well, we expect to have a validated accurate serology test number one, so you can actually see if somebody has anybody, which will be helpful, I would say our supply chain and this is a benefit of being a health system has just been phenomenal in sourcing both reagents and PPE, you know, the search for PPE, you feel almost like a drug dealer sometime. You know, you’re wiring money to China, not sure you’re going to get the supplies but we’ve worked with the University of Vermont and as a large purchaser has been able to secure large shipments of level two masks for our institutions. And the same people that are sourcing PPE are working really hard to source reagents, I would say that the manufacturers are starting to ramp up. And that probably will be an issue that solved by September. I would expect people who will have appropriate PPE will have appropriate reagents will have accurate tests will be able to do the test more quickly. And we should have a reliable antibody blood tests by then; those are all good things. I think we’ll be in a much better position in September. Gary Bisbee 22:33 Have you begun to treat elective non-emergency surgeries at this point? Joanne Conroy 22:38 We’re starting with time-sensitive surgeries and we started on Monday with that. And we feel that after a couple weeks of work in that backlog of people that actually were asked to delay their procedures, then we’ll move into more elective procedures that I call that more preference-sensitive. That means the patient could have it now, or they could have it three months from now. And patients do want to have their procedures. There are a subset of patients that are nervous about leaving their homes. And those patients may elect to wait two or three more months, but they’ll eventually want to have their procedure. So we’re trying to figure out how do we accommodate time-sensitive first and then roll into elective? Gary Bisbee 23:25 That’s a good transition into Dartmouth Hitchcock’s economics, which of course, has not been a pretty picture of any place in the country for our health systems. How does the economics in 2020 look for Dartmouth Hitchcock? Joanne Conroy 23:40 So like every health system, we tried to figure out how much we could lose. But yeah, with the backstop it and we had positioned ourselves well. We actually had finance two of our major construction projects before January of 2020 and we actually secured line of credit with our banks that give us more cash should we need that. And we started out in a pretty strong cash position. But having said that the revenue losses are breathtaking. We know how to shut down a facility and we were able to decrease all of our semi elective procedures very quickly. And I think over a week, we probably shut down almost 80% of our operations to prepare for the surge. It doesn’t take a lot of math expertise to figure out what that does to revenue. We think we’re going to be 10% off at the end of the year and our year does end June 30. And right now we’re thinking about how do we create a budget for ’21. We have gone back and forth whether or not we are going to really try to do a budget or are we just going to do a roll forward budget from ’20. And just constantly adjust it. We’re debating that right now. Gary Bisbee 25:08 Well, if there’s another surge or at least partial surge in September, then it sounds like the first quarter to 2021 will be under attack as well. Joanne Conroy 25:18 It could be. Not necessarily though I think that we know how to manage COVID and non-COVID patients together. What it will do will probably displace some non-COVID cases, but we’re not going to shut down the institution as we did before. We will just create COVID and non-COVID units and train people appropriately and use the appropriate mechanisms to actually route patients. So they’ve asked us to do to have kind of separate patient flow areas for COVID versus non-COVID patients. COVID patients when they are admitted, actually Gary are quite sick. If you look at the CMI most of their admissions are pretty high. And they’re very resource-intensive to care for them. But you don’t have to shut down the entire institution in order to provide that care. You just have to make sure it’s appropriately cohorted. Gary Bisbee 26:19 Well, that’s good news, and that’s clearly learning from what we’ve gone through, which is also good news. Could we transition to governance for a moment? How did you communicate with your board of directors? Joanne Conroy 26:31 We have been communicating a very lengthy update about every 10 days that addresses COVID-19. The search the best things we know about the transmission, the impact on the community, as well as the financial challenges that it creates for the organization and we’ve been very transparent with our board. Our March board meeting was virtual. And I would say our board members were unified and encouraging us to focus on taking care of what was most important, which was preparing for the surge and taking care of patients and taking care of the community at that time. Our June board meeting will probably be a hybrid of both people that are present and people that choose not to travel because many of our board members travel from up and down the eastern seaboard. But it will be probably a little bit more streamlined because we have kept them so well informed during this period of time. Gary Bisbee 27:30 I’m asking everybody this question any tips for a smooth virtual board meeting? Joanne Conroy 27:35 You need to spend a lot of time training your trustees that don’t spend a lot of time online. How to position their technology. I would say even with our staff, I encourage people to put their laptop on three or four books, so their camera points at them rather than up their nose, number one. Number two, we encourage people