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Welcome to the Clinical
Center Grand Rounds,

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a weekly series of educational
lectures for physicians and

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health care professionals
broadcast from the Clinical

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Center at the National
Institutes of Health in

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Bethesda, MD.

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The NIH Clinical Center is the
world's largest hospital totally

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dedicated to investigational
research and leads the global

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effort in training today's
investigators and discovering

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tomorrow's cures.

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Learn more by visiting us online
at http://clinicalcenter.nih.gov

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I'M HENRY MASUR,
CHIEF OF

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CLINICAL CARE MEDICINE, I AM

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REALLY PLEASED TO WELCOME ALL OF

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YOU TO THIS GREAT TEACHERS GRAND

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ROUNDS AND I'M PARTICULARLY

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PLEASED THAT AN OLD FRIEND AND

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COLLEAGUE WES ELY FROM TULANE

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UNIVERSITY IS HERE EARLY IN THE

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ACADEMEC YEAR TO TALK TO US.

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I WOULD LIKE

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TO TELL YOU A LITTLE BIT ABOUT

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HIS BACKGROUND.

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WES STARTED OUT HIS CAREER IN

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SHREVEPORT WHERE HE GREW UP,

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WENT TO HIGH SCHOOL AND HAD

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EXPERIENCES PARTICULARLY WORKING

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IN THE FIELD DURING THE SUMMER,

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SUMMER JOB WHERE HE LEARNED A

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LOT ABOUT THE HEALTHCARE THAT

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SOME OF HIS COLLEAGUES WORKING

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THERE DID NOT HAVE AND I THINK

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YOU CAN TELL THAT THAT

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INFLUENCED THE DIRECTION HE WENT

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FOR THE REST OF HIS LIFE.

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HE THEN STAYED IN THE SOUTH TO

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GO TO TULANE UNIVERSITY FOR HIS

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UNDERGRADUATE MEDICAL DEGREES,

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THEN WENT TO WAKE FORREST FOR

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RESIDENCY, FOR HIS CHIEF

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RESIDENT AND IT WAS THERE REALLY

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THAT A RESIDENT AND FELLOW FIRST

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CAME TO NATIONAL PROMINENCE

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BECAUSE AS A CHIEF RESIDENT, HE

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WAS ABLE TO PUBLISH AN ARTICLE

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ON VENT LATERS IN THE NEW

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ENGLAND JOURNAL OF MEDICINE,

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NOTABLE ACCOMPLISHMENT FOR

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SOMEBODY THAT EARLY IN HIS

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CAREER AND THAT WOULD REALLY

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MARK WHERE HE WENT LATER.

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AFTER A BRIEF SOJOWRN IN

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ST. LOUIS, HE WENT TO VANDERBILT

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UNIVERSITY WHERE HE'S BEEN FOR

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THE REST OF HIS CAREER.

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NEXT SLIDE.

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SO IN THE NEXT SLIDE,--MAYBE

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WE'RE HAVING TROUBLE FORWARDING

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THIS--I MEAN WES IS REALLY KNOWN

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FOR A NUMBER OF THINGS, I DON'T

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KNOW IF WE CAN MOVE TO THE NEXT

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SLIDE OR NOT, WES TRAINED TO BE

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A PULMONARY CARE PHYSICIAN AND I

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THINK BOTH AT VANDERBILT AND

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NATIONALLY HE'S KNOWN AS A SUPER

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CLINICIAN AND REALLY A GIFTED

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EDUCATOR AND COMMUNICATOR.

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HE'S WELL KNOWN FOR HIS EARLY

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INVESTIGATIONS IN ADULT REZONING

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PIRATTORY DISTRESS SYNDROME

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WHERE HE STUDIES

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PATHOPHYSIOLOGY, DIAGNOSIS,

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THERAPY AND OUTCOMES AND

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ESTABLISHESSED HIS SCIENTIFIC

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CREDENTIALS.

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HE THEN GOT INTERESTED IN THE

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LONG-TERM OUTCOME OF PATIENTS IN

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THE ICU AND HE WILL TELL YOU A

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LITTLE BIT ABOUT THE

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SOPHISTICATED CALLED

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ABCDEF BUNDLES WHICH ARE 6

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SAFETY ELEMENTS ADOPTED BY THE

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SOCIETY OF CLINICAL CARE

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MEDICINE AND HELP PATIENTS ON

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VENTILATORS, AND LASTLY HE WAS

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THE LEADER IN DEVELOPING THE CAM

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ICU AND METRIC INFUSEMENT

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ASSESSMENT IN THE ICU, SOMETHING

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THAT IS WIDELY USED NOW TO

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EVALUATE PATIENTS AND TELL US

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ABOUT IT.

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NEXT SLIDE.

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WES THOUGH HAS A NUMBER OF

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DIFFERENT CAREERS.

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I TOLD YOU AS A CLINICIAN, AS AN

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EDUCATOR, HE'S ALSO BEEN A VERY

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EFFECTIVE HIGH PROFILE

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COMMUNICATOR.

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HE'S BEEN SEEN ON LOCAL NEWS,

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NATIONAL NEWS TALKS ABOUT HIS

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PATIENT'S STUDY EXPTION ABOUT

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WHAT PATIENTS IN THE ICU REALLY

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EXPERIENCE.

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HE PUBLISHES WIDELY IN THE

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POPULAR PRESS,'VE PROBABLY SEEN

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SOME OF HIS ARTICLES IN THE

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WASHINGTON POST OR WALL STREET

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JOURNAL AND RECENTLY, HE CAME

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OUT WITH A VERY WELL RECEIVED,

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EVERY DEEP KRAWN BREATH WHICH IS

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TAKEN FROM A JOHN STEINBECK

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QUOTE BUT THIS IS REALLY HIS

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EXPERIENCE ON HEALING,

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RECOVERING AND TRANSFORMING

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MEDICINE IN THE ICU, AND FOR ANY

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OF YOU WHO KNOW WHAT IT'S LIKE

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TO BE IN THE ICU AND THE

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LONG-TERM CONSEQUENCES, THIS IS

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AN AMAZING BOOK TALKING ABOUT

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HIS EXPERIENCE IN THE DIRECTION

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HE THINKS WE OUGHT TO GO.

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SO WES, IT'S REALLY WONDERFUL WE

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COULD HAVE YOU HERE, VIRTUALLY

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WE CAN HAVE YOU HERE SOMETIMES

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IN PERSON AND WE'RE LOOKING

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FORWARD TO WHAT YOU HAVE TO SAY

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ABOUT COVID.

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WES?

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>> THANK YOU HENRY, THANK
YOU

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FRIEND, THANK YOU FOR TAKING

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TIME OUT OF YOUR BUSY LIVES TO

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BE HERE TODAY AND WHAT I WILL DO

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IS TAKE A DATA DRIVEN APPROACH

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TO SHARING WITH YOU, THE PROCESS

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OF MY OWN LEARNING DURING COVID

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AND HOW WE CAN TAKE I THINK THE

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PREVIOUS 2 AND HALF DECADES

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WORTH OF RESEARCH, BRING THEM

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INTO WHAT HAPPENED TO US DURING

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COVID WHICH WAS HARD AND

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SUFFERING FOR OUR PATIENTS AND

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FOR US IN THE SCIENTIFIC FIELD

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AS WELL AND HOW WE CAN FIND A

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WAY FORWARD AND TRY AND FIND A

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WAY TO REBUILD WHAT COVID TOOK

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FROM US AND I WILL BE VERY

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HONEST WITH YOU THAT MY JOURNEY

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IN ALL THIS THAT HENRY WENT OVER

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JUST NOW, I'VE JUST BEEN

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SURROUNDED BY THE RIGHT PEOPLE.

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I'VE APPROACHED THIS AT THE

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PATIENT LEVEL FIRST.

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WHO IS THIS PERSON SITTING IN

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FRONT OF ME?

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HOW ARE THEY SUFFERING?

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AND INSTEAD OF SAYING, WHAT'S

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THE MATTER WITH YOU, SAY TO

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THEM, MISS SMITH TELL ME WHAT

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MATTERS TO YOU?

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I MET WITH THE STUDENTS THIS

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MORNING, THE NEXT GENERATION OF

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NIH INVESTIGATORS AND LEADERS IN

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MEDICINE AND I EMPHASIZED THIS

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SWITCHING OF THE PREPOSITION

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FROM WHAT MATTERS--FROM WHAT'S

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THE MATTER WITH YOU TO TO, WHAT

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MATTERS TO YOU.

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AND I THINK WHEN WE ALWAYS KEEP

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OUR MIND AND OUR EYEOT PATIENT

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THAT WE WILL FIND OUR BEST WAY

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FORWARD AND IN COVID SOME REALLY

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BAD THINGS HAPPENED IN MEDICINE,

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LIKE NONAPOPTOTIC VISITATION

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POLICIES WHICH I WROTE ABOUT IN

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THE WALL STREET JOURNAL IN THE

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WAJO ACCIDENT AND WE MADE LEFT

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TURNS IF THEY WERE NOT RIGHT, I

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DON'T KNOW IF THAT'S THE RIGHT

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WAY TO PHRASE THAT BUT WE DID

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SOME HING THINGS THAT WERE NOT

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IN THE BEST INTEREST OF OUR

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PATIENTS.

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LET ME SAY IT THAT WAY BUT WE

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HAVE DATA TO SUPPORT MAKING GOOD

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CHOICES GOING FORWARD IN A WAY

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WE CAN BOTH ACHIEVE RECOVERY FOR

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OUR PATIENTS, AND RECOVERY FOR

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OURSELVES AS WELL, SO LET'S TALK

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ABOUT FROM A 

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PERSPECTIVE, I WILL SHARE MY

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SLIDES WITH YOU AND I WILL HAVE

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US GET STARTED NOW.

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 BY WAY OF
DISCLOSURE I

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WANT YOU TO KNOW THAT I DO NOT

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HAVE ANY RELEVANT INDUSTRY

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RELATED DISCLOSURES, I AM NIH

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AND VA FUNDED, I WAS AN UNFUNDED

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INVESTIGATOR ON A COVID STUDY

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CALLED CO-BEAR QUER WHICH I WILL

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REVIEW WITH YOU THE DATA ABOUT

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BECAUSE IT LED TO THE FDA

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APPROVAL OF THE SECOND FDA

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APPROVED DRUG FOR COVID BEHIND

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REMDESIVIR, I DO NOT HAVE ANY

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FINANCIAL INTEREST IN THIS DRUG

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AT ALL, BUT I DO BELIEVE THE

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DATA IS IMPORTANT SO LET'S GO

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OVER THIS IN A MINUTE.

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I THINK IT'S IN A LAUNCHING

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POINT FOR OUR OWN PATH TO

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DISCOVERY AND I WILL TELL THIS

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STORY BECAUSE I WANT YOU TO

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THINK ABOUT YOUR OWN LIFE AND

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YOUR OWN DISCERNMENT IN HOW

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YOU'RE MOVING THROUGH, DECIDING

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HOW TO SPEND YOUR TIME, WHERE

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DO--WHERE TO DEVOTE YOURSELF AS

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AN INVESTIGATOR, AS A PHYSICIAN

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SCIENTIST, OR NURSE SCIENTIST OR

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WHATEVER YOUR BACKGROUND IS, IN

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THIS PARTICULAR CASE, I HAPPEN

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TO BE ON A TREADMILL 1 DAY,

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READING THE NEW ENGLAND JOURNAL

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OF MEDICINE AND A PAPER CAME OUT

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SAYING THAT WE COULD FIND A

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BETTER WAY TO GET PEOPLE OFF THE

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VENTILATOR.

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AND IN THE FIRST LINE OF THE

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RESULT SECTION, IT SAID THIS 1

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SENTENCE THAT CHANGED MY ENTIRE

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LIFE, IT SAYS 85% OF THE

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PATIENTS COULD NOT BE ENROLLED

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IN THIS RANDOMIZED TRIAL BECAUSE

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THEY WERE READY TO BE TAKEN OFF

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THE VENTILATOR WHEN THEY WERE

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SCREENED.

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AND I THOUGHT TO MYSELF, WAIT A

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MINUTE WHAT?

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WHY WERE 85% OF THEM NOT

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ENROLLABLE BECAUSE THEY WERE

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ALREADY READY THEN WHY WEREN'T

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THEY TAKEN OFF THE VENTILATOR

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THE DAY BEFORE THAT OR THE DAY

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BEFORE THAT?

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SO I SET THUP INVESTIGATION

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WHICH WAS THE FIRST EVER TRIAL

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OF A PROTOCOL TO USE RESPIRATORY

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THERAPISTS TO GET PEOPLE OFF THE

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VENTILATOR SOONER AND I THE

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FIRST THING I WANT TO TELL YOU

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IS OUT OF 82 INTENSIVISTS AT THE

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INSTITUTION.

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EIGHTY-ONE OF THEM SAID IT WOULD

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BE A BAD IDEA AND THAT THEY

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DIDN'T WANT US TO MOVE FORWARD.

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SO I HAD 1 MENTOR WHOSE NAME WAS

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ED [INDISCERNIBLE], HE SAID,

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LET'S DO THIS.

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HE IS THE SENIOR AUTHOR ON THIS

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PAPER, WE DESEEBED A TRIAL, I

260
00:09:44,440 --> 00:09:46,640
WOULD REPORT, SCREEN MY

261
00:09:46,640 --> 00:09:47,720
PATIENTS, ENROLL THESE PEOPLE

262
00:09:47,720 --> 00:09:49,160
AND AT THE END OF THE DAY, WE

263
00:09:49,160 --> 00:09:52,360
PROVED THAT TAKING THE DECISION

264
00:09:52,360 --> 00:09:54,520
MAKING OUT OF THE DOCTOR'S HANDS

265
00:09:54,520 --> 00:09:57,520
AND PLACING IT INTO A

266
00:09:57,520 --> 00:09:58,200
RESPIRATORY CARE PRACTITIONER

267
00:09:58,200 --> 00:10:00,440
GROUP THAT WE COULD DO BETTER.

268
00:10:00,440 --> 00:10:03,160
SO IN MY MIND IT WAS DESILOING

269
00:10:03,160 --> 00:10:05,120
THE WAY WE CARE FOR PATIENTS AND

270
00:10:05,120 --> 00:10:06,360
EMBRACING A TEAM APPROACH IN THE

271
00:10:06,360 --> 00:10:08,680
ICU, AND THE PATIENTS GOT OFF

272
00:10:08,680 --> 00:10:11,400
THE VENTILATOR 2 DAYS EARLIER,

273
00:10:11,400 --> 00:10:14,760
WE HAVE THE COMPLICATION RATES

274
00:10:14,760 --> 00:10:15,800
AND WE SAVE $5000 PER PATIENT.

275
00:10:15,800 --> 00:10:18,520
NOW, I WANT TO SHARE WITH YOU

276
00:10:18,520 --> 00:10:22,760
THIS QUOTE FROM ANN HATCHET, 1

277
00:10:22,760 --> 00:10:24,640
OF MY FAVORITE AUTHORS, AND SHE

278
00:10:24,640 --> 00:10:25,960
WRITES:  NEVER BE SO FOCUSED ON

279
00:10:25,960 --> 00:10:27,280
WHAT YOU'RE LOOKING FOR THAT YOU

280
00:10:27,280 --> 00:10:29,800
OVERLOOK THE THING YOU ACTUALLY

281
00:10:29,800 --> 00:10:30,200
FIND.

