Podcasts about Yale New Haven Hospital

In this episode of Behind the Breath, Marjorie Cullinan, MSHA, RRT, RRT-NPS, RPFT, Operations Manager of Pulmonary Function Testing at Yale New Haven Hospital, sits down with AARC Vice President of Membership and Customer Care, Monique Kimmel to discuss the importance of AARC resources and networking in the Diagnostics Specialty Section, her journey in adult and pediatric respiratory critical care, and how her mentors help shape her career.Additional Resources AARC Diagnostics Specialty SectionBehind the Breath Video with Marjorie Cullinan and Monique KimmelSend us a textSupport the show

Comment on the Show by Sending Mark a Text Message.The alarming reality of physician burnout has reached crisis levels, with six out of ten doctors now experiencing burnout—up significantly from pre-pandemic numbers. Behind these statistics are real people and real stories that demand our attention.This episode takes a deep dive into the disturbing allegations contained in Dr. Allison Schmeck's legal complaint against Yale University and Yale New Haven Hospital. Read a copy of the federal complaint HERE. As a triple board-certified anesthesiologist, Dr. Schmeck's experience reveals the dark underbelly of academic medicine: alleged gender discrimination where female physicians were assigned double the workload of male colleagues, disability discrimination where her disclosed history of depression was labeled as "baggage," and devastating retaliation when she reported unethical practices and requested mental health accommodations.The most heartbreaking aspect of this case is how systemic failures allegedly drove a talented physician to the brink of suicide—making concrete plans including updating her will and arranging for her pets' care. Dr. Schmeck's journey exposes how institutions might weaponize mental health history against physicians who speak up, while simultaneously denying them opportunities granted to less qualified male colleagues. When leadership allegedly defines "positive faculty experience" as making superiors happy rather than supporting staff wellbeing, it reveals fundamental flaws in medical culture.This powerful examination connects one doctor's personal nightmare to nationwide physician mental health statistics, where 80% of doctors acknowledge the stigma preventing them from seeking help. What must change in our medical institutions to protect those who dedicate their lives to healing others? How many talented physicians are we losing to these systemic failures? Listen and consider what responsibility we all share in demanding better for those who care for us at our most vulnerable moments. If you enjoyed this episode of the Employee Survival Guide please like us on Facebook, Twitter and LinkedIn. We would really appreciate if you could leave a review of this podcast on your favorite podcast player such as Apple Podcasts. Leaving a review will inform other listeners you found the content on this podcast is important in the area of employment law in the United States. For more information, please contact our employment attorneys at Carey & Associates, P.C. at 203-255-4150, www.capclaw.com.Disclaimer: For educational use only, not intended to be legal advice.

Navigating Medicine and Faith: A Conversation with Dr. Sharon Stoll In this episode, Dr. Sharon Stoll discusses her background growing up in a modern Orthodox Jewish community in Philadelphia, her journey to becoming a neuroimmunologist, and her professional experiences working at Yale and now in Philadelphia. The conversation touches on her approach to patient education, especially around COVID-19 and various medications, including GLP-1 agonists like Ozempic and SSRIs for mental health. Dr. Stoll also speaks about her role in JOWMA (Jewish Orthodox Women's Medical Association) and the importance of educating her community on medical issues.    The discussion covers her views on IVF, the ethical considerations of genetic selection, and the interplay of anxiety and genetic predispositions within the Ashkenazi Jewish community. Dr. Stoll shares personal anecdotes and insights into balancing professional and personal life, making this an in-depth and enlightening conversation.   00:00 Introduction and Background 01:19 Professional Journey and Achievements  02:08 Balancing Media and Medicine 03:48 Involvement with Jowma 05:40 Views on Vaccination 14:26 Discussion on SSRIs and Ozempic 28:16 Challenges in the Frum Community  34:38 Debunking Misconceptions About Diabetes 35:07 Educational Gaps and Community Efforts 36:43 Health Education in Schools 39:06 Challenges of Motherhood and Societal Expectations 43:43 Genetic Risks and Mental Health in Ashkenazi Jews 54:38 IVF, Genetic Selection, and Ethical Dilemmas  01:02:34 Concluding Thoughts and Personal Reflections   About Our Guest: Dr. Sharon Stoll is a board-certified neurologist, neuro-immunologist. She currently serves as Director of Neurology at Stoll Medical Group in Philadelphia. For the past 8 years she worked as assistant professor, in the department of neurology at Yale School of Medicine. She completed her neurology residency training at Thomas Jefferson University Hospital in Philadelphia and her Neuroimmunology fellowship at Yale New Haven Hospital. Dr. Stoll played an active role in academic development and continuing medical education. She currently serves on several steering committees and advisory boards. She has been published in numerous peer-reviewed journals and served as Principal Investigator on several clinical trials. Dr. Stoll has received numerous awards, including Top Neurologist, 40 under 40, the Rodney Bell teaching award, and is a national multiple sclerosis society grant recipient. Dr. Stoll is also a medical editor for Medscape and Healthline and previously worked as a medical editor for ABC News. She is also a medical commentator for several national and local news outlets, including ABC, NBC, and CBS News, and has been on a variety of shows, including “The Doctors”. She is an internationally renowned speaker and patient advocate.   https://www.drsharonstoll.com https://www.instagram.com/drsharonstoll/?hl=en https://www.jowma.org  

In this episode of 'Inspire to Lead,' host Talia Mashiach interviews Dr. Sharon Stoll, a board-certified neurologist and neuroimmunologist from Philadelphia. Sharon discusses her upbringing, her unwavering passion for medicine despite societal discouragement, and how she navigated through medical school and residency while managing family life. She shares the pivotal role her supportive husband played in her success and addresses the challenges and triumphs of balancing a demanding career with motherhood. The conversation also delves into the expectations placed on Jewish women in their communities and the importance of pursuing fulfilling careers to maintain overall happiness and effectiveness as both mothers and wives. Sharon's story is an inspiring testament to resilience, determination, and the impact of supportive relationships.   00:00 Introduction to Inspire to Lead Podcast 00:29 Meet Sharon Stoll: A Journey to Medicine 02:38 Balancing Media and Medicine 08:44 Personal Life and Family Dynamics 15:15 Navigating Career and Marriage 37:12 Parenting in Modern Times 39:14 Balancing Career and Family Aspirations 42:43 The Journey to Motherhood 43:16 Navigating Medical School and Motherhood 54:24 Support Systems and Community 01:01:46 Reflections and Advice 01:16:09 Biggest Accomplishments and Lessons Learned     About Dr. Sharon Stoll: Dr. Sharon Stoll is a board-certified neurologist, neuro-immunologist. She currently serves as Director of Neurology at Stoll Medical Group in Philadelphia. For the past 8 years she worked as assistant professor, in the department of neurology at Yale School of Medicine. She completed her neurology residency training at Thomas Jefferson University Hospital in Philadelphia and her Neuroimmunology fellowship at Yale New Haven Hospital. Dr. Stoll played an active role in academic development and continuing medical education. She currently serves on several steering committees and advisory boards. She has been published in numerous peer-reviewed journals and served as Principal Investigator on several clinical trials. Dr. Stoll has received numerous awards, including Top Neurologist, 40 under 40, the Rodney Bell teaching award, and is a national multiple sclerosis society grant recipient. Dr. Stoll is also a medical editor for Medscape and Healthline and previously worked as a medical editor for ABC News. She is also a medical commentator for several national and local news outlets, including ABC, NBC, and CBS News, and has been on a variety of shows, including “The Doctors”. She is an internationally renowned speaker and patient advocate. https://www.drsharonstoll.com   Powered By Roth & Co The JWE For guest suggestions, please email Talia: podcast@thejwe.org

In this episode, join moderator Brea Burmeister and experts Dr. Scott Weiner and Dr. Arjun Venkatesh as they explore how quality measures can transform opioid use disorder (OUD) care in emergency departments. Discover innovative metrics, quality improvement initiatives, and EHR data integration to optimize patient outcomes. Learn about overcoming barriers like stigma and resource shortages and get key recommendations from recent OUD treatment studies. Perfect for healthcare professionals and anyone interested in advancing OUD care.What You'll Learn:Challenges and opportunities of addressing the opioid epidemic in emergency medicineACEP's work on metrics and the development of quality improvement measuresKey quality initiatives to enhance OUD care and reduce harmThe barriers to adopting these initiatives and strategies to overcome themRecommendations based on recent studies in OUD treatment and medicationMODERATOR: Brea BurmeisterMember, CHIME Opioid Task ForceBio: With 23 years in healthcare, Brea specializes in managing relationships within Integrated Delivery Network (IDN) Health Systems, regional Group Practices, and Specialty Pharmacy accounts. She strengthens value-based care models by developing strategic plans, analyzing performance data, improving care coordination, and implementing process improvements. Brea's work enhances patient outcomes and experiences while reducing costs. Additionally, her volunteer work with the Opioid Task Force reflects her commitment to public health advocacy and community well-being.GUEST: Scott Weiner, MD, MPH, FAAEM, FACEP, FASAMEmergency and Addiction Medicine Physician, Brigham and Women's HospitalAssociate Professor, Harvard Medical SchoolCo-chair, Clinical Advisory subcommittee, CHIME Opioid Task ForceBio: Dr. Weiner is the McGraw Distinguished Chair in the Department of Emergency Medicine at Brigham and Women's Hospital and an Associate Professor of Emergency Medicine at Harvard Medical School. He is board-certified in emergency medicine and addiction medicine. He is an active researcher, working on multiple projects that focus on prevention and treatment of opioid use disorder.GUEST: Arjun Venkatesh, MD, MBA, MHSChair, Department of Emergency Medicine, Yale University School of MedicineChief, Emergency Medicine, Yale New Haven HospitalBio: Dr. Venkatesh is Chair and Chief of Emergency Medicine at the Yale University School of Medicine and Yale New Haven Hospital. He has received over $ 12 million in funding by the NIH, CMS, AHRQ, and CDC to develop measures and interventions that improve acute care outcomes and value. He has supported CMS's development of the Overall Hospital Quality Star Ratings, has led the development of quality measures for the Clinical Emergency Data Registry, and is PI of the Emergency Quality Network (E-QUAL). His work has produced over 200 publications and been implemented in numerous national quality and value programs. He is a graduate of Northwestern University School of Medicine, a proud graduate of the HAEMR Class of 2012 often referred to as the Greatest Class Ever, and completed the RWJF Clinical Scholars Program at Yale.Additional Resources:ACEP E-QUAL opioid initiativeCedr

We're back with more exciting case reviews filled with many valuable lessons and this time, we explore cases that almost ended in disaster for the doctors involved. We are joined again by Oral and Maxillofacial Surgeon Dr. David Salomon – currently practicing at Yale New Haven Hospital, Connecticut – who begins by sharing his thoughts on our first case in review involving an accidental violation of the Hippocratic Oath. Then, we discuss a patient with hypertension who seized mid-operation, why leading with empathy is the foundation for avoiding possible lawsuits, the role of vulnerability between doctors and patients, and how two wrongs never make a right. We end with an extraction gone wrong for an 18-year-old high school softball player, communication and other referral problems that exist across the industry, fail-safes to improve referral protocols, how to address minor patients who feel they've been wronged, and why we need to implement more timeouts as standard practice. As a bonus final act, doctors Salomon and Stucki reminisce on when Dr. Salomon saved Dr. Stucki's life.  Key Points From This Episode:An unfortunate and accidental breach of privacy. The best practices for doctors engaging with patients online, especially on public platforms. Unpacking the malpractice case of a patient who had a seizure on the operating table. How to make amends when things go wrong, and the importance of leading with empathy.Why vulnerability matters, and how to avoid adding fuel to the fire. How a wrongful extraction highlights some of the key issues doctors face with referrals.  What practitioners can do to ensure referrals receive the same care as self-referrals. The ins and outs of timeouts and their undeniable importance. How Dr. Salomon intervened in Dr. Stucki's near-fatal encounter! Links Mentioned in Today's Episode:Dr. David Salomon on LinkedIn — https://www.linkedin.com/in/david-salomon-b8ab1431/ Yale New Haven Hospital — https://www.ynhh.org/ Coastal Connecticut — https://www.coastalctoms.com/ Risk Tips Archive | MedPro Dental — https://oms.medprodental.com/category/risk-tips  Dr. Ira Satinover on Healthgrades — https://www.healthgrades.com/physician/dr-ira-satinover-y8hpw Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Susan Allison-Dean is a Board Certified Advanced Holistic Nurse and Certified Clinical Aromatherapy professional with over thirty years of experience in nursing.  During the first half of her career, she practiced mainly as a Certified Wound, Ostomy, & Continence Clinical Nurse Specialist, holding a joint position with Yale-New Haven Hospital & Yale University.In 1999, she experienced the profound loss of two significant family members just two days apart.  This loss and the profound healing experiences that she experienced in nature led her to leave the disease-care model and shift her practice to health promotion, specifically nature and health.Sue is the Founder and CEO of TheNatureNurse.com, which focuses on connecting women with nature so they may live more joyous, vibrant, awe-inspiring lives in harmony with Mother Nature.  She is the co-chair of the Global Nature Nurse Network, connecting nurses who specifically partner with the natural world to enhance holistic health and prevent disease.Sue also enjoys writing, traveling with her husband, and dabbling in other creative arts.  She lives in New York and North Carolina in the US.How you became a Nature Nurse 4:12 deep level grief, profound loneliness, pain 6:02  mother nature 24/7 availability - transformative - helped me to live a joyous and productive life. Bring light into people's lives. 9:03 Florence Nightingale "nature itself is healing"14: Nurse Pioneers in Global Nature Nurse Network Verla cites podcast episode with Professor Andy Jones systematic review and meta analysis of green space exposure and health outcomes (103 observational and 40 interventional studies investigating 100 outcomes: green space exposure decreased heart rate and blood pressure, HDL cholesterol, increased HRV, decreased preterm birth, diabetes, and all cause mortality in particular cardiovascular mortality.  For transcript see verlafortier@substack.com  Nature Nurse on Instagram https://www.linkedin.com/in/susan-allison-dean-rn-ms-ahn-bc-ccap/  For peer reviewed research on how your time spent in green space can change your mindset, balance your nervous system and your heart rate please go to verlafortier@substack.com and check out my books Take Back Your Outside Mindset: Live Longer, Stress Less, and Control Your Chronic Illness and Optimize Your Heart Rate: Balance Your Mind and Body With Green Space

Why do bone defects occur, and how can we best manage them? In this episode, Dr. Frumberg joins us as we explain the intricacies of bone defect classifications, the role of host factors, and groundbreaking treatments like the Masquelet technique, vascularized fibula grafts, and distraction osteogenesis. From the smallest Type I defects to the most complex Type IV challenges, this conversation is packed with actionable insights for orthopedic surgeons and enthusiasts alike. Plus, hear Dr. Frumberg's expert take on when amputation might be the best option and the importance of preserving joint function and stability in treatment planning. Click here for show notes David Frumberg, MD, is an Assistant Professor of Orthopaedics and Rehabilitation at Yale School of Medicine. He is co-director of the Yale Limb Restoration and Lengthening Program. He is the Director of the Cerebral Palsy Program at Yale-New Haven Hospital. He specializes in complex orthopedic conditions that require more attention and care. He works closely with patients and their families to understand their needs and unique goals. He enjoys collaborating with other medical professionals to maximize the functioning and comfort of patients of all ages. Dr. Frumberg utilizes state of the art surgical techniques, and is devoted to providing his patients with innovative and compassionate care. His areas of expertise include: Limb lengthening and stature lengthening Limb deformity correction Cerebral palsy Arthrogryposis Neurologic conditions that cause joint contractures Fracture nonunions and malunions Musculoskeletal infections Goal of episode: To develop a baseline knowledge of bone defects. In this episode, we discuss: Causes of bone defects Classification Treatment and many more. This episode is sponsored by the American Academy of Orthopaedic Surgeons: Filled with content that has been vetted by some of the top names in orthopaedics, the AAOS Resident Orthopaedic Core Knowledge (ROCK) program sets the standard for orthopaedic education. Whether ROCK is incorporated into your residency curriculum, or you use it independently as a study tool, the educational content on ROCK is always free to residents. You'll gain the insights and confidence needed to ensure a successful future as a board-certified surgeon who delivers the best patient care. Log on at https://rock.aaos.org/.

What would you like to see more of? Let us know!In this episode of Discover Daily, we explore three compelling stories shaping our world. First, Amazon deepens its AI ambitions with a $4 billion investment in Anthropic, designating AWS as the company's primary cloud provider while allowing Anthropic to maintain partnerships with other tech giants. This strategic move positions Amazon more competitively against Microsoft's OpenAI partnership and Google's DeepMind.Second, scientists have discovered promising natural hydrogen reserves beneath the Midcontinent Rift, a 1,200-mile stretch of ancient volcanic rock under Lake Superior. The University of Nebraska-Lincoln's research team, supported by a $1 million National Science Foundation grant, is investigating how this geological formation could provide clean energy through natural hydrogen production, with test wells showing encouraging results.Our episode concludes with a fascinating historical journey from World War I to modern medicine, revealing how observations of mustard gas's effects on soldiers led to the development of chemotherapy. From the first clinical trial at Yale New Haven Hospital in 1942 to today's sophisticated cancer treatments, this story shows how careful scientific observation transformed a deadly weapon into a cornerstone of cancer therapy.From Perplexity's Discover Feed:https://www.perplexity.ai/page/amazon-invests-4b-in-anthropic-Y3ZOPzPzTxK0Q4d_MaTsswhttps://www.perplexity.ai/page/midcontinent-rift-s-hydrogen-t-UXzIbQh1RKGd91QoYDVdKwhttps://www.perplexity.ai/page/chemotherapy-s-precursor-D8oZDWLrSfu7mNh3rycoTQPerplexity is the fastest and most powerful way to search the web. Perplexity crawls the web and curates the most relevant and up-to-date sources (from academic papers to Reddit threads) to create the perfect response to any question or topic you're interested in. Take the world's knowledge with you anywhere. Available on iOS and Android Join our growing Discord community for the latest updates and exclusive content. Follow us on: Instagram Threads X (Twitter) YouTube Linkedin

Maternal health refers to the health of women during pregnancy, childbirth, and the postnatal period. Even though important progress has been made in the last two decades in this area, we still have a lot of work to do. The World Health Organization says about 287,000 women died during and following pregnancy and childbirth in 2020. To help us understand the things that need to be done in order to bring these numbers down, Nicole sought out Dr. Daileann Hemmings. She is a doctoral prepared perinatal nurse with a focus in the Community/Public Health sector, with over 20 years of nursing experience specializing in perinatal health at some of the country's top hospitals, such as Yale New Haven Hospital and Johns Hopkins. Right now, Daileann serves as the Program Director of Maternal Health Equity at Hartford Hospital in which she works to address health disparities that impact mortality & morbidity. Nicole and Daileann share in a very candid and open conversation about how we can better support mothers -- especially those of color, some of the inequities that individuals of color experience, the initiatives she has helped implement to address the issues, and the preventability of maternal deaths. You will walk away from this episode with not only more knowledge on this topic, but a greater understanding of what you can do to help other support other moms experiencing such inequality when it comes to their maternal health.-----------------------------------SHOW NOTES:Host: Nicole Nalepa | @NicoleNalepaTVGuest: Daileann Hemmings

Howie and Harlan are joined by Max Laurans, a Yale neurosurgeon and hospital administrator, and a founder of the healthcare staffing company Nomad Health. Harlan discusses the problem of doctors giving too much weight to suggestions from AI; Howie celebrates a milestone in the campaign to eliminate trachoma, a common cause of preventable blindness in the developing world.   Links: Automation Bias “Some doctors are using public AI chatbots like ChatGPT in clinical decisions. Is it safe?” “Measuring the Impact of AI in the Diagnosis of Hospitalized Patients: A Randomized Clinical Vignette Survey Study” “Automation Bias and Assistive AI: Risk of Harm From AI-Driven Clinical Decision Support” “Combining Human Expertise with Artificial Intelligence: Experimental Evidence from Radiology” Max Laurans Maxwell Laurans, MD, MBA, FAANS Nomad Health: Travel Nurse and Travel Allied Health Jobs 2003 residency placements for Yale medical students “Yale New Haven Hospital breaks ground on $838 million, 505,000 square foot Neurosciences Center” “Hospitals across the U.S. face IV fluid shortage after Hurricane Helene” Trachoma Mayo Clinic: Trachoma “Elimination of trachoma as a public health problem in India” The Carter Center: Waging Peace. Fighting Disease. Building Hope Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

Ischemic heart disease is a leading cause of morbidity and mortality. While atherosclerotic coronary artery disease (CAD) is the focus of most outpatient and inpatient evaluations for cardiovascular symptoms, up to two thirds of patients suffer from myocardial ischemia with non-obstructive coronary arteries (INOCA). Patients with INOCA have unique symptoms and are more likely to have functional limitation and repeat presentations for cardiovascular evaluation. While there has been increasing recognition of INOCA there is no specific functional status measure, limiting our ability to evaluate the course of illness or effectiveness of therapies. In this presentation, Dr. Samit Shah, interventional cardiologist at Yale New Haven Hospital who recently gave grand rounds recently to the Mayo Clinic Department of Emergency Medicine, reviews the causes of ischemic heart disease, challenges with current symptom assessment, and proposes a new path for better diagnosis and treatment of heart disease.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda; @SamitShahMD YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

Medical debt has a strange and storied history in America. Stretching back to colonial times, physicians and patients alike have grappled with its harsh realities. In recent years, hospitals have resorted to selling medical debt to third parties, who then aggressively pursue patients. In today's episode, medical historian Luke Messac, MD, PhD, guides us through the past and present landscape of medical debt, examining perspectives from patients, providers, hospitals, and governments. We delve into a form of indentured servitude in the name of debt clearance, the birth of nonprofit hospitals, a pivotal shift in the 1980s, feasibility of operating healthcare under free market principles, medical economics in the 1600s, hospitals suing patients, and the emergence of medical debt as its own thriving industry.