to use a headset, if their connections are questionable at all because audio sometimes is the most difficult aspect of this. We do use WebEx from a security perspective. But that requires an active manager to highlight people who are speaking on the screen. I would say that we are very careful to make sure that people actually do a run through. I can’t tell you how many minutes are spent sometimes dealing with echo audio because somebody has their computer audio on as well as their phone. So those are the things that it’s just it’s worth it to spend a half an hour 45 minutes with your board members ahead of time to make sure they’re good to go and it’s a better experience for them. Nothing is more frustrating than running into technical issues when you’re really trying to have an important conversation. On a completely different note, it’s becoming clear that public health is part of the national security. I think there’s a growing view of that. How do you think about that, Joanne? Public health has been the stepchild of Western medicine for a long time. And I think this is really emphasized to people the value of public health. I would say we’re going to see a couple things happen. Number one, I think medical students will really be interested in public health. And there are so many important aspects of medical education that will change because of this experience. People will spend a lot more time thinking about public health. I would say the whole telehealth experience we’re doing a medical student elective on telehealth because it’s a new skill for the future. I would say that our epidemiologists are embedded as members of our incident command and are really important members of that and I’m not sure that’s going to go away. I think this is kind of the heyday for infectious disease and epidemiology, probably like it was back in the 80s when we were dealing with AIDS when it first came out, and we didn’t completely understand it. So this is kind of another resurgence and awareness of the importance of that discipline. Gary Bisbee 30:19 Well, if you could say this, back to the public health issue, how do your fellow AHA board members think about that? Joanne Conroy 30:27 I think they’re integrating it into what they think how they can intervene on the things that we’ve discovered, through the COVID-19 experience, for example, disparities, all of a sudden, it’s become real. The impact of your economic situation and access to healthcare during this crisis. So I would say instead of generally saying we believe everybody deserves the same access to health care. This is a real example for many of the AHA board members, many of whom are from urban areas, but a lot also from rural areas. But there’s seen the impact of socio-economic disparities in the care and outcomes that people in their communities. So I think it moves it from something that’s good to be supportive to something that actually impacts the people you care for. Gary Bisbee 31:26 Let’s come back to that new normal question that we were talking about earlier. Both Dr. Marc McClellan and Governor Bob Kerrey, sitting at this microphone made the point that there will be a new normal one, how do you think about that? And you’ve basically already said that you agree with that. What do you think is going to change going forward? Joanne Conroy 31:49 A couple of things that we have already talked about. So telehealth, you can’t put that genie back in the bottle. Remote work. I think that’s going to be a really important part of our workforce in the future. I also think that our ambulatory care enterprise will change. Well, you may say what doesn’t change? I don’t think our in-patient enterprise changes. In fact, I think there’s a greater focus on moving to private rooms. I think the issue of a semi-private room is going to be a standard that’s going to be hard to support probably in the future. I would say that all of us will be looking at our ambulatory enterprise and trying to consider how much of that business will stay in the telehealth space and how much we’ll come back with face to face visits. And then it’s also how do we actually space out the patient flow in the ambulatory enterprise we see 4000 people a day here in Lebanon, and some of the waiting rooms are actually very busy, that’s not going to be acceptable anymore. So we actually have to look at our physical plant as well as our patient flow to figure out how can we make sure that people have appropriate social distancing, but we actually move them through the facility in an effective and efficient way. I would say waiting rooms may even disappear, and we’ll have different patient flow. So people go right into a room. When it is an appropriate time for them to see their provider. So it’s going to change that dramatically. I believe, Gary Bisbee 33:28 Joanne, this has been a terrific interview as expected, always great chatting with you. So thank you very much for your time today. Joanne Conroy 33:34 Thank you, Gary. Gary Bisbee 33:37 This episode of fireside chat is produced by Strafire please subscribe to Fireside Chat on Apple podcasts or wherever you’re listening right now. Be sure to rate and review fireside chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we have found that podcasts are known through word of mouth. We appreciate your spreading the word to friends or those who might be interested Fireside Chat is brought to you from our nation’s capital in Washington DC, where we explore the intersection of healthcare politics, financing, and delivery. For additional perspectives on health policy and leadership. Read my weekly blog Bisby’s brief. For questions and suggestions about fireside chat contact me through our website, fireside chat podcast dot com, or Gary at hm Academy dot com. Thanks for listening. Transcribed by Otter