282
00:10:30,200 --> 00:10:32,160
TURNS OUT THAT A FEW YEARS LATER

283
00:10:32,160 --> 00:10:34,920
I WAS ASKED TO GO TO A RESEARCH

284
00:10:34,920 --> 00:10:37,640
GROUP BRINGS TGHTD THE IDEA OF

285
00:10:37,640 --> 00:10:40,400
AGING AND CRITICAL CARE AND I

286
00:10:40,400 --> 00:10:41,680
THOUGHT THAT I WAS GOING TO

287
00:10:41,680 --> 00:10:44,880
PROVE A BET ARE WAY TO GET OLDER

288
00:10:44,880 --> 00:10:47,040
PEOPLE OFF THE VENTILATOR BUT

289
00:10:47,040 --> 00:10:50,480
WHEN I ANALYZE THE DATA FROM THE

290
00:10:50,480 --> 00:10:51,720
ARDS NEST, 902 PATIENTS AND WE

291
00:10:51,720 --> 00:10:53,280
GOT THE DATA TOGETHER TO PRESENT

292
00:10:53,280 --> 00:10:55,480
DOWN THERE AT THIS MEETING OF

293
00:10:55,480 --> 00:10:57,120
GERIATRICS AND CRITICAL CARE,

294
00:10:57,120 --> 00:10:59,640
WHAT I FOUND WAS THAT OLDER

295
00:10:59,640 --> 00:11:01,040
PEOPLE'S LUNGS GOT BETTER AS

296
00:11:01,040 --> 00:11:02,920
QUICKLY AS YOUNG PEOPLE'S LUNGS,

297
00:11:02,920 --> 00:11:04,600
BUT THAT DOWN THE LINE, A WEEK

298
00:11:04,600 --> 00:11:05,880
OR 2 LATER THE OLD PEOPLE WOULD

299
00:11:05,880 --> 00:11:08,440
GO ON TO HAVE MORE TROUBLE, MORE

300
00:11:08,440 --> 00:11:10,080
BOUNCE BACKS INTO THE ICU, MORE

301
00:11:10,080 --> 00:11:10,320
DEATH.

302
00:11:10,320 --> 00:11:18,360
SO I WAS LOOKING FOR A WAY TO

303
00:11:18,360 --> 00:11:19,960
DISSECT THE DIAPHRAGM FOR MY

304
00:11:19,960 --> 00:11:21,920
NEXT MOVE AND PATRICK WAS SAYING

305
00:11:21,920 --> 00:11:23,600
DON'T BE MARRIED TO YOUR

306
00:11:23,600 --> 00:11:27,800
PREVIOUS IDEAS, BE ACCEPTING OF

307
00:11:27,800 --> 00:11:31,040
THE AND PAYING ATTENTION TO WHAT

308
00:11:31,040 --> 00:11:32,160
YOU THOUGHT YOU WOULD, NOUGHT

309
00:11:32,160 --> 00:11:33,920
WHAT YOU THOUGHT YOU WOULD FIND.

310
00:11:33,920 --> 00:11:35,400
AND SO MOVING FORWARD, I BEGAN

311
00:11:35,400 --> 00:11:36,760
TO HEDGE MY BETS ON THE FACT

312
00:11:36,760 --> 00:11:38,480
THAT WHAT WAS CAUSING THESE

313
00:11:38,480 --> 00:11:39,800
OLDER PEOPLE PROBLEMS WAS THEIR

314
00:11:39,800 --> 00:11:45,880
BRAINS AND IT WAS VERY MUCH

315
00:11:45,880 --> 00:11:47,360
AN ANTITHESIS OF WHAT I'VE BEEN

316
00:11:47,360 --> 00:11:48,080
TRAINED TO DO.

317
00:11:48,080 --> 00:11:50,120
IN THE ICU WE WERE ALL ABOUT THE

318
00:11:50,120 --> 00:11:51,240
LUNGS, VENTILATOR AND SETTINGS

319
00:11:51,240 --> 00:11:54,560
AND IN FACT 1 OF THE SENIOR

320
00:11:54,560 --> 00:11:55,520
INVESTIGATORS AND SPEAKER THIS

321
00:11:55,520 --> 00:11:59,120
IS MORNING ON THE GOOD

322
00:11:59,120 --> 00:11:59,920
TEACHER'S, GREAT TEACHER'S GROUP

323
00:11:59,920 --> 00:12:00,800
WITH THE STUDENTS SAID WHEN I

324
00:12:00,800 --> 00:12:03,560
WAS IN THE ICU, I NEVER HAD ANY

325
00:12:03,560 --> 00:12:04,960
RELATIONSHIPS WITH MY PATIENTS,

326
00:12:04,960 --> 00:12:07,920
ALL WE DID WAS KEEP THEM SNOWED

327
00:12:07,920 --> 00:12:09,320
WITH SEDATION AND TRY AND GET

328
00:12:09,320 --> 00:12:11,240
THEM THROUGH THE TECHNOLOGICAL

329
00:12:11,240 --> 00:12:12,800
LIFE SUPPORT BUT I NEVER KNEW

330
00:12:12,800 --> 00:12:15,160
ANYTHING ABOUT THESE PEOPLE.

331
00:12:15,160 --> 00:12:16,800
AND WE HAVE NOW TURNED THAT ON

332
00:12:16,800 --> 00:12:18,720
ITS HEAD IN THE ICU AND I WILL

333
00:12:18,720 --> 00:12:20,040
TELL YOU THE STORY OF HOW WE'VE

334
00:12:20,040 --> 00:12:21,800
DONE THAT BECAUSE NOW, IN THE

335
00:12:21,800 --> 00:12:24,680
ICU, WE WANT OUR PATIENTS AWAKE,

336
00:12:24,680 --> 00:12:28,040
ALERT, OUT OF THE BED, WALKING

337
00:12:28,040 --> 00:12:28,720
EVENOT VENTILATOR, ENGAGING WITH

338
00:12:28,720 --> 00:12:29,840
US AND THEIR FAMILY MEMBERS AND

339
00:12:29,840 --> 00:12:34,560
HOW WE GOT STARTED WAS BACK IN

340
00:12:34,560 --> 00:12:38,080
1998, 1999 WHEN WE DESIGNED THIS

341
00:12:38,080 --> 00:12:40,520
TOOL CALLED THE CAM ICU.

342
00:12:40,520 --> 00:12:44,400
AND WE PROVED THAT WE COULD

343
00:12:44,400 --> 00:12:45,960
MEASURE [INDISCERNIBLE], WE

344
00:12:45,960 --> 00:12:47,760
COULD DO IT WHEN SOMEONE

345
00:12:47,760 --> 00:12:51,320
COULDN'T SPEAK TO US, WE DID IT

346
00:12:51,320 --> 00:12:52,400
WITH SPECIFICITY, THE NURSES DID

347
00:12:52,400 --> 00:12:54,200
THIS WORK IN LESS THAN 2

348
00:12:54,200 --> 00:12:55,480
MINUTES, THE GROUP SHOWED THAT

349
00:12:55,480 --> 00:12:57,920
THE TOOL WAS VALID AND RELIABLE

350
00:12:57,920 --> 00:12:59,080
IN THIS OLDER PEOPLE AND THOSE

351
00:12:59,080 --> 00:13:01,120
WITH HIGH OR LOW SEVERITY OF

352
00:13:01,120 --> 00:13:03,960
ILLNESS SO WITH THE TEST

353
00:13:03,960 --> 00:13:05,520
CHARACTERISTICS WE PUBLISHED IN

354
00:13:05,520 --> 00:13:07,560
JAMA AND WE MOVED FORWARD.

355
00:13:07,560 --> 00:13:08,640
BUT THAT WAS A WAY TO TELL

356
00:13:08,640 --> 00:13:10,680
WHETHER OR NOT SOMEBODY WAS

357
00:13:10,680 --> 00:13:13,240
THINKING CLEARLY BUT IT WASN'T A

358
00:13:13,240 --> 00:13:14,800
MEASUREMENT OF HOW ACEROUSABLE

359
00:13:14,800 --> 00:13:16,760
THEY ARE WERE AND CONSCIOUSNESS

360
00:13:16,760 --> 00:13:19,120
IS A MEASURE OF ACEROUSABILITY

361
00:13:19,120 --> 00:13:20,400
AND CONTENT OF CONSCIOUSNESS.

362
00:13:20,400 --> 00:13:23,200
SO A COUPLE YEARS LATER I WORKED

363
00:13:23,200 --> 00:13:26,000
WITH ANOTHER INVESTIGATOR NAMED

364
00:13:26,000 --> 00:13:27,400
KIRK [INDISCERNIBLE] IN

365
00:13:27,400 --> 00:13:28,920
RICHMOND, VIRGINIA AND WE

366
00:13:28,920 --> 00:13:35,200
VALIDATED THIS TOOL CALLED THE

367
00:13:35,200 --> 00:13:35,800
RASS, KURT PUBLISHED FIRST IN

368
00:13:35,800 --> 00:13:38,520
THE BLUE JOURNAL BUT HE DIDN'T

369
00:13:38,520 --> 00:13:40,920
WANT TO CALL IT SESESLER'S

370
00:13:40,920 --> 00:13:42,880
AGITATION, BECAUSE THEN THEY

371
00:13:42,880 --> 00:13:44,760
WOULD REFER TO AS SESESLER'S

372
00:13:44,760 --> 00:13:47,360
ASS, SO WE NAMED IT RASS,

373
00:13:47,360 --> 00:13:48,720
INSTEAD AND PUBLISHED THIS PAPER

374
00:13:48,720 --> 00:13:50,440
IN JAMA WHICH WAS ANOTHER

375
00:13:50,440 --> 00:13:51,320
VALIDATION AND STUDY.

376
00:13:51,320 --> 00:13:52,840
AND THE 2 THINGS TOGETHER BECAME

377
00:13:52,840 --> 00:13:55,040
THE SISTER INSTRUMENTS OF HOW WE

378
00:13:55,040 --> 00:13:57,120
MEASURE THE BRAIN IN THE ICU.

379
00:13:57,120 --> 00:13:59,840
AROUSABILITY WITH THE RASS,

380
00:13:59,840 --> 00:14:01,120
CONTENT OF CONSCIOUSNESS WITH

381
00:14:01,120 --> 00:14:02,880
THE CAM ICU AND THEN WE WENT ON

382
00:14:02,880 --> 00:14:05,880
TO USE THOSE TOOLS TO PROVE THAT

383
00:14:05,880 --> 00:14:07,960
DELERIUM WAS A PREDICTOR OF

384
00:14:07,960 --> 00:14:10,400
MORTALITY AND THOSE WHO LOVE

385
00:14:10,400 --> 00:14:12,320
STORIES OF WORDS, I AM A WRITER

386
00:14:12,320 --> 00:14:14,880
AND SO I LOVE WORDS, THIS WORD

387
00:14:14,880 --> 00:14:17,040
PREDICTOR HERE WAS NOT CHOSEN BY

388
00:14:17,040 --> 00:14:20,280
ME, IT WAS CHOSEN BY THE JAMA

389
00:14:20,280 --> 00:14:22,880
EDITOR, AND THE STATIST KALG

390
00:14:22,880 --> 00:14:24,880
EDITOR OF JAMA.

391
00:14:24,880 --> 00:14:26,920
DEBORAH COOK WAS THE EDITOR, I

392
00:14:26,920 --> 00:14:28,320
WAS READING AND ASSOCIATE IT

393
00:14:28,320 --> 00:14:30,160
WITH MORTALITY BUT I DIDN'T WANT

394
00:14:30,160 --> 00:14:31,360
TO OVERSTATE MY FINDINGS BUT

395
00:14:31,360 --> 00:14:33,640
THEY NO, NO, NO, YOU HAVE USED

396
00:14:33,640 --> 00:14:34,320
THE APPROPRIATE STATISTICAL

397
00:14:34,320 --> 00:14:36,240
TOOLS TO SAY IT IS A PREDICTOR

398
00:14:36,240 --> 00:14:38,200
OF DEATH HERE SO WE'RE GOING TO

399
00:14:38,200 --> 00:14:39,480
EMBRACE THAT WORD, WE'RE GOING

400
00:14:39,480 --> 00:14:44,320
TO CHANGE YOUR TITLE FOR YOU AND

401
00:14:44,320 --> 00:14:46,640
IN THIS CARING FOR THE

402
00:14:46,640 --> 00:14:47,960
CRITICALLY ILL COLUMN IN JAMA WE

403
00:14:47,960 --> 00:14:49,520
WILL MAKE THIS READER KNOW THAT

404
00:14:49,520 --> 00:14:51,760
THIS IS AN INDEPENDENT PREDICTOR

405
00:14:51,760 --> 00:14:53,280
OF SURVIVAL AND WE NOW KNOW THAT

406
00:14:53,280 --> 00:14:56,280
EVERY ADDITIONAL DAY OF DELERIUM

407
00:14:56,280 --> 00:14:59,000
IS A 10% INCREASE RISE IN THE

408
00:14:59,000 --> 00:15:01,640
LIKELIHOOD OF SOMEBODY DYING.

409
00:15:01,640 --> 00:15:04,280
AND THIS IS A TRIPLING OF THE

410
00:15:04,280 --> 00:15:08,240
RISK OF DEATH AFTER 30--AFTER 6

411
00:15:08,240 --> 00:15:08,520
MONTHS.

412
00:15:08,520 --> 00:15:11,320
SO, WE NOW USE THIS AS A

413
00:15:11,320 --> 00:15:12,160
BAROMETER, A PROGNOSTIC MARKER

414
00:15:12,160 --> 00:15:14,520
AND IT IS SOMETHING THAT YOU AND

415
00:15:14,520 --> 00:15:15,920
YOUR LOVED 1S SHOULD ALL HAVE

416
00:15:15,920 --> 00:15:18,200
MONITORED IF YOU ARE IN THE ICU

417
00:15:18,200 --> 00:15:20,560
AND THE GUIDELINES OF THE

418
00:15:20,560 --> 00:15:21,440
SOCIETY OF CRITICAL CARE

419
00:15:21,440 --> 00:15:24,040
MEDICINE AND ALL INTERNATIONAL

420
00:15:24,040 --> 00:15:24,560
GUIDELINES RECOMMENDING

421
00:15:24,560 --> 00:15:25,880
APPROPRIATE EVIDENCE BASED CARE

422
00:15:25,880 --> 00:15:27,840
FOR CRITICALLY ILL PATIENTS SAY

423
00:15:27,840 --> 00:15:30,800
THAT EVERY PATIENT, EVERY DAY IN

424
00:15:30,800 --> 00:15:33,000
EVERY ICU, ACROSS THE LAND

425
00:15:33,000 --> 00:15:37,800
SHOULD BE MEASURED FOR DELERIUM,

426
00:15:37,800 --> 00:15:38,360
WHY?

427
00:15:38,360 --> 00:15:40,240
BECAUSE YEARS AGO, IT WAS THE

428
00:15:40,240 --> 00:15:42,640
CULTURE OF CRITICAL CARE THAT WE

429
00:15:42,640 --> 00:15:49,480
SHOULD AND THIS AD WAS OUT OF A

430
00:15:49,480 --> 00:15:53,320
THROW AWAY, FOR THE USE OF

431
00:15:53,320 --> 00:15:55,880
MIDAZOLAM, FOR CALM IN THE ICU.

432
00:15:55,880 --> 00:15:57,320
THIS WAS THE WAY WE WERE

433
00:15:57,320 --> 00:15:59,520
TRAINED, TO KEEP THE PATIENTS SO

434
00:15:59,520 --> 00:16:01,280
SEDATED THAT WE WEREN'T AWARE

435
00:16:01,280 --> 00:16:02,720
OFA WHAT WAS GOING ON.

436
00:16:02,720 --> 00:16:04,400
AND WHAT HAPPENED IN MY BRAIN IS

437
00:16:04,400 --> 00:16:07,240
WAIT A MINUTE, OLDER PEOPLE ARE

438
00:16:07,240 --> 00:16:08,000
SUCCUMBING TO SOMETHING DOWN THE

439
00:16:08,000 --> 00:16:09,520
LINE AND IF IT'S A BRAIN

440
00:16:09,520 --> 00:16:11,040
DYSFUNCTION AND IF THAT BRAIN,

441
00:16:11,040 --> 00:16:14,960
THAT CPU OF OUR HUMAN BODY IS

442
00:16:14,960 --> 00:16:16,080
CAUSING A DOWN STREAM PROBLEM

443
00:16:16,080 --> 00:16:17,160
WITH SURVIVAL AND QUALITY OF

444
00:16:17,160 --> 00:16:19,960
LIFE, THEN WE NEED TO KNOW ABOUT

445
00:16:19,960 --> 00:16:20,280
THIS.

446
00:16:20,280 --> 00:16:22,120
WE NEED TO UNEARTH THIS AND PUT

447
00:16:22,120 --> 00:16:24,400
A SAFETY BELT ON OUR PATIENTS IF

448
00:16:24,400 --> 00:16:26,160
YOU WILL.

449
00:16:26,160 --> 00:16:28,640
SO, THIS IS WHAT WE BEGAN TO DO.