This month we're joined on the TrainSmart Podcast by Dr. Melynda Barnes. As a a double board-certified Facial Plastic and Reconstructive Surgeon and Otolaryngologist and Chief Medical Officer at Ro, Dr. Barnes brings a wealth of perspective on physician training, how to best coach physician faculty, and the value of a medical device rep. Tune in for great insight, encouragement, and inspiration for working with physicians! Related Resources: Dr. Barnes is a double board-certified Facial Plastic and Reconstructive Surgeon and Otolaryngologist. Previously, she was an Assistant Professor at Yale-New Haven Hospital and Yale School of Medicine and also served on the board of directors for Yale Medical Group. She earned her BAS from Stanford and her medical degree from the Mount Sinai School of Medicine. Connect with us on LinkedIn:   ⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠Cumby Consulting⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠Rachel Medeiros⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Liz Cumby⁠⁠⁠⁠⁠About Cumby Consulting:   Cumby Consulting's team of professionals deliver innovative MedTech training services for physicians, sales representatives, teaching faculty, key opinion leaders and clinical development teams. Whether you need a complete training system developed to deliver revenue sooner or a discrete training program for a specific meeting, Cumby Consulting will deliver highly strategic, efficient programs with uncompromising standards of quality.

Join us for a thought-provoking discussion on diversity, equity, and inclusion in healthcare with Dr. Benjamin Mba, Vice Chair for Diversity, Equity, and Inclusion at Yale New Haven Hospital and Yale School of Medicine. Dr. Mba shares insights into challenges facing minority physicians, his experience with Yancy Forums, and his vision for the future of healthcare. Tune in for valuable perspectives on fostering inclusivity in medical practice.

Dr. Asima Ahmad discusses the significant role doulas can play in pregnancy, childbirth, and postpartum care, highlighting the importance of clear roles and communication between healthcare professionals, doulas, and birthing individuals for optimal outcomes. Dr. Asima's personal experience with a doula demonstrates the benefits of having tailored support for physical and emotional well-being, underscoring the potential for doulas to alleviate stress and anxiety, and contribute to a more positive birthing experience. The conversation also addresses controversies surrounding doula services, emphasizing the necessity of teamwork and understanding in medical settings to prevent miscommunication and ensure the safety and health of both the mother and baby, with research supporting the positive impact of doulas on reducing medical interventions and improving mental health outcomes. To learn more -- or read the transcript -- visit the official episode page. “So I think there's a lot of different roles that doulas can play. I don't think it's just like a copy and paste for all. Personally, I've had five pregnancies, I have four children, and I'm lucky that I've always had a good support system in place. But for this last delivery, I did have a postpartum doula, and even though I had gone through it three times before, I found her insight and support to be valuable to not only myself but also to my family and friends.” ~Asima Ahmad, MD, MPH Our guest, Asima Ahmad, MD, MPH, is a co-founder and the chief medical officer (CMO) of Carrot Fertility, the leading global fertility care platform. As Carrot's CMO, Ahmad leads clinical strategy, overseeing the company's expansive network and telehealth program, which offers access to more than 10,000 reproductive endocrinologists, urologists, adoption experts, mental health experts, OB/GYNs, doulas, and midwives.   In addition to her role at Carrot, Ahmad is a practicing reproductive endocrinologist and infertility specialist. She is double board certified in reproductive endocrinology and infertility and obstetrics and gynecology. Ahmad earned a combined medical and public health degree from the University of Chicago's Pritzker School of Medicine and the Harvard T.H. Chan School of Public Health in Boston. She completed her residency in OB/GYN at Yale-New Haven Hospital in Connecticut and her fellowship training in reproductive endocrinology and infertility at the University of California, San Francisco. She has worked alongside and received mentorship from former ASRM presidents Dr. Hugh Taylor and Dr. Marcelle Cedars. Ahmad's work has been published extensively in academic literature and internationally on various topics related to infertility, reproductive and hormonal health, gynecologic malignancies, and patient safety.  Ahmad has been recognized by Entrepreneur magazine and Fierce Healthcare on their Women of Influence lists and named to Business Insider's 30 under 40 in Healthcare list. She has also spoken at The World Economic Forum and has been featured in The New York Times, the “Today” show, “Good Morning America,” NPR, CNN, USA Today, Women's Health, and more. Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author. Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can't imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, I talk with orthopedic surgeon and sports medicine specialist, Dr. Jervis Yau, MD. We discuss a wide range of topics including hip impingement, rotator cuff tears, PRP and stell cell injections and ACL recontructions. Dr. Yau has a particular interest in minimally invasive techniques of the shoulder, knee, hip, elbow and ankle, as well as joint preservation and cartilage restoration procedures. He has published articles in peer-reviewed publications, books and orthopedic presentations dedicated to sports medicine and orthopedic conditions and treatments. Dr. Yau graduated from the University of California, San Diego and completed his Doctor of Medicine at New York Medical College where he was elected to the Alpha Omega Alpha Honor Medical Society. He completed his orthopedic surgery residency at Yale New Haven Hospital, Yale University School of Medicine, followed by his sports medicine fellowship at Sports Orthopedic and Rehabilitation (SOAR). If you enjoyed this episode, please consider leaving a 5-star review for my podcast. It really helps the podcast build momentum and reach more people.  Click HERE to learn more about Dr. Yau's clincial practice in Santa Barbara, CA. Click HERE to learn more about my book. 

Why are we so afraid of facing death? What's it like to regularly see death and dying as an aspect of your work? Is there a better way to die? In this week's episode, I talk with Nathan Patti, a BU School of Theology graduate and chaplain resident at Yale New Haven Hospital. We discuss Tillich, drug addiction, chaplaincy, and what it means to be "called."

Audible Bleeding editor Wen (@WenKawaji) is joined by second year medical student Nishi (@Nishi_Vootukuru), 3rd year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes) and JVS-CIT associate editor Dr. O'Banion (@limbsalvagedr) to discuss two great articles in the JVS family of journals regarding endovascular management of acute limb ischemia and ultrasound-based femoral artery calcification score. This episode hosts Dr. Thomas Maldonado (@TomMaldonadoMD) and Dr. Raul J. Guzman, the authors of the following papers:   Articles:   Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia by Dr. Maldonado and colleagues. An ultrasound-based femoral artery calcification score by Dr. Raul Guzman and colleagues.     Show Guests: Dr. Thomas Maldonado is the Schwartz - Buckley endowed professor of surgery in the Vascular Division at New York University Langone Medical Center in New York,  Co-Director of Center for Complex Aortic Disease Dr. Raul J. Guzman is the Donald Guthrie Professor of Vascular Surgery, Chief of Division of Vascular Surgery at Yale New Haven Hospital. He is also Surgeon-in-Chief of Vascular Surgery, Heart and Vascular Center for the Yale New Haven Health System. (raul.guzman@yale.edu)   Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.  

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, the Reverend Jane Jeuland discusses what people with cancer should know about the role of chaplains in cancer care, including how chaplains are trained, the type of support they can provide for people with cancer and their family members and caregivers, and how someone with cancer can ask for spiritual support from their health care team. Ms. Jeuland received her Masters of Divinity from Yale Divinity School. She is an ordained Episcopal priest. She received her chaplaincy training from Yale New Haven Hospital and is a board-certified chaplain. She has served as an oncology chaplain and was the first palliative care chaplain at Yale New Haven Hospital. She has no relevant relationships to disclose.  Jane Jeuland: Hi, my name is Jane Jeuland, and I am the palliative care clinic chaplain at Yale New Haven Hospital. I'm here today to talk a little bit about what I do at Yale New Haven Hospital, and also, what is a chaplain? What is it that we offer and provide? How are we trained? And some other questions that people have for us as chaplains. So I'll start by just describing a little bit about what I do at Yale New Haven Hospital in my role. In addition to seeing patients in our clinic, I visit with patients one-on-one through video platforms, phone, and I also visit with patients in person for scheduled appointments. And in those appointments, we get to know each other, we build a rapport and a relationship. And I help people process how they make meaning, find purpose and belonging in their lives, and how that is impacting their cancer care, but also how their cancer is really impacting their meaning, purpose, and belonging. In addition to those individual meetings, I also visit with patients in group settings. I host several groups over Zoom where patients get to talk to one another and share deeply and support each other. And last but certainly not least, I also have started a podcast with my patients called In the Midst of It All, which you can find on Apple Podcasts and Spotify. And in that podcast, patients share their stories that they've written about their lives, about their cancer journey, and about their spirituality, and how that has helped them through all that they're going through. So, how do chaplains get trained? I think this is one thing that people ask me quite a bit. What is your training like? Our training is pretty extensive. We need to have a 3-year Master's degree, typically a degree of divinity. And then after that, we have a year of training called Clinical Pastoral Education, CPE for short. And in that year of training, we are with a cohort of about 4 to 5 other chaplains in training. And we are supervised by a highly trained supervisor as well who has quite an extensive and long process to get certified to do that. And what our supervisors do is they help us really go out, visit with patients, and then reflect on those visits. We do things called “verbatims.” So what is a verbatim? When we write up a verbatim, we're writing up word for word an interaction that we have with a patient. And obviously, we will keep the patient confidential. But we do this with our group and with our supervisor to really kind of drill down and see where are the places that we are inserting ourselves, our own beliefs, our own needs, and how can we really better meet the patient where they are? We talk a lot about positive use of self so that we become really aware of our own self in the midst of our interaction with patients. And over the course of the year, we really learn how to focus on the patient's spirituality, their beliefs, their values, what they need in that moment. And we're all about helping people discover their spirituality and their faith. I think sometimes a lot of people think that we might be coming in to convert someone or to make them believe a certain belief system or a certain religion. But actually, we're really here to help any patient and caregiver really figure out what it is that they believe, and how that's impacting their cancer care or how their cancer is impacting their beliefs. So that means that we do visit with people of all different faiths. We visit with people who are atheists and agnostic as well. And really, again, just try to help people discover, what is that value that you have? What are your beliefs? Where do you find meaning, purpose, and belonging? And so what are some things that come up as we meet with patients? I, again, work in palliative care in the clinic settings. I'm outpatient. But a lot of chaplains work inpatient in a variety of settings. And so you'll have chaplains in a medical intensive care unit (ICU), or you'll have a chaplain in an infusion suite or on a floor as well. And so we see patients at all different stages. We see patients who are just newly diagnosed and have a cancer that's highly treatable. We see patients who are doing really, really well on their treatments. And we also see patients who are starting to kind of struggle with lots of symptoms, pain through sometimes months or years of cancer treatments. And then on the other end of this spectrum, we see patients who are very advanced in their cancer, have a terminal diagnosis, and we really see them through all that that entails, the outpatient visits as well as the inpatient, and even as someone comes to the end of their lives. And so what can come up in our meetings as I meet with patients? When someone's diagnosed with a terminal diagnosis, there is a lot of discussion about fear of dying, what happens in the process of dying, and then also, of course, what happens after we die? What is there after we die? Is there anything after we die? Or what is the afterlife like? And so often, again, I try to help people really reflect on what they may think the afterlife is like, if there is one. And then we have rich discussions around that. For kind of that big question of what happens as we're dying, that's when I like to pull in other members of the team. But certainly, chaplains can help process that as well. We also really do help people articulate their thoughts about the divine and whatever name they give to the divine. And often, what I hear in my appointments is not so much, “Is the divine as God giving me this cancer?” but, “Why would God allow it?” So as I talk with folks, folks will say, "I really believe in a loving God and a God that heals and a God that helps us. Why would a God like that allow me to have this cancer? Why would God allow my loved one to have this cancer and for their lives to be taken far, far too soon?" And for that, it's a tricky one. We, as chaplains, don't have a pill that we can give you and send you home and say, "OK, here's your prescription. Take that, and you'll get all the answers to why would God allow this?" So it's really a process of talking through this. It's a process of kind of discovering a little bit more about what we believe God is, what the patient believes about God, and God's character in the midst of it all. And it's also just sitting in the mystery of it that we don't know. We don't know why a loving God would allow this, why a God that heals would heal some people and not others, why a God who heals would heal at this point in your life, and then not at a different point in your life, and why this happens at all. And so chaplains don't rush quick to give advice. We allow sitting in that grief, in that suffering, in the sorrow. But then again, as we talk about who is God for this person, I also like to help people see, OK, if God isn't healing right now, if we can't understand why God is allowing this to happen, where is God in the midst of it? And this is what I love about my job so much is that I hear from such a variety of faiths and people of different values and spiritualities, how they do see the divine working in their lives. And so for some, "I have a lot of pain, but I know that God is with me, and I don't feel alone in this." Or, "I was feeling grief and loss over a loved one and wondering what my afterlife's going to be like as I face the end of my life and I was having this turmoil. And all of a sudden, I felt this deep, deep, deep peace wash over me. And I feel like that might be God." Or for someone who maybe doesn't have a particular religion, they may say, "I know that the love of my family and friends is so powerful. It's helping me through this. It's getting me through the dark times. And I know that that is what holds us together. And it's more than just what we can see and taste and feel, that that love is something greater and bigger." So it's really rich conversations like that that I get to have. I think also some other topics that come up is cancer is grueling. Cancer, it can be long. And there are things, people talk about scan anxiety. Of course, the side effects and physical pain. I hear a lot about insurance and how that's just so difficult and such a struggle to get on the phone, talk about insurance when time is so precious and so short. And for others who are healing from cancer, it sometimes is a lot of conversation about, "Well, how do I get back to life? And I used to do this amazing job, but I don't think that I can do that anymore. I don't have the stamina. I don't know how I would be able to do that job." And so I help people process that a lot. And again, that goes back to how do we find purpose in life, that meaning, purpose, belonging. And a lot of us find our purpose in work, in what we do. And so chaplains can help people through topics like that as well. And for survivors, we're always so happy in our palliative care clinic to help people heal. A lot of people think palliative care is just end of life. It is not. I have a lot of survivors I meet with, and they'll talk about kind of always looking over their shoulder. Is it going to come back? And finding a way to give back and to help other patients. And that is something I really love helping people with is, how do we give back? What are some ways to help others after I've had cancer? How can I help people? And so I have to say, I've been really, really privileged in my work as I meet with patients and individually in groups and help them write their stories and read their stories and interview on the podcast. I've just been so, so struck by all of the beauty, the resilience, the strength that I hear, the really depth and the richness of people's spirituality as they go through cancer care and really do some hard work to unpack and process all that's going on. And some of the common themes that I've heard is people will talk about how cancer has completely changed their perspective. And so people will talk about how before they had cancer, they were focused on their wonderful job, but also the pay and making sure they get ahead and can have stuff, that newest car or that bigger home. And when they have come through cancer and all that that entails, they start to think, "Gosh, you know what? I like those things, but what's much more important is the people that are right in front of me. It's the things that are free. It's time. It's talking with a loved one. It's really sharing deeply what's on your heart and mind, knowing that time is precious." And so I really am so struck by some of the things that people will share with me about their loved ones, their caregivers. If you are a caregiver, you know that you are loved, and that everything you're doing is really helpful and so, so appreciated, and that the time that you spend together and the things that you're able to share is so important. It doesn't have to be a big trip or people think about bucket list things, and it doesn't have to be all that. It's sometimes just that conversation over coffee or as you're going to sleep at night, those words that are shared are so important. And so people's perspectives, I think, really do shift and change and deepen. And people also find God in the midst of everything that they're going through. I had a patient who heard stories on the podcast and said, "I really want to write my own." So we worked together. And we talked a lot about her faith, and she wasn't really sure what to believe. She had had a hard time growing up in terms of her spirituality. And through her writing, and also through her cancer journey, she was able to really articulate her sense of God as a loving companion to give her peace, not one that's punishing, but a God that's loving. And now, as she comes to the end of her life, she's really finding a great more deal of peace, thinking about God and knowing that God is with her. I think as I share stories like these, though, I'm always so mindful, too, that I think in our culture, we think a lot about things being 5 easy steps. You can do this, and you can get better, and you can find insight and meaning in 5 easy steps. And it's really not that. It's really a process. And so as you hear stories from other cancer patients who may be in that place of peace and accepting and belonging and you're not there, also know that they were not there at a certain point and that it is a process, and it does take time. And so, again, that's what chaplains are really here for. We're here to help unpack a lot of that, to help people process that. And so you might be actually wondering, "You know what? I am going through a lot of cancer care here where I am, and I really would actually like to talk to a chaplain. How do I do that?" So the best way is to simply ask for a chaplain. We're most often called chaplains, but sometimes we're called spiritual counselors, spiritual care providers. So maybe a different term where you're located. But you can ask a nurse, your oncologist, anyone on the team, your social worker, to contact a chaplain. There are different levels of care in different settings. So you may have a chaplain in an outpatient setting, but maybe not. And so most likely, most hospitals have inpatient chaplains. If you are outpatient, though, and you really want to talk to a chaplain, I still encourage you to ask for one. And in that case, call the spiritual care or chaplaincy department directly, and you should be able to do that through your information line in your hospital. But in the hospital, for the most part, the hospitals have inpatient chaplains. Many have 24/7 on-call chaplains. And so always don't hesitate to ask the nurse, and we're happy to come by. We also do provide support for families. And so this is something that we do quite often, especially in the inpatient setting, in an ICU setting, at those times when decisions are being made. What should we do? What we often call in our hospital setting “goals of care” conversations. What is the goal of care here? Are we going to continue with aggressive interventions? Are we going to start to move to aggressive comfort care? And so chaplains help talk through that as well. So you can always call or ask for a chaplain when you're inpatient, certainly when those decisions are being made. And we're there for you as a patient, but again, we're also there for your caregivers, your loved ones. And in those settings, we're often meeting with families sometimes outside of the room even. And we help your loved ones process as well. Just like I've mentioned, all the other things that I help patients process, we also help caregivers with a lot of those topics. In addition, of course, for a caregiver, we sit with them in the pain and the suffering and the loss and the anxiety, and talk through their ways that they find meaning, purpose, and belonging, and how they're processing all that's going on with their loved one, who's the patient. I've heard from more than one patient that they say, "I feel like as hard as cancer is, it's easier on me than it is on my loved one. I hate to see what they're going through. I sometimes feel like a burden." But whenever I talk to a caregiver about that, they always say, "Absolutely not. You're not a burden. I wouldn't want to be anywhere else in the world." If they're sitting there in the ICU, long hours, surviving on coffee, very little sleep, lots of interruptions, sleeping in a chair beside your bed. Every single time, those caregivers will say, "I would not want to be anywhere else in the world. I want to be here. This is what I want to be doing." If you're the patient, feeling like a burden, know that more often than not, your loved one is really wanting to do what they're doing. But caregiver burnout is real, too, especially if your care is going on for a long, long time. And so chaplains can help caregivers process that burden. And we also work with the team, sometimes social workers and others to find support systems so that if they need help, so that they can just have a moment to themselves, go for a walk, that we can help them think about resources that may be their faith community, their church, their synagogue, their mosque, their faith community can come and help give that relief or that respite for them, but also other resources in the hospital. So you may have an integrative medicine component. So I hope that you've been able to learn a little bit more about chaplains, about how we're trained, about what we typically hear from patients, and what we can provide support around. How we also support caregivers. We are inpatient, we are outpatient, we are 24/7 most often, and how you can get in touch with a chaplain. I really encourage you to reach out to a chaplain. We're always happy to help. It's what we're here to do. So thank you so much for having me on the podcast today. It was really a delight to be here. And I hope you have peace. I hope that you find strength, meaning, purpose, and belonging in the midst of it all. ASCO: Thank you, Ms. Jeuland. Learn more about the role of chaplains at www.cancer.net/palliative. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

 Recent advancements in treatment and a multimodal approach to care are improving outcomes for patients with head and neck cancer, however access to therapies and unique patient challenges due to disease symptoms, difficulty eating, difficulty communicating, and other psychosocial factors can reduce patient quality of life. In this episode, CANCER BUZZ speaks with Angelea Bruce, RD, CSO, OPN-CG, registered dietician and head and neck program navigator at Sharp Memorial Hospital and Brittney Watts, RN, head and neck patient care coordinator at Yale New Haven Hospital, about the importance of head and neck nurse navigation and how a dedicated navigator can help address these unique patient needs and improve care for patients with head and neck cancer.  “I think looking at it through the eyes of the physicians, the health insurance, the organization [cancer program], and looking at what are the patient outcomes, success rates, delays in care, survivorship...I think those are important metrics to monitor and we [as head and neck patient navigators] can let a program know whether the patient's needs are being met.” –Angelea Bruce, RD, CSO, OPN-CG “Having a specific nurse coordinator for the head and neck community is vital to the patient's journey within the entire process. This is the point person for the patient, for the providers, and you are the connection for the patient to the healthcare facility.” –Brittney Watts, RN Guests Angelea Bruce, RD, CSO, OPN-CG Registered Dietician, Head & Neck Program Navigator Sharp Memorial Hospital San Diego, California   Brittney Watts, RN Head & Neck Cancer Patient Care Coordinator Yale New Haven Hospital New Haven, Connecticut  This episode, developed in connection with the ACCC education program Multidisciplinary Approaches to Head and Neck Cancer Care, was made possible with support by EMD Serono. Additional Reading/Sources Multidisciplinary Approaches to Head & Neck Cancer Care Head and Neck Patient and Caregiver Resources  

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Paul Feuerstadt MD, FACG, AGAF C. difficile is a major problem in the United States. On top of that, patients who are diagnosed with this infection have the chance of getting caught in a vicious cycle of recurrence. So how can we provide our patients with the best care and work with them to give them the best treatment option? Learn more with Dr. Peter Buch as he takes a deep dive with Dr. Paul Feuerstadt, Assistant Clinical Professor of Medicine at Yale-New Haven Hospital.