In this episode of ACOG District II's On the Front Line: Managing OUD in Pregnancy, we're joined by Dr. David Garry to discuss the basics of buprenorphine, supports needed to start prescribing, and next steps once you receive your waiver. Our guest, Dr. Garry, is a Professor of Clinical Obstetrics & Gynecology at the Renaissance School of Medicine at Stony Brook University. He is a maternal fetal medicine specialist, who trained in obstetrics and gynecology at the Catholic Medical Center of Brooklyn and Queens, and did his clinical fellowship in Maternal Fetal Medicine New York Medical College. He now serves as the Director of Maternal Fetal Medicine at Stony Brook Medicine. For more information on managing OUD in pregnancy, visit www.acogny.org. Be sure to follow us on Twitter and Instagram at @ACOGD2 for updates on OUD and other cutting edge medical education resources.

Dave Gambaccini is a CCIM Designee and the 2020 President of The New England CCIM Chapter as well as the Senior Director of Commercial Brokerage with SVN Commercial Real Estate Advisors, in Bedford, New Hampshire. Dave has successfully operated his own independent commercial real estate investment company since 2006 as an owner/investor and was a Director with KW Commercial. He is now focused on the efforts of expanding the SVN brand in New Hampshire. Dave provides superior commercial real estate services to investors, family offices, high-net-worth individuals, developers, owners, and operators, helping them to identify, acquire, develop, sell or reposition assets in the $1MM to $25MM range throughout New England and across the U.S. Dave is licensed in New Hampshire and Massachusetts. Dave is heavily involved in his community and serves on the Board of Directors for the New Hampshire Commercial Investment Board of Realtors (NHCIBOR), is a member of the New Hampshire Association of Realtors (NHAR) and is the Vice-Chairman on The Town of Bedford, NH, Conservation Commission. Dave is a Certified Therapy Dogs International pet therapy handler and trained his personal dog to be a Therapy Dog. Dave and his yellow lab, Banana, regularly volunteer emotional support therapy to the Catholic Medical Center as well as volunteer to children’s reading programs at Bedford Village Morning School in Bedford, in addition to other schools and libraries. Dave is also a living kidney donor and supports the efforts of Donate Life. What You Will Learn: How my program changed Dave’s perspective on real estate investing How Dave managed to scale his business model and start working with higher price points How Dave made the transition from residential to commercial as a broker How the tools, techniques, and strategies from my program helped Dave understand CCIM Generational and geographical trends in the real estate industry Additional Resources from Dave Gambaccini: Website: www.svn.com LinkedIn: https://www.linkedin.com/in/dave-gambaccini-ccim-85b29a9/ Facebook: https://www.facebook.com/davegambonh/ Twitter: @dave_gambo Additional Resources from Gary Wilson: My Investment Services Silver Membership: https://edu.myinvestmentservices.com/silver-level-membership See Gary’s Upcoming Events Here

In this episode Scott talks to Parson Hicks, Director of Patient Financial Services at Catholic Medical Center. Here she discusses revenue cycle, her career, advice for women leaders, mentors, and more.