450
00:16:28,640 --> 00:16:31,520
TO GET A BETTER SAFETY BELT FOR

451
00:16:31,520 --> 00:16:36,000
OUR PATIENTS, WE SET OUT TO

452
00:16:36,000 --> 00:16:37,240
DESIGN NUMEROUS RANDOMIZED

453
00:16:37,240 --> 00:16:39,000
CONTROL TRIALS, MULTICENTER THAT

454
00:16:39,000 --> 00:16:45,120
BEGAN TO PEEL AWAY THE LAYERS OF

455
00:16:45,120 --> 00:16:46,640
IMMOBILITY, DEEP SEDATION AND

456
00:16:46,640 --> 00:16:48,080
ABSENCE OF FAMILY, ET CETERA

457
00:16:48,080 --> 00:16:50,280
THAT I THINK WERE 1 BY 1

458
00:16:50,280 --> 00:16:53,120
STRIPPING PATIENTS OF THE DESIRE

459
00:16:53,120 --> 00:16:54,920
TO LIVE, OF THE ABILITY TO SEE

460
00:16:54,920 --> 00:16:57,200
THE PURPOSE AND FIND THEIR WHY.

461
00:16:57,200 --> 00:17:01,560
YOU KNOW VICTOR FRANKLE IN HIS

462
00:17:01,560 --> 00:17:06,560
BOOK, MAN'S SEARCH FOR MEANING

463
00:17:06,560 --> 00:17:10,400
QUOTES NICHES FROM TWILIGHT OF

464
00:17:10,400 --> 00:17:13,000
THE IDOMAINS, NICHE WROTE IF A

465
00:17:13,000 --> 00:17:16,040
MAN HAS A WHY TO LIVE, HE CAN

466
00:17:16,040 --> 00:17:17,440
GET BY WITH ALMOST ANY HOW.

467
00:17:17,440 --> 00:17:19,480
SO WE HAVE TO SAY AS CAREGIVERS

468
00:17:19,480 --> 00:17:20,440
FOR OUR PATIENTS, HOW CAN I

469
00:17:20,440 --> 00:17:22,240
SERVE THIS PERSON THAT IS

470
00:17:22,240 --> 00:17:23,800
SUFFERING IN MY ICU AND THE BEST

471
00:17:23,800 --> 00:17:27,080
WAY TO SERVE THAT PERSON IT TO

472
00:17:27,080 --> 00:17:30,640
HELP THEM FIND THEIR WHY TO

473
00:17:30,640 --> 00:17:30,920
LIVE.

474
00:17:30,920 --> 00:17:32,560
OKAY, A PERSON CANNOT FIND THEIR

475
00:17:32,560 --> 00:17:37,040
WHY IF THEY ARE UNCONSCIOUS IN A

476
00:17:37,040 --> 00:17:37,240
COMA.

477
00:17:37,240 --> 00:17:38,680
THEY HAVE TO BE AWAKE AND

478
00:17:38,680 --> 00:17:39,840
ENGAGING WITH THE THINGS THAT

479
00:17:39,840 --> 00:17:41,520
MATTER MOST TO THEM IN LIFE AND

480
00:17:41,520 --> 00:17:44,320
I AS A CLINICIAN CANNOT BE A

481
00:17:44,320 --> 00:17:47,400
TRUE HEALER IF I KEEP THEM

482
00:17:47,400 --> 00:17:50,400
SNOWED IN A SEDENTARIAATIVE COMA

483
00:17:50,400 --> 00:17:51,440
WHERE THEY CANNOT ENGAGE AND

484
00:17:51,440 --> 00:17:53,520
TALK TO ME, WHERE I CANNOT LEARN

485
00:17:53,520 --> 00:17:55,280
ABOUT THEM, SO EVERY SINGLE DAY

486
00:17:55,280 --> 00:17:57,480
WHAT WE PROVED AND I WILL SHOW

487
00:17:57,480 --> 00:17:59,800
YOU THE DATA WE PROVE THAD EVERY

488
00:17:59,800 --> 00:18:00,640
DAY, PATIENTS SHOULD NO MATTER

489
00:18:00,640 --> 00:18:03,160
WHAT YOU THOUGHT WAS RIGHT

490
00:18:03,160 --> 00:18:04,480
YESTERDAY, WHEN THE SUN COMES UP

491
00:18:04,480 --> 00:18:06,440
THE NEXT DAY, YOU SHOULD TURN

492
00:18:06,440 --> 00:18:07,920
OFF THE SEDENTARIATIVES, TURN

493
00:18:07,920 --> 00:18:09,600
OFF THE VENTILATOR, SEE IF

494
00:18:09,600 --> 00:18:15,640
THEY'RE STILL REQUIRED AND SEE

495
00:18:15,640 --> 00:18:19,000
IF THE PERSON AND IN SO DOING WE

496
00:18:19,000 --> 00:18:20,120
ACTUALLY SAVED LIVES.

497
00:18:20,120 --> 00:18:23,920
IN THIS ABC STUDY HERE WE

498
00:18:23,920 --> 00:18:25,840
PUBLISHED IN LANCET, WE SHOWED

499
00:18:25,840 --> 00:18:28,960
IN THE CAP LANMIER CURVE A THOO%

500
00:18:28,960 --> 00:18:35,120
REDUCTION IN RISK REDUCTION, 15%

501
00:18:35,120 --> 00:18:42,400
IN FACT THE NEW ENGLAND JOURNAL

502
00:18:42,400 --> 00:18:44,520
AND WE HAVE IT SUBMITTED THEY

503
00:18:44,520 --> 00:18:46,240
HAD IT FOR A YEAR AND THEY WERE

504
00:18:46,240 --> 00:18:50,800
LIKE OH MY GOSH, YES, AND SO WE

505
00:18:50,800 --> 00:18:52,080
SHOWED THAT FOR EVERY 7 PEOPLE

506
00:18:52,080 --> 00:18:53,800
TREATED WITH THIS WAKE UP AND

507
00:18:53,800 --> 00:18:54,800
BREATHE APPROACH, WAKE THEM UP,

508
00:18:54,800 --> 00:18:57,240
SEE IF THEY CAN BREATHE ON THEIR

509
00:18:57,240 --> 00:18:59,680
OWN, THAT 1 LIFE WILL BE SAVED.

510
00:18:59,680 --> 00:19:03,200
AND WHEN WE DID THAT, WE STARTED

511
00:19:03,200 --> 00:19:05,280
A LOT OF PEOPLE IN THE WORLD

512
00:19:05,280 --> 00:19:07,200
STARTED NOTICING THAT MAYBE

513
00:19:07,200 --> 00:19:08,000
THERE WERE UNINTENDED BENEFITS

514
00:19:08,000 --> 00:19:09,120
OF THIS,A PROACH.

515
00:19:09,120 --> 00:19:12,080
LET ME SHARE WITH YOU

516
00:19:12,080 --> 00:19:14,240
AN ANECDOTE ABOUT DONNIE HILLY,

517
00:19:14,240 --> 00:19:17,560
SHE WAS A CEO ON MUSIC ROW, HERE

518
00:19:17,560 --> 00:19:19,760
HERE SHE IS IN STRIPES WITH HER

519
00:19:19,760 --> 00:19:21,080
SISTER IN WHITE, I THIS IS THE

520
00:19:21,080 --> 00:19:22,520
BOOK THAT HENRY WAS SHOWING YOU

521
00:19:22,520 --> 00:19:23,960
EARLIER, THIS IS THE PAPER BACK,

522
00:19:23,960 --> 00:19:25,200
IT CAME OUT YESTERDAY AND BY THE

523
00:19:25,200 --> 00:19:26,960
WAY, I DON'T MAKE ANY MONEY OFF

524
00:19:26,960 --> 00:19:31,640
THIS BOOK, I CALL IT EDDB, EDDB,

525
00:19:31,640 --> 00:19:34,680
EVERY PENNY IN THE PROCEEDS FROM

526
00:19:34,680 --> 00:19:36,560
THIS BOOK GOES INTO AN ENDOWMENT

527
00:19:36,560 --> 00:19:38,280
WHERE WE HAVE SOCIAL WORKERS

528
00:19:38,280 --> 00:19:39,640
HIRED TO HELP PEOPLE PICK UP THE

529
00:19:39,640 --> 00:19:41,320
PIECES OF THEIR LIFE.

530
00:19:41,320 --> 00:19:44,120
SO THROUGH OUR RESEARCH CENTER

531
00:19:44,120 --> 00:19:45,720
HERE THE CIBS, CRITICAL ILLNESS,

532
00:19:45,720 --> 00:19:47,280
BRAIN DYSFUNCTION AND

533
00:19:47,280 --> 00:19:49,000
SURVIVORSHIP, YOU CAN FIND US ON

534
00:19:49,000 --> 00:19:55,160
THE WEB SAIT ICUDELERIUM.ORG, WE

535
00:19:55,160 --> 00:19:57,320
HAVE AN EDUCATIONAL WEBSITE THAT

536
00:19:57,320 --> 00:19:58,600
WE PROVIDE FREE SUPPORT FOR

537
00:19:58,600 --> 00:19:59,960
COVID USERS EVERY DAY, SUPPORT

538
00:19:59,960 --> 00:20:01,400
GROWFS FOR THEIR SPOUSES AS

539
00:20:01,400 --> 00:20:05,440
WELL, FOR FAMILY MEMBERS AND WE

540
00:20:05,440 --> 00:20:07,240
CONSIDER OURSELVES PUBLIC

541
00:20:07,240 --> 00:20:12,480
SERVANTS HERE TO HELP PEOPLE

542
00:20:12,480 --> 00:20:14,840
LIKE DONNA HILLEY, SO I WRITE,

543
00:20:14,840 --> 00:20:16,920
DURING THIS TIME OF UNCERTAINTY

544
00:20:16,920 --> 00:20:20,120
I RECEIVED A LETTER FROM DIANE

545
00:20:20,120 --> 00:20:22,320
WHITTEN-VILE, HER SISTER HAD

546
00:20:22,320 --> 00:20:26,160
BEEN SPENT 10 DAYS IN ON THE

547
00:20:26,160 --> 00:20:27,520
VEPTALATOR IN ICU, WRESTLING

548
00:20:27,520 --> 00:20:29,560
WITH SEPTIC SHOCK, I REMEMBER

549
00:20:29,560 --> 00:20:31,640
SHE HAD STRUPGLED HERRIBLELY

550
00:20:31,640 --> 00:20:33,160
WITH DELERIUM NOT KNOWING WHERE

551
00:20:33,160 --> 00:20:34,920
SHE WAS OR RECOGNIZING VISITORS

552
00:20:34,920 --> 00:20:35,640
TO HER ROOM.

553
00:20:35,640 --> 00:20:39,440
SHE WAS A CEO ON MUSIC ROW IN

554
00:20:39,440 --> 00:20:40,880
NASHVILLE WHO OVERSAW

555
00:20:40,880 --> 00:20:41,720
MULTIMILLION DOLLAR MUSIC

556
00:20:41,720 --> 00:20:44,720
CATALOG PURCHASES AND ORGANIZED

557
00:20:44,720 --> 00:20:46,040
DINNERS FOR WASHINGTON ELITE.

558
00:20:46,040 --> 00:20:48,200
AND AFTER SHE DEVELOPED DELERIUM

559
00:20:48,200 --> 00:20:49,880
WE COULDN'T GET MORE MENTAL

560
00:20:49,880 --> 00:20:51,320
CLOUDING CLEARS FOR MONTHS.

561
00:20:51,320 --> 00:20:52,720
SHE HAD TRIED TO GO BACK TO WORK

562
00:20:52,720 --> 00:20:54,560
ALTHOUGH SHE CANNOT SEEM TO

563
00:20:54,560 --> 00:20:56,560
FULLY BOUNCE BACK.

564
00:20:56,560 --> 00:20:57,880
SHE'S LOST HER SPARK.

565
00:20:57,880 --> 00:21:01,200
SHE WAS SUCH A PERSONAL

566
00:21:01,200 --> 00:21:02,160
PREILLNESS, SO GREGARIOUS AND

567
00:21:02,160 --> 00:21:04,760
REALLY THE LIFE OF THE PARTY BUT

568
00:21:04,760 --> 00:21:06,960
SHE IS VERY FLAT NOW, SHE HAS

569
00:21:06,960 --> 00:21:08,840
MEMORY PROBLEMS, SOME LONG-TERM

570
00:21:08,840 --> 00:21:09,800
BUT MOSTLY SHORT-TERM.

571
00:21:09,800 --> 00:21:13,840
SHE LOOKS MUCH OLDER, LIKE AN

572
00:21:13,840 --> 00:21:16,120
ELDERLY WOMAN, NOW AND WACHOVIAS

573
00:21:16,120 --> 00:21:18,520
VERY SLOWLY ALWAYS HOLDING ON TO

574
00:21:18,520 --> 00:21:20,560
RAILS, SHE IS VAJILE AND VACANT.

575
00:21:20,560 --> 00:21:22,080
WHAT'S GOING ON HERE, WHAT'S

576
00:21:22,080 --> 00:21:22,880
GOING ON.

577
00:21:22,880 --> 00:21:23,640
ONE MORE STORY.

578
00:21:23,640 --> 00:21:28,960
AFTER WE PUBLISHED OUR DATA, WE

579
00:21:28,960 --> 00:21:30,520
GOT SLEWS OF TESTIMONIALS FROM

580
00:21:30,520 --> 00:21:31,480
PEOPLE ON THE INTERNET SAYING

581
00:21:31,480 --> 00:21:32,960
THINGS LIKE THIS, AFTER 5

582
00:21:32,960 --> 00:21:34,280
MONTHS, I FELT BETTER AND

583
00:21:34,280 --> 00:21:36,360
RETURNED TO WORK BUT WAS FIRED

584
00:21:36,360 --> 00:21:37,400
10 WEEKS LATER, IT DIDN'T

585
00:21:37,400 --> 00:21:39,000
SURPRISE ME BECAUSE I WAS

586
00:21:39,000 --> 00:21:40,520
STRUGGLING TERRIBLY, I COULDN'T

587
00:21:40,520 --> 00:21:42,720
ORGANIZE MY WORK, COMMITTED MANY

588
00:21:42,720 --> 00:21:44,200
ERRORS IN DOCUMENTATION,

589
00:21:44,200 --> 00:21:45,000
FREQUENTLY LOST THINGS, FORGOT

590
00:21:45,000 --> 00:21:47,640
MEET EXPTION DID NOT MANAGE MY

591
00:21:47,640 --> 00:21:48,520
TIME WELL.

592
00:21:48,520 --> 00:21:51,080
WHAT DOES THIS SOUND LIKE TO YOU

593
00:21:51,080 --> 00:21:54,080
RIGHT NOW IN 2022?

594
00:21:54,080 --> 00:21:54,360
RIGHT.

595
00:21:54,360 --> 00:21:55,160
LONG COVID.