Curious about how to find an egg donor, sperm donor or surrogate? Gail Sexton Anderson, the visionary behind Donor Concierge, addresses all of these questions and provides insights about how  the process operates and who covers expenses.     Donor Concierge assists clients requiring third party fertility (aka donor or surrogacy support) in their family building journey. Choosing someone outside your family to enable your family to grow can be really complicated and emotional and together we explore all these nuances.  Gail and her team are dedicated to supporting clients through every step. If using a donor or a surrogate is on your mind, this episode is not to be missed—it's brimming with vital information.   IN THIS EPISODE: [2:51] Gail explains what services the Donor Concierge provides and defines language used in the field [6:36] Gail shares the details of how Donor Concierges operates, how they assist clients navigating through the donor field and what clients are looking for in their search [18:06] There are three types of searches: egg donor, sperm donor and surrogacy search. What kinds of information are shared, and what are good reasons for openness in the process rather than anonymity  [26:59] Where are surrogates found, and what are the trends [35:44] What is the future of the way fertility and third-party fertility are supported, and are there legal issues  [42:37] When should an intended parent seek the Donor Concierge [46:15] Gail shares what family means to her   KEY TAKEAWAYS: Finding the correct egg or sperm donor cannot be overstated. It does make a difference because an egg is not just an egg, and sperm is not just sperm. Every egg carries genetic information that forms who your child will be one day.  Multiple things can and do go wrong in the process of building a family through egg and sperm donation and surrogacy. Having a firm like Donor Concierge on your side is beneficial because they walk through those difficulties with you.  The process of egg and sperm donation or having a surrogate is not just a means to an end. It is your child's story; it is your family's story. Open communication is essential, and anonymity should be a thing of the past. There is too much information lost when anonymity is a factor.    RESOURCE LINKS: Stork'd - Facebook Stork'd - Instagram Stork'd - YouTube  Donor Concierge - Website   BIOGRAPHY:  Gail Sexton Anderson has dedicated her career to helping intended parents from all walks of life build families. She founded Donor Concierge as a compassionate approach to helping intended parents sort through the gauntlet of egg donor, sperm donor and surrogacy options. Gail is a Harvard-trained counselor with 25 years of experience helping intended parents have the baby they always dreamed of.   After graduate school, Gail joined a research group in the Psychology Department at Yale University. Later, she joined a group of researchers in pediatric neurology at Yale New Haven Hospital doing developmental testing with children born prematurely of very low birth weight. Gail is also a graduate of Alice Domar's Mind Body Fertility Program through Boston IVF and has served on a Radcliffe panel with other fertility experts. In her career in the fertility industry, Gail has been the Executive Director of one of the leading surrogacy agencies and helped start two different egg donor agencies. Gail is an empathic listener who brings a calming influence to what can often be an emotionally stressful process.

Joining us on Well Said is Dr. Paul Desan, Director of the Psychiatric Consultation Service for Yale New Haven Hospital, Associate Professor at the Yale University School of Medicine, where he leads the Winter Depression Research Clinic and co-founder of Pursuit of Happiness Project, a nonprofit, data-driven enterprise that provides science-based information on life skills needed to fight depression and experience greater psychological well-being. Dr. Desan will be talking Seasonal Affect Disorder, also known as SAD, a condition that can for periods of the year affect how we feel, think about ourselves, and interact with others.

Listen to our episode on Diagnosis of Acetabulum Fractures as Dr. Leslie gives us an excellent overview. Click here for show notes Michael P. Leslie DO, FAOA, is an orthopaedic surgeon who specializes in the care and treatment of patients with complex orthopaedic injuries and complex hip replacement needs. He has particular expertise in hip reconstruction, replacement and revision surgeries. He cares for patients in collaboration with the multidisciplinary trauma team at Yale New Haven Hospital. Dr. Leslie chose his field because he wanted to help people of all backgrounds and situations manage traumatic events, which can be among the most difficult experiences they will face. “I am able to provide a calm presence and bring the skill of many subspecialties to the patient,” he says. Dr. Leslie said he became a doctor of osteopathy—a specialist who treats patients using a holistic approach to patient care—because it allows him to take into account every aspect of his patient's condition. He believes this is especially important in trauma, where patients often have medical problems in that need to be addressed in addition to their injury. Goal of episode: To develop a baseline knowledge on the diagnosis of acetabulum fractures. In this episode, we discuss:  Anatomy Mechanism of injury Associated injuries Physical exam Imaging Evaluating Xrays AP + more Enjoy!

Welcome to the Derm Club Podcast, where I recently had the pleasure of hosting Dr. William Damsky, a leading figure in cutaneous sarcoidosis. In this session, Dr. Damsky, from Yale New Haven Hospital and a recipient of the American Academy of Dermatology's Young Investigator Award, shares his extensive knowledge on sarcoidosis. We dive into what cutaneous sarcoidosis is, its causes, and risk factors like genetics and environmental exposures. Dr. Damsky also sheds light on the intriguing roles of epigenetics and occupational factors in sarcoidosis. Join us for this insightful conversation exploring the complexities and current treatments of this multifaceted autoimmune disease. Please SUBSCRIBE to the Derm Club Podcast wherever you like to listen whether on YouTube, Apple, or Spotify. Together, let's explore the fascinating secrets of dermatology and skincare. Connect with me across Social: Twitter: https://twitter.com/drhankopelman Instagram: https://www.instagram.com/doctor.han/ TikTok: https://www.tiktok.com/@drhankopelman Blog: https://www.hannahkopelman.com/blog/ The content of this podcast is for entertainment and educational purposes only. This content is not meant to be a substitute for medical advice or treatment for any medical condition. --- Send in a voice message: https://podcasters.spotify.com/pod/show/hannah-kopelman/message

Dr. Nojan Bakthiari graduated from New York University College of Dentistry in 2011, followed by a 1-year General Practice Dentistry Program at Kingsbrook Jewish Medical Center. He then completed a 2-year CODA-accredited Orofacial Pain program at New York University College of Dentistry. He started a private practice part time while teaching part time at Yale New Haven Hospital, Oral Surgery Department. Later on, he led the Orofacial Pain didactic and clinical curriculum at the University of Connecticut, School of Dental Medicine. Currently, he has an academic appointment at Columbia University but spends the majority of his time in his own private practice. His practice is one of the few ones which from it's inception was limited to evidence-based care of temporomandibular disorders, orofacial pain and associated headaches. He also serves on the Board of Directors at the New York University Dentistry Alumni Association and the Executive Council of the American Academy of Orofacial Pain.

For Chris O'Connor, becoming president and CEO of Yale New Haven Health was something of a homecoming. “I was born at Yale New Haven Hospital,” O'Connor told the CBIA BizCast. “I was a little premature, so I needed their special care unit and grew up here in New Haven.” He joins the CBIA BizCast to share his story and what is ahead for the health system.

Dr. John Krystal is McNeil Professor and Chair of Psychiatry at Yale and Yale-New Haven Hospital. He studies the neurobiology and treatment of psychiatric disorders. He directs the Yale Center for Clinical Investigation, Center for the Translational Neuroscience of Alcohol, and Neuroscience Division of the National Center for PTSD. Today on the show we discuss: The biggest risks people are overlooking with cannabis, why cannabis can be harmful for the brain and increase your risk of psychosis or schizophrenia, Dr. Krystal's thoughts on how cannabis impacts mental health and PTSD, why maintaining a healthy lifestyle is so important for your mental health, why cannabis is so addictive, whether or not the brain can heal itself after coming off cannabis and much more. ⚠ WELLNESS DISCLAIMER ⚠ Please be advised; the topics related to health and mental health in my content are for informational, discussion, and entertainment purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your health or mental health professional or other qualified health provider with any questions you may have regarding your current condition. Never disregard professional advice or delay in seeking it because of something you have heard from your favorite creator, on social media, or shared within content you've consumed. If you are in crisis or you think you may have an emergency, call your doctor or 911 immediately. If you do not have a health professional who is able to assist you, use these resources to find help: Emergency Medical Services—911 If the situation is potentially life-threatening, get immediate emergency assistance by calling 911, available 24 hours a day. National Suicide Prevention Lifeline, 1-800-273-TALK (8255) or https://suicidepreventionlifeline.org.  SAMHSA addiction and mental health treatment Referral Helpline, 1-877-SAMHSA7 (1-877-726-4727) and https://www.samhsa.gov Learn more about your ad choices. Visit megaphone.fm/adchoices

Join Kristine Olson, Director of Work-life Well-being Analytics at Yale New Haven Hospital, and Mike Ivy, Deputy Chief Medical Officer, in this episode of the Becker's Healthcare Podcast as they dive into their innovative efforts to combat physician burnout at Yale. Discover the insights they gained during forum discussions, explore the strategies that have proven most effective in recruiting and retaining top talent, and get an exclusive sneak peek into what's on the horizon for Yale New Haven Hospital. Tune in for an enlightening conversation on healthcare workforce well-being and the future of this renowned institution.

* Hamas' Brutal Attack on Israel Provokes New Cycle of Bloodshed and Vengeance; John Nichols, The Nation magazine's National Affairs correspondent; Producer: Scott Harris. * Azerbaijani Military Operation Succeeds in the Ethnic Cleansing of Nagorno-Karabakh; Sharon Chekijian, MD, MPH, associate professor of Emergency Medicine at Yale New Haven Hospital; Producer: Scott Harris. * Major ‘Stop Cop City' Protest Action Planned for November 10-13; Jamie Peck, a Stop Cop City organizer; Producer: Melinda Tuhus.