Today’s guest is Alex Walker, the Executive Vice President and Chief Operating Officer for Catholic Medical Center in Manchester, New Hampshire. Alex took an unusual route to senior leadership in the healthcare field. Prior to joining Catholic Medical Center in 2012, he spent more than twenty years practicing corporate law and litigation at one of New Hampshire’s largest and most prestigious law firms. In the podcast we talk about Alex’s journey from his early experiences in the Marine Corps, to what it was like to rise to become President of Devine and Millimet, and ultimately his decision to change careers and industries and join the team at Catholic Medical Center. What I thought was especially interesting about Alex’s story was how he described the experience of joining a mission driven non-profit hospital, and how important that was to him. I hope you enjoy this conversation as much as I did. For more information, please see our web site, https://healthleaderforge.blogspot.com/2019/03/alex-walker-executive-vice-president.html

Our Nurse of the Week is Rebecca Roma, a floor nurse in the cardiovascular surgical unit at Catholic Medical Center, who used her vacation time to volunteer aboard Mercy Ships. The international charity operates floating hospitals that provide free medical care in some of the poorest spots around the world. ship was docked in Cameroon, Africa, where the medical personnel perform life-saving surgeries and life-changing treatments on local residents. Volunteers also provide training to local doctors and nurses. Many patients in the region have medical conditions that distort their appearance, and for many, Mercy Ships is the first place they’ve come where someone welcomes them and takes care of them.

Dr. Ayman Shahine is a highly regarded and skilled surgeon he has been working with and sculpting the female body for over 20 years. As a cosmetic surgeon, he knows the extra details and artistry that it takes to create an amazing cosmetic outcome for the patients. Surgeon in chief, NY and NJ laser Lipo CenterFellow of American Congress of Obstetricians & GynecologistsMember of the American Academy of Cosmetic SurgeryMember of the American Society of Lipoplastic SurgeryMember of the American Society of Hair Restoration SurgeryMember of the International Society of Hair Restoration SurgeryMember of the International Society of Cosmetogynecology In addition to being an accomplished physician, Dr. Shahine is also a superb mentor and teacher. In 1996 he served as a clinical instructor at the NYU School of Medicine, and in 1998 he was Chief of the Section of Endoscopic and Vaginal surgery at the Catholic Medical Center of St. Mary's Hospital. In 1999 Dr. Shahine was voted the Physician and Surgeon Teacher of the year by the residents and medical students at St. Mary's Hospital, and in 2005 he received an honorary proclamation from the Borough President of Brooklyn, New York for his excellent work and service to the community. Dr. Shahine is also an inventor and an innovator in the field of medicine: He has modified and improved several surgical procedures and instruments, and is the co-inventor of the TOPAL liposculpture technique that produces superior skin retraction and tightening, resulting in a more natural appearance also he developed a unique technique that sculpt and enhances natural curves in female body, buttock lift and augmentation, and fat transfer and grafting. 

Dr. Ayman Shahine is a highly regarded and skilled surgeon he has been working with and sculpting the female body for over 20 years. As a cosmetic surgeon, he knows the extra details and artistry that it takes to create an amazing cosmetic outcome for the patients.Surgeon in chief, NY and NJ laser Lipo CenterFellow of American Congress of Obstetricians & GynecologistsMember of the American Academy of Cosmetic SurgeryMember of the American Society of Lipoplastic SurgeryMember of the American Society of Hair Restoration SurgeryMember of the International Society of Hair Restoration SurgeryMember of the International Society of CosmetogynecologyIn addition to being an accomplished physician, Dr. Shahine is also a superb mentor and teacher. In 1996 he served as a clinical instructor at the NYU School of Medicine, and in 1998 he was Chief of the Section of Endoscopic and Vaginal surgery at the Catholic Medical Center of St. Mary’s Hospital. In 1999 Dr. Shahine was voted the Physician and Surgeon Teacher of the year by the residents and medical students at St. Mary’s Hospital, and in 2005 he received an honorary proclamation from the Borough President of Brooklyn, New York for his excellent work and service to the community.Dr. Shahine is also an inventor and an innovator in the field of medicine: He has modified and improved several surgical procedures and instruments, and is the co-inventor of the TOPAL liposculpture technique that produces superior skin retraction and tightening, resulting in a more natural appearance also he developed a unique technique that sculpt and enhances natural curves in female body, buttock lift and augmentation, and fat transfer and grafting. 