596
00:21:55,160 --> 00:22:01,840
THIS IS THE STORY OF LONG COVID

597
00:22:01,840 --> 00:22:02,920
PATIENTS RIGHT NOW AND YET THIS

598
00:22:02,920 --> 00:22:06,760
IS FROM A HICKS PATIENT 15-TWEBT

599
00:22:06,760 --> 00:22:07,800
YEARS AGO, FOR DECADES NOW WE

600
00:22:07,800 --> 00:22:09,000
HAVE BEEN CREATING A

601
00:22:09,000 --> 00:22:10,720
CIRCUMSTANCE WHERE SOME PEOPLE

602
00:22:10,720 --> 00:22:14,520
SURVIVE AND END UP WITH AN

603
00:22:14,520 --> 00:22:18,280
ACQUIRED DEMENTIA AND THIS

604
00:22:18,280 --> 00:22:19,120
ACQUIRED DEMENTIA DOES ENTAIL

605
00:22:19,120 --> 00:22:20,680
THE LOSS OF NILIONS OF NEURONS

606
00:22:20,680 --> 00:22:23,000
IN THEIR BRAIN AND THIS IS WELL

607
00:22:23,000 --> 00:22:25,320
DOCUMENTED AND REALLY FLESHED

608
00:22:25,320 --> 00:22:27,320
OUT IN EDDB, BUT NOW WE HAVE A

609
00:22:27,320 --> 00:22:29,120
NEW PROBLEM WHERE PEOPLE ARE

610
00:22:29,120 --> 00:22:32,000
SUCCUMBING TO THE CORONA VIRUS,

611
00:22:32,000 --> 00:22:35,080
AND ABOUT 100 DAYS LATER THEY

612
00:22:35,080 --> 00:22:36,600
ARE HAVING ALL THESE BRAIN FOG

613
00:22:36,600 --> 00:22:37,800
PROBLEMS, IN FACT IT'S NOW 2

614
00:22:37,800 --> 00:22:39,560
YEARS LATER AND PEOPLE ARE STILL

615
00:22:39,560 --> 00:22:41,280
HAVING ALL KINDS OF PROBLEMS

616
00:22:41,280 --> 00:22:43,040
WITH THEIR EXECUTIVE FUNCTION

617
00:22:43,040 --> 00:22:45,400
AND MEMORY, THIS IS ABSOLUTELY

618
00:22:45,400 --> 00:22:47,600
WELL DOCUMENTED, WE ARE DOING

619
00:22:47,600 --> 00:22:49,120
LOTS OF NIH INVESTIGATIONS RIGHT

620
00:22:49,120 --> 00:22:50,240
NOW FINDING THE LINKS TO THE 2

621
00:22:50,240 --> 00:22:51,840
AND WHAT I WILL SHARE WITH YOU

622
00:22:51,840 --> 00:22:53,480
TODAY, THIS IS UNPUBLISHED BUT

623
00:22:53,480 --> 00:22:55,160
IT'S A PAPER IN PRESS, THAT WE

624
00:22:55,160 --> 00:23:00,480
HAVE NOW PROVEN A LINK TWOON

625
00:23:00,480 --> 00:23:03,720
DELERIUM IN COVID AND THE

626
00:23:03,720 --> 00:23:05,440
SEVERITY OF THE

627
00:23:05,440 --> 00:23:06,520
NEUROPSYCHOLOGICAL DEFINITES IN

628
00:23:06,520 --> 00:23:06,920
COVID SURVIVORS.

629
00:23:06,920 --> 00:23:09,760
SO THIS IS A WAY THAT IT MIGHT

630
00:23:09,760 --> 00:23:10,760
LOOK ON A NEUROIMAGE.

631
00:23:10,760 --> 00:23:12,640
HERE YOU HAVE AN MRI ON THE LEFT

632
00:23:12,640 --> 00:23:14,360
OF A PATIENT WHO DID NOT HAVE

633
00:23:14,360 --> 00:23:15,920
DELERIUM AND 1 ON THE RIGHT OF

634
00:23:15,920 --> 00:23:17,920
SOME INTHB WHO HAD 12 DAYS OF

635
00:23:17,920 --> 00:23:19,520
DELERIUM JUST LIKE DONNA HILLEY

636
00:23:19,520 --> 00:23:22,400
AND YOU CAN SEE THE TREMENDOUS

637
00:23:22,400 --> 00:23:23,040
AMOUNT OF ATROPHY.

638
00:23:23,040 --> 00:23:27,120
IN THIS CASE, WE USE A BAROMETER

639
00:23:27,120 --> 00:23:29,120
OF ATROPHY AS A VENTRAL TO BRAIN

640
00:23:29,120 --> 00:23:30,680
RATIO, YOU CAN SEE THAT THE VBR

641
00:23:30,680 --> 00:23:35,920
IS VERY HIGH ON THE IMAGE IN B

642
00:23:35,920 --> 00:23:38,720
BUT NOT IN A, AND SO THEY HIRE

643
00:23:38,720 --> 00:23:41,240
THE VBR, MORE ATROPHY OCCURRED

644
00:23:41,240 --> 00:23:44,000
AND WE SHOWED THIS IN DIFFERENT

645
00:23:44,000 --> 00:23:45,520
MANUSCRIPTS THAT DELERIUM IS AN

646
00:23:45,520 --> 00:23:47,040
INDEPENDENT PREDICTOR OF THE

647
00:23:47,040 --> 00:23:49,680
HIGHER BRAIN RATIO IN ICU

648
00:23:49,680 --> 00:23:50,080
SURVIVORS.

649
00:23:50,080 --> 00:23:51,440
WELL, YEARS DOWN THE LINE WE

650
00:23:51,440 --> 00:23:55,240
BEGAN TO STUDY THIS IN TERMS OF

651
00:23:55,240 --> 00:23:56,960
LARGE COHORT STUDIES, DID

652
00:23:56,960 --> 00:23:58,960
DELERIUM ALSO PREDICT AN

653
00:23:58,960 --> 00:24:00,560
ACQUIRED DEMENTIA.

654
00:24:00,560 --> 00:24:03,640
AND 2013, WE PUBLISHED OUR DATA

655
00:24:03,640 --> 00:24:06,600
ON LONG-TERM COGNITIVE

656
00:24:06,600 --> 00:24:08,200
IMPAIRMENT, READ ACQUIRED

657
00:24:08,200 --> 00:24:10,000
DEMENTIA FROM 121 PATIENTS, 34%

658
00:24:10,000 --> 00:24:14,120
OF WHOM HAD THE EQUIVALENT OF

659
00:24:14,120 --> 00:24:16,560
MODERATE TBI AND 24% THE

660
00:24:16,560 --> 00:24:18,920
EQUIVALENT OF MODERATE TO MILD

661
00:24:18,920 --> 00:24:19,360
ALZHEIMER'S DISEASE.

662
00:24:19,360 --> 00:24:21,040
I AM PRIVILEGED TO BE ON

663
00:24:21,040 --> 00:24:25,520
THE--THANKFUL TO BE ON THE

664
00:24:25,520 --> 00:24:26,680
NATIONAL AKD--SALLY ME OF

665
00:24:26,680 --> 00:24:28,640
SCIENCE AND MEDICINE FORUM ON

666
00:24:28,640 --> 00:24:29,520
TRAUMATIC BRAIN INJURY AND I'M

667
00:24:29,520 --> 00:24:30,160
WORKING RIGHT NONAPOPTOTIC YOU

668
00:24:30,160 --> 00:24:32,720
WITH A GROUP OF PEOPLE TO TRY

669
00:24:32,720 --> 00:24:34,320
AND UNDERSTAND HOW WE CAN DO A

670
00:24:34,320 --> 00:24:36,360
BETTER JOB TEACHING THE LAY

671
00:24:36,360 --> 00:24:38,680
PUBLIC AND OUR MEDICAL COMMUNITY

672
00:24:38,680 --> 00:24:39,880
ABOUT TBI, WELL, LONG THE WAY

673
00:24:39,880 --> 00:24:43,160
I'VE BEEN THINKING ABOUT HOW OUR

674
00:24:43,160 --> 00:24:44,800
ICU SURVIVORS ESSENTIALLY HAVE

675
00:24:44,800 --> 00:24:47,360
ATBI, AFTER THEY GET OUT OF THE

676
00:24:47,360 --> 00:24:49,160
ICU, THEY DIDN'T GET AN OUTRIGHT

677
00:24:49,160 --> 00:24:50,960
BONK ON THE HEAD WHICH SHOWS UP

678
00:24:50,960 --> 00:24:53,600
AS A MACROINJURY ON THEIR CTs

679
00:24:53,600 --> 00:24:57,760
AND MRIs, WHAT THEY HAVE A

680
00:24:57,760 --> 00:24:59,840
GLOBAL MICROINJURY ACROSS THEIR

681
00:24:59,840 --> 00:25:01,640
DORSAL LATERAL PREPRONTAL

682
00:25:01,640 --> 00:25:03,040
CORTEX, HIPPOCAMPUS AND NUMEROUS

683
00:25:03,040 --> 00:25:06,160
OTHER REGIONS OF THE BRAIN WHICH

684
00:25:06,160 --> 00:25:07,560
LEAVES THEM ESSENTIALLY AD AND

685
00:25:07,560 --> 00:25:09,600
TBI AND WHAT HAPPENED AT THE NIH

686
00:25:09,600 --> 00:25:11,360
IS, WHICH IS INTERESTING IS THAT

687
00:25:11,360 --> 00:25:13,440
FOR ABOUT 10 YEARS WE TRIED TO

688
00:25:13,440 --> 00:25:16,640
GET THIS ICU SURVIVORSHIP

689
00:25:16,640 --> 00:25:21,080
DEMENTIA INTO THE CAMP OF MONEY

690
00:25:21,080 --> 00:25:24,120
FOR RESEARCH, FOR NIA FUNDED

691
00:25:24,120 --> 00:25:24,560
DEMENTIA WORK.

692
00:25:24,560 --> 00:25:26,440
WE NOW HAVE ACCOMPLISHED, NOT

693
00:25:26,440 --> 00:25:29,320
ME, MEANING ONLY ME BUT

694
00:25:29,320 --> 00:25:30,520
SCIENTISTS GENERALLY HAVE

695
00:25:30,520 --> 00:25:32,480
ACCOMPLISHED THAT THE NIA NOW AS

696
00:25:32,480 --> 00:25:35,320
HAS A TERM CALLED ADRD WHICH IS

697
00:25:35,320 --> 00:25:39,000
ALZHEIMER'S DISEASE AND RELATED

698
00:25:39,000 --> 00:25:42,200
DEMENTIAS, WHICH IS NOW A WIDER

699
00:25:42,200 --> 00:25:44,320
RUBRIC UNDER WHICH THE ICU

700
00:25:44,320 --> 00:25:45,880
ACQUIRED DEMENTIA OR PICKS

701
00:25:45,880 --> 00:25:48,200
RELATED DEMENTIA FALLS AND SO WE

702
00:25:48,200 --> 00:25:49,320
ACTUALLY--THIS STUDY RIGHT HERE

703
00:25:49,320 --> 00:25:51,960
WAS FUNDED BY THE NIA WITH A

704
00:25:51,960 --> 00:25:54,280
10 MILLION-DOLLAR GRANT FROM THE

705
00:25:54,280 --> 00:25:56,080
NIA FOR ABRK AFTER THE ICU, WE

706
00:25:56,080 --> 00:25:58,160
WENT ON TO GET ANOTHER

707
00:25:58,160 --> 00:26:00,920
RANDOMIZED CONTROL TRIAL FUNDED

708
00:26:00,920 --> 00:26:03,720
AT NIA FOR ANTIPSYCHOTICS AND

709
00:26:03,720 --> 00:26:06,000
DELERIUM UNDER THE AD/RD RUBRIC

710
00:26:06,000 --> 00:26:07,760
AND WE NOW HAVE THIS STUDY RIGHT

711
00:26:07,760 --> 00:26:09,360
HERE WAS CALLED BRAIN 1, WE NOW

712
00:26:09,360 --> 00:26:12,920
HAVE BRAIN 2 GOING ON WHICH IS A

713
00:26:12,920 --> 00:26:13,840
20 MILLION-DOLLAR NIA FUNDED

714
00:26:13,840 --> 00:26:15,040
COHORT STUDY WHERE WE ARE

715
00:26:15,040 --> 00:26:17,480
COLLECTING THE BRAINS OF THE

716
00:26:17,480 --> 00:26:19,200
THESE ICU PATIENTS ONCE THEY

717
00:26:19,200 --> 00:26:22,200
DIE, WHETHER IT BE IN THE ICU OR

718
00:26:22,200 --> 00:26:25,760
IN THE HOSPITAL WARD SYSTEM OR

719
00:26:25,760 --> 00:26:27,920
YEARS LATER AND WE'RE LOOKING AT

720
00:26:27,920 --> 00:26:30,000
THESE BRAINS WITH NEUROIMAGING

721
00:26:30,000 --> 00:26:34,000
AND NUMEROUS DIFFERENT

722
00:26:34,000 --> 00:26:34,520
BIOLOGICAL PATHOLOGICAL

723
00:26:34,520 --> 00:26:35,560
INVESTIGATIONS TO TRY TO FIND

724
00:26:35,560 --> 00:26:38,200
OUT EXACTLY WHAT KIND OF

725
00:26:38,200 --> 00:26:40,320
DEMENTIA IS THIS.

726
00:26:40,320 --> 00:26:42,880
IS IT PLAQUES AND TANGLES LIKE

727
00:26:42,880 --> 00:26:44,240
AD, MORE VASCULAR IN ORIGIN, IS

728
00:26:44,240 --> 00:26:49,480
IT SOMETHING THAT HAPPENED WITH

729
00:26:49,480 --> 00:26:56,040
THIS DIFFUSED ANXIETY, INVERSED

730
00:26:56,040 --> 00:26:57,920
USE OF DIAZAPENES, AND ONCE WE

731
00:26:57,920 --> 00:27:01,320
GET THAT HOPEFULLY WE CAN CREATE

732
00:27:01,320 --> 00:27:01,840
DATA.

733
00:27:01,840 --> 00:27:03,440
BUT HERE AT 1 STUDY WE SHOWED

734
00:27:03,440 --> 00:27:04,880
MEASURING AT 3 AND 12 MONTHS

735
00:27:04,880 --> 00:27:06,640
WHETHER YOU WERE 65 AND OLDER OR

736
00:27:06,640 --> 00:27:07,960
YOUNGER THAN 65, THAT THE PATES

737
00:27:07,960 --> 00:27:10,520
ENDED UP WITH THEIR COGNITIVE

738
00:27:10,520 --> 00:27:13,040
FUNCTION DOWN THERE AROUND THE

739
00:27:13,040 --> 00:27:15,040
BLUE AND MAGENTA OR RED LINES OF

740
00:27:15,040 --> 00:27:17,600
TBI AND AD AND WHAT WAS REALLY

741
00:27:17,600 --> 00:27:19,480
STRIKING WAS WHEN WE PLOTTED IT

742
00:27:19,480 --> 00:27:21,920
OUT FOR THOSE WHO WERE LESS THAN

743
00:27:21,920 --> 00:27:24,360
50, THAT IS 30 AND 40 YEAR-OLDS,

744
00:27:24,360 --> 00:27:26,880
AFTER THE ICU, NONE OF WHOM

745
00:27:26,880 --> 00:27:29,840
SHOULD HAVE HAD A DEMENTIA AND

746
00:27:29,840 --> 00:27:31,840
YET, THEY'RE DOWN THERE AROUND

747
00:27:31,840 --> 00:27:34,520
THE AD TBI LINES.

748
00:27:34,520 --> 00:27:37,160
IN THOSE DATA, WE ALSO SHOWED

749
00:27:37,160 --> 00:27:40,560
THE DELERIUM WAS THE STRONGEST

750
00:27:40,560 --> 00:27:42,400
PREDICTER OF THIS COGNITIVE

751
00:27:42,400 --> 00:27:45,560
DECLINE, SO EVERY ADDITIONAL

752
00:27:45,560 --> 00:27:47,840
DELERIUM INCREASED BY RELATIVE

753
00:27:47,840 --> 00:27:57,480
35%, THE RISK OF LONG-TERM

754
00:27:57,480 --> 00:27:58,440
COGNITIVE IMPAIRMENT.

755
00:27:58,440 --> 00:28:00,080
ABOUT A THOUSAND OUTLETS

756
00:28:00,080 --> 00:28:01,280
REPORTED ON THE BRAIN ICU STUDY

757
00:28:01,280 --> 00:28:03,720
AND THIS IS AN EXAMPLE OF A LET

758
00:28:03,720 --> 00:28:05,320
WE GOT BACK, WHEN I RETURNED TO

759
00:28:05,320 --> 00:28:07,520
WORK, THE WORK I DID BEFORE

760
00:28:07,520 --> 00:28:09,400
SEEMED FOREIGN AND UNFAMILIAR, I

761
00:28:09,400 --> 00:28:11,640
BECAME ISOLATED AND EXCLUDED

762
00:28:11,640 --> 00:28:13,760
FROM EVERYONE, NO 1 WANTED TO BE

763
00:28:13,760 --> 00:28:15,400
AROUND ME, MY WIFE WAS 36 YEARS

764
00:28:15,400 --> 00:28:17,160
TOLD MIVE WAS FEELING SORRY FOR

765
00:28:17,160 --> 00:28:19,000
MYSELF AND I JUST NEEDED TO GET

766
00:28:19,000 --> 00:28:20,640
ON WITH MY LIFE, I NEARLY ENDED

767
00:28:20,640 --> 00:28:22,880
MY LIFE FOR A FEW TIMES AND THEN

768
00:28:22,880 --> 00:28:26,760
AFTER 5 YEARS OF THIS HELL ON

769
00:28:26,760 --> 00:28:27,360
OCTOBER 22nd, 2013, SHORTLY

770
00:28:27,360 --> 00:28:30,360
AFTER THE PAPER AND CBS COVERAGE

771
00:28:30,360 --> 00:28:33,080
CBS RAN A REPORT ABOUT PEOPLE

772
00:28:33,080 --> 00:28:33,760
JUST LIKE ME.