Welcome back to Analyze Scripts, where a psychiatrist and a therapist analyze what Hollywood gets right and wrong about mental health. Today, we are analyzing the 2007 film "Awake." This movie stars Hayden Christensen, Jessica Alba and Terrence Howard. There is a nefarious plot to kill Clay who finds out during surgery. According to our guest, Dr. Gonzalez from the Yale Anesthesia Department, Clay experiences intraoperative awareness AKA "awareness" during surgery. The movie is filled with plot holes and some pretty inaccurate medical information. We learn so much from Dr. Gonzalez about anesthesia and patient pain. PTSD, medical factiods and financial stressors are topics in this episode. We hope you enjoy! Dr. Gonzalez Podcast Episode on Interoperative Awareness Website TikTok Instagram Dr. Katrina Furey, MD: Hi, I'm Dr. Katrina Fieri, a psychiatrist. And I'm Portia Pendleton, a licensed clinical social worker. And this is Analyze Scripts, a podcast where two shrinks analyze the depiction of mental health in movies and TV shows. Our hope is that you learn some legit info about mental health while feeling. Portia Pendleton, LCSW: Like you're chatting with your girlfriends. Dr. Katrina Furey, MD: There is so much misinformation out there, and it drives us nuts. And if someday we pay off our. Portia Pendleton, LCSW: Student loans or land a sponsorship, like. Dr. Katrina Furey, MD: With a lay flat airline or a major beauty brand, even better. So sit back, relax, grab some popcorn and your DSM Five, and enjoy. Welcome back for another very exciting episode of Analyze Scripts. As part of our Halloween month today, we are covering the 2007 thriller mystery movie called Awake with our wonderful guest, Dr. Antonio Gonzalez. And I cannot think of anything scarier than being awake during a surgery, so this is perfect for our Halloween month. But just as a quick bio, dr. Gonzalez is an associate professor of anesthesiology and the director of the Obstetrics anesthesia Fellowship at Yale New Haven Hospital. He completed his residency program at Rutgers in New Jersey and decided to pursue a fellowship in obstetric anesthesia at Columbia University in New York. And I will actually be joining one of his podcasts in the near future to talk about eternal mental health and anesthesia, which I'm really excited about. But thank you so much, Dr. Gonzalez, for joining us. Dr. Antonio Gonzalez, MD: Thank you so much for the invitation. I'm really happy to be here with you today. Dr. Katrina Furey, MD: So, Portia, where do we even get started with this movie? Have you seen it before? Portia Pendleton, LCSW: I have not seen the movie ever. I think that something like this would probably have been a little scary to watch. Yeah, I think a lot of people who are not in medicine and maybe people who are in medicine, I think it's a common fear to wake up during surgery. I think a lot of people going in get really calmed down once talking to the anesthesiologist or telling them that this is their process or this is. Dr. Katrina Furey, MD: How it's going to be. Portia Pendleton, LCSW: And all of the machines and monitors that they now have, you were saying a little bit before we got started today. So I think this is just like a pretty common fear that people have going into surgery. Dr. Katrina Furey, MD: What do you think, Dr. Gonzalez? Dr. Antonio Gonzalez, MD: Yes, I think that definitely introvertive awareness. It's definitely a fear of our patients. And unfortunately, this movie actually may have hyped that fear. But fortunately, the reality is that introvertive awareness is relatively rare, particularly these days. We have way better medications, way better monitors that help us to prevent intraperative awareness. The incidence has been documented to be somewhere around 0.1% to 0.2% in the United States. Dr. Katrina Furey, MD: So what is that, like, one to two out of 1000 cases? Something like that? Dr. Antonio Gonzalez, MD: That is correct, yeah. Because there are so many surgeries in the united States, that's about 20,000 to 40,000 cases a year, which still a lot. Right. The consequences of interoperative awareness can go from just having fear of future surgeries, even withholding surgeries for some of their relatives, particularly their kids, because they are so scared of what happened to them, they may actually be very fearful of letting their relatives go through surgery. Yeah. So that is one of the consequences. But, again, it's relatively rare these days. Dr. Katrina Furey, MD: Okay. Dr. Gonzalez. Portia Pendleton, LCSW: Is there anything in common. Dr. Katrina Furey, MD: That the people who this happens to. Portia Pendleton, LCSW: With each other, or is it just kind of like yeah. Dr. Katrina Furey, MD: Is there, like, a way to predict it that it could? Dr. Antonio Gonzalez, MD: So we don't have particularly great ways of predicting who will have operative awareness. We do know that there is a certain patient population or certain surgeries. So there are surgeries like trauma, cardiac surgery, and Obstetric. Anesthesia. Obstetric cases seem to be and when I mean Obstetric cases, Caesarean deliveries, particularly. These are cases that are very well known to have an increased risk of intraperative awareness. The reason behind it is because trauma patient and cardiac patients have a very delicate hemodynamics, meaning their blood pressure, it's low, tends to be on the lower side. They have a high risk of coronary vascular disease. So having their blood pressure too high or too low, it's at extreme risk. So in order to maintain that balance between the anesthesia that it's provided and the hemodynamics, those patients tend to be at a higher risk. And that implies for both trauma patients and cardiac patients. Now, the Obstetric patient population is at increased risk because of the risk that the anesthesiologist may perceive from the drugs transferring to the baby. So all the medications we give to mom will go to baby, and that increase in medications has been thought to be pretty dangerous to the baby. So anesthesiologists at some point, we're very scared of giving extra medications to mom nowadays. Again, I think that because our monitoring and the drugs that we have available and the awareness that introvertive awareness in this particular patient population, it's higher, we have improved the techniques that we have for providing general anesthesia. Now, that being said, we do a lot of our anesthesia under regional, and having pain during a surgery, even with epidural or a spinal, can be equally as scary, if not even more scary than having introvertive awareness while asleep. Dr. Katrina Furey, MD: I was wondering that. So, before we get into this a little further, I just want to give a quick recap of the plot of this movie. So, in the movie Awake, we see Hayden Christensen playing the main character, Clay Bearsford Jr. Who is, like a fancy pants financial person, super uber rich. He does something with stocks, probably, that I don't understand. And you see this interesting relationship with his mom early on, who's played her name's Lilith, and she's played by Lena Olin. And then we see Jessica Alba. This is one of her big roles, playing Sam Lockwood, who's his fiance. They get married very quickly because he is waiting for a cardiac transplant due to history of cardiomyopathy, which is something that happens. That seemed pretty accurate. And then we see Terrence Howard playing his friend and surgeon, Dr. Jack Harper. And spoiler alert, turns out all of the medical professionals on the team, including his fiance, were in on this plot to murder him during the transplant in order to inherit all his money and pay off some malpractice debt. Luckily, I think it was the anesthesiologist. The original one backed out. So this other guy was there, and somehow he figured out the plot, and he alerted authorities. And eventually, I think Dr. Harper injected the heart with adriamycin. I believe the Clay did, I guess, technically die on the table. When they delivered that news to his family, the mother committed suicide. I can't remember what she overdosed on. I'm assuming maybe Digoxin, which was in his bag. And then they wheeled the mom in and gave him her heart. And so he survived, and all the people got arrested. The end. That's basically the plot. Really quick. So getting back to what you were saying, Dr. Gonzalez, about the intraoperative awareness. So when you were saying that with these certain cases, trauma, cardiac, and OB with regional anesthesia, I'm thinking like an epidural, like for a C section or something like that. Like, if they give the epidural and it fails either in a C section or a regular delivery, vaginal delivery, would that be considered interoperative awareness? Dr. Antonio Gonzalez, MD: Well, if the patient is experiencing pain, yes, that can be as traumatic as experiencing intraperative awareness, because the patient mentally is completely there, but the patient is completely feeling the experience of the pain. And the definition of pain, actually, it's not only physical, but there is an emotional component to pain. Right. So what you describe as pain, you can only be the person that knows what pain is for you. So what we've learned through the years is that we are not the best judge of what pain is. The patient is the best judge of what pain is because pain is what the patient tells you pain is. Portia Pendleton, LCSW: I'm so glad you said that. Dr. Katrina Furey, MD: I think that's really important and to keep in mind the emotional side of it. Portia Pendleton, LCSW: I like that also, just as I don't know a similarity right. In mental health, like pain mental pain, emotional pain is, like, what the patient is describing versus my definition in the DSM. But I really like that. Or just validating their experience. Well, this is what they experienced. Maybe someone else's was different. Dr. Katrina Furey, MD: Right. Portia Pendleton, LCSW: I really like that. Dr. Antonio Gonzalez, MD: Yeah. I think that it's a great opportunity, because, as you mentioned, sometimes if, as physicians, we try to give an explanation to pain, right. We may actually minimize the patients. And at the end of the day, what ends up happening is that the patients feels that their feelings, they're being gaslighted. So the patient is telling you, this is what I feel, and you say, well, it's not that big of a deal. Right. But it is to the patient, it is. So pain is, again, what the patient tells you pain is. Dr. Katrina Furey, MD: No, I think that's great. And in my line of work, in private practice, I do end up seeing well, I see primarily women around pregnancy and postpartum. So I've heard many cases where the epidural failed, or it only took on half the side, or someone had a history of back surgery, so they met with the anesthesiologist ahead of time to talk about pain management options. And it is a super important aspect of prenatal care, especially delivery, and I'm sure that extends to other surgeries as well. So, Dr. Gonzalez, what are your thoughts about the way anesthesia was depicted in this movie? What they get right, what they get wrong? Dr. Antonio Gonzalez, MD: Well, there are so many things that they well, the one thing that they got right was to select the patient that was having a cardiac surgery. As we mentioned, patients with cardiac surgery have an increased risk of having introvertive awareness. So they got that one part right. Then the other thing is that it seems like they have a substitute anesthesiologist that's coming from another institution. It doesn't quite happen that way. You need to have privileges at that place. It's a little credentialed. Yeah. Unless he's a traveler. Sometimes we have anesthesiologists that are considered what is the term? Locums. That's correct, yes. So locums might have been a locums that they call in to substitute, but it's actually quite hard to find locums for very specific cardiac surgery. So I think that the other thing that I think was very wrongfully depicted was how easy he may look. The induction. The induction was basically he took this three CC syringe or four CC syringe. He gave it to the patient. He said, count back to ten. Cardiac inductions are very complicated. It requires a balance of many medications. Again, because there is this hemodynamic balance that you want to maintain. You don't want the patient's blood pressure to go too high. Do you want the patient's blood pressure to go too low? So that also it seems like it was completely off. And there is a point where the surgeons are discussing, like, well, we won't need you for a little bit, so go get a drink. We never leave the operating room. Dr. Katrina Furey, MD: Right. Dr. Antonio Gonzalez, MD: I know there is always somebody from anesthesia in the room that be like the anesthesiologist or anesthetist, but we just don't leave the patient in the or. Just because the surgeon tells us that they're not going to need us for a bit. So that was totally wrong. Dr. Katrina Furey, MD: Right. In my experience in medical school, rotating through that's exactly right. Even these long cases like cardiothoracic surgery, the anesthesiologist, maybe a resident, maybe the nurse, anesthetist. These words are hard to say. Someone's always there watching the monitor. They might be doing something else at the same time. I remember one time there was a resident practicing his golf swing, and I was like, this seems pretty unprofessional. But they're always watching the monitors. And I would imagine like this, especially watching the blood pressure, the heart rate, things like that. And they're always checking. They kept checking, at least in the cases I would be in, they would do things to check. The patient was still under enough. Not too far under. Not coming out of it either. Dr. Antonio Gonzalez, MD: Yes. And as you mentioned, sometimes the anesthesiologist, a lot of what we do, we may not be actually looking at the monitors, but because we're actually trained for so it's a three year program. By the sound of the machines, you actually know what is wrong. Like the pulse oximeter has a very typical sound. When the saturation drops, the alarms on the monitors are set off to go at X levels. Right. So you can set up your alarms. So even if we're like, let's say, fixing our medication drips or we're working on something that it's not necessarily looking at the monitor, just hearing the monitor, we are aware of what actually the vital signs are, and of course, the alarms are ever present. So we're always very aware of these alarms and everything that surrounds. We use pretty much all our senses when caring for patients. Dr. Katrina Furey, MD: That makes a lot of sense. Portia Pendleton, LCSW: It's interesting. I think there was an episode on Grey's Anatomy years ago about the anesthesiologist at the hospital was like, has a substance use disorder. And he was, like, falling asleep next to the patient. And of course, it's a drama, so the young resident had to do something and didn't want to get in trouble by the attending or something. But I feel like I've seen not a lot of medical dramas. I mean, that's not like my jam. But the couple that I have there seems to always be the anesthesiologist is like sometimes a villain. I don't know. Dr. Katrina Furey, MD: Is that a stereotype? Yeah. Is that a stereotype? Portia Pendleton, LCSW: Or like, maybe just in TV, the. Dr. Katrina Furey, MD: Psychopath is often the villain too, so we can empathize. Portia Pendleton, LCSW: Yeah, it seems like it's a lot of risk with that job. Dr. Antonio Gonzalez, MD: I think that psychiatrists, dentists, and anesthesiologist seems to be the highest the physicians with the highest incidence of substance use. Dr. Katrina Furey, MD: Disorder, I believe that's right, yeah. Dr. Antonio Gonzalez, MD: And suicide as well, I think. Yeah. Maybe media has picked up on that. Maybe. Dr. Katrina Furey, MD: Interesting. I think in my training, I was taught that in those specialties, you have the easiest access to controlled substances in terms of the risk of substance use disorders. So that's one reason the rates are higher. And then suicide. I didn't know anesthesiologists also had a high rate of suicide. Dr. Antonio Gonzalez, MD: Yeah. I haven't reviewed the statistics on this, but I think that it used to be that way. I think actually, dentists might be number one. For some strange reason, anesthesiologists are high up in there. Dr. Katrina Furey, MD: One big issue I had with this movie was the plot, because I feel like they went to great lengths to pay off a prior malpractice lawsuit. And I feel like they'd all have malpractice insurance, right? Even if I know there's certain specialties. Like, I think OB, for example, has a really high rate of malpractice insurance. Wouldn't they have malpractice to cover any claims? Dr. Antonio Gonzalez, MD: Yes, they would. Dr. Katrina Furey, MD: Think. And Portia, I think you were reading some criticisms of the movie. I think the general public also caught on to that, like, wow, this is like a really intricate plot to go through to pay off prior lawsuits. Portia Pendleton, LCSW: I don't know. Murdering someone, you have to be so backed into the corner hopeless, like no other options. And it's like, I mean, A, yeah, like, you're right about the malpractice. You should have an insurance through the hospital. You're not even in private practice paying for your own, and that maybe you cut corners with that. It just seems OD that they taking going to these lengths of murdering a patient that Dr. Jack Harper was, like, friend. And it's like, at what point did the friendship turn into this? Was it fake? The whole, like, I think that's know, I watched the movie, you know, taking. Dr. Katrina Furey, MD: Notes because we're professionals. Portia Pendleton, LCSW: We're professionals at watching TV here, and I was just lost with a lot of the line, so I'm glad to hear it know, I guess just me, but pretty gaping holes in some of it. Dr. Katrina Furey, MD: Yeah. And what did you think about that relationship of the friendship between Dr. Harper and Know? Because at least in psychiatry, we are big and not just psychiatry, but mental health in general, we are big boundary people. We really talk about boundaries and how to maintain them, especially in professional settings. I think in some other fields of medicine, I'm thinking more like primary care pediatrics in the old school days when you'd have the family doctor who took care of everyone in the town, I think the boundaries would have been a little different. But I always thought, especially when it came to things like surgery, it was really important not to operate or doing a seizure on people you're close to. Is that still the case? Dr. Antonio Gonzalez, MD: Well, I think it's probably the right thing to do because your feelings for your significant other or friend may actually interfere with your judgment. But again, I think it's more of a judgment call than a set rule. I do think that there are certain surgeries and certain procedures that we probably shouldn't be doing for our family members or for close friends, because, again, our judgment may be cloud by our feelings for that person. You may not necessarily take the best decision when you're put in that place. Dr. Katrina Furey, MD: Yeah, I think suturing up a superficial wound like your child cuts their knee. Oh, I can suture that up real quick. Feels very different to me than doing cardiac anesthesia or surgery on your buddy that you go fishing with. Yeah, right. Yeah, I would agree. Portia Pendleton, LCSW: I could see I was thinking just, like, what would I be comfortable with a friend doing? But maybe I don't know. I mean, I'm thinking of specialties, like, ortho I could see a friend doing but not OB. It's, like, all private, and then definitely not psychiatry, but I don't know. Cardiac surgery? I don't think cardiac no, it's like your heart opening my chest. I don't want you I think it's. Dr. Katrina Furey, MD: Important you feel like you trust the surgeon and the anesthesiology team, but to have it be like your buddy, that's risky. And what an ultimate betrayal. Portia Pendleton, LCSW: I mean, he trusted this person. He chose to have this procedure done by, I guess, at least rating wise, like a doctor with a lower success rate than right. The mom brought in this specialist who was operating on presidents and had all. Dr. Katrina Furey, MD: This prestige play picked Dr. Harper. Portia Pendleton, LCSW: And then right. To have this nefarious plot going on was just I was really shocked. I was also really shocked that Sam was in on it, his fiance, because at first, I think the movie kind of sets you up to not, like the mom. Right. Like, Lilith seems, you know, like, she doesn't have his best interests at heart. Dr. Katrina Furey, MD: It's controlling. Maybe they're enshring and not letting him. Portia Pendleton, LCSW: Live or be independent. Right. But then know, I was like, wow, really weaseled her way in. So I don't but she was a nurse, I think, so she had some info about his medications, which the mom, Lilith, was first, really surprised and pleased. Like, wow, like, you really have been taking care of him. I see all the medications in your bag. But then that's also ultimately how she found out that Sam was in on it. Right. Dr. Katrina Furey, MD: She saw, like, I think Sam left her purse behind, and the medications fell out. And when she went to go put everything back in the purse, she saw some mail where the name didn't match up, and then somehow she put it. Portia Pendleton, LCSW: Together, but that wasn't clear. Dr. Katrina Furey, MD: But again, also like, okay, so the names don't match up. That wouldn't automatically make me think, like. Portia Pendleton, LCSW: Oh, no, you're in on it to. Dr. Katrina Furey, MD: Murder my son while he's in this heart transplant. The plot was a little far fetched, but I did think it was entertaining, and I did know with Clay on the table, often the anesthesiologist is, like, the first person you meet when you're coming in for surgery that day and. Portia Pendleton, LCSW: The first person you see when you wake up. Dr. Katrina Furey, MD: So I think that's very important, as well, to your whole experience of surgery. And can you tell us a little bit, Dr. Gonzalez, about in your role, what that entails and how you sort of take care of the patient in broad strokes. And if this movie we've already talked about how the induction was totally off, but what the movie sort of got right and wrong. Dr. Antonio Gonzalez, MD: Yeah. So I think that the role of the anesthesiologist is very important. And I think that as anesthesiologist, we realize that, as you mentioned, unfortunately, the way our system is, we usually meet our patients just the day of surgery, right? So what that entails is that we actually need to create rapport with our patients very quickly. We know that the patients are coming in for a very stressful moment in their life. Sometimes it's very big surgery, sometimes it's very minor surgeries, right? But independently of what type of surgery the patients are coming for, we need to create that rapport and we need to bring the confidence to the patient. And as anesthesiologist, I think that we try to do that the moment we're talking to the patient. The first time we talk to the patients, it's all about creating rapport and creating a team experience in which you let me know what are your goals and we can try to meet those goals and expectations. What are your fears? Some patients tell you that their major fear is pain. Some patients tell you their major fear is throwing up because all the nausea, they've experienced so much nausea after. So then you can reassure the patient, okay, so this is our plan. This is going to be our plan to address the pain. This is going to be our plan to address the nausea. And again, we do this for all types of surgery. And I think that's very important as anesthesiologist to try to create that rapport and always be, when talking to the patient, basically addressing what are your major fears and how this is our plan to address those. Portia Pendleton, LCSW: That's such an important question. I think such an important part of the team. I think other people are just kind of part of the team, which makes sense. Like, okay, this is a surgery. They ask you a million questions like why are you here? What's your name? What's your birthday? Over and over again. So they're doing the right thing. But then for someone to ask, right, what are you scared of? Dr. Katrina Furey, MD: Right? Portia Pendleton, LCSW: What are you scared of today? How can we help you? Do you have any questions? Is really helpful. And I think just lets see the patient feel like they're a part of the team, like they're being validated, listened to, important, which of course they are. But I think in the system when you have maybe two to five, maybe surgeries that day, it's just like it becomes for everybody that's working, there just procedure. So I think those questions just stand out as really helpful and nice, good patient care. Dr. Katrina Furey, MD: And the anesthesiologist is the person who you really meet at the beginning, who asks you all these questions, checks on your allergies, looks in your mouth to see like, okay, how big are those tonsils? How are we going to sort of intubate? You most comfortably asks you what you're worried about, and then they walk with you in most of the time, and they're with you, getting you on the table, getting you positioned, making sure you're comfortable, saying, okay, it's going to be cold in here, let's put a blanket on. They do a lot of that caretaking right away. I think when people are really scared, even if it's a minor surgery, I don't know who's not scared when they're going into a surgery. And of course, the surgeon comes in and they're really focused on the surgery, and of course, they want to make the experience good, too. But you're usually, like with the anesthesiologist, I think, the longest as you're consciously awake and then coming out of the surgery, that's who's also waking you up and making sure you're okay. That's who's checking on you in post op and things like that. So it is interesting that such an important member of the team and you're right, you really meet them that day and then you don't see them again, right? Like at the follow up for the surgery and stuff, you never get to see them. Is that a part of the job? Do you mind that, or do you wish that you could check on these people again? Dr. Antonio Gonzalez, MD: Well, it's actually very interesting that you ask because one of the things that actually inspired me to become an obstetric anesthesiologist, particularly, was I sometimes felt that I was in these very long surgeries, and when I went to see the patients post op, they would not remember me. And there wasn't really a problem with the patient not remembering me. It wasn't really an ego thing. It was more like, I don't feel like he thinks I'm part of this team taking care of him. I didn't feel like I was part of the team again. But on the other hand, I just happened to see a patient in a hallway and he's like, oh, you did my epidural for labor. And I'm like, oh, I did. And that was like, oh, these patients do remember me. Do appreciate what we're doing. And although, again, it's not an ego thing, but it's just that feeling of being part of something more, like, you know, that you help somebody and they actually remember that you were part of that, alleviating the pain, and it just feels good. It makes you feel like you're really part of a team that addresses the patient's pain and all this. And that's what really brought me into obstetric anesthesia. Going back to what we were talking about, the patients, the pre op part. Again, because of my obstetric anesthesia background, most of the literature that I've reviewed is on that field. And there is a very interesting article that has changed the way I practice that basically addressed what we were just discussing, which was basically, you ask the patients would you rather have better analgesia or more side effects, depending on the dose? And the interesting thing it's a very interesting study, but the outcome of the study was that patients actually knew exactly what they wanted. The patients that were overly concerned about pain ended up consuming more pain medication. And the patients that were overly concerned with the side effects did not consume as many medications. So the patients always know. And that's why always asking your patients, what are your weigh the risk and benefits, or what are your main outcomes? What do you want to experience here? More pain, slightly less pain, slightly more side effects of the medications, or you're okay with pain knowing that your side effects are going to be less? Dr. Katrina Furey, MD: The patients know that's actually really interesting and really important to keep sort of their autonomy and their preferences. So, Dr. Gonzalez, I know you're not like a transplant surgeon, but I thought it was pretty unlikely that the mother would just be, like, wheeled in, especially after having overdosed on something and her heart would be given right to her son. Dr. Antonio Gonzalez, MD: Yeah, absolutely. Dr. Katrina Furey, MD: What do you think about that? Dr. Antonio Gonzalez, MD: Yeah, absolutely. I think you're absolutely right. And at some point, I was hoping to bring that up. First of all, as you mentioned, there is a battery of tests that the donor needs to go through before they can be a donor. Portia Pendleton, LCSW: That's number one blood type, right? Dr. Katrina Furey, MD: It's not just like, oh, it's a blood type match. There's like, so many more things they have to check. Dr. Antonio Gonzalez, MD: There's so many more tests. And it seems from the movie that the mom have actually taken the purse from Sam, right? So presumably she took medications that could have actually make her heart stop. Right, which means that the period of ischemia of the heart may not have make her a good donor for her heart. She might have been able to donate her cornea and other things that actually don't have a very specific ischemia time. But there are organs that have a very limited ischemia time, meaning that the time that the organ is without perfusion or without oxygenation, without blood flow. And that is very important. The heart is one of the organs that needs perfusion for very crucial timing. It's a very small window of ischemia for the heart yes. Dr. Katrina Furey, MD: That she'd take, again, cardiac medication that likely stopped her heart. It does seem like she called her surgeon of choice ahead of time and was like, get here now. We only have so much time. But still, it's just completely unlikely that that would have happened. It was kind of a beautiful, I guess, part of the story that they could both, in this other realm, connect with each other and she could talk to him and they got to say this goodbye. That was pretty beautiful. But in terms of accuracy, there's no way that would have happened. And so getting. Back to the title of the movie Awake, and the whole premise that he's awake in surgery and aware of everything that's going on. I think a fascinating question that comes to my mind is like, how do we define awake? Is it consciousness? Is it memory? Is it feeling? And then how do you assess it during and after something like a major surgery? Dr. Antonio Gonzalez, MD: Yeah, that's a very interesting question. And I was thinking myself the same thing throughout the movie. And at the end, I'm still not even clear that either he was awake. We probably will never know the answer, according to the movie. But interoperative awareness, it's basically the incidence of a failure to suppress arousal, experience and episodic memory. So for you to have recall, in order for you to have introoperative awareness, there has to be recall. There are some incidents of patients actually hearing things, but they may not have necessarily distress about it because hearing and depth of sedation, the depth of sedation goes anywhere from hearing to actually not even being able to have recall. So you're going to see the worst cases of interoperative awareness when there is recall, and the patient can actually tell you how stressed they were about the experience. So they've come up with some classification. It's called the Michigan Awareness Classification, and it goes from zero, class zero, which is basically no awareness, to class one, which is auditory perceptions, class two, which is tactile perception. So they feel the surgical manipulation, they feel the endotracheal tube. And then there is class three, which is they actually feel pain. Class four, they actually have paralysis. And this is what seems to actually be happening here. He's experiencing paralysis because he said, just move something, right? He's trying to move something. He can't move anything. So he probably is there at a class four. Later on, we know that he's definitely at class five, where he's probably experiencing pain and paralysis. And then you can actually assign a D if the patient tells you that it was very stressful. They have the fear, they had fear, they had anxiety, a sense of suffocation or doom. So basically all these classifications, you can actually add a D to them. And the higher they are, and especially if they have a D next to them, the more likely these patients will have sequela. As in your profession, you can probably talk about what happens to these patients that have interpreted awareness. Right? And you were talking about moms that have pain during surgery. So that could lead to post traumatic stress disorder. But I'm not the expert there. Dr. Katrina Furey, MD: I would imagine it would. Right. I would imagine when we think about post traumatic stress disorder, I like to think of that as a disorder of Stuckness. And I always tell my patients, like, it's normal after you've lived through something traumatic, to have the symptoms of PTSD, the hyperarousal, the hyper, vigilance, intrusive thoughts, altered avoidance, altered mood, altered line of thinking and things like that initially, because who wouldn't? We sort of call that an acute stress response. But then once it persists, usually after, like, a month or continues beyond that, then we start to think of it as something called PTSD or post traumatic stress disorder. And there's some really great treatments out there for that, including things like cognitive processing therapy or CPT, EMDR, different types of psychotherapies and medications, and patients can really get a lot better. I love treating PTSD for that reason. But I would imagine the first criterion to meet diagnostic criteria for PTSD is to have a life threatening situation happen to you or to be vicariously exposed to it, which I think is really important as a new addition to the DSM criteria. I think this will qualify. Portia Pendleton, LCSW: Yeah, I'm just even imagining a patient coming in and describing this. I would expect a person to develop PTSD from it, and then it's like. Dr. Katrina Furey, MD: Is that a disorder, or is that, like, a normal human response to being consciously awake but paralyzed during cardiac surgery? Right. Portia Pendleton, LCSW: That's where you're like, well, like, trouble sleeping following. I would imagine maybe some nightmares. Might be afraid to fall asleep 100%. Or obviously, like you were saying before, Dr. Gonzalez, afraid of returning for future medical care or surgeries or telling loved ones to not do it, or their experience. So it feels really serious. And obviously, many traumas can be, but also unique. I haven't worked with someone that this has occurred to, obviously, because it is rare, but I'm just imagining, like, poor Clay when he wakes up, and if he does recall at one of those levels that you described, then what? And also write the murder plot. I mean, that was like taking the cake, let alone feeling pain. Dr. Katrina Furey, MD: I know. Like, such intense pain, right. And being so paralyzed and helpless. I almost can't imagine anything worse. Portia Pendleton, LCSW: He's standing up. We talked a little bit about the dissociation. That being an interesting way to show it. So sometimes when somebody's experiencing a trauma, they might dissociate and kind of see. Dr. Katrina Furey, MD: Themselves from up above. And they did show that when he sort of zoomed out, then it took a turn where he's then solving the. Portia Pendleton, LCSW: Plot, like, walking around, figuring it out. Dr. Katrina Furey, MD: Like, I don't think yeah, that's not quite dissociation, but up until that point. Portia Pendleton, LCSW: It was a great depiction of. Dr. Antonio Gonzalez, MD: It. Portia Pendleton, LCSW: Just it was wild. Dr. Katrina Furey, MD: It was wild. What a wild movie. Dr. Gonzalez, as we wrap up, is there anything else you'd like to add or anything we haven't touched on that you think is important? Dr. Antonio Gonzalez, MD: What it's really important here is for the patients to really voice out their experience. Right. One of the things that we see as physicians, we're not necessarily, particularly not psychiatrists or psychologists, we are not necessarily very well versed in how to deal with the consequences of what happens interoperatively. And it's important for the patients to say, hey, this is what I felt. But equally as important is for physicians to actually avoid minimizing what the patient felt and actually acknowledge that something happened and say, hey, I'm really sorry that you went through this. Let's try to figure out what resources we have to help you to get better, to get through these. It's actually something that I've always wondered is when is the best time to reach out for the patients? When, for example, in our case, we do C sections, right? And the patients are telling us that they're feeling pain, so they actually quickly voice out their experience so we can quickly do something about it. And even then, it's hard to figure out if you should approach the patient, shouldn't approach the patient, because not every patient won't consider a short time of discomfort or pain as traumatic. So it's a thin line in which basically we rely on the patient telling us, this is what I felt, this is how I feel now, so that we can actually look for help again, because as anesthesiologist or, surgeons may not be the best person to deal with it, but we can look for the resources. Dr. Katrina Furey, MD: And I do think, actually, at least in my clinical experience, given what I do, it has been I can tell you without a shadow of a doubt, it has been so validating and healing for my patients who have experienced trauma within previous childbirth deliveries or IVF procedures or other things like that, who felt minimized by the team at the time when they go in for the next thing and their anesthesiologist is the one who asks them just the questions you're mentioning. Now, I'm wondering if it was you. Portia Pendleton, LCSW: Or if you've just trained, like, some. Dr. Katrina Furey, MD: Really good team members. But when they ask them about these things and they share their prior traumatic experience, which is very hard for them, right, like, to even share, period, but then, especially if they've felt minimized or invalidated in the past, when they share it this time, and it's met with compassion and validation, it goes so far in their healing. And so I think you're spot on, and I hope this can serve and your continuing education can serve to just keep reinforcing that to the anesthesiology team that that is really important and such a crucial time to give that validation to patients who might really need it. And I think that would go for any patient, but especially any patient with a history of PTSD prior to that. And that's a hard thing to ask about. Portia Pendleton, LCSW: Yeah, I could definitely see it in pregnancy traumas. I think it's a pretty common experience with just, like, whether or not it's their perspective of something happening. Everything moves fast sometimes, as both of you know, I'm sure if it's supposed to be a regular delivery and all of a sudden it's not like that can be scary. And sometimes you have to prioritize saving a patient so things aren't explained slowly. It's the after of, like, okay, I know. That was really scary. Dr. Katrina Furey, MD: Kind of debriefing. Portia Pendleton, LCSW: Yeah, the debrief I would imagine being really helpful. Dr. Katrina Furey, MD: And we always I think in mental health, we always assume our patients have a trauma history rather than assume they don't. And I don't think that's because there's like I mean, maybe there is a higher incidence given the patients we're seeing. But I think then if you can just sort of approach it in more of like a trauma informed framework and just assume, like, okay, let's just assume this person has had some experience in their life where they felt helpless or stuck or not heard. How do we approach them here so that they don't feel that you don't even have to ask, do you have a trauma history? You could just assume. And then I think that just goes a really far away. So I'm so glad, Dr. Gonzalez, to hear that you're just doing know that makes this psychiatrist very happy. Dr. Antonio Gonzalez, MD: Yeah, well, I think that a lot of it has to do with the fact that some time ago, we actually read this very nice article that came out that was titled Failure of Communication, and it was actually written by a patient who experienced interoperative pain. I actually had the pleasure to have a podcast with Susanna Stanford, who is a patient who experienced introvertive pain, and she shared with us through that paper that was a couple of years ago, her experience. And from the time I read that paper, I started realizing how important that communication part is and not minimizing their pain and actually trying to address the situation in the moment and offering alternatives. Right. The most important thing, as you mentioned, is the patient needs to feel that first of all, they're being heard and that their concerns will be addressed. The worst we can do is tell them that it's not that big of a deal. Baby is okay. That's usually what we hear. Oh, the baby's okay. So it's going to be fine. The means doesn't justify the end. Dr. Katrina Furey, MD: Well, that's wonderful. Thank you so much, Dr. Gonzalez, for joining us today. I think we will try to link to that paper in our show Notes. If anyone is interested in reading that. Portia Pendleton, LCSW: Further and maybe also your podcast, if you want to tell us, give us. Dr. Katrina Furey, MD: A little shout out yeah. Portia Pendleton, LCSW: Where they can find your podcast. Dr. Antonio Gonzalez, MD: Yes, the podcast is Yale Anesthesiology, and I will share the link as well. Dr. Katrina Furey, MD: Thank you. And we want to thank all of our listeners for joining us today. You can find us at Analyze Scripts podcast on Instagram and TikTok. We recently updated our Instagram handle, so now it's Analyze Scripts podcast across the board, and we hope that you will join us next week as we cover the Nightmare Before Christmas on our Halloween month. Portia Pendleton, LCSW: Yes. Dr. Katrina Furey, MD: So we'll see you next Monday. Portia Pendleton, LCSW: Thank you so much for joining us. Dr. Katrina Furey, MD: Bye. Dr. Antonio Gonzalez, MD: All right. Thank you so much for having me. This was great. Thank you. Dr. Katrina Furey, MD: This podcast and its contents are a copyright of analyzed scripts, all rights reserved. Any redistribution or reproduction of part or all of the contents in any form is prohibited. Unless you want to share it with your friends and rate review and subscribe, that's fine. All stories and characters discussed are fictional in nature. No identification with actual persons, living or deceased places, buildings, or products is intended or should be inferred. This podcast is for entertainment purposes only. The podcast and its contents do not constitute professional mental health or medical advice. Listeners might consider consulting a mental health provider if they need assistance with any mental health problems or concerns. As always, please call 911 or go directly to your nearest emergency room for any psychiatric emergencies. Thanks for listening and see you next time. Dr. Katrina Furey, MD: Our don't.