Dr. Ayman Shahine is a highly regarded and skilled surgeon he has been working with and sculpting the female body for over 20 years. As a cosmetic surgeon, he knows the extra details and artistry that it takes to create an amazing cosmetic outcome for the patients. Surgeon in chief, NY and NJ laser Lipo CenterFellow of American Congress of Obstetricians & GynecologistsMember of the American Academy of Cosmetic SurgeryMember of the American Society of Lipoplastic SurgeryMember of the American Society of Hair Restoration SurgeryMember of the International Society of Hair Restoration SurgeryMember of the International Society of Cosmetogynecology In addition to being an accomplished physician, Dr. Shahine is also a superb mentor and teacher. In 1996 he served as a clinical instructor at the NYU School of Medicine, and in 1998 he was Chief of the Section of Endoscopic and Vaginal surgery at the Catholic Medical Center of St. Mary’s Hospital. In 1999 Dr. Shahine was voted the Physician and Surgeon Teacher of the year by the residents and medical students at St. Mary’s Hospital, and in 2005 he received an honorary proclamation from the Borough President of Brooklyn, New York for his excellent work and service to the community. Dr. Shahine is also an inventor and an innovator in the field of medicine: He has modified and improved several surgical procedures and instruments, and is the co-inventor of the TOPAL liposculpture technique that produces superior skin retraction and tightening, resulting in a more natural appearance also he developed a unique technique that sculpt and enhances natural curves in female body, buttock lift and augmentation, and fat transfer and grafting. 

The Perkins Bass Lecture Rockefeller Center Introduction: Representative Charlie Bass '74 Former U.S. Congressman (R-NH) Son of the late Representative Perkins Bass '34 Governor John Lynch Former Governor of New Hampshire Perkins Bass Distinguished Visitor Re-elected in 2010 to a historic fourth term, Gov. John Lynch has been a strong, effective leader in working to make real progress on the issues that matter most to New Hampshire families and businesses ­-- improving the quality of education, promoting job creation and economic development, reducing health care costs, ensuring public safety and protecting New Hampshire's environment and natural resources. Under Gov. Lynch, New Hampshire was named the "Most Livable State" in the nation, as well as the "Safest State" for three years in a row. New Hampshire has one of the lowest unemployment rates in the nation, the lowest states taxes, and fourth lowest government spending per capita. Under Gov. Lynch it has been named one of the most business-friendly and best-managed states in the nation. Gov. Lynch has worked with Democrats and Republicans to make kindergarten available to every child, to cut New Hampshire's high school dropout rate in half, pass the toughest laws in the nation to protect children from sexual predators, to reduce spending by making government more efficient and build the economy by making it easier for companies to retain and hire new workers, increasing job training and providing tax credits for research and development. A commitment to putting the interests of people first is an extension of Gov. Lynch's work as a business and community leader. As the President and CEO of Knoll, Inc., a national furniture manufacturer, he transformed a company losing $50 million a year into one making a profit of nearly $240 million. Under his leadership, Knoll created new jobs, gave factory workers annual bonuses, established a scholarship program for the children of employees, created retirement plans for employees, and gave workers stock in the company. Gov. Lynch has also served as chair of the University System Board of Trustees, where he worked to keep tuition increases to a minimum; as director of Admissions at the Harvard Business School, where he made ethics one of the criteria for admissions; and as president of the Lynch Group, a business-consulting firm in Manchester. Long a community leader, John Lynch served on the board of Catholic Medical Center in Manchester and on the board of the Capitol Center for the Arts. He is the past president of the UNH alumni association, and a longtime coach of youth soccer, hockey, softball and baseball. Working his way through college, Gov. Lynch earned his undergraduate degree from the University of New Hampshire in 1974. He also holds an M.B.A. from the Harvard Business School and a law degree from Georgetown University Law Center. He and his wife of over 30 years, Susan, live in Hopkinton, and have three children, Jacqueline, Julia and Hayden.