773
00:28:33,760 --> 00:28:38,800
FROM THAT REPORT I FOUND YOUR

774
00:28:38,800 --> 00:28:39,520
WEBSITE, ICUDELERIUM.ORG, I

775
00:28:39,520 --> 00:28:41,040
CRIED FOR A LONG TIME.

776
00:28:41,040 --> 00:28:44,800
IT CHANGED MY WIFE'S OPINION OF

777
00:28:44,800 --> 00:28:46,200
ME, FOR THE FIRST TIME IN 5

778
00:28:46,200 --> 00:28:50,440
YEARS, I THINK I BELIEVE I HAVE

779
00:28:50,440 --> 00:28:52,200
A FUTURE.

780
00:28:52,200 --> 00:28:54,000
HIS WRITING, SO WHAT WAS HE

781
00:28:54,000 --> 00:28:54,600
WRITING ALL THIS?

782
00:28:54,600 --> 00:28:55,840
WELL WHAT WE HAVE DONE IN THE

783
00:28:55,840 --> 00:28:58,360
PAST 15 YEARS, TAKEN THE

784
00:28:58,360 --> 00:28:59,280
RANDOMIZED CONTROL TRIALS, 35-40

785
00:28:59,280 --> 00:29:02,240
OF WHICH HAVE BEEN PUBLISHED IN

786
00:29:02,240 --> 00:29:05,840
THE NEW ENGLAND JOURNAL, JAMA

787
00:29:05,840 --> 00:29:07,240
AND LANCET, THE TIPPING POINT

788
00:29:07,240 --> 00:29:08,600
SAID THAT FOR THINGS TO TIP,

789
00:29:08,600 --> 00:29:10,800
THEY NEED TO BE STICKY, NEEDS TO

790
00:29:10,800 --> 00:29:12,520
BE APE STICKY MESSAGE, WELL THE

791
00:29:12,520 --> 00:29:17,440
ALPHABET IS VERY STICKY.

792
00:29:17,440 --> 00:29:19,760
SO A-ANNAL GEEZIA, B,-BOTH,

793
00:29:19,760 --> 00:29:22,560
STOPPING DRUGS AND STOPPING THE

794
00:29:22,560 --> 00:29:26,800
VENTILATOR, C-CHOICE OF

795
00:29:26,800 --> 00:29:27,920
SEDATION, D-DELERIUM,

796
00:29:27,920 --> 00:29:33,040
MANAGEMENT, E-EARLY MOBILITY AND

797
00:29:33,040 --> 00:29:33,360
F-FAMILY.

798
00:29:33,360 --> 00:29:34,560
THESE 6 SAFETY STEPS ARE THE WAY

799
00:29:34,560 --> 00:29:36,320
THAT THE SOCIETY OF CRITICAL

800
00:29:36,320 --> 00:29:38,800
CARE MEDICINE SAYS TO TAKE CARE

801
00:29:38,800 --> 00:29:39,200
OF OUR PATIENTS.

802
00:29:39,200 --> 00:29:40,840
AND UPON WHAT ARE THEY BASED?

803
00:29:40,840 --> 00:29:45,320
WELL I'M GOING TO ONLY SHOW YOU

804
00:29:45,320 --> 00:29:47,440
THE DATA, THE TRIALS FROM THE

805
00:29:47,440 --> 00:29:50,280
NEW ENGLAND JOURNAL OF JAMA AND

806
00:29:50,280 --> 00:29:51,760
LANCET TO THINK ABOUT THE OTHER

807
00:29:51,760 --> 00:29:54,240
400 PAPERS THAT SUPPORT THIS

808
00:29:54,240 --> 00:29:54,760
APPROACH.

809
00:29:54,760 --> 00:29:56,880
I SKIPPED A BECAUSE ANNAL GEEZIA

810
00:29:56,880 --> 00:29:59,080
DOES NOT HAVE ANY NEW ENGLAND

811
00:29:59,080 --> 00:30:04,600
JOURNAL JAMA OR LANCET PAPERS

812
00:30:04,600 --> 00:30:06,920
WE'RE ALL GOING TO TAKE CARE OF

813
00:30:06,920 --> 00:30:07,920
PAIN, THAT'S OUR FIRST PRIORITY,

814
00:30:07,920 --> 00:30:10,680
WE CAN SEE B, THE NEW ENGLAND

815
00:30:10,680 --> 00:30:12,680
JOURNAL AND JAMA ASK LANCET

816
00:30:12,680 --> 00:30:15,880
PAPERS, THEN CHOICE OF DRUG, AND

817
00:30:15,880 --> 00:30:26,360
MAINLY IT'S ABOUT AVOIDANCE OF

818
00:30:26,360 --> 00:30:28,800
BENZODIAZAPINES, AND A COLLEAGUE

819
00:30:28,800 --> 00:30:30,560
FROM FRANCE SAID 86% OF PATE

820
00:30:30,560 --> 00:30:34,200
PATIENTS WERE ON BENZOs, A

821
00:30:34,200 --> 00:30:35,160
DISASTER, VERY ANTIDATA DRIVEN

822
00:30:35,160 --> 00:30:37,240
APPROACH BUT IT HAPPENED, IT

823
00:30:37,240 --> 00:30:38,720
HAPPENED ALL OVER THE WORLD

824
00:30:38,720 --> 00:30:39,800
INCLUDING IN EUROPE AND MY

825
00:30:39,800 --> 00:30:40,400
HOSPITAL AS WELL.

826
00:30:40,400 --> 00:30:43,440
WE WILL GET BACK TO THAT.

827
00:30:43,440 --> 00:30:49,320
D-DELERIUM, LOTS OF DOTTA, E,

828
00:30:49,320 --> 00:30:50,520
MOBILITY, F-FAMILY ENGAGEMENT.

829
00:30:50,520 --> 00:30:51,400
JAMA NUCLEOTIDES ENGLAND

830
00:30:51,400 --> 00:30:52,320
SCWOWRNAL LET'S HAVE THE FAMILY

831
00:30:52,320 --> 00:30:54,800
AT THE BEDSIDE, WHAT HAPPEN

832
00:30:54,800 --> 00:30:58,560
INDEED COVID, ICE ISOLATION.

833
00:30:58,560 --> 00:31:01,560
CLOSED VISITATION, NO FAMILY.

834
00:31:01,560 --> 00:31:03,920
THIS IS ANTIMEDICINE, MY

835
00:31:03,920 --> 00:31:04,200
FRIENDS.

836
00:31:04,200 --> 00:31:07,880
WE CANNOT HEAL PEOPLE WITH

837
00:31:07,880 --> 00:31:10,040
SCIENCE ALONE WE CANNOT HEAL

838
00:31:10,040 --> 00:31:13,160
THEM WITH ANTIBIOTICS OR VASE O

839
00:31:13,160 --> 00:31:13,960
SUPPRESSORS OR VENTILATORS I

840
00:31:13,960 --> 00:31:15,240
HAVE TO HAVE THEIR ABILITY TO

841
00:31:15,240 --> 00:31:17,000
FIND THEIR WHY IN LIFE AND WE DO

842
00:31:17,000 --> 00:31:18,520
THAT BY HAVING THE FAMILY TO

843
00:31:18,520 --> 00:31:20,480
BEDSIDE AND BY ME SAYING TO MY

844
00:31:20,480 --> 00:31:21,880
PATIENTS, OR THE FAMILY, HEY, I

845
00:31:21,880 --> 00:31:25,120
NEED TO UNDERSTAND WHO IS THIS

846
00:31:25,120 --> 00:31:25,360
PERSON?

847
00:31:25,360 --> 00:31:28,320
ASK 4 SIMPLE QUESTIONS EVERY

848
00:31:28,320 --> 00:31:29,560
DAY.

849
00:31:29,560 --> 00:31:30,400
WHAT'S THEIR FAVORITE MUSIC?

850
00:31:30,400 --> 00:31:32,120
WHAT'S THEIR PETS NAMES?

851
00:31:32,120 --> 00:31:32,480
FAVORITE FOOD?

852
00:31:32,480 --> 00:31:34,360
TELL ME WHAT THEIR HOBBIES ARE?

853
00:31:34,360 --> 00:31:37,320
SOY IF I KNOW HOBBIES AND PETS

854
00:31:37,320 --> 00:31:38,280
NAMES AND FOOD AND MUSIC THEN I

855
00:31:38,280 --> 00:31:40,360
WILL LOOK AT THIS PERSON AND SAY

856
00:31:40,360 --> 00:31:42,600
AH, I SEE YOU, I SEE AS A

857
00:31:42,600 --> 00:31:46,440
PERSON. 

858
00:31:46,440 --> 00:31:49,280
AND I IN THE INTENSIVE CARE

859
00:31:49,280 --> 00:31:51,400
UNIT, I SEE YOU AND I WANT TO

860
00:31:51,400 --> 00:31:52,480
PROVIDE SUPPORT AND LOVE AND

861
00:31:52,480 --> 00:31:52,760
MERCY.

862
00:31:52,760 --> 00:31:54,480
SO THIS IS WHAT THE BUNDLE IS

863
00:31:54,480 --> 00:31:55,680
ABOUT, IT'S A BURN OUT

864
00:31:55,680 --> 00:31:56,480
PREVENTION PROGRAM BECAUSE THE

865
00:31:56,480 --> 00:31:58,480
REASON I'M NOT BURNED OUT, THE

866
00:31:58,480 --> 00:32:00,680
REASON I KEEP COMING BACK TO THE

867
00:32:00,680 --> 00:32:03,840
BEDSIDE, IS BECAUSE I FIND SUCH

868
00:32:03,840 --> 00:32:07,200
JOY AND LOVE IN DIVING INTO MY

869
00:32:07,200 --> 00:32:08,800
PATIENT'S CHAOS AND DOING WHAT I

870
00:32:08,800 --> 00:32:10,680
CAN TO HELP THEM WITH THIS

871
00:32:10,680 --> 00:32:12,800
BUNDLE FIND THEIR WAY FORWARD.

872
00:32:12,800 --> 00:32:13,600
NOW THOSE INDIVIDUAL REFERENCES

873
00:32:13,600 --> 00:32:17,480
THAT I JUST SHOWED YOU WERE HOW

874
00:32:17,480 --> 00:32:19,680
YOU BUILD PIECES OF A SAFETY

875
00:32:19,680 --> 00:32:20,800
BUNDLE, BUT WHAT YOU AND I NEED

876
00:32:20,800 --> 00:32:22,080
TO KNOW IS THAT THOSE INDIVIDUAL

877
00:32:22,080 --> 00:32:23,040
PIECES WHEN THEY'RE PUT

878
00:32:23,040 --> 00:32:26,360
TOGETHER, HAVE TO THEN BE TEST

879
00:32:26,360 --> 00:32:27,680
TD TOGETHER AS A BUNDLE.  THIS

880
00:32:27,680 --> 00:32:31,040
IS WHAT WE LEARNED THROUGH DON

881
00:32:31,040 --> 00:32:33,520
BURWICK AND THE IHI IS THAT WE

882
00:32:33,520 --> 00:32:36,960
HAVE TO KNOW THAT THE SUM CAN BE

883
00:32:36,960 --> 00:32:39,600
GREATER THAN INDIVIDUAL PARTS,

884
00:32:39,600 --> 00:32:41,560
LIKE JACK SAID FROM HOPKINS OR

885
00:32:41,560 --> 00:32:43,000
INDIVIDUALLY PROVEN STEPS MUST

886
00:32:43,000 --> 00:32:45,200
BE TESTED TOGETHER TO CALL THEM

887
00:32:45,200 --> 00:32:47,400
A BUNDLE, DON BURR WICK IHI, SO

888
00:32:47,400 --> 00:32:50,120
HERE ARE 18 REFERENCES AND THERE

889
00:32:50,120 --> 00:32:52,240
ARE PLENTY MORE SHOWING YOU THE

890
00:32:52,240 --> 00:32:55,680
DATA BEHIND THIS AS A BUNDLE.

891
00:32:55,680 --> 00:32:55,880
OKAY?

892
00:32:55,880 --> 00:32:58,960
THEN WHY IS IT, THAT THIS WOMAN

893
00:32:58,960 --> 00:33:02,520
HERE IN THE ICU SHOULD BE

894
00:33:02,520 --> 00:33:03,560
TREATED WITH SEDATION,

895
00:33:03,560 --> 00:33:05,440
IMMOBILIZED IN A BED INSTEAD OF

896
00:33:05,440 --> 00:33:07,680
WOKEN UP EVERY DAY AND WALKED

897
00:33:07,680 --> 00:33:09,520
AND ALLOWING HER FAMILY TO SEE

898
00:33:09,520 --> 00:33:12,760
HER, WELL, THIS IS JANET KEY,

899
00:33:12,760 --> 00:33:14,640
HER STORY IS IN EDDB ALONG WITH

900
00:33:14,640 --> 00:33:16,080
ALL THE OTHER PATIENT STORIES,

901
00:33:16,080 --> 00:33:17,960
BY THE WAY I RECORDED THEIR

902
00:33:17,960 --> 00:33:19,760
STORIES WITH THIS RECORDER AND

903
00:33:19,760 --> 00:33:21,560
THEN TRANSCRIBED THEM, IT'S A

904
00:33:21,560 --> 00:33:24,360
LOT OF FUN TO USE THEIR OWN

905
00:33:24,360 --> 00:33:26,880
WORDS IN THE INVESTIGATIONS, IN

906
00:33:26,880 --> 00:33:30,840
THE WRITING AND JANET KEY HAD

907
00:33:30,840 --> 00:33:32,400
NECK RAITIZING FASC YIETIS OF

908
00:33:32,400 --> 00:33:34,800
HER FACE, I HAVE PERMISSION TO

909
00:33:34,800 --> 00:33:36,200
USE THESE PICTURES, SHE AND I

910
00:33:36,200 --> 00:33:37,040
ARE NOW GREAT FRIENDS.

911
00:33:37,040 --> 00:33:39,600
EVERY DAY SHE WAS IN THE UNIT, I

912
00:33:39,600 --> 00:33:42,480
WHISPERED IN HER EAR, SHE HAD

913
00:33:42,480 --> 00:33:44,640
HER PICTURE NEXT TO HER BED OF

914
00:33:44,640 --> 00:33:46,720
HERSELF AT THE EIFFEL TOWER, I

915
00:33:46,720 --> 00:33:48,440
DON'T KNOW WHY BUT LOOKING

916
00:33:48,440 --> 00:33:50,600
REFINED AT THE EIFFEL TOWER, I

917
00:33:50,600 --> 00:33:51,960
WOULD SAN FRANCISCO SAY JANET

918
00:33:51,960 --> 00:33:54,360
MISS KEY, YOU ARE A REFINED BADA

919
00:33:54,360 --> 00:33:55,920
SS, AND YOU WILL GET OUT OF THIS

920
00:33:55,920 --> 00:33:57,360
BED TODAY, AND SO WHILE SHE FERS

921
00:33:57,360 --> 00:33:59,120
SICK LIKE THIS AND INTUBATE TD

922
00:33:59,120 --> 00:34:00,640
EVERY DAY WE WALKED HER SO THAT

923
00:34:00,640 --> 00:34:03,080
THE DAY THAT SHE FINALLY GOT OFF

924
00:34:03,080 --> 00:34:06,000
THE VENTILATOR, SHE WAS LIKE

925
00:34:06,000 --> 00:34:07,680
THIS, SHE CALLED HERSELF THE

926
00:34:07,680 --> 00:34:09,680
LONE RANGER, SHE HAD THIS

927
00:34:09,680 --> 00:34:13,080
BRANDON ACROSS HER FACE BAH WE

928
00:34:13,080 --> 00:34:15,840
HAD REMOVED THE PORTION OF HER

929
00:34:15,840 --> 00:34:18,720
FACE WITH 21 SURGERIES WITH NECK

930
00:34:18,720 --> 00:34:20,200
ROUGH ATOMITIZING FASC, SO SHE'S

931
00:34:20,200 --> 00:34:21,680
OUT OF THE ABOUT ED AND WALKED

932
00:34:21,680 --> 00:34:24,200
DOWN THE HALL AND SHE WAS ONLY

933
00:34:24,200 --> 00:34:25,760
EXTUBATED 30 MINUTES PRIOR TO

934
00:34:25,760 --> 00:34:27,520
THIS PICTURE, NOW YOU WHO WORK

935
00:34:27,520 --> 00:34:30,080
IN THE UNIT, YOU KNOW IF YOU

936
00:34:30,080 --> 00:34:31,760
KEEP SOMEBODY IMMOBILIZED IN THE

937
00:34:31,760 --> 00:34:33,360
BED FOR MULTIPLE DAYS THEY CAN'T

938
00:34:33,360 --> 00:34:34,480
WALK DOWN THE HALL LIKE THIS BUT

939
00:34:34,480 --> 00:34:36,120
THE REASON SHE WAS ABLE TO IS

940
00:34:36,120 --> 00:34:36,880
SHE WAS WALKING BEFORE THE DAY

941
00:34:36,880 --> 00:34:39,520
BEFORE THAT AND THE DAY BEFORE

942
00:34:39,520 --> 00:34:39,720
THAT.