It was nothing short of a miracle. A woman was barely hanging on to life at Yale-New Haven Hospital in 1942. She had been running a fever of 106 degrees for four weeks, and doctors were out of options. A new treatment – never before tried in the U.S. – brought her back to life in less than 24 hours. Hear the incredible story about the first use of penicillin in the U.S. from the Director of Infection Prevention at Yale-New Haven Hospital, Dr. Richard Martinello.

This episode is very personal and special for Arden. She is joined by Gail Sexton Anderson and Gloria Li from Donor Concierge, and together, they explore the invaluable services offered to women aspiring to become mothers. Donor Concierge has played a pivotal role in bringing countless families into existence by serving as dedicated advocates. They collaborate with many agencies involved in sperm and egg donation and surrogacy. This intricate and sensitive process is a remarkable journey of creation. Anyone interested in parenthood or donation will find this episode enlightening and informative.   IN THIS EPISODE:   [01:18] Gail explains why she founded Donor Concierge, and Gloria shares how she became involved [03:36] Arden explains her personal story and asks what are the challenges in finding egg or sperm donors [07:36] What are the realistic expectations of a concierge business in this field [11:59] How Donor Concierge serves the affluent family and answers questions they may have [17:57] Do donors do this for the money and an explanation of the process involved for intended parents [26:09] Are some want-to-be parents excluded from the process [29:29] Discussion of clients who are recognizable by the public or extremely wealthy families, where the field is going in the future, and being open about how your family was created    KEY TAKEAWAYS:   Finding a surrogate, a sperm donor, and an egg donor is not as easy as it may sound. It is a crucial decision, and hiring experts to guide you is best. Affluent parents have the option of a direct search program where they create a landing page to share with potential donors who they are.  Surrogacy allows you to give joy to a mother who otherwise would not have a child.   RESOURCES: Beyond the Balance Sheet Website   Donor Concierge - Website   BIOGRAPHIES:  CEO & Founder Gail has dedicated her career to helping intended parents from all walks of life build families. She founded Donor Concierge as a compassionate approach to helping intended parents sort through the gauntlet of egg donor and surrogacy options. Gail is a Harvard-trained counselor with 25 years of experience helping intended parents have the baby they always dreamed of. After graduate school, Gail joined a research group in the Psychology Department at Yale University. Later, she joined a group of researchers in pediatric neurology at Yale New Haven Hospital doing developmental testing with children born prematurely of very low birth weight. Gail is also a graduate of Alice Domar's Mind Body Fertility Program through Boston IVF and has served on a Radcliffe panel with other fertility experts. In her career in the fertility industry, Gail has been the Executive Director of one of the leading surrogacy agencies and helped start two different egg donor agencies. Gail is an empathic listener who brings a calming influence to what can often be an emotionally stressful process. A frequent speaker at fertility conferences, Gail consults with organizations creating fertility service programs. She is a former board member of SEEDS, The Society for Ethics in Egg Donation and Surrogacy, and the Co-Founder of TULIP, a new online platform for third-party fertility. Married since 1984 with two wonderful children, Gail says having the privilege of being a mother has ignited her passion for helping others experience the joy of parenting.   Gloria Li, BA, PMP Executive Director Gloria is responsible for managing the Donor Concierge, overseeing all aspects of the company. Gloria has worked in fertility since 2013 and is an expert on egg donation, gestational surrogacy, and fertility care management. Her vision, passion for the mission, and attention to detail have set a high mark in our commitment to excellence, and her leadership has helped Donor Concierge become the premier resource for intended parents worldwide.

Have you ever wondered about the hidden truths of the pharmaceutical industry? Well, you're not alone. Today, I had a powerful conversation with Dr. Neda Ashtari, a dedicated resident at Yale New Haven Hospital, who is bravely challenging the Big Pharma. We plunged into the depths of the system and its practices, shedding light on how the drugs are developed, the role of marketing in promoting drug safety, and where all the money actually goes. Neda's personal connection to this fight against Big Pharma and her commitment to the University's Allied for Essential Medicines adds an extra layer of passion and authenticity to our discussion.Delving deeper, we examined the cost implications of the current pharmaceutical system. It's shocking to discover how taxpayer money funds drug development without necessarily ensuring affordability for consumers. The stark reality of how pharmaceutical companies exploit market dynamics to set skyrocketing prices was a topic that we couldn't ignore. As a consequence, we uncover the crisis of unaffordable drugs in the US and the global lack of access to essential medicines. Dr. Ashtari gave an insider's perspective on these pressing issues that will leave you questioning the system as you know it.In the final stretch of our conversation, we zeroed in on the surrogate endpoints, conflicts of interest, and marketing tactics used by the pharmaceutical industry. We also discussed the industry's impact on drug pricing and the public's role in drug development. The most shocking revelation was perhaps the fact that pharmaceutical companies spend more on marketing than on research and development. This episode is a deep dive into the pharmaceutical industry, its practices, and its implications. So, plug in your earphones and join us in this enlightening journey with Dr. Neda Ashtari. Trust me; you won't look at your medicine cabinet the same way again.Check out the shownotes to learn more!__________________Click here to join the exclusive GHP online community!Support the PodcastClick here to send in a one time or monthly donationJoin the Podcast Mailing list: https://www.globalhealthpursuit.com/mailing-list Make sure to follow Hetal on LinkedIn, Instagram and Facebook!Email her at hetal@globalhealthpursuit.com.Thank you so much. We deeply appreciate you.

In 2020, over a 5-month period, 65 women entered The Yale Fertility Center, which is part of Yale New Haven Hospital for fertility care. Their experience can only be classified as horrific. These women were perplexed by their unexplained excruciating pain during the procedure, and even the doctors and clinic staff were unable to provide answers. In the absence of concrete information about the true cause of the pain, patients, families, and even the staff seemed to restore to creating their own narratives to make sense of it. Join us in the first episode of a three-part series exploring How is this Possible?----------------------------------------------------------------------Link to the Patient No Longer Podcast Brandon was interviewed on: Put your mask on first A warrior's tale on how to provide great careNew website: https://www.purposedrivenpx.com/real-nurses-real-talk-podcastInterest form to tell your story: https://form.jotform.com/230685346709060Be sure to connect with us on Instagram:@realnurses_pcSend questions, topic ideas, and/or comments to realnursespc@gmail.com.

Are Cancer Doctors Being Trained In The Importance Of Nutrition On Cancer? Dr Jonathan Stegall MD • http://www.cancersecrets.com • Book – Cancer Secrets  #JonathanStegall#Cancer #IntegrativeOncology Dr Jonathan Stegall MD is a medical Integrative Oncology doctor and a bestselling author of Cancer Secrets and host of an award-winning podcast, The Cancer Secrets Podcast. His book Cancer Secrets is a much-needed resource for cancer patients and their families, with vital information on evidenced-based treatments from both modern medicine and alternative medicine This book is about Cancer being the second leading cause of death in the United States, and will soon overtake heart disease as the #1 killer. This year alone in the United States, there will be 1.7 million new cancer cases, and over 600,000 cancer deaths. The lifetime risk of developing cancer is now 1 in 3 people, and is quickly approaching 1 in 2. Despite billions of dollars devoted to cancer research, we are no closer to a cure. Sadly, we are losing the war on cancer. Patients diagnosed with cancer, as well as their family and friends, are left with a difficult decision: do I follow the standard of care, consisting of chemotherapy, radiation, and surgery, or do I seek alternative treatments on my own? Do I listen to my doctor, or do I follow advice from the internet? Who do I listen to? Who can I trust? Until now, cancer patients and their families did not have a reliable resource for optimally treating cancer. In this breakthrough book, Cancer Secrets, you will learn critical information about what cancer is (and is not) and how to best treat it using the best that both modern medicine and alternative medicine have to offer.  Integrative oncologist, Jonathan Stegall, MD, provides a long-awaited and much-needed remedy for our cancer problem. Dr. Stegall has a successful integrative oncology practice in Atlanta, GA, and has seen first hand what works and what doesn't when it comes to cancer treatment. This book is a "must have" if you or a loved one is fighting cancer! Dr. Stegall believes that there are many potentially valuable therapies which are not (yet) part of the conventional standard of care. All of these therapies have a scientific study suggesting their mechanism of action and potential therapeutic benefit. These therapies include, but are not limited to, local hyperthermia, sono-photodynamic therapy, lymphatic drainage therapy, nutrition, supplementation, and stress reduction therapy. These therapies, which are all considered natural approaches, make sense to incorporate as well. He earned his bachelor's degree at Clemson University and master's degree in physiology from Georgetown University. He earned his medical degree at the University of South Carolina. After medical school he did his internal medicine residency through the Yale University School of Medicine, with clinical training at Greenwich Hospital in Greenwich, Conn., as well a Yale New Haven Hospital in New Haven, Conn. Then completed his fellowship in Integrative Oncology through the Metabolic Medical Institute, affiliated with the University of South Florida Morsani College of Medicine. He holds membership in several organizations, including the American Society of Clinical Oncology (ASCO), the Society for Integrative Oncology (SIO), and the International Organization of Integrative Cancer Physicians (IOICP). The Center for Advanced Medicine is transforming how cancer is treated. I am very proud of the transformative work we do, and the powerful difference we make in the lives of our patients. I run my practice in a way that is consistent with my Christian faith, based on love. My team and I love what we do, and we love the patients we treat. He is married and has two sons and a daughter. To Contact Dr Jonathan Stegall, M.D. go to   cancersecrets.com Disclaimer:Medical and Health information changes constantly. Therefore, the information provided in this podcast should not be considered current, complete, or exhaustive. Reliance on any information provided in this podcast is solely at your own risk. The Real Truth About Health does not recommend or endorse any specific tests, products, procedures, or opinions referenced in the following podcasts, nor does it exercise any authority or editorial control over that material. The Real Truth About Health provides a forum for discussion of public health issues. The views and opinions of our panelists do not necessarily reflect those of The Real Truth About Health and are provided by those panelists in their individual capacities. The Real Truth About Health has not reviewed or evaluated those statements or claims. 

Howie and Harlan are joined by Alan Friedman, chief medical officer at Yale New Haven Hospital, to talk about the organizational and cultural changes that the hospital has made to minimize medical errors and unprofessional behavior that harm patients. Howie reports on a Yale study showing a gap in excess deaths between Republicans and Democrats after the COVID-19 vaccine was introduced; Harlan discusses the continued problem of financial toxicity for patients, and a new study casting doubt on the effectiveness of “neuroprotective” diets. Links: “Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic” “State-Level Excess Mortality in US Adults During the Delta and Omicron Waves of COVID-19” “Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study” “To Err is Human: Building a Safer Health System” “The Safety of Inpatient Health Care” “We're Already Paying for Universal Health Care. Why Don't We Have It?” “Out-of-Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States” “Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

An Integrative Approach To Cancer Treatment Dr Jonathan Stegall MD • http://www.cancersecrets.com • Book – Cancer Secrets  #JonathanStegall#Cancer #IntegrativeOncology Dr Jonathan Stegall MD is a medical Integrative Oncology doctor and a bestselling author of Cancer Secrets and host of an award-winning podcast, The Cancer Secrets Podcast. His book Cancer Secrets is a much-needed resource for cancer patients and their families, with vital information on evidenced-based treatments from both modern medicine and alternative medicine This book is about Cancer being the second leading cause of death in the United States, and will soon overtake heart disease as the #1 killer. This year alone in the United States, there will be 1.7 million new cancer cases, and over 600,000 cancer deaths. The lifetime risk of developing cancer is now 1 in 3 people, and is quickly approaching 1 in 2. Despite billions of dollars devoted to cancer research, we are no closer to a cure. Sadly, we are losing the war on cancer. Patients diagnosed with cancer, as well as their family and friends, are left with a difficult decision: do I follow the standard of care, consisting of chemotherapy, radiation, and surgery, or do I seek alternative treatments on my own? Do I listen to my doctor, or do I follow advice from the internet? Who do I listen to? Who can I trust? Until now, cancer patients and their families did not have a reliable resource for optimally treating cancer. In this breakthrough book, Cancer Secrets, you will learn critical information about what cancer is (and is not) and how to best treat it using the best that both modern medicine and alternative medicine have to offer.  Integrative oncologist, Jonathan Stegall, MD, provides a long-awaited and much-needed remedy for our cancer problem. Dr. Stegall has a successful integrative oncology practice in Atlanta, GA, and has seen first hand what works and what doesn't when it comes to cancer treatment. This book is a "must have" if you or a loved one is fighting cancer! Dr. Stegall believes that there are many potentially valuable therapies which are not (yet) part of the conventional standard of care. All of these therapies have a scientific study suggesting their mechanism of action and potential therapeutic benefit. These therapies include, but are not limited to, local hyperthermia, sono-photodynamic therapy, lymphatic drainage therapy, nutrition, supplementation, and stress reduction therapy. These therapies, which are all considered natural approaches, make sense to incorporate as well. He earned his bachelor's degree at Clemson University and master's degree in physiology from Georgetown University. He earned his medical degree at the University of South Carolina. After medical school he did his internal medicine residency through the Yale University School of Medicine, with clinical training at Greenwich Hospital in Greenwich, Conn., as well a Yale New Haven Hospital in New Haven, Conn. Then completed his fellowship in Integrative Oncology through the Metabolic Medical Institute, affiliated with the University of South Florida Morsani College of Medicine. He holds membership in several organizations, including the American Society of Clinical Oncology (ASCO), the Society for Integrative Oncology (SIO), and the International Organization of Integrative Cancer Physicians (IOICP). The Center for Advanced Medicine is transforming how cancer is treated. I am very proud of the transformative work we do, and the powerful difference we make in the lives of our patients. I run my practice in a way that is consistent with my Christian faith, based on love. My team and I love what we do, and we love the patients we treat. He is married and has two sons and a daughter. To Contact Dr Jonathan Stegall, M.D. go to   cancersecrets.com Disclaimer:Medical and Health information changes constantly. Therefore, the information provided in this podcast should not be considered current, complete, or exhaustive. Reliance on any information provided in this podcast is solely at your own risk. The Real Truth About Health does not recommend or endorse any specific tests, products, procedures, or opinions referenced in the following podcasts, nor does it exercise any authority or editorial control over that material. The Real Truth About Health provides a forum for discussion of public health issues. The views and opinions of our panelists do not necessarily reflect those of The Real Truth About Health and are provided by those panelists in their individual capacities. The Real Truth About Health has not reviewed or evaluated those statements or claims. 

In this episode, I sit down with menopause maven Dr. Mary Jane Minkin, a clinical professor of Ob-Gyn at Yale University, to discuss articles published in the most recent edition of Menopause: The Journal of the North American Menopause Society. We discuss the following 5 articles*:  Treating where it hurts—a randomized comparative trial of vestibule estradiol for postmenopausal dyspareunia Goetsch MF, Garg B, Lillemon J, Clark AL. Treating where it hurts-a randomized comparative trial of vestibule estradiol for postmenopausal dyspareunia. Menopause. 2023 May 1;30(5):467-475. doi: 10.1097/GME.0000000000002162. Epub 2023 Feb 14. PMID: 36787525. The association between hormone therapy and the risk of lung cancer in postmenopausal women: a 16-year nationwide population-based study Wu CC, Chung CH, Tzeng NS, Wu MJ, Tsao CH, Wu TH, Chien WC, Chen HC. The association between hormone therapy and the risk of lung cancer in postmenopausal women: a 16-year nationwide population-based study. Menopause. 2023 May 1;30(5):521-528. doi: 10.1097/GME.0000000000002165. Epub 2023 Feb 27. PMID: 36854166. Effects of menopausal hormone therapy on the risk of ovarian cancer: Yuk JS, Kim M. Effects of menopausal hormone therapy on the risk of ovarian cancer: Health Insurance Database in South Korea-based cohort study. Menopause. 2023 May 1;30(5):490-496. doi: 10.1097/GME.0000000000002176. Epub 2023 Apr 4. PMID: 37022299. Diagnosis, causes, and treatment of dyspareunia in postmenopausal women Streicher LF. Diagnosis, causes, and treatment of dyspareunia in postmenopausal women. Menopause. 2023 Jun 1;30(6):635-649. doi: 10.1097/GME.0000000000002179. Epub 2023 Apr 11. PMID: 37040586. Menopause hormone therapy and urinary symptoms: a systematic review Christmas MM, Iyer S, Daisy C, Maristany S, Letko J, Hickey M. Menopause hormone therapy and urinary symptoms: a systematic review. Menopause. 2023 Jun 1;30(6):672-685. doi: 10.1097/GME.0000000000002187. Epub 2023 May 16. PMID: 37192832. *Please note: I have provided links to the articles, but they are behind a paywall, meaning you will only see a summary.  Mary Jane Minkin MD Website: madameovary.com Mary Jane Minkin, MD, is a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine, and has been in private practice in New Haven (CT) for more than 40 years. Dr. Minkin is board-certified in obstetrics and gynecology, and she practices at Yale-New Haven Hospital. She earned her medical degree from Yale Medical School and her undergraduate degree from Brown University. She did her internship and residency at Yale-New Haven Hospital, the former in internal medicine, the latter in obstetrics and gynecology. She is a fellow of the American Congress of Obstetricians and Gynecologists (FACOG) and has been a North American Menopause Society Certified Menopause Practitioner (NCMP) since 2002. Dr. Minkin has been Director of the Sexuality, Intimacy and Menopause clinic in the Division of Gynecological Oncology, in the Smilow cancer center at Yale New Haven Hospital since 2008. She has also been Director of the Yale Obstetrical and Gynecological Society (YOGS) since its inception in 2006. Other episodes that address these topics: Episode 5: Vaginal Estrogen- Rings, Creams, and Other Things Episode 11: Vaginal Estrogen is Not Poison Episode 27:  Using Vaginal Estrogen but Sex Still Hurts Like Hell  Episode 44 A Deep Dive into RECURRENT UTI Episode 74 Ospemifene- A Pill a Day to Keep Dryness Away  Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society.  Sign up to receive DR. STREICHER'S FREE NEWSLETTER Dr. Streicher is the medical correspondent for Chicago's top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.  Subscribe and Follow Dr. Streicher on  DrStreicher.com Instagram @DrStreich Twitter @DrStreicher Facebook  @DrStreicher YouTube  DrStreicherTV Books by Lauren Streicher, MD  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy

Ok so you lost your period. Now what? Join Brooke and Brittany where they talk about the basics of period loss and how to get it back - which by the way, you DO want it back!! Brittany is a Registered Dietitian and Board Certified Specialist in Sports Dietetics based in the Dallas, Texas area. She received her bachelor's degree from Rice University, completed her dietetic internship at Yale-New Haven Hospital prior to becoming a sports dietitian. In her early career she worked with athletes of various levels , including spending time as a team dietitian at both Texas Christian University and The University of Georgia.Brittany has over five years of experience in individualized nutrition care for athletes and active women, and knows how important a collaborative experience with other care providers can be to achieve optimal results.Brittany enjoys spending time outdoors with her husband & Golden Retriever,  teaching indoor cycling classes, reading, and working on home projectsFind Brittany on IG: @period.recovery.dietitian Website: https://fueledandwell.com/

Dr. Irwin Braverman conceptualized visits to an art museum and observation of an unknown painting as a useful visual exercise for doctors to improve observational skills. He touches on the backstory behind this program, what he thinks emotional intelligence is, why he doesn't think it can be taught, and having no regrets. Dr. Irwin Braverman, MD is Professor Emeritus of Dermatology at Yale University. He received his undergraduate degree from Harvard College and his MD from Yale University in 1955 and trained as an intern, resident, and fellow at Yale as well as Yale-New Haven Hospital and Medical Center. He is board certified in dermatology as well as dermatopathology. He retired from being a full-time faculty member in the Department of Dermatology in 2010 after 48 years of service. His research focused on the cutaneous microcirculation, cutaneous T-cell lymphoma, and aging. He is the author of Skin Signs of Systemic Disease.

In this episode, Dr. David Hanscom continues his discussion with world renowned surgeon and best-selling author, Bernie Sigel, MD.  He discusses how patient drawings offer key insights into how the patient feels about their illness and treatment, as well as key events that have shaped their lives. He shares stories that illustrate these insights and how he used them to help patients tap into their innate healing power. He suggests that physicians should use patient drawings as a way to build trust and understanding with the patient. Bernie S. Siegel, MD, is a well-known proponent of integrative and holistic approaches to healing that heal not just the body but also the mind and soul.  He attended Colgate University and studied medicine at Cornell University Medical College. His surgical training took place at Yale–New Haven Hospital, West Haven Veterans Hospital, and the Children's Hospital of Pittsburgh. In 1978 Bernie pioneered a new approach to group and individual cancer therapy called Exceptional Cancer Patients (ECaP), which utilized patients' drawings, dreams, and feelings, and he broke new ground in facilitating important patient lifestyle changes and engaging the patient in the healing process. He is the best-selling author of Love, Medicine & Miracles and The Art of Healing.  For more information, visit: berniesiegelmd.com.

In this episode, Dr. David Hanscom talks with world renowned surgeon and best-selling author, Bernie Sigel, MD. He shares stories that illustrate the importance of the doctor-patient relationship. He stresses the key role of understanding the patient's story – their life situation, challenges, motivations and fears to the healing process. He expresses his belief that listening to the patient and helping them tap into their innate ability to heal is the real business of medicine. Bernie S. Siegel, MD, is a well-known proponent of integrative and holistic approaches to healing that heal not just the body but also the mind and soul.  He attended Colgate University and studied medicine at Cornell University Medical College. His surgical training took place at Yale–New Haven Hospital, West Haven Veterans Hospital, and the Children's Hospital of Pittsburgh. In 1978 Bernie pioneered a new approach to group and individual cancer therapy called Exceptional Cancer Patients (ECaP), which utilized patients' drawings, dreams, and feelings, and he broke new ground in facilitating important patient lifestyle changes and engaging the patient in the healing process. He is the best-selling author of Love, Medicine & Miracles and The Art of Healing.  For more information, visit: berniesiegelmd.com.