943
00:34:39,720 --> 00:34:41,880
SO THE BUNDLE, REHUMANIZES THE

944
00:34:41,880 --> 00:34:45,000
ICU, AND PRIOR TO COVID, IN 40

945
00:34:45,000 --> 00:34:47,320
COUNTRIES AROUND THE WORLD, WE

946
00:34:47,320 --> 00:34:49,520
PROVED IN PUBLIC AND INTENSIVE

947
00:34:49,520 --> 00:34:50,840
CARE MEDICINE THAT WE 70-80%

948
00:34:50,840 --> 00:34:52,680
COMPLIANCE OF THE BUNDLE.

949
00:34:52,680 --> 00:34:54,560
WHY DID PEOPLE DO THAT?

950
00:34:54,560 --> 00:34:56,600
BECAUSE THEY KNEW DATA LIKE

951
00:34:56,600 --> 00:34:57,000
THIS.

952
00:34:57,000 --> 00:34:59,760
HERE'S THE PAPER WE PUBLISHED IN

953
00:34:59,760 --> 00:35:01,240
BARNS DAILY, WE SHOW BOTH LINES

954
00:35:01,240 --> 00:35:02,920
GO UP, LINE ON THE LEFT, MORE

955
00:35:02,920 --> 00:35:04,920
COMPLIANCE WITH THE BUNDLE ON

956
00:35:04,920 --> 00:35:09,280
THE X-AXIS, YIELDED IN 6000

957
00:35:09,280 --> 00:35:10,000
PATIENTS, INDEPENDENT OF

958
00:35:10,000 --> 00:35:11,720
ADJUSTMENT FOR AGE, SEVERITY OF

959
00:35:11,720 --> 00:35:12,800
ILLNESS AND WEATHER YOU WERE ON

960
00:35:12,800 --> 00:35:16,680
A VENT OR NOT, YIELDED HIGHER

961
00:35:16,680 --> 00:35:19,440
RATES OF SURVIVAL.

962
00:35:19,440 --> 00:35:23,760
SO EVERY 10% INCREASE IN

963
00:35:23,760 --> 00:35:25,600
COMPLIANCE YIELDED A 15%

964
00:35:25,600 --> 00:35:27,760
INCREASE IN SURVIVAL, AND THE

965
00:35:27,760 --> 00:35:31,800
SAME THING ON DELERIUM AND COMA

966
00:35:31,800 --> 00:35:33,960
FREEDOM ON THE RIGHT.

967
00:35:33,960 --> 00:35:35,960
EVERY 10% INCREASE IN COMPLIANCE

968
00:35:35,960 --> 00:35:37,320
YIELDED A 15% LIKELIHOOD THAT

969
00:35:37,320 --> 00:35:40,360
THESE PATIENTS WERE FREE OF

970
00:35:40,360 --> 00:35:41,080
DELERIUM IN COMA.

971
00:35:41,080 --> 00:35:43,240
SO WOO HAD MORE DATA, THIS IS

972
00:35:43,240 --> 00:35:45,680
WAS THE ICU LIBERATION

973
00:35:45,680 --> 00:35:46,240
COLLABORATIVE SPONSORED BY

974
00:35:46,240 --> 00:35:49,320
GORDON MOORE WHO WAS THE FOUNDER

975
00:35:49,320 --> 00:35:50,520
OF INTEL, GORDON MOORE WAS CRAZY

976
00:35:50,520 --> 00:35:52,680
SICK IN THE ICU IN CALIFORNIA I

977
00:35:52,680 --> 00:35:53,720
WON'T MENTION WHICH 1, HE DID

978
00:35:53,720 --> 00:35:55,400
NOT GET TO VISIT WITH HIS

979
00:35:55,400 --> 00:35:56,840
FAMILY, HE WAS SUPER MAD ABOUT

980
00:35:56,840 --> 00:35:58,160
THAT, HE SAID IT WAS A MISERY

981
00:35:58,160 --> 00:36:00,280
AND SO HE GAVE MONEY TO SOCIETY

982
00:36:00,280 --> 00:36:02,120
OF CRITICAL CARE MEDICINE AND

983
00:36:02,120 --> 00:36:02,800
SAID FIX THIS.

984
00:36:02,800 --> 00:36:04,120
THEY CALLED ME, I WAS THANKFUL

985
00:36:04,120 --> 00:36:05,400
ENOUGH TO BE THE PRINCIPAL

986
00:36:05,400 --> 00:36:06,240
INVESTIGATOR FOR THIS PROGRAM

987
00:36:06,240 --> 00:36:07,920
AND FOR THESE HOSPITALS ALL OVER

988
00:36:07,920 --> 00:36:10,160
THE UNITED STATES AND PUERTO

989
00:36:10,160 --> 00:36:12,960
RICO, WE SHOWED AFTER 15,000

990
00:36:12,960 --> 00:36:15,760
PEOPLE, AND ADJUSTMENT FOR 22 CO

991
00:36:15,760 --> 00:36:16,800
VARIANTS, THAT COMPLIANCE WITH

992
00:36:16,800 --> 00:36:20,600
THE BUNDLE WAS AN INDEPENDENT

993
00:36:20,600 --> 00:36:23,520
PREDICTER OF A HIGHER LIKELIHOOD

994
00:36:23,520 --> 00:36:24,720
OF ICU DISCHARGE, HIGHER

995
00:36:24,720 --> 00:36:27,960
COMPLIANCE WITH THE BUNDLE, HIGH

996
00:36:27,960 --> 00:36:29,040
LIKELIHOOD OF HOSPITAL DISCHARGE

997
00:36:29,040 --> 00:36:32,400
AND A LOWER LIKELIHOOD OF DEATH.

998
00:36:32,400 --> 00:36:38,360
THAT IS THE MORE THAT YOU AS A

999
00:36:38,360 --> 00:36:39,800
CLINICIAN INCORPORATED THIS

1000
00:36:39,800 --> 00:36:44,520
BUNDLE, GOT PEOPLE UP, GOT THEM

1001
00:36:44,520 --> 00:36:47,600
OUT OF BED, REHUMANIZE THEIR

1002
00:36:47,600 --> 00:36:49,680
CARE, ARE NOW COMPLIANT.

1003
00:36:49,680 --> 00:36:52,000
YOU CAN SEE, WE GO UP AND

1004
00:36:52,000 --> 00:36:54,240
COMPLIANCE, WE GO DOWN IN COMA,

1005
00:36:54,240 --> 00:36:56,440
DOWN IN DELERIUM, DOWN IN

1006
00:36:56,440 --> 00:36:57,160
RESTRAINT USE.

1007
00:36:57,160 --> 00:36:58,520
NOW I PREDICTED WE WOULD HAVE 1

1008
00:36:58,520 --> 00:36:59,840
THING GO UP IN THE WRONG

1009
00:36:59,840 --> 00:37:04,160
DIRECTION AND THAT WOULD BE

1010
00:37:04,160 --> 00:37:04,720
SIGNIFICANT PAIN AWARENESS.

1011
00:37:04,720 --> 00:37:04,880
WHY?

1012
00:37:04,880 --> 00:37:07,400
BECAUSE PEOPLE CAN TELL ME ABOUT

1013
00:37:07,400 --> 00:37:09,560
THEIR PAIN, THEY'RE NOT

1014
00:37:09,560 --> 00:37:11,000
DELERRUOUS, THEY'RE AWAKE, THEY

1015
00:37:11,000 --> 00:37:12,400
CAN SAY DOCTOR I'M HURTING SO I

1016
00:37:12,400 --> 00:37:14,160
WANT TO SEE THIS GO UP, I DON'T

1017
00:37:14,160 --> 00:37:15,240
WANT THEM IN MORE PAIN BUT I

1018
00:37:15,240 --> 00:37:17,080
WANT TO KNOW ABOUT THEIR PAIN SO

1019
00:37:17,080 --> 00:37:18,000
I ADDRESS IT.

1020
00:37:18,000 --> 00:37:20,960
THAT'S STEP A OF THE BUNDLE,

1021
00:37:20,960 --> 00:37:22,200
REMEMBER, ANNAL GEEZIA, SO THIS

1022
00:37:22,200 --> 00:37:23,280
RESULT INDEED ULTIMATELY BETTER

1023
00:37:23,280 --> 00:37:23,680
PAIN CONTROL.

1024
00:37:23,680 --> 00:37:26,600
WE ALSO SO MORE COMPLIANCE LED

1025
00:37:26,600 --> 00:37:28,560
TO LESS ICU REMISSIONS, LESS

1026
00:37:28,560 --> 00:37:29,720
DISCHARGES TO OTHER FACILITIES.

1027
00:37:29,720 --> 00:37:33,600
SO HERE'S THE BUNDLE.

1028
00:37:33,600 --> 00:37:34,720
ANNAL GEEZIA, STOPPING THE VENT

1029
00:37:34,720 --> 00:37:38,160
AND THE DRUGS, CHOOSING THE

1030
00:37:38,160 --> 00:37:39,920
RIGHT SEDENTARIAATIVES, AVOIDING

1031
00:37:39,920 --> 00:37:41,440
BENZOs, AND GETTING THEM OUT

1032
00:37:41,440 --> 00:37:44,120
OF BET WITH FAMILY ENGAGEMENT,

1033
00:37:44,120 --> 00:37:46,000
DURING COVID, THIS PLUMMETED

1034
00:37:46,000 --> 00:37:50,680
DOWN TO A 10-20% COMPLIANCE

1035
00:37:50,680 --> 00:37:51,160
GLOBALLY.

1036
00:37:51,160 --> 00:37:51,400
SO SAD.

1037
00:37:51,400 --> 00:37:52,760
SOME GOOD THINGS HAPPENED IN

1038
00:37:52,760 --> 00:37:54,720
COVID, SOME BAD THINGS HAPPEN

1039
00:37:54,720 --> 00:37:56,280
INDEED COVID, ABOUT LON BAD

1040
00:37:56,280 --> 00:37:59,080
THING WAS TOO MUCH BENZO, THIS

1041
00:37:59,080 --> 00:38:02,640
IS THE PAPER I TOLD YOU ABOUT IN

1042
00:38:02,640 --> 00:38:05,520
THE NEW ENGLAND, LOOK AT THE TOP

1043
00:38:05,520 --> 00:38:09,200
RIGHT, LOOK AT THE BENZO USE,

1044
00:38:09,200 --> 00:38:12,200
AND NOT A SINGLE TIME HAVE

1045
00:38:12,200 --> 00:38:13,080
BENZOs BEATEN OUT WHATEVER

1046
00:38:13,080 --> 00:38:13,920
THEY WERE COMPARED TO.

1047
00:38:13,920 --> 00:38:15,640
WE DID A STUDY CALLED THE COVID

1048
00:38:15,640 --> 00:38:18,600
D STUDY TO GIVE YOU FRAMING,

1049
00:38:18,600 --> 00:38:20,800
HISTORICALLY, WE HAVE DELERIUM

1050
00:38:20,800 --> 00:38:23,280
RATES IN VENTILATED PATIENTS

1051
00:38:23,280 --> 00:38:24,080
AROUND 70-80%.

1052
00:38:24,080 --> 00:38:28,800
AFTER INCORPORATION OF THE

1053
00:38:28,800 --> 00:38:31,080
BUNDLE IN 2016-2019, DELERIUM

1054
00:38:31,080 --> 00:38:32,880
RATES WENT DOWN 40-50% RIGHT

1055
00:38:32,880 --> 00:38:33,920
HERE, DURING COVID THEY WENT

1056
00:38:33,920 --> 00:38:36,720
BACK UP TO 80% AND BENZO USE

1057
00:38:36,720 --> 00:38:38,120
WENT BACK UP TO 80%.

1058
00:38:38,120 --> 00:38:39,960
SO THIS WAS A VERY NEGATIVE

1059
00:38:39,960 --> 00:38:42,120
THING THAT HAPPENED DURING THE

1060
00:38:42,120 --> 00:38:42,560
PANDEMIC.

1061
00:38:42,560 --> 00:38:44,200
WE PUBLISHED OUR COVID D STUDY,

1062
00:38:44,200 --> 00:38:45,960
I HAD NEVER BEEN ON SOCIAL MEDIA

1063
00:38:45,960 --> 00:38:47,760
BEFORE BUT THEY SAID WES, IF YOU

1064
00:38:47,760 --> 00:38:49,800
GET ON TWITTER, I SAID NO, NOT

1065
00:38:49,800 --> 00:38:51,040
TWITTER, I'M NOT GETTING ON

1066
00:38:51,040 --> 00:38:52,480
TWITTER, I'VE GOT ALL THIS GRAY

1067
00:38:52,480 --> 00:38:54,760
HAIR BUT THEY HAD ME TWEET OUT

1068
00:38:54,760 --> 00:38:57,040
THIS STUDY AND IT WORKED, AND IN

1069
00:38:57,040 --> 00:39:01,640
2 WEEKS, WE ENROLLED 2100 PEOPLE

1070
00:39:01,640 --> 00:39:05,600
AND WE DID THIS INTERNATIONAL

1071
00:39:05,600 --> 00:39:06,640
INVESTIGATION, 14 COUNTRIES, 69

1072
00:39:06,640 --> 00:39:17,160
SITES ANDY WOO FOUND THAT THERE

1073
00:39:17,680 --> 00:39:20,080
WERE 2 THINGS DRIVING THIS USE,

1074
00:39:20,080 --> 00:39:22,760
1 WAS SEDENTARIAATIVE, AND 1 WAS

1075
00:39:22,760 --> 00:39:25,080
FAMILY OVERUSE, OVERUSE OF

1076
00:39:25,080 --> 00:39:26,720
BENZOs, UNDER USE OF FAMILY,

1077
00:39:26,720 --> 00:39:28,400
THOSE WERE 2 THE HIGHEST DRIVERS

1078
00:39:28,400 --> 00:39:30,160
OF THE DELERIUM, I'M COMING TO A

1079
00:39:30,160 --> 00:39:32,160
CLOSE IN MY SLIDES HERE, WE HAVE

1080
00:39:32,160 --> 00:39:33,120
TO DO SOMETHING DIFFERENT

1081
00:39:33,120 --> 00:39:34,560
FRIENDS IN THE WAY WE SEE THE

1082
00:39:34,560 --> 00:39:36,640
WORLD HERE, WE HAVE TO LOOK

1083
00:39:36,640 --> 00:39:41,240
DIFFERENTLY AT WHAT WE ARE DOING

1084
00:39:41,240 --> 00:39:42,920
AT THE BEDSIDE WITH OUR

1085
00:39:42,920 --> 00:39:43,280
PATIENTS, OKAY?

1086
00:39:43,280 --> 00:39:46,000
ONE OF MY MESSAGES IN EVERY DEEP

1087
00:39:46,000 --> 00:39:47,720
DRAWN BREATH IS, DON'T BE AFRAID

1088
00:39:47,720 --> 00:39:50,840
TO GO AGAINST THE GRAIN.