Welcome back to Analyze Scripts, where a psychiatrist and a therapist analyze what Hollywood gets right and wrong about mental health. Today, we are thrilled to be joined by Dr. Tobias Wasser, a forensic psychiatrist from Yale University, in analyzing the 2010 film "Shutter Island." Dr. Wasser explains how forensic psychiatry bridges the gap between the criminal justice and mental health care systems. He describes what it's really like to work on a forensic psychiatry unit and compares his experience to that depicted in the film. We also ask him to explain the difference between competency to stand trial and the NGRI (not guilty by reason of insanity) plea. He also shares his opinions about our favorite narcissistic psychopaths - Joe Goldberg, Logan Roy, and Tom Wambsgans. We learned a ton and hope you enjoy! Instagram TikTok Website [00:00] Dr. Katrina Furey: Our channel. [00:10] Portia Pendleton: Hi, I'm Dr. Katrina Fury, a psychiatrist. And I'm Portia Pendleton, a licensed clinical social worker. And this is Analyze Scripts, a podcast where two shrinks analyze the depiction of mental health in movies and TV shows. Our hope is that you learn some legit info about mental health while feeling like you're chatting with your girlfriend. There is so much misinformation out there, and it drives us nuts. And if someday we pay off our student loans or land a sponsorship, like with a lay flat airline or a major beauty brand, even better. So sit back, relax, grab some popcorn and your DSM Five and enjoy. Welcome back to Analyze scripts. Portia and I are super excited to be joined today by Dr. Tobias Wasser, who is an associate professor of psychiatry at the Yale School of Medicine. He completed all of his psychiatry training at Yale, including the psychiatry Residency program and two fellowships in forensic psychiatry and public psychiatry. He currently serves as the Deputy medical Director for Community and Forensic Psychiatry for Yale New Haven Hospital and the Assistant Chair for Program development in the Yale Psychiatry department. He's previously held leadership roles in Yale psychiatry residency program and for five years served as the chief medical officer of Connecticut's State Forensic Hospital. And most importantly, he was my chief resident for a whole day at the very beginning of my intern year. So welcome, Tobias. Thank you so much for coming and joining us today. [01:46] Dr. Katrina Furey: Hi, thank you so much for having me. [01:49] Portia Pendleton: So interestingly. I'm sure you don't remember this, Tobias, but I remember my very first day of psychiatry residency. I was on the inpatient psych unit. You were observing me do, I think, like, my very first interview as a resident, and I was interviewing a patient with a psychotic disorder. I don't think I'd ever really interviewed someone with one of those before. And afterwards you told me something that has stuck with me ever since, and I think is really pertinent to this movie you were telling me. And you were so nice in the way that you would tell me this criticism, but it's very kind. You were saying, you did a great job, but when you're listening to someone talk about their delusions, try really hard not to nod as they're talking. It's like a very natural thing to do. But if you're nodding, you're kind of confirming for them, like, yeah, this is true. This is true. What a perfect sort of clinical pearl to think about as we talk about Shutter Island today, right? [02:53] Dr. Katrina Furey: Well, you're right that I don't totally remember saying that to you, but I guess maybe it'll make you feel better to know you're not the only individual to whom I've given that feedback. [03:05] Portia Pendleton: Good. [03:06] Dr. Katrina Furey: It is a common aspect of people learning how to practice psychiatry and mental health. So as you said, I think it's a natural reaction. So clearly it helped you. [03:17] Portia Pendleton: I'm glad it's but I just like that sort of popped in my mind as I rewatched the movie today, knowing you join us because in this movie, they do this whole weird experiment, right? And so I think before we dive in and really pick your brain on what it's like to be a forensic psychiatrist and what you think about this movie, portia is going to give us just a really quick rundown of the plot. [03:43] Dr. Tobias Wasser: So the movie came out in 2013 by Martin Scorsese, all star cast, all star director. We have Teddy Daniels, who is played by Leonardo DiCaprio. And then we have Chuck, played by Mark Rafalo. And so we see these two people kind of heading to this island where there's apparently this mental institution where the criminally insane are being held. And it opens up with vomiting, which we talk about this a lot. [04:12] Portia Pendleton: I was like, great, portia hates vomiting. [04:16] Dr. Tobias Wasser: And so they are going to kind of investigate someone who's missing. [04:20] Portia Pendleton: And they are state marshals. [04:23] Dr. Tobias Wasser: Yes, marshals. And so you kind of see them exploring the island. It looks really scary. And there's a few different kind of living arrangements, it seems like. One where more, I would say, like, peaceful patients are housed. And then another one that feels really gross and dirty and more jail like. And the movie does take place in 1954. So it's like post World War II, which I think is interesting with the differences in how we treat mental health. So we kind of see them investigating this crime or this person who's missing, as we have some questions of Teddy's mental status. So he has these migraines. There's some flashbacks to his time during World War II at some concentration camps. Really, really traumatic, it seems like some experiences that he's had. And then also these kind of flashbacks to this family, but then to this other wife without kids. And it's confusing. So I was kind of confused watching it at first. And then we see him kind of continuing to investigate and believe that there are these inhumane trials going on or. [05:41] Portia Pendleton: Clinical trials or like experimentation, almost experimentations. [05:46] Dr. Tobias Wasser: Kind of going on that we see, and he doesn't find any. And so the movie kind of arcs all of a sudden to where I initially thought, so this was the first time that I saw it, that he was being kind of like, pushed into insanity, quote, unquote. He was being given some medications. All of a sudden there's this part where it's like, well, have you been eating the food? Have you been taking medications from them? Have you been smoking your own cigarettes? And he starts to kind of feel. [06:14] Portia Pendleton: Like he was poisoned or something. [06:15] Dr. Tobias Wasser: Yeah. And so then all of a sudden, we find out that he is the test subject of this really immersive. I don't want to say well done, but well done. [06:30] Portia Pendleton: Well executed. [06:31] Dr. Tobias Wasser: Maybe set up for him in order to help his psychosis or delusions in order to kind of have him kind. [06:40] Portia Pendleton: Of come back, snap out of it. [06:41] Dr. Tobias Wasser: Which is his wife killed his three children and then he killed her. [06:46] Portia Pendleton: And so he is actually a patient. [06:48] Dr. Tobias Wasser: To make someone potentially have a psychotic break or experience some psychosis. So I will say that I'm probably going to take a little bit of a backseat to this episode. I think the only experience I have with psychosis is, like, drug induced. So it's not my poor kid. I don't think I've ever interviewed or come across a patient with non drug induced psychosis. So that's kind of the story of the movie. And I think it leaves off with two questions. Did they trick him? And that was a whole trick to kind of get him to stay there, or was he really a patient? [07:23] Portia Pendleton: Yeah, I think he was the 67th patient that he was looking for the whole time. And then at the very end, I felt like the whole premise, once you figured out what was going on, was they were trying to restore his sanity once and for all with this elaborate hoax in hopes that he could avoid a lobotomy. Right? And then at the very end, you see him sort of slip back into his delusional way of thinking and go off to get the lobotomy. And I think actually he knew what he was doing. I think he sort of didn't actually slip back into that delusional frame of mind. I think he finally realized what had happened and didn't want to live with it. So it was really fascinating movie. I always love Leonardo DiCaprio, especially with a Boston accent. I'm just like, anytime. But one thing that hit me right away was just like, there's like this big, scary mental hospital in the middle of the ocean where you can't get to and we're going to play this big scary music, and there's rocks everywhere, and there's like, police everywhere. And just like this. It reminded me of Alcatraz in San Francisco, which was just a jail, I believe, not a forensic psych hospital. But I was just like, oh, my God. Just like, yeah. It's like, oh, God. [08:39] Dr. Katrina Furey: Yeah. [08:39] Portia Pendleton: The mentally we're so scary. It just really right away really knocked you over with that intensity. What did you think, Tobias, about sort of the way they started off. [08:51] Dr. Katrina Furey: Yeah. So I think you're right about the ending. I saw Capri a really extreme form of denial, almost like choosing an extreme form of denial that once he knew what he had done, he didn't want to live with it anymore, and choosing surgical interventions to try to keep that out of his mind as far as the depiction of what the place looks like. So I definitely think you're right. It played into all of our worst stigmas about psychiatric hospitals. It's criminally insane and this scary island in the middle of nowhere, and that it has to be surrounded by miles and miles of water to prevent anyone from escaping. And I think also, Portia, your point about this is post night. This is in the 1950s, and so it's a very different understanding of what mental illness is at the time in any case. But I'll say as someone who, as Katrina you mentioned in the brief bio, someone who spent many years running a current forensic hospital, it's a very different experience than how it's been depicted in the movie. I think we often imagine these really horrible, scary places. And I will say there are aspects of it that align with my experience. But for the most part, we've come a long way in the 50 years. If that's what it really was like 70 years ago, we've come a long way. But I definitely agree that it was trying to really I think it was trying to immerse the viewer in experience of being terrified. And I think it succeeded in that. [10:26] Portia Pendleton: Yes, it did. So what parts of it sort of matched with your experience working in a modern day forensic hospital? [10:33] Dr. Katrina Furey: Yeah, so I think part of it is what Portia alluded to with this idea that there might be different parts of the hospital. So that continues to be true today. So not all forensic hospitals are like this, but many of them will have what we call different services. So in Connecticut, for example, the hospital that I was a chief medical officer for, for five years, we did have two different services. We had what we called a maximum security service, which was for patients who are at a higher risk for violence or who may have engaged in more violent behavior before they came to the hospital or currently were engaging in unsafe behaviors. And that is more like a synthesis between a typical hospital or typical psychiatric hospital and a correctional setting. At least on the one in Connecticut. The walls are cinder block and in order to get in, you have to go through multiple layers of security and double locking doors. We call a Sally Port, like you're entering a prison facility. So there are layers of security to it that are similar, and the structure is somewhat similar. When you get on the unit, though, it looks more as opposed to in the movie where people are in jail cells and they're locked up, and it really looks like a jail facility. Once you actually get into the physical space where the patients are living, it's more like an inpatient unit. People have bedrooms, they don't have cells, they don't have bars on the doors. They can enter and exit as they wish. There are group rooms in which therapeutic activities occur. There's a shared dining space, there's television. So there are some aspects that are similar, but hopefully it's a little bit more humane when you actually get onto the unit. The one in Connecticut is a much older facility. It was built in 1970. So actually not long after this movie supposedly takes place. And there are a couple of much more modern facilities that have been built, one in Washington, DC. And one in Missouri, that are really picturesque, very aesthetically pleasing. They really focus on things that are supposed to enhance individual recovery, like access to natural light spaces and all those things. So the more modern facilities have really come a long, long way and they look nicer than some typical psychiatric hospitals. Not for forensic patients. And then the other aspect is going to say, so there is a second service, again, even in our own hospital, for safer patients, patients who have engaged in less serious violence, but for some reason have engaged in some kind of behavior that got them involved with the criminal justice system. And they require psychiatric treatment. And those settings, at least in Connecticut, looks much more like a typical hospital that you'd expect. And those patients actually are given grounds privileges. They can walk the ground, sort of like we saw in the movie, that they can walk around. [13:17] Portia Pendleton: Are they handcuffed like we saw in the movie? People would be like in shackles, walking around, but like their feet shackled up. [13:26] Dr. Katrina Furey: That's a great question. So no, they're not modern day because there's been so much emphasis on patients rights and advocacy movements for all patients, not just these kinds of patients. And maybe I should just take a step back to define what does it mean to be a forensic patient. So forensic really refers to in mental health or in psychiatry. It's talking about the intersection of psychiatry and the law. So when we talk about forensic hospitals or forensic patients, sort of like in the movie, they are typically places where individuals who've been found not guilty by reason of insanity. So they've committed a crime. They've pledged what's anecdotally called, colloquially called the insanity defense, meaning that they're saying they're not criminally responsible for their actions because at the time of the crime, they either didn't appreciate that what they were doing was wrong or they couldn't control their behavior because of a mental illness. They're found not guilty by reason of insanity, which is a horrible stigmatizing moniker, but it's still what we call it. And then they're sent for long term psychiatric treatment in a hospital setting. [14:30] Portia Pendleton: And then is the goal. We just released an episode about the movie side effects. I don't know if you ever saw that movie, it's also an older movie, but in that movie it seemed like the goal was to restore the character who was found not guilty by reason of insanity to sanity, so then she could go back to them, be tried. Does that actually happen? [14:56] Dr. Katrina Furey: Yes, that's a great question. It's kind of mixing two different topics in forensics, like two different populations. So we do have the one group who is what I just described, not guilty by visa and sanity. We have a second group of individuals who are found not competent to stand trial, which similar but is different. So being found not competent to stand trial. So for all of us, if we are accused of a crime, we're all presumed or assumed to be competent. Meaning you understand what's going on in court. For some individuals with mental illness or cognitive disorders, they're not able or intellectual disabilities, they're not competent as a result of their capacities. And so if they're not able to understand what's going on in court, they don't know what a judge is, what a lawyer is, or they have delusions that the court is out to get them and they're paranoid about it or because of an intellectual disability, they're just not able to effectively understand what's happening. Or maybe because of mood instability, they're so upset and get so upset so easily and angry and yelling and screaming. They can't really work. A lawyer, they're a court hearing. Those are all reasons somebody might be found not competent to stand in trial. [16:09] Portia Pendleton: Got it. [16:10] Dr. Katrina Furey: And that's very much like on here and now at the time you're supposed to show up to court, you will get what's going on. [16:17] Portia Pendleton: Got it. [16:17] Dr. Katrina Furey: Whereas the insanity defense is much more about when you did the thing right. [16:23] Portia Pendleton: Okay, so for this second group, this. [16:26] Dr. Katrina Furey: Not competent group, it would be more like what you were talking about with Sideways, where they might also come to our hospital and they're going to be sent there for treatment and we're going to try to restore them. So we're going to try to make them better so that they can go back to court and deal with their charges. And that might be through getting medications, group therapies and just education about the court system. Sometimes there's an educational deficit and then we try to send them back so they can deal with their charges. The other group we talked about, the insanity defense, folks, we are trying to make them better, but they're not going to go back and face their charges. They've already been found not guilty and their trial is over. [17:06] Portia Pendleton: Got it. [17:07] Dr. Katrina Furey: Now we're just going to re. [17:10] Portia Pendleton: Got it. That makes a lot of sense. Portia we've been talking about that for weeks. We're discovering and doing this podcast that a lot of the shows we watch and that other people are asking us to cover involve narcissists and psychopaths. This keeps coming up. Yeah, apparently fascinating. [17:33] Dr. Tobias Wasser: I think also we see, which I think is an interesting shift. In the movie, Dr. Kauley makes a comment that sanity is not a choice. And then also if you treat a patient with respect, you can reach them. So I think that's kind of like the shift into more current times with respecting patients and having them understand what's happening and having a right to choose maybe different medication trials or therapies and stuff like that. And I think that's great and wonderful and it seemed like what he was doing at the time was really kind of like shocking and out there. [18:07] Portia Pendleton: Right. [18:08] Dr. Tobias Wasser: And you even see Teddy the Marshall like being angry. Some of these patients are being treated well or, you know, they're not just. [18:18] Portia Pendleton: Being, um, so cool, like they're being believed. Right. I'm so curious to biased to hear your views about the forensic psychiatrist they depict who is played by Ben Kingsley, dr. Collie. I did write down a couple of quotes that either he said, I think he said them that I actually thought were pretty lovely. So at one point he was sort of telling Teddy Leonardo DiCaprio's character like what they do at Ashcliffe and he said something like this is the moral fusion between law and order and clinical care. And I thought like, well, that's kind of a lovely description of or definition of forensic psychiatry. And then I really appreciated when Dr. Collie would correct the marshals, when they would refer to the patients as prisoners. And he kept saying they're patients, they're patients. And I think Teddy at one point is like, how can you even treat them like knowing these awful things that they've done? And he said something like I treat the patients, not their victims, I'm not the one here to judge. And I just thought like, wow, I don't know. What are your thoughts about his character Tobias and the depiction of him and the other psychiatrists? All of which I'll just point out were old white men, which is accurate probably for the think. [19:42] Dr. Katrina Furey: You have picked up on some really lovely quotes and some themes in this that I also aligned with, noticed as being really interesting and as you're saying, portion of the time probably were very progressive. And now I think I wouldn't say they're mainstream, but I think they really what's reflected in this is a lot of the tensions that we do see in the practice of modern forensic days, modern day forensic psychiatry that even now working in these facilities. So we've come a long way since the 1950s and there have been this enormous movement around patients rights and giving them the right to choose what does it mean to accept or refuse medication, what abilities do you have to have to be able to do that? Just because you've been committed to a hospital doesn't mean you can be forced to take medications necessarily. And all the things you're saying about in a forensic hospital, about calling them patients, not prisoners, thinking about their illness and their symptoms rather than the criminal behavior they're accused of or been convicted of. And yet we struggle with this all the time still all day working in these facilities. You often find this tension between how he described the law and order and the clinical care you hope for, that the mental health clinician will be the ones really advocating for the treatment component, that they're going to want to think about the person and their illness. Many of these individuals have been horribly traumatized and see an enormous amount of comorbidity in terms of histories of physical, emotional and sexual trauma in their youth that leads them then to enact this kind of behavior when they're older or it's not surprising to any of us. And so we try to get our staff who are demonstrated, like orderlies or the police officers or security guards, whatever they are, to help them understand that these patients are people and that yes, they may have done something really horrible, but that's not what we're going to define them by. But it's still really a struggle and it really falls on those of us who are providing the care or leadership roles in these institutions to keep holding on to that moralistic value and try to keep advancing things forward. And I often found that in these environments, you often see some amount of regression by the staff, meaning that they start to act in more primitive and earlier ways because it can be an unsafe environment. There is more aggression in these environments than the typical mental health setting. And when people start to feel unsafe, they start to regress into these earlier states of being. And so you'll see more interest in punishment than maybe clinical care. They want the patients to have consequences. [22:18] Portia Pendleton: When they do that right, or sometimes. [22:21] Dr. Katrina Furey: They'Ll refer to them by their crime as opposed to by their name or their diagnosis. They're just a murderer, they're just a rapist, something horrible like that. And so it takes a lot of work and a lot of effort to continue to hold the line and to not be drawn into that because I think it's kind of a natural human proclivity and it taxes all of us. But it's also our responsibility when you work in these settings to try to keep holding on to that. The role I had running the hospital for the patients, particularly the individuals who have been found not guilty by reason of insanity, they had to have mandatory public hearings every two years in terms to monitor their progress. And if there was ever an effort to try to move them from the hospital to the community and this happens, every state handles it differently. But every state has some process where either the court or a quasi judicial body, like in Connecticut, we have this separate board. It's kind of like a synthesis between a mental health it's sort of like a mental health parole board, essentially, that these folks, as they move through the system to less and less restrictive environments. And whenever you have to have these hearings, families will come, and they have the opportunity, or they have the opportunity at least to give victim statements, the victim themselves or the family of the victim. And it was heart wrenching. It was really awful to hear and really difficult to many of them have been horribly traumatized by what happened to them or their family members. And as difficult and uncomfortable as it was, it was extremely important, I know for myself and others who work in that environment to hear that for two reasons. One, because I think you don't. As much as we're focused on the patients and wanting to get them better, I think as opposed to how the movie depicts it, where it's I don't think about the other things. I just think about this. We have to at least consider that. I mean, one, because it affects their risk, their initial behavior, even if they were really ill at the time they committed some horrific act, we know that's the riskiest thing potentially they could do, right? If they became ill again, if they medicine or they were out of treatment, that could happen again. And so we have to account for that. The second thing is you can become a little too myopic if all you think about is the patient. There has to be some consideration for the impact of this on the community, both just as a human and if you're trying to advocate that this person returns to the community. And that's probably the biggest reason, is if you advocate that this person returns to the community, this is a reflection of what they might experience in the community. The victims will be there, the family of the victims or other victims who have been suffered at the hands of other individuals. And so the patient has to be ready to manage that, and you have to help the patient to be ready to manage that. And so you can't entirely turn a blind eye to it and just say, oh, that's something that happens out there. Because if the goal is to help the patient get back to out there, you want them to be prepared to what that's going to be like. So I think it's extremely difficult. I don't want to pretend like it's easy, but I think it's a really important part of doing this type of work. [25:33] Portia Pendleton: This sounds like a really hard job. [25:37] Dr. Katrina Furey: It's not an easy job. [25:38] Portia Pendleton: It sounds really hard. Like just thinking about not just being the psychiatrist for patients like this. I think some would argue these might be like the sickest of the sick, but then also managing the whole team, treating them, who every team member brings in their own experiences. And so they're also probably getting triggered by different things, as we all are right in this line of work. And then thinking about the community at large, I'm just thinking like, gosh, that sounds like a lot of pressure to be the one, I guess at the end of the day to decide like, okay, yes, I think you're ready to reintegrate, or no, I don't know if I could do that. It sounds really hard. [26:23] Dr. Katrina Furey: It's really tough. And I think raising a couple of points. One is the community. No community wants these individuals in their community. There actually was a New York Times Magazine article back in, I think, either 2017 or 2018, where they interviewed folks who run these types of hospitals all over the country because they talked about the fact that it's so hard to get patients out of the hospital because nobody wants a former arsonist to be their next door neighbor. [26:50] Portia Pendleton: Right? [26:51] Dr. Katrina Furey: Arsonist with schizophrenia. I mean, doesn't that sound really inviting that you want to move next door and not to be I don't want to be overly stigmatizing. Maybe that's how people in the community experience this. The other aspect of it that you talk about, the experience of staff who have been traumatized, and so part of it is, as you are saying, they may have had trauma in their own lives that might be triggering when they do this work. As much as I don't want to propagate the idea that individuals mental illness are violent, they're much more likely to be the victims of violence and the perpetrators of violence. But when you have enclosed environments dedicated for individuals who have been accused of crimes, many of who engaged in violent behavior, there is an increased risk of violence in those environments. And some of these staff members will become they will be harmed, of course, their work. And that, of course, can be very traumatizing. And then the final pieces in these environments, the patients tend to stay there for much longer than at a usual hospital. So, I mean, typical, if someone has to go to the psychiatric hospital, they're there maybe seven to 14 days. For our patients, the shortest period of time they're there is usually 60 to 90 days, and the longest is two decades. [28:02] Portia Pendleton: Wow. [28:03] Dr. Katrina Furey: People will be there for very long periods of time. And to incentivize, particularly general healthcare workers to work in these environments, they're usually part of unions that are through the state. They have really good benefits, and so they work there for long periods of time. And so you can only imagine the kinds of relationships and dynamics that evolve over the course of years with employees with their own history of trauma, most well trained in managing personality disorders, your psychopaths, your narcissist, your borderline personality disorders, and then you've got those individuals living in an enclosed environment for a decade. It's fraught with all sorts of drama and trauma. [28:40] Portia Pendleton: Drama and trauma, yeah, for sure. One thing we wanted to ask you, Tobias, is are you able to comment at all about what are the common diagnoses you see or the most common diagnoses you tend to see? Because I think, just like you said, it's really important to us also that in releasing these podcast episodes, that we keep getting the message out there that people with mental illness are so much more likely to be victims of crimes rather than perpetrators of crimes. And yet a lot of these shows depict these raging psychopathic narcissistic. People who are hurting everyone all around them. So I'm just curious if you're able to comment on that or if that was something you noticed in doing this work. [29:30] Dr. Katrina Furey: Yeah, so I think this is very much a generalization based on data, statistics or anything, but generally you tend, for the most part to see two kinds of kind of diagnostic profiles. So I think on the one hand, you tend to see individuals who have some kind of a psychotic and or genetic illness schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features. Sometimes they become depressed with psychosis, but mostly it's more in the kind of bipolar and psychotic rain. And their illness is untreated. Either it's been unrecognized or it has been. But they've got off medication for a long period of time. And because of their severe symptoms, their severe mood and psychotic symptoms, they develop either delusional beliefs or they hear voices tell them to do violent things, and then they end up engaging in some kind of risky or violent behavior, whether that's directly being harmful, physical assault, sexual assault, setting a fire, something of that nature. That's kind of one large diagnostic group we tend to see. The second tends to be much more, actually, unfortunately, you said you don't have experience with this, but it tends to actually be probably people you might have been more likely to see, which are individuals who have severe personality disorders and then may or may not develop some. They're usually using substances and may or may not develop a substance induced psychosis. So they're typically, as I was saying, really people with some kind of antisocial personality disorder, which means that they disregard the rights of others. They don't care about rules. They're really only out for themselves. They usually have a heavy dose of narcissism. And then you see a fair number of individuals with borderline personality disorders with this relationship instability and all sorts of other things. You add some substances on top of that, whether it's alcohol, marijuana, coffee, opiates, whatever it might be. And then sometimes they start to develop psychop psychosis or extreme mood instability. And with that group so with the first group we talked about who has a more classic psychotic, manic illness, they actually tend to do it because once they get to the hospital, they get treatment. We know how to treat that group, right? Medicines we have that are tried and true, therapies we have that are tried and true. And they actually tend to get out of the hospital sooner if they're willing to kind of go along with the treatment program. The second group is enormously difficult to treat. And as you guys will know, we certainly don't have medicines because usually what happens is, once they're in the hospital, they're not using illicit substances. So that psychotic or manic illness, dissipates, and all we're left with is the personality disorder, and we don't have medicines to treat it. Our therapies are intermittently or variably effective, depending. Particularly, we don't really have much for antisocial, right? We're a little better with borderline antisocial. But then they're also in these contained environments which are full of law and worship, just like described in the OB. And these individuals don't tend to they don't like it. [32:39] Portia Pendleton: Lots of rules and law being told. [32:41] Dr. Katrina Furey: What to do and long term relationships with either their peers or staff who keep showing up every single day. So those individuals are really challenging for the staff, and they're really challenging to reintegrate into the environment. [32:57] Portia Pendleton: Do you come across a fair amount of malingering? [33:01] Dr. Katrina Furey: So you do. Where you tend to see more malingering, you tend to see a lot of malingering in those. Not a lot, I should say we see more for the most part, there is not a lot of malingering, but we do see it probably more than other environments. And when we tend to see it, it tends to be in those individuals who not the insanity defense folks, but those people who are found not competent to stand trial. So again, every state is different, but in most states, the legal regulations are essentially that if you're not competent to stand trial, you cannot be tried for your crime, because the courts place this emphasis on human dignity, essentially. And so the idea is, if you're not mentally sound, how can we try you for a crime if you don't understand what's going on? Work effectively to your lawyer. So it depends on the state, but if you're not able to be competent or restored to your competence, you may never face your charges. And so how that's dealt with is different. You may end up in a psychiatric hospital, you may not, but most of those people won't face their crime. And so there's a number of individuals, whether their crimes are significant or more minor, who essentially think, can I fake crazy? [34:15] Portia Pendleton: Can I fake crazy in order to. [34:16] Dr. Katrina Furey: Get out of facing my crime and dealing with the consequences. So we do see that more than most things, and most of hospitals like this employ psychologists who can do psychological testing and screen for malinkering as a way of trying to help us substitute that out. That's a big part of the assessment we do, especially if we suspect that somebody might be faking it more than might be faking it, period. [34:39] Portia Pendleton: When you're getting ready to discharge patients from these forensic hospitals, are there specific community clinics or places that you sort of go to who can sort of do you get to collaborate with them after the patient leaves to sort of make sure they're okay or their check ins. Or if they start to unravel, they can sort of quickly come back into treatment. Or is that just like a fantasy I'm creating in my head? [35:05] Dr. Katrina Furey: No, you're not far off. So again, my experience is here in the state of Connecticut. So here we tend to work with our state mental health department and almost all the patients receive treatment at community mental health centers that are part of the state mental health system. [35:20] Portia Pendleton: Okay. [35:22] Dr. Katrina Furey: They work with those folks and because it's so hard to get them to the community, there are usually prolonged transition periods where they're meeting their community clinicians while they're still at the hospital. They're beginning they have transitional visits if they're going to be in some kind of they're almost always living in some kind of supervised setting, whether it's a supervised apartment or a group home or something. And so they do transitional visits before they actually leave the hospital. And they may spend months, maybe even up to a year, just engaged in a transition process before they actually go and leave the hospital. And then usually in most states, there's some mechanism for bringing us back to the hospital if they're not doing well. So there's a concept called conditional release, which is the idea that they can be released to the hospital, but it's conditional on their safety, good behavior or whatever you want to say. And it can be both. That's why it's conditional if there's some safety related concern and they can be brought back to the hospital. [36:22] Portia Pendleton: I see. Okay. Wouldn't this be nice for almost everyone needing inpatient psychiatric care to just have more time getting treatment and then have this nice transition period? And it just seems like such a better model overall. And I wonder if that's what it used to be like back in the day where people would not just get two days of treatment and then be discharged. [36:45] Dr. Katrina Furey: I think in a world that's less driven by insurance reimbursement, this probably was I don't know that quite this extreme, but I imagine this was the model. And I do think as so much of our health care is now decided by what will be paid for and not paid for, we've really gotten away from this. And I think not everybody needs this, but many individuals for whom they could benefit from this kind of care. And part of what's talked about in public entities, state, county funded institutions, is this idea that kind of like the allocation of resources really depends on what the law requires you to do. And so there's always a limited fund of resources in any state, county, whatever. And so where you shift your resources is what's required. So like, for example, Connecticut is not one of them. But most states have some form of involuntary outpatient commitment for individuals who need to be they're chronically ill, chronically dangerous, and they want something like what you're describing, which is a way to bring them into the hospital quickly if they're not doing well in the community. [37:47] Portia Pendleton: I think New York has something like that, right? Where if you're not complying with your injectable antipsychotic or something. [37:55] Dr. Katrina Furey: Exactly, yeah. So New York actually 46 of the 50 states have laws like this but New York was one of the first, called Kendra's Law. North Carolina was an early adopter of this as well. They've done the most research on it, and there's some evidence that it works. But the major concerns with laws like this one is that it tends to be overly representative of minoritized individuals, people who are black, brown, Hispanic, from low socionomic status, that we tend to see more of those individuals. And so there's a significant concern that's been raised that these ideas are built on racist practices and structures, and so it's inappropriately used in those populations too often. The second concern that's often raised, which I think is where I was going before, was that because there's a limited pot or pool of resources, when you construct laws like what I'm describing, for involuntary outpatient commitment, it requires the public entity to give the resources to those individuals usually at the loss of the resources for other individuals who aren't engaging in those same behaviors but might equally benefit from them. Because you're going to kind of shift your focus to whatever you have to do, and whatever you don't have to do, you're less likely to do. [39:12] Portia Pendleton: That makes a lot of sense. I also feel like that could be really used against patients in an icky way. It's so hard. It's like I understand it, but then it just feels like it could be really coercive. [39:26] Dr. Katrina Furey: Yeah, it's not the same, but it's a little similar to when you have patients if you're caring for individuals who are on probation. And then there's this polls as well. Your probation officer is not going to like it if you don't show up. I'm going to call them again. I think it's like this well intended effort to try to keep the person engaged in treatment and engaged and using the interventions that you think will keep them safe and well and out of trouble. But it's really manipulative kind of co opting the purpose of treatment, which ought to be for treatment, and we ought to be giving people a choice. And if they want to participate, great. And if they don't, they may have consequences for those choices, but it's not our responsibility as mental health providers to be enacting those consequences. And that's often the challenge that people find themselves in, that somehow they get drawn into that in a well intended but kind of inappropriately administered way. [40:18] Portia Pendleton: Yeah. [40:18] Dr. Tobias Wasser: And I want motivational interviewing gone wrong, helping them explore the potential consequences and what that might be like versus I'm going to call them myself. [40:31] Portia Pendleton: It reminds me when I threaten to call Santa Claus on my children when they won't just get dressed in the morning. So Tobias, do you have any criticisms about this movie and the way anything was portrayed? Or I guess on the flip side, did they get anything really right that you really liked? [41:01] Dr. Katrina Furey: I found myself really struggling with the ending. When you find out that this whole thing has been kind of an elaborate and effort to lean into the delusions. I think back to your anecdote. [41:17] Dr. Tobias Wasser: There was a part of me that. [41:18] Dr. Katrina Furey: You don't know why. [41:19] Portia Pendleton: Right. What are you doing? I learned this my very first day of training. [41:25] Dr. Katrina Furey: Yeah. And then you don't want to trick your patients. That's not a way of engendering trust and all these things. And then there was another part of me that thought, like, this is really interesting. Would this work? Is there any chance that trying to align with the patient in some way could be effective? I think I reached a conclusion. No, I don't think so. I don't think we want to. It's a tightrope walk, as we probably talked about that fateful day. I think you want to help the patient feel supported without reinforcing that the beliefs that you think are symptoms of an illness are actually happening. [42:02] Portia Pendleton: Right. [42:03] Dr. Katrina Furey: I think that it wasn't surprising to me, I guess, given that this was supposed to be such a novel, progressive treatment model, that they would try to enact this on Shutter Island. But I found myself troubled by it, ultimately. [42:20] Portia Pendleton: And I couldn't believe it was his psychiatrist who was, like, the other Marshall. Right. Like Mark Ruffalo's character. Like, for a while, I kept thinking, like, was Mark Ruffalo like a hallucination? Was that his part of his mind that was still sane in some ways? And then when it comes out that that's actually the psychiatrist they all said was on vacation, I was like, how do you do that? How is he ever going to trust you again? [42:47] Dr. Tobias Wasser: Yeah. [42:48] Portia Pendleton: What did you think about when they were all having their scotch at the end of their night, like, in their big, fancy velvet chairs and thrilling their mustaches? And that one psychiatrist kept saying, I feel like I want to use this in social conversation. Somehow he kept looking at Teddy and going, you have great defense mechanisms. Do you remember that? Wow, these are great defense. But it was like an underhanded comment. I don't know. [43:15] Dr. Katrina Furey: Was that not part of your training? [43:17] Portia Pendleton: No, I missed that part. I must have been on maternity leave. [43:23] Dr. Katrina Furey: Yeah. I just thought it was so stereotypical of psychiatrists. Who knows? Maybe that is what really happened in the 50s. But it was just this kind of idea of the old boys club, and let's sit around and be very sophisticated and talk about our analytics theory right. [43:42] Portia Pendleton: And judge and analyze everyone. Right. I feel like I think we all probably get this in social situations, like when you're just trying to make friends or whatever, and people hear your psychiatrist and everyone gets so nervous, and they're like, oh, are you analyzing me now? But I think movies like this sort of perpetuate that when these people are analyzing everyone so quickly. One thing that I wanted to touch on was Michelle Williams's character. I forget her name, but she was basically Teddy Daniels's wife. And she did end up, it seems like well, she did end up killing their three children. And I just wanted to bring it up because it reminds me of postpartum psychosis, which has been in the news lately. And as a reproductive psychiatrist, anytime I can talk about this and sort of just get some info out there, I like to, because it is the most severe complication of childbirth. I mean, mental health complications like depression, anxiety, OCD are the most common complication of childbirth beyond any physical complication. And then postpartum psychosis is the most severe and also the most rare. And if you develop postpartum depression or anxiety, that does not increase your risk for having postpartum psychosis. These are two separate disease pathways. So I see a lot of women in my practice who have had postpartum depression or anxiety, especially lately, I think, with what's being said in the news, who get really scared that if they want to have a baby, does that mean that they could lose their mind, so to speak? So this condition occurs in one to two out of every thousand births. So, again, super rare. About 40% of women have the baby blues after delivering a baby. That's just where you feel like you're on an emotional roller coaster, and it's awful, but it's totally normal. And then about ten to 15% develop postpartum depression, anxiety, OCD. And then, again, one to two out of 1000. I can't do that fraction in my head, but very rare to get postpartum psychosis. Again, I feel like I don't think that's what this character was experiencing because her children look too old. I don't think there was a baby involved. Usually, postpartum psychosis develops in hours to weeks after delivery, so that first, like, two to four weeks is really critical to be monitoring someone. A lot of times, women who develop this condition, you'll have symptoms of hallucinations, hearing or seeing things that aren't there, delusional lines of thinking that aren't in line with the broader cultural beliefs that you're growing up in. And a lot of times, unfortunately, these delusional thoughts are directed toward the baby. You think, like, the baby is possessed by a demon. The only way of helping them is by killing them, for example. Something like that. So the rates of suicide infanticide are really high. Sadly, I think there's like a 4% risk of suicide and around the same for infanticide. And that's incredibly sad. In this movie, it seems like the children were older. So again, postpartum psychosis would develop really early or up to a year. A lot of times, women with this condition end up having an underlying bipolar disorder. So, again, if you have a history of bipolar disorder, you really want to be monitored carefully. Again, it's still rare, but it could happen. But I feel like, if I remember correctly in the movie, the kids were older, so it makes me wonder if the mom had depression with psychotic features or a personality disorder. We don't really know. We don't really get to know anything about her. But I couldn't watch it this time. I had to fast forward through those scenes near the end. It was, like, way too much for me to watch. I don't know about you guys. Yeah. [47:35] Dr. Tobias Wasser: They had said in the movie and using their words at the time that his wife was insane and a manic depressive. Suicidal tendencies was how they described her to him when he was kind of. [47:48] Portia Pendleton: Coming out of right. So maybe she had some kind of bipolar disorder or schizoaffective disorder or something. [47:58] Dr. Tobias Wasser: And I think, too, I was just, like, reflecting on his trauma in the war and then coming home and kind of finding his children deceased. And then his wife kind of really flippant about it. And I think that could make a lot of people react the way he did with killing her in that moment. Emotions are so high because I was thinking it's like, why did he end up here? I might be way off here. I don't know at all. He was there not because of the crime of killing his wife, but because of his then, like, delusion after because I feel like you could kill someone and you go to jail versus, like, a forensic hospital. [48:48] Portia Pendleton: Maybe he was found not guilty by reason of insanity because they were saying maybe have happened. [48:53] Dr. Tobias Wasser: I'm assuming then for him to end up on that island versus, like, a jail. [48:57] Portia Pendleton: Right? No, I think you're right. And I think I wrote down when the team kept talking about Rachel Solano, the brunette woman who allegedly went missing, I felt like if you rewatched it, you could hear their thoughts about Teddy, right? Like, as they're all part of this big hoax. I think they're actually, like, talking to Teddy, and they said something about how the greatest obstacle to recovery is the inability to face what she's done. And I feel like that was him. And I think, like you said earlier, Tobias, it really speaks to is he delusional or an extreme denial? And we kind of saw that foundation laid. I thought with all the flashbacks to war and that he clearly had PTSD, looks like he developed an alcohol use disorder, and then this happened. Why wouldn't he still be using his excellent defense mechanisms to stay in this world of denial? Is there anything else you want to mention before we ask you your thoughts about some of our other favorite psychopaths? [50:09] Dr. Katrina Furey: No. I hate you guys at all. I welcome your psychopath. [50:16] Portia Pendleton: So you have seen the show. You right. At least some of it. [50:20] Dr. Katrina Furey: Yes. I've seen the first couple of seasons. [50:22] Portia Pendleton: I'm so jealous whenever I meet someone who isn't caught up because it's so good, and, like, season three and four are so good. So we're dying to know your thoughts about Joe Goldberg? [50:36] Dr. Katrina Furey: Yeah. And I've heard some of your guys discussions about this, about the episode, the seasons. I have seen that he is such an interesting sociopath. [50:48] Portia Pendleton: Right. [50:48] Dr. Katrina Furey: He's got this level of compassion in him that you just don't typically see. And it's confusing. I mean, like his relationship, like with. [50:59] Portia Pendleton: Paco, the little boy. [51:01] Dr. Katrina Furey: Exactly. Neighbor boy. Clearly there's some projection identification there, but there are just ways in which he clearly connects exactly in a way that you don't typically get. It makes it almost feel not real. But in my experience working with individuals with social personality disorder, and even the ones who would be identified as sociopaths, I've never come across somebody like that before. You tend to see much more callousness, much more narcissism, self directed interest. And he clearly has plenty of callousness and self directed interest and erotic fantasies and all sorts of other things. But I think that's the part to me that's most notable because it humanizes the character in a way that you almost root for him. [51:52] Portia Pendleton: Right. [51:53] Dr. Katrina Furey: Dominique, sociopathic, right? [51:56] Portia Pendleton: Yeah. What do you think about Logan Roy? Do you watch Succession? [52:06] Dr. Katrina Furey: I'm just thinking about this in anticipation of today and I guess are you guys convinced that he's a sociopath or a psychopath? I think he's an extreme narcissist, doesn't care about other people. I don't know that he purposely tries to harm me. To me, I view his character pathology as all being about himself and a way of fulfilling his own needs, seeing himself as more important than anybody else. I don't see him necessarily as like I guess he doesn't care about the rules, but it just all seems so self serving. So maybe I'm drawing the lines of distinctions that don't exist, but I don't know what you guys think. [52:47] Portia Pendleton: I still think he's very, like a malignant narcissist. However, I could maybe be convinced that this was a very intense, complex PTSD and developments of putting his own needs first to survive in a trauma informed kind of way based on the way he was brought up. Like, he doesn't know any better, but then he just does stuff to the kid, to his kids who are adults, but I always call them kids that just feel so icky and like to his grandson, and maybe he's going to poison them or not, where then I'm just like. [53:25] Dr. Katrina Furey: Yeah, that's fair. Poisoning of the children. [53:31] Portia Pendleton: That'S usually not cool. What do you think about that? [53:35] Dr. Tobias Wasser: Is that also learned? [53:37] Portia Pendleton: Right? [53:38] Dr. Tobias Wasser: This is how he was hit, or this is how you make a man, or this is how you make someone who's self sufficient views at times like Kendall and specifically, it feels like Kendall is really soft, right. Not hard enough, not like a killer. And I don't know, it's like almost his disappointment in that, because he is, but it's like he was raised that way. I think it is confusing. I mean, a lot of trauma always there seems to be. But does he love does he feel good when he hurts them because he hurts them, or does he not think about it, or does he feel like he's helping them? I don't know. [54:23] Portia Pendleton: Right. [54:25] Dr. Katrina Furey: I think I can see that, and I guess I've seen it more as maybe an adaptive behavior. I think that based on the difficult life experiences that we learned recently that he had and upbringing, the challenges he had to overcome, I think both. He literally had to overcome a lot. And it seems like there's this learned aspect that espousing a machado and a machismo. Like, this is the way that you're big and you're tough and you got to get through life to get over these things. And he does some horrible things, but usually it's to achieve some personal, self serving end. [54:59] Portia Pendleton: Usually the reason, not because he's, like, getting off on hurting someone else. [55:04] Dr. Katrina Furey: Yeah. Again. I don't pretend to fully understand logan Roy. It doesn't seem like he hurts for the sake of hurting. He seems to hurt as a means to the end of his own success and survival. [55:16] Portia Pendleton: Right? Yeah. Right. What do you think about Tom? [55:20] Dr. Katrina Furey: He's, like, slimy and slithery and will do whatever he has to do to anybody in order to get to that ultimate goal. And it's hard to know. He probably is probably born that way, whatever. But it does seem like it stems differently from this deep seated insecurity about his upbringing and always wanting something grand and great and wanting to feel grand and great. And it seems like he hopes that if he can be in the presence of greatness, then he will be great, and then he will ascend to greatness, and he'll finally, basically, finally convince Mommy to love him. [55:53] Dr. Tobias Wasser: I had the wool over my eyes for him until recently. [55:57] Portia Pendleton: That's okay, portia. You have a pure heart. You have a pure heart. Got to watch out. People like him will get you like it for real. Thank you so much, Tobias. This is super helpful. So thanks for listening to another episode of Analyze Scripts. You can find us on Instagram at Analyze scripts. You can find us on TikTok at Analyze Scripts podcast and stay tuned for our next episode, and we'll see you next Monday. Bye. This podcast and its contents are a copyright of Analyzed Scripts. All rights reserved. Any redistribution or reproduction of part or all of the contents in any form is prohibited. Unless you want to share it with your friends and rate review and subscribe, that's fine. All stories and characters discussed are fictional in nature. No identification with actual persons, living or deceased places, buildings, or products is intended or should be inferred. This podcast is for entertainment purposes only. The podcast and its contents do not constitute professional mental health or medical advice. Listeners might consider consulting a mental health provider if they need assistance with any mental health problems. Or concerns. As always, please call 911 or go directly to your nearest emergency room for any psychiatric emergencies. Thanks for listening and see you next time. [57:29] Dr. Katrina Furey: Our channel.

In this episode of the Gut Doctor podcast, Dr. Parikh interviews Dr. Thiru Muniraj, Director of the Yale Center for Pancreatitis and Associate Chief of Digestive Health at Yale New Haven Hospital. Dr. Muniraj discusses symptoms, risk factors, and diagnostic tools for pancreatic cancer.

Synopsis: We recorded this episode in December 2022 with Florian Brand and Srinivas Rao, the Co-Founders and CEO & CSO, respectively, of atai Life Sciences, a biopharmaceutical company that leverages a decentralized platform approach to incubate and accelerate the development of highly effective mental health treatments that address the unmet needs of patients, including psychedelics and digital therapeutics. Florian and Srinivas provide an overview of the neuropsychiatry landscape, the history of psychedelics within mental health, and the role COVID played in increasing mental health awareness. They also discuss the model at atai around drug development and how they approach tackling such a massive unmet need. Finally, Florian talks about how self-awareness can lead to healthier habits and decision-making, and the importance of investing in therapy. Biography: Florian Brand is the co-founder and Chief Executive Officer of atai Life Sciences. Prior to joining atai, Florian was starting and building user-centric technology companies as a serial entrepreneur. Florian suffered from anxiety in his youth and was able to achieve remission through a combination of psychotherapy and robust meditation practice. It was ultimately his experiences seeing his friends and loved ones failed by the mental healthcare system that inspired him to join the movement to transform the treatment landscape for patients who have been unable to find relief in currently available therapies. In 2022, Florian was recognized in Fortune's 40 Under 40 list spotlighting influential individuals shaping business and Business Insider's 30 Under 40 in Healthcare. Florian was also featured in Endpoint News' list of 20 Under 40 Innovators in Biotech in 2021. He is a proud member of the Founders Pledge, a global community of mission-aligned entrepreneurs dedicated to doing good. Srinivas Rao is the Chief Scientific Officer at atai Life Sciences. Dr. Rao has over 19 years of professional experience in the pharmaceutical and biotechnology industries. Prior to atai, Dr. Rao has held the titles of Chief Scientific, Medical, or Executive Officer at companies ranging from venture-backed startups to vertically-integrated, publicly-traded pharmaceutical companies. Dr. Rao completed an internship in Internal Medicine at Yale-New Haven Hospital. He received his Ph.D. in neurobiology from Yale Graduate School and his M.D. from Yale School of Medicine. He holds both a Bachelor of Science and Master of Science degree in Electrical Engineering from Yale College and Yale Graduate School, respectively.

The Cardiorenal Syndrome is commonly encountered, and frequently misunderstood. Join the CardioNerds team as we discuss the complex interplay between the heart and kidneys with Dr. Elliott Miller (Assistant Professor of Medicine at Yale University School of Medicine and Associate Medical Director of the Cardiac Intensive Care Unit of Yale New Haven Hospital), and Dr. Nayan Arora (Clinical Assistant Professor of Medicine and Nephrologist at the University of Washington Medical Center). We are hosted by FIT lead Dr. Matthew Delfiner (Cardiology Fellow at Temple University), Cardiac Critical Care Series Co-Chairs Dr. Mark Belkin (AHFTC faculty at University of Chicago) and Dr. Karan Desai (Cardiologist at Johns Hopkins Hospital), and CardioNerds Co-Found Dr. Dan Ambinder. In this episode we discuss the definition and pathophysiology of the cardiorenal syndrome, explore strategies for initial diuresis and diuretic resistance, and management of the common heart failure medications in this setting. Show notes were developed by Dr. Matthew Delfiner. Audio editing by CardioNerds Academy Intern, student doctor Akiva Rosenzveig. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Management of Cardiorenal Syndrome in the CICU Cardiorenal syndrome (CRS) represents a range of clinical entities in which there is both heart and kidney dysfunction, and can be driven by one, or both, of the organs. CRS is caused by reduced renal perfusion, elevated renal congestion, or a combination of the two. Treatment therefore focuses on increasing perfusion, by optimizing cardiac output and mean arterial pressure, and reducing congestion through diuresis. Patients should be monitored for an adequate response to the initial diuretic dose within 2 hours of administration. If the response is inadequate, the loop diuretic dose should be doubled. Diuretic resistance can be managed via sequential nephron blockade, most commonly with thiazide diuretics, but also with amiloride, high-dose spironolactone, or acetazolamide, as these target different regions of the nephron. In cases of refractory diuretic resistance, hypertonic saline can be considered with the help of an experienced clinician. Continuation or cessation of renin-angiotensin-aldosterone system (RAAS) inhibitors in the setting of CRS should be made on a case-by-case basis. Show notes - Management of Cardiorenal Syndrome in the CICU 1. Cardiorenal syndrome (CRS) is a collection of signs/symptoms that indicate injury to both the heart and kidneys. Organ dysfunction in one can drive dysfunction in the other. Cardiorenal syndrome can be categorized as: Type 1 - Acute heart failure causing acute kidney injury Type 2 - Chronic heart failure causing chronic kidney injury Type 3 - Acute kidney injury causing acute heart failure Type 4 - Chronic kidney injury causing chronic heart failure Type 5 - Co-development of heart and kidney injury by another systemic process. These categories can be helpful for education, discussion, and research purposes, but they do not usually enter clinical practice on a regular basis since different categories of cardiorenal syndrome are not necessarily treated differently. 2. CRS is caused by either reduced renal perfusion, elevated renal congestion, or a combination of the two. When dealing with CRS, note that: CRS can be caused by poor kidney perfusion,

If you've ever wanted to heal from illness, or feel better about your life, then do we have the Humor and Healing show for you.   I'll be talking with Dr. Bernie Siegel, about how to laugh your way to self-healing, and happiness.   Bernie Siegel is an American writer and retired pediatric surgeon, who writes on the relationship between the patient and the healing process and the best selling author of numerous books including Love, Medicine and Miracles, Love Animals and Miracles, The Art of Healing, and a phenomenal little audiobook Humor and Healing.   Topics Include: What does it mean to become a love warrior? What it means to send someone love and help change their life? What is 365 Prescriptions for the Soul? How do we heal from the feeling that we are a failure? What we can learn from stories about our life? What we can learn from Simon and Garfunkel? Why you want to wear a bandage when you are not injured! What is the importance of sharing what is ailing you with others? Why people never die, and what it means for you? What laughter means for our health? Why your attitude is so important for your survival? What we can learn from people who have a few months to live? What people have done when they were told they were dying that dramatically extended their lives? What does it mean to choose to live? What does it mean to take back the reigns of your life? How can parents “use love as your weapon”? What does it mean to breathe peace?   Dr. Bernie Siegel was born in Brooklyn, NY. He attended Colgate University and Cornell University Medical College. He holds membership in two scholastic honor societies, Phi Beta Kappa and Alpha Omega Alpha and graduated with honors. His surgical training took place at Yale New Haven Hospital, West Haven Veteran's Hospital and the Children's Hospital of Pittsburgh. He retired from practice as an assistant clinical professor of surgery at Yale of general and pediatric surgery in 1989 to speak to patients and their caregivers.   In 1978 he originated Exceptional Cancer Patients, a specific form of individual and group therapy utilizing patients' drawings, dreams, images and feelings. ECaP is based on “carefrontation,” a safe, loving therapeutic confrontation, which facilitates personal lifestyle changes, personal empowerment and healing of the individual's life. The physical, spiritual and psychological benefits which followed led to his desire to make everyone aware of his or her healing potential. He realized exceptional behavior is what we are all capable of.   Bernie, and his wife and coworker Bobbie, live in a suburb of New Haven, Connecticut. They have five children and eight grandchildren. Bernie and Bobbie have co-authored their children, books and articles. Their home with its many children, pets and interests resembled a cross between a family art gallery, museum, zoo and automobile repair shop. It still resembles these things, although the children are trying to improve its appearance in order to avoid embarrassment.   www.dailywoohoo.com - Sign up for my FREE daily newsletter for high-vibration content.   To find out more visit: https://amzn.to/3qULECz - Order Michael Sandler's book, "AWE, the Automatic Writing Experience" www.automaticwriting.com  - Automatic Writing Experience Course www.inspirenationuniversity.com - Michael Sandler's School of Mystics https://inspirenationshow.com/ -  www.dailywoohoo.com - Sign up for my FREE daily newsletter for high-vibration content. ……. Follow Michael and Jessica's exciting journey and get even more great tools, tips, and behind-the-scenes access. Go to https://www.patreon.com/inspirenation   For free meditations, weekly tips, stories, and similar shows visit: https://inspirenationshow.com/   We've got NEW Merch! - https://teespring.com/stores/inspire-nation-store   Follow Inspire Nation, and the lives of Michael and Jessica, on Instagram - https://www.instagram.com/InspireNationLive/   Find us on TikTok - https://www.tiktok.com/@inspirenationshow

Dr. John Krystal — All Things Ketamine, The Most Comprehensive Podcast Episode Ever | Brought to you by Athletic Greens all-in-one nutritional supplement, Helix Sleep premium mattresses, and Allform premium, modular furniture. Dr. John Krystal is the Robert L. McNeil, Jr., Professor of Translational Research; Professor of Psychiatry, Neuroscience, and Psychology; Chair of the Department of Psychiatry at Yale University; and Chief of Psychiatry and Behavioral Health at Yale-New Haven Hospital.Dr. Krystal is a leading expert in the areas of alcoholism, post-traumatic stress disorder, schizophrenia, and depression. His work links psychopharmacology, neuroimaging, molecular genetics, and computational neuroscience to study the neurobiology and treatment of these disorders. He is best known for leading the discovery of the rapid antidepressant effects of ketamine in depressed patients.He directs/co-directs the Yale Center for Clinical Investigation (CTSA), NIAAA Center for the Translational Neuroscience of Alcoholism, and Clinical Neuroscience Division of the National Center for PTSD (VA).Dr. Krystal is a member of the U.S. National Academy of Medicine; co-director of the Neuroscience Forum of the U.S. National Academies of Sciences, Engineering, and Medicine; Fellow of the American Association for the Advancement of Science (AAAS); and editor of Biological Psychiatry, one of the most selective and highly cited journals in the field of psychiatric neuroscience.He is the co-founder and Chief Scientific Advisor of Freedom Biosciences, a clinical-stage biotechnology platform developing next-generation ketamine and psychedelic therapeutics that recently emerged from stealth in August 2022.ONE VERY IMPORTANT DISCLAIMER: I'm not a doctor, nor do I play one on the Internet. None of the content in this podcast constitutes medical advice or should be construed as a recommendation to use ketamine or psychedelics. There are psychological, physical, and sometimes legal risks with such usage. Please consult your doctor before considering anything we discuss in this episode.Please enjoy!*This episode is brought to you by Helix Sleep! Helix was selected as the #1 overall mattress of 2020 by GQ magazine, Wired, Apartment Therapy, and many others. With Helix, there's a specific mattress to meet each and every body's unique comfort needs. Just take their quiz—only two minutes to complete—that matches your body type and sleep preferences to the perfect mattress for you. They have a 10-year warranty, and you get to try it out for a hundred nights, risk-free. They'll even pick it up from you if you don't love it. And now, Helix is offering up to 200 dollars off all mattress orders plus two free pillows at HelixSleep.com/Tim.*This episode is also brought to you by Athletic Greens. I get asked all the time, “If you could use only one supplement, what would it be?” My answer is usually AG1 by Athletic Greens, my all-in-one nutritional insurance. I recommended it in The 4-Hour Body in 2010 and did not get paid to do so. I do my best with nutrient-dense meals, of course, but AG further covers my bases with vitamins, minerals, and whole-food-sourced micronutrients that support gut health and the immune system. Right now, Athletic Greens is offering you their Vitamin D Liquid Formula free with your first subscription purchase—a vital nutrient for a strong immune system and strong bones. Visit AthleticGreens.com/Tim to claim this special offer today and receive the free Vitamin D Liquid Formula (and five free travel packs) with your first subscription purchase! That's up to a one-year supply of Vitamin D as added value when you try their delicious and comprehensive all-in-one daily greens product.*This episode is also brought to you by Allform! If you've been listening to the podcast for a while, you've probably heard me talk about Helix Sleep mattresses, which I've been using since 2017. They also launched a company called Allform that makes premium, customizable sofas and chairs shipped right to your door—at a fraction of the cost of traditional stores. You can pick your fabric (and they're all spill, stain, and scratch resistant), the sofa color, the color of the legs, and the sofa size and shape to make sure it's perfect for you and your home.Allform arrives in just 3–7 days, and you can assemble it yourself in a few minutes—no tools needed. To find your perfect sofa and receive 20% off all orders, check out Allform.com/Tim.*For show notes and past guests on The Tim Ferriss Show, please visit tim.blog/podcast.For deals from sponsors of The Tim Ferriss Show, please visit tim.blog/podcast-sponsorsSign up for Tim's email newsletter (5-Bullet Friday) at tim.blog/friday.For transcripts of episodes, go to tim.blog/transcripts.Discover Tim's books: tim.blog/books.Follow Tim:Twitter: twitter.com/tferriss Instagram: instagram.com/timferrissYouTube: youtube.com/timferrissFacebook: facebook.com/timferriss LinkedIn: linkedin.com/in/timferrissPast guests on The Tim Ferriss Show include Jerry Seinfeld, Hugh Jackman, Dr. Jane Goodall, LeBron James, Kevin Hart, Doris Kearns Goodwin, Jamie Foxx, Matthew McConaughey, Esther Perel, Elizabeth Gilbert, Terry Crews, Sia, Yuval Noah Harari, Malcolm Gladwell, Madeleine Albright, Cheryl Strayed, Jim Collins, Mary Karr, Maria Popova, Sam Harris, Michael Phelps, Bob Iger, Edward Norton, Arnold Schwarzenegger, Neil Strauss, Ken Burns, Maria Sharapova, Marc Andreessen, Neil Gaiman, Neil de Grasse Tyson, Jocko Willink, Daniel Ek, Kelly Slater, Dr. Peter Attia, Seth Godin, Howard Marks, Dr. Brené Brown, Eric Schmidt, Michael Lewis, Joe Gebbia, Michael Pollan, Dr. Jordan Peterson, Vince Vaughn, Brian Koppelman, Ramit Sethi, Dax Shepard, Tony Robbins, Jim Dethmer, Dan Harris, Ray Dalio, Naval Ravikant, Vitalik Buterin, Elizabeth Lesser, Amanda Palmer, Katie Haun, Sir Richard Branson, Chuck Palahniuk, Arianna Huffington, Reid Hoffman, Bill Burr, Whitney Cummings, Rick Rubin, Dr. Vivek Murthy, Darren Aronofsky, Margaret Atwood, Mark Zuckerberg, Peter Thiel, Dr. Gabor Maté, Anne Lamott, Sarah Silverman, Dr. Andrew Huberman, and many more.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.