1089
00:39:50,840 --> 00:39:54,120
LET'S SEE WHAT WE'RE DOING WRONG

1090
00:39:54,120 --> 00:39:57,240
FACE IT HEAD ON AND YOU AS

1091
00:39:57,240 --> 00:39:59,080
INVESTIGATORS OF THE NIH, YOU

1092
00:39:59,080 --> 00:40:01,680
ARE LEADING THE WORLD IN YOUR

1093
00:40:01,680 --> 00:40:02,120
RESEARCH ENDEAVORS.

1094
00:40:02,120 --> 00:40:04,160
YOU ARE CHALLENGING ALL OF THE

1095
00:40:04,160 --> 00:40:04,360
FORMS.

1096
00:40:04,360 --> 00:40:07,400
ONE OF THE THINGS THAT I WROTE

1097
00:40:07,400 --> 00:40:09,000
IN EDDB WAS THAT SOMETIMES, THIS

1098
00:40:09,000 --> 00:40:10,600
WILL BE A PARAPHRASE, IT SEEMS

1099
00:40:10,600 --> 00:40:12,680
TO BE A QUOTE PEOPLE LIKE,

1100
00:40:12,680 --> 00:40:15,120
SOMETIMES, THE WAYS THAT WE HURT

1101
00:40:15,120 --> 00:40:18,120
PEOPLE AREN'T SO MUCH A

1102
00:40:18,120 --> 00:40:22,760
MISPLACED CENTRAL LINE OR AN

1103
00:40:22,760 --> 00:40:25,800
ANTIBIOTIC ALLERGY OR AN ERRANT

1104
00:40:25,800 --> 00:40:28,640
USE OF VASO-REPRESSORS BUT

1105
00:40:28,640 --> 00:40:30,960
RATHER ACCEPTING STATUS QUO AS

1106
00:40:30,960 --> 00:40:33,560
OKAY AND GOOD WHEN INDEED IT

1107
00:40:33,560 --> 00:40:35,280
ACTUALLY CREATING HARM.

1108
00:40:35,280 --> 00:40:38,720
AND WHAT I FOUND IN MY LIFE AS A

1109
00:40:38,720 --> 00:40:40,520
PHYSICIAN, WAS I WAS CREATING

1110
00:40:40,520 --> 00:40:43,000
HARM IN THE PATIENT'S THAT I WAS

1111
00:40:43,000 --> 00:40:44,200
CARING FOR.

1112
00:40:44,200 --> 00:40:47,040
IN FACT, I WILL READ YOU--I WILL

1113
00:40:47,040 --> 00:40:47,920
LEAVE YOU WITH 1 STORY AND THEN

1114
00:40:47,920 --> 00:40:49,480
I WILL STOP AND TAKE YOUR

1115
00:40:49,480 --> 00:40:49,960
QUESTIONS.

1116
00:40:49,960 --> 00:40:52,880
THIS IS A STORY ABOUT TERESA

1117
00:40:52,880 --> 00:40:53,120
MARTIN.

1118
00:40:53,120 --> 00:40:55,960
SHE WAS A WOMAN WHO TAUGHT ME SO

1119
00:40:55,960 --> 00:40:57,360
MUCH, IN HER MID20S.

1120
00:40:57,360 --> 00:40:58,960
SHE CAME TO ME WHEN I WAS IN

1121
00:40:58,960 --> 00:41:04,360
TRAINING BACK WHEN WE DID

1122
00:41:04,360 --> 00:41:05,520
OVERUSE SEDENTARIATIVES AND

1123
00:41:05,520 --> 00:41:06,920
INVERSE RATIO VENTILATION AND

1124
00:41:06,920 --> 00:41:08,320
PARALYSIS, KIND OF LIKE THE WAY

1125
00:41:08,320 --> 00:41:11,120
WE DID WITH THESE PATIENTS

1126
00:41:11,120 --> 00:41:11,440
DURING COVID.

1127
00:41:11,440 --> 00:41:14,440
THIS WOMAN, THIS INDEXED PATIENT

1128
00:41:14,440 --> 00:41:15,720
OF MINE TAUGHT ME I WAS CREATING

1129
00:41:15,720 --> 00:41:17,280
HARM AND AFTER THIS THING I'M

1130
00:41:17,280 --> 00:41:18,800
ABOUT TO READ YOU, I CARRIED

1131
00:41:18,800 --> 00:41:19,800
SHAME FOR MANY YEARS BECAUSE I

1132
00:41:19,800 --> 00:41:21,760
KNEW I WAS HURTING PEOPLE SO

1133
00:41:21,760 --> 00:41:23,400
TERESA WAS IN THE UNIT, I TOOK

1134
00:41:23,400 --> 00:41:24,960
CARE OF HER ON THE VENTILATOR, I

1135
00:41:24,960 --> 00:41:29,360
WAS PROUD SHE HAD GOTTEN BETTER,

1136
00:41:29,360 --> 00:41:30,160
ENOUGH TO SURVIVE.

1137
00:41:30,160 --> 00:41:31,360
RIGHT BACK HERE, ACTUALLY, I

1138
00:41:31,360 --> 00:41:35,160
HAVE HER MEDICAL RECORDS WHICH I

1139
00:41:35,160 --> 00:41:36,240
GOT DURING THE PANDEMIC WHEN I

1140
00:41:36,240 --> 00:41:41,240
WAS WRITING THIS BOOK, AND MY

1141
00:41:41,240 --> 00:41:43,120
OWN HANDWRITING ON HER DISCHARGE

1142
00:41:43,120 --> 00:41:44,720
SUMMARY, I WRITE THIS AND YOU

1143
00:41:44,720 --> 00:41:46,960
CAN SEE I HILIGHTED THIS IN

1144
00:41:46,960 --> 00:41:48,840
YELLOW, YOU CAN SEE THIS, IT IS

1145
00:41:48,840 --> 00:41:51,880
IN YELLOW, BUT I WROTE THIS

1146
00:41:51,880 --> 00:41:54,080
PRECOMPUTERRIZED RECORDS, IT'S

1147
00:41:54,080 --> 00:41:55,360
PRETTY EMPARASSING, HOWEVER

1148
00:41:55,360 --> 00:41:58,120
AMAZINGLY ENOUGH THE PATIENT

1149
00:41:58,120 --> 00:41:59,240
STILL MANIFEST SINGLE ORGAN

1150
00:41:59,240 --> 00:42:02,760
DAMAGED LUNGS WITH GOOD RENAL GI

1151
00:42:02,760 --> 00:42:03,240
CARDIOVASCULAR FUNCTION.

1152
00:42:03,240 --> 00:42:05,800
MY OWN HANDWRITING.

1153
00:42:05,800 --> 00:42:06,600
I AM GUILTY.

1154
00:42:06,600 --> 00:42:09,520
AND THEN WAS THAT ACCURATE?

1155
00:42:09,520 --> 00:42:11,040
WELL, MONTHS LATER SHE CAME BACK

1156
00:42:11,040 --> 00:42:15,000
TO SEE ME AND HERE'S WHAT

1157
00:42:15,000 --> 00:42:15,280
HAPPENED.

1158
00:42:15,280 --> 00:42:17,640
SHE CAME IN THIS A WHEELCHAIR IN

1159
00:42:17,640 --> 00:42:19,800
HER 20S, ALMOST IMMEDIATELY

1160
00:42:19,800 --> 00:42:21,520
TERESA'S MOM ASK WHY CAN'T SHE

1161
00:42:21,520 --> 00:42:24,040
BEND HER ARMS AT THE ELBOWS OR

1162
00:42:24,040 --> 00:42:26,480
MOVER SHOULDERS, HER MOM LOOKED

1163
00:42:26,480 --> 00:42:28,800
DRAINED MORE TIRE THAN WHEN SHE

1164
00:42:28,800 --> 00:42:30,120
VISITED HER DAUGHTER IN THE

1165
00:42:30,120 --> 00:42:32,280
HOSPITAL, WE RAN THROUGH I

1166
00:42:32,280 --> 00:42:34,320
LITANY OF THINGS THAT WERE

1167
00:42:34,320 --> 00:42:35,440
HAPPENING SHE COULDND SWAL OR

1168
00:42:35,440 --> 00:42:38,080
SLEEP OR ABOUT GO TO THE

1169
00:42:38,080 --> 00:42:38,440
BATHROOM ALONE.

1170
00:42:38,440 --> 00:42:40,360
SHE COULD NOT DRESS OR SHOWER,

1171
00:42:40,360 --> 00:42:43,080
SHE COULD WALK ONLY A FEW STEPS

1172
00:42:43,080 --> 00:42:45,040
FOR A WHILE AND STAIRS WERE

1173
00:42:45,040 --> 00:42:47,240
IMPOSSIBLE, THE LIST OF AILMENTS

1174
00:42:47,240 --> 00:42:48,400
WERE DIZZYING, I HAVE NO

1175
00:42:48,400 --> 00:42:50,040
SOLUTIONS AND EVEN LESS EVER AN

1176
00:42:50,040 --> 00:42:51,040
UNDERSTANDING WHERE THE PROBLEMS

1177
00:42:51,040 --> 00:42:52,240
WERE COMING FROM SO I DID WHAT I

1178
00:42:52,240 --> 00:42:54,520
KNEW HOW TO DO, I ORDER BLOOD

1179
00:42:54,520 --> 00:42:56,640
WORK AND X-RAYS, THE LABS DIDN'T

1180
00:42:56,640 --> 00:42:59,440
SHOW ANYTHING ALARMING BUT THE

1181
00:42:59,440 --> 00:43:01,720
X-RAY IMAGES OF HER ARMS AND

1182
00:43:01,720 --> 00:43:03,520
LEGS REVEAL CALLSIUM DEPOSITS IN

1183
00:43:03,520 --> 00:43:08,680
HER ELBOWS SHOULDER AND KNEES,

1184
00:43:08,680 --> 00:43:11,040
THERESA HAD HETEROTOPIC

1185
00:43:11,040 --> 00:43:12,360
CALCIFICATION A CONDITION WHERE

1186
00:43:12,360 --> 00:43:13,960
BONES FORM WHERE THEY SHOULDN'T

1187
00:43:13,960 --> 00:43:16,480
T. WAS AS IF SHE HAD WROKS

1188
00:43:16,480 --> 00:43:17,760
GROWING INSIDE HER JOINTS I HAD

1189
00:43:17,760 --> 00:43:18,600
NEVER SEEN ANYTHING LIKE IT

1190
00:43:18,600 --> 00:43:21,520
BEFORE AND I DIDN'T KNOW WHAT TO

1191
00:43:21,520 --> 00:43:21,720
THINK.

1192
00:43:21,720 --> 00:43:23,040
TERESA DIDN'T REACT AT ALL WHEN

1193
00:43:23,040 --> 00:43:25,480
I SHOWED HER THE DISTURBING

1194
00:43:25,480 --> 00:43:28,040
IMAGES BUT HER MOTHER NOD INDEED

1195
00:43:28,040 --> 00:43:29,280
AFFIRMATION AS IF SHE HAD

1196
00:43:29,280 --> 00:43:30,840
PERMISSION TO TALK ABOUT HER

1197
00:43:30,840 --> 00:43:34,040
OTHER CONCERNS, SHE TOLD ME

1198
00:43:34,040 --> 00:43:35,600
TERESA'S BRAIN WASN'T WORKING

1199
00:43:35,600 --> 00:43:36,040
PROPERLY.

1200
00:43:36,040 --> 00:43:37,400
SHE WOULD FORGET THINGS,

1201
00:43:37,400 --> 00:43:39,320
PEOPLE'S NAMES, SHE HAD GROWN

1202
00:43:39,320 --> 00:43:40,400
AFRAID, MISMARTIN STOPPED AND

1203
00:43:40,400 --> 00:43:42,640
SHIFTED IN HER SEAT, SHE'S A

1204
00:43:42,640 --> 00:43:47,160
COMPLETELY DIFFERENT PERSON NOW.

1205
00:43:47,160 --> 00:43:48,680
SHE GLANCED AT HER DAUGHTER

1206
00:43:48,680 --> 00:43:51,880
SITTING NEXT TO HER IN A

1207
00:43:51,880 --> 00:43:52,920
WHEELCHAIR AND SIGHED, 2

1208
00:43:52,920 --> 00:43:54,080
PARAGRAPH MY AUTHOR'S NOTE AND I

1209
00:43:54,080 --> 00:43:55,840
WILL STOP TALKING AND TAKE YOUR

1210
00:43:55,840 --> 00:43:56,600
QUESTIONS, MANY PEOPLE BELIEVE

1211
00:43:56,600 --> 00:43:59,240
MEDICINE IS GROUNDED IN THE

1212
00:43:59,240 --> 00:44:00,200
BENEVOLENCE IN WITCHING GOOD,

1213
00:44:00,200 --> 00:44:02,200
IT'S MORE THAN THAT, THE TARGET

1214
00:44:02,200 --> 00:44:05,200
PRINCIPLE OF MEDICINE MUST BE A

1215
00:44:05,200 --> 00:44:06,920
HIGHER STANDARD, BENEFICENCE,

1216
00:44:06,920 --> 00:44:09,880
DOING GOOD, THIS BREEDS TRUST

1217
00:44:09,880 --> 00:44:11,520
BETWEEN MY PATIENT AND ME WHICH

1218
00:44:11,520 --> 00:44:13,640
IS THE CORNERSTONE OF MY ART AND

1219
00:44:13,640 --> 00:44:15,600
PRACTICE AND RETURN FOR HER

1220
00:44:15,600 --> 00:44:16,680
TRUST, I PROMISE ALWAYS TO TRY

1221
00:44:16,680 --> 00:44:18,440
TO HELP HER AND NEVER HARM HER.

1222
00:44:18,440 --> 00:44:20,760
EVERY TIME I STEP INTO THE

1223
00:44:20,760 --> 00:44:24,160
HOSPITAL, I REMIND MYSELF OF THE

1224
00:44:24,160 --> 00:44:26,040
ENORMITY OF THIS PROMISE THAL

1225
00:44:26,040 --> 00:44:31,720
COVENANT, EARLY IN MY CAREER, I

1226
00:44:31,720 --> 00:44:32,440
STRAYED NOT INTENTIONALLY BUT

1227
00:44:32,440 --> 00:44:35,560
OUT OF A DESIRE TO CONTROL EVERY

1228
00:44:35,560 --> 00:44:36,960
MEDICAL CIRCUMSTANCE.

1229
00:44:36,960 --> 00:44:39,160
I DIDN'T LISTEN ENOUGH.

1230
00:44:39,160 --> 00:44:40,920
OUR GREATEST TREASURE IS FOUND

1231
00:44:40,920 --> 00:44:41,720
IN DEEP COMPLIEWNICATION WITH

1232
00:44:41,720 --> 00:44:43,640
EACH RPGHT WHEN THIS IS NUT

1233
00:44:43,640 --> 00:44:44,280
URTED ESPECIALLY IN IMPEDIMENTS

1234
00:44:44,280 --> 00:44:45,880
TREATMENT OF SUBSTANCE ABUSE OF

1235
00:44:45,880 --> 00:44:46,920
SUFFERING, 2 PEOPLE CAN

1236
00:44:46,920 --> 00:44:49,120
ESTABLISH SOMETHING OF ALMOST

1237
00:44:49,120 --> 00:44:50,360
MYSTICAL QUALITY, A RECIPROCAL

1238
00:44:50,360 --> 00:44:52,280
CONNECTION THAT I THINK PRSITOUS

1239
00:44:52,280 --> 00:44:54,600
A PLACE OF CHARITY AND EMPATHY

1240
00:44:54,600 --> 00:45:00,520
THAT CROSSES SOCIAL, RACIAL AND

1241
00:45:00,520 --> 00:45:03,280
FINANCIAL BOUNDARIES, WE ARE ALL

1242
00:45:03,280 --> 00:45:03,560
1.

1243
00:45:03,560 --> 00:45:04,440
THANKS FRIENDS, APPRECIATE

1244
00:45:04,440 --> 00:45:05,640
QUESTIONS AND APPRECIATE MY TIME

1245
00:45:05,640 --> 00:45:07,240
WITH YOU TODAY AND IF I CAN BE

1246
00:45:07,240 --> 00:45:09,600
OF SERVE TO YOU ANY TIME IN THE

1247
00:45:09,600 --> 00:45:20,120
FUTURE, PLEASE REACH OUT, I AM

1248
00:45:22,960 --> 00:45:23,520
WES.ELY.ICU.ORG, AND I WILL

1249
00:45:23,520 --> 00:45:27,560
BRING US BACK TO OUR MAIN TALK.

1250
00:45:27,560 --> 00:45:27,960
THANKS EVERYBODY.

1251
00:45:27,960 --> 00:45:30,200
>> THAT WAS A GREAT TALK
WITH A

1252
00:45:30,200 --> 00:45:31,000
LOT OF INFORMATION.

1253
00:45:31,000 --> 00:45:31,800
HOW MUCH DIFFERENCE DO YOU THINK

1254
00:45:31,800 --> 00:45:35,400
THERE IS IN TERMS OF LONG-TERM

1255
00:45:35,400 --> 00:45:37,240
COGNITIVE PROBLEMS AND PATIENTS

1256
00:45:37,240 --> 00:45:39,280
IN THE ICU VERSUS PATIENTS IN

1257
00:45:39,280 --> 00:45:40,680
OTHER PARTS OF THE HOSPITAL THAT

1258
00:45:40,680 --> 00:45:41,960
ARE IN LONG-TERM CARE FACILITY

1259
00:45:41,960 --> 00:45:43,680
WHO IS HAVE DIFFERENT PROBLEMS

1260
00:45:43,680 --> 00:45:46,600
BUT THEY'RE ALSO HOSPITALIZED?

1261
00:45:46,600 --> 00:45:48,080
>> IT'S A GREAT QUESTION,
THERE

1262
00:45:48,080 --> 00:45:49,520
ARE ABSOLUTELY GOOD DATA PUBLISH

1263
00:45:49,520 --> 00:45:50,600
INDEED THE AMERICAN JOURNAL OF

1264
00:45:50,600 --> 00:45:52,960
MEDICINE AND THE ANNALS WHICH

1265
00:45:52,960 --> 00:45:54,760
SHOW THAT HOSPITALIZED PATIENTS

1266
00:45:54,760 --> 00:45:55,880
FOR PNEUMONIA FOR EXAMPLE WHO

1267
00:45:55,880 --> 00:45:58,560
NEVER GET IN THE ICU ALSO ACCRUE

1268
00:45:58,560 --> 00:46:00,160
THIS SORT OF COGNITIVE DECLINE.

1269
00:46:00,160 --> 00:46:02,520
WE HAVE A PAPER THAT WE

1270
00:46:02,520 --> 00:46:05,400
PUBLISHED IN JAMA IN 2010 WITH

1271
00:46:05,400 --> 00:46:06,720
JACK WASHINGTON SHOWING

1272
00:46:06,720 --> 00:46:07,560
INCREMENTAL DEFICITS IN

1273
00:46:07,560 --> 00:46:10,880
COGNITION AS WELL, ACCORDING TO

1274
00:46:10,880 --> 00:46:12,080
DIFFERENT LEVELS OF SEVERITY.

1275
00:46:12,080 --> 00:46:14,520
SO THIS IS NOT A PROBLEM

1276
00:46:14,520 --> 00:46:17,400
ISOLATED TO THE ICU.

1277
00:46:17,400 --> 00:46:21,800
BUT THE ICU PATIENTS ARE JUST

1278
00:46:21,800 --> 00:46:23,880
NEARER TO DISASTER BUT YOUR

1279
00:46:23,880 --> 00:46:25,760
FLOOR PATIENTS ARE ACCRUING

1280
00:46:25,760 --> 00:46:27,280
COGNITIVE DECLINE DURING THIS AS

1281
00:46:27,280 --> 00:46:28,560
WELL, THEY HAVE SYSTEMIC

1282
00:46:28,560 --> 00:46:30,360
INFLAMMATION AND THEY GET

1283
00:46:30,360 --> 00:46:34,400
EXPOSED TO MEDICATIONS WHICH

1284
00:46:34,400 --> 00:46:35,040
CAUSE THEM NEURONAL DYSFUNCTION

1285
00:46:35,040 --> 00:46:38,800
AS WELL, SO IT'S A PROBLEM

1286
00:46:38,800 --> 00:46:41,080
ACROSS THE BOARD, BUT THE

1287
00:46:41,080 --> 00:46:43,240
GREATEST PROBLEM OF COURSE IS IN

1288
00:46:43,240 --> 00:46:45,960
THE CRITICAL CARE UNITS WHERE WE

1289
00:46:45,960 --> 00:46:48,520
KEEP PEOPLE IMMOBILIZED AND

1290
00:46:48,520 --> 00:46:49,480
DEEPLY SEDATED AND BEAUTIFULLY,

1291
00:46:49,480 --> 00:46:51,280
THOSE ARE THE AREAS WHERE WE

1292
00:46:51,280 --> 00:46:53,240
COULD HAVE THE GREATEST MARGIN

1293
00:46:53,240 --> 00:46:55,880
OF IMPROVEMENT AS WELL BECAUSE

1294
00:46:55,880 --> 00:47:06,440
THOSE ARE MODIFIABLE COMPONENTS

1295
00:47:16,240 --> 00:47:16,880
OF THEIR ILLNESS.

1296
00:47:16,880 --> 00:47:18,720
--I DON'T THINK YOU CAN

1297
00:47:18,720 --> 00:47:20,120
EXPLICITLY DO THAT, I WAS IN A

1298
00:47:20,120 --> 00:47:22,000
UNIT LAST WEEK AND I HAD 6

1299
00:47:22,000 --> 00:47:23,080
PATIENTS ON MY SERVICE WITH

1300
00:47:23,080 --> 00:47:24,360
COVID, I REMEMBER THE NUMBER WAS

1301
00:47:24,360 --> 00:47:26,280
6 BECAUSE I REMEMBER THAT 3 OF

1302
00:47:26,280 --> 00:47:27,760
THEM WERE IMMUNO COMPROMISED AND

1303
00:47:27,760 --> 00:47:32,640
3 OF THEM WERE UNVACCINATED IT

1304
00:47:32,640 --> 00:47:34,360
WAS A DIFFERENT GROUP, 3 WERE

1305
00:47:34,360 --> 00:47:38,000
VACCINATED AND 3 HAD NOT BEEN

1306
00:47:38,000 --> 00:47:40,400
AND 2 OF THEM 2 OF THEM WERE IN

1307
00:47:40,400 --> 00:47:42,160
THE UNIT WITH COVID BUT NOT

1308
00:47:42,160 --> 00:47:43,600
BECAUSE OF COVID.

1309
00:47:43,600 --> 00:47:45,160
THEIR ILLNESSES WERE DISTINCT,

1310
00:47:45,160 --> 00:47:49,200
THEY WERE ADMITTED FOR OTHER

1311
00:47:49,200 --> 00:47:51,520
PROBLEMS 1 HAD COAL O CYSTITIS

1312
00:47:51,520 --> 00:47:53,560
AND DIDN'T HAVE ANYTHING TO DO

1313
00:47:53,560 --> 00:47:54,880
WITH COVID FOR EXAMPLE BUT 4 OF

1314
00:47:54,880 --> 00:47:56,360
THEM THEY HAD COVID, THEY WERE

1315
00:47:56,360 --> 00:47:57,880
SUFFERING FROM COVID, SO IN THE

1316
00:47:57,880 --> 00:47:58,680
CLINICAL CIRCUMSTANCE, I FEEL

1317
00:47:58,680 --> 00:47:59,880
LIKE IT'S NOT THAT COMPLICATED

1318
00:47:59,880 --> 00:48:02,120
TO TELL WHO IS SUFFERING FROM

1319
00:48:02,120 --> 00:48:04,320
COVID, VERSUS WITH COVID.

1320
00:48:04,320 --> 00:48:06,080
I THINK THAT'S NOT VERY

1321
00:48:06,080 --> 00:48:07,680
COMPLICATED BUT ON DEATH

1322
00:48:07,680 --> 00:48:10,360
CERTIFICATES ON A GLOBAL SCALE

1323
00:48:10,360 --> 00:48:16,440
FROM A POLICY PERSPECTIVE, I

1324
00:48:16,440 --> 00:48:18,760
THINK THAT'S REALLY HARD, WE

1325
00:48:18,760 --> 00:48:21,000
HAVE AN EASIER TIME OF IT THAN

1326
00:48:21,000 --> 00:48:22,280
ON DEATH CERTIFICATES.

1327
00:48:22,280 --> 00:48:23,680
>> THAT IS A INDUSTRY
PROBLEM

1328
00:48:23,680 --> 00:48:25,320
THAT DAN [INDISCERNIBLE] WHO

1329
00:48:25,320 --> 00:48:28,400
INVITED YOU IT FOR THIS IS

1330
00:48:28,400 --> 00:48:29,360
ANOTHER MEETING TODAY HAS AN

1331
00:48:29,360 --> 00:48:31,880
ARTICLE THAT'S GOING TO COME OUT

1332
00:48:31,880 --> 00:48:35,040
SOON ON 44 AUTOPSIES IN WHICH

1333
00:48:35,040 --> 00:48:37,000
THEY SHOWED PATIENTS WITH COVID

1334
00:48:37,000 --> 00:48:38,960
VIRAL PARTICLES IN THE CNS, SO

1335
00:48:38,960 --> 00:48:40,320
IT IS HARD TO DISTINGUISH WHAT'S

1336
00:48:40,320 --> 00:48:43,360
THE VIRUS, LAWEDDER DALE'S THE

1337
00:48:43,360 --> 00:48:45,560
IMMUNOLOGIC CHANGE AND WHAT ARE

1338
00:48:45,560 --> 00:48:47,560
YOUR PRACTICES, SO IT REALLY IS

1339
00:48:47,560 --> 00:48:48,360
A COMPLEX ISSUE.

1340
00:48:48,360 --> 00:48:50,800
>> THERETO ME HIT ON THAT
WHILE

1341
00:48:50,800 --> 00:48:53,080
WE GO, I DID HAVE A PIECE IN THE

1342
00:48:53,080 --> 00:48:54,240
WASHINGTON POST 2 WEEKS AGO AND

1343
00:48:54,240 --> 00:48:56,000
1 LAST WEEK IN THE BOSTON GLOBE

1344
00:48:56,000 --> 00:48:56,760
THAT ADDRESSED THIS.

1345
00:48:56,760 --> 00:48:59,200
I WILL GIVE YOU MY SNIPIT ON

1346
00:48:59,200 --> 00:49:02,560
THIS, I THINK THAT THE THEORY OF

1347
00:49:02,560 --> 00:49:03,440
IMMUNOLOGICAL DISREGULATION IN

1348
00:49:03,440 --> 00:49:04,520
COVID WHICH LEADS TO LONG COVID

1349
00:49:04,520 --> 00:49:09,960
AND ALSO  FEARYY OF VIRAL GHOSTS

1350
00:49:09,960 --> 00:49:12,280
WHICH IF YOU LOOK AT THE IMIEWNL

1351
00:49:12,280 --> 00:49:13,120
REACTION TO PATIENTS AFTER

1352
00:49:13,120 --> 00:49:14,640
COVID, THERE ARE DATA IN NATURE

1353
00:49:14,640 --> 00:49:18,160
AND NATURE MEDICINE THAT SHOW

1354
00:49:18,160 --> 00:49:19,640
THAT THE IMMUNE RESPONSE DOES

1355
00:49:19,640 --> 00:49:23,720
MIRROR AND INDICATE THAT THERE'S

1356
00:49:23,720 --> 00:49:24,400
ONGOING ANTIGENIC STIMULATION IN

1357
00:49:24,400 --> 00:49:29,000
THE HUMAN BODY LONG AFTER THE

1358
00:49:29,000 --> 00:49:29,680
ACUTE INFECTION,

1359
00:49:29,680 --> 00:49:30,200
[INDISCERNIBLE], STEVEN

1360
00:49:30,200 --> 00:49:31,360
[INDISCERNIBLE] AND OTHERS IN

1361
00:49:31,360 --> 00:49:32,640
THE COUNTRY DO BELIEVE AND WE

1362
00:49:32,640 --> 00:49:33,840
HAVE GOOD DATA TO SUPPORT LIKE

1363
00:49:33,840 --> 00:49:35,720
THE PAPER YOU JUST MENTIONED

1364
00:49:35,720 --> 00:49:40,280
THAT WILL COME OUT SOON THAT

1365
00:49:40,280 --> 00:49:43,960
THERE IS ONGOING ANTIGENIC

1366
00:49:43,960 --> 00:49:45,840
STIMULATION WITH VIRAL GENERATE

1367
00:49:45,840 --> 00:49:46,320
BRAIN DYSFUNCTION.

1368
00:49:46,320 --> 00:49:47,600
NOW HOW DO THEY DO THAT?

1369
00:49:47,600 --> 00:49:49,560
THERE IS A DISRUPTION AT THE

1370
00:49:49,560 --> 00:49:51,240
BLOOD BRAIN BARRIER, THEY AFFECT

1371
00:49:51,240 --> 00:49:52,680
THE ENDOTHELIAL CELLS AT THE

1372
00:49:52,680 --> 00:49:55,560
BLOOD BRAIN BARRIER BUT THEY

1373
00:49:55,560 --> 00:49:57,760
ALSO AFFECT ASHING THE ASTRO

1374
00:49:57,760 --> 00:49:59,160
SITES AND DPLEEL CELLS THAT ARE

1375
00:49:59,160 --> 00:50:00,600
SUPPORTING THE NETWORK AND

1376
00:50:00,600 --> 00:50:01,920
NUTTERRING ENVIRONMENT FOR THE

1377
00:50:01,920 --> 00:50:03,640
NEURONS SO AT THE BEGINNING OF

1378
00:50:03,640 --> 00:50:04,480
COVID, WE TOOK SOLACE IN THE

1379
00:50:04,480 --> 00:50:05,880
FACT THAT THE NEURONS THEMSELVES

1380
00:50:05,880 --> 00:50:07,000
DIDN'T SEEM TO BE INFECTED BUT

1381
00:50:07,000 --> 00:50:09,600
IT DOESN'T MATTER IF THE NEURONS

1382
00:50:09,600 --> 00:50:11,320
AREN'T DIRECTLY INFECTED IF THE

1383
00:50:11,320 --> 00:50:13,360
GLIAL CELLS WHICH SUPPORT THEM

1384
00:50:13,360 --> 00:50:17,080
ARE INFECTED AND DIE AND THE

1385
00:50:17,080 --> 00:50:17,800
NEURONS DIE INDIRECTLY AND I

1386
00:50:17,800 --> 00:50:19,800
THINK THAT MAY BE HAPPENING IN

1387
00:50:19,800 --> 00:50:22,200
LONG COVID.

1388
00:50:22,200 --> 00:50:22,520
>> THANKS.

1389
00:50:22,520 --> 00:50:26,000
I HOPE THAT IN OUR ICU AT THE

1390
00:50:26,000 --> 00:50:27,280
CLINICAL CENTER WE ENCOURAGER

1391
00:50:27,280 --> 00:50:28,200
FAMILY PRESENCE AS MUCH AS

1392
00:50:28,200 --> 00:50:30,800
POSSIBLE BUT 1 OF OUR ICU

1393
00:50:30,800 --> 00:50:33,000
ATTENDINGS WANTS TO KNOW, SINCE

1394
00:50:33,000 --> 00:50:34,000
YOU TALKED ABOUT DECREASE

1395
00:50:34,000 --> 00:50:35,840
[INDISCERNIBLE] USE AND

1396
00:50:35,840 --> 00:50:37,080
INCREASING FAMILY PRESENCE OF

1397
00:50:37,080 --> 00:50:39,440
THE BEDSIDE SHOULD WE BE

1398
00:50:39,440 --> 00:50:41,280
REDESIGNING OUR ICUs TO

1399
00:50:41,280 --> 00:50:42,320
ENCOURAGE MORE PRESENCE.

1400
00:50:42,320 --> 00:50:43,680
I MEAN CERTAINLY IN CHILDREN

1401
00:50:43,680 --> 00:50:45,280
THEY OFTEN HAVE ROOMING IN,

1402
00:50:45,280 --> 00:50:46,720
SHOULD WE BE ENCOURAGING MORE OF

1403
00:50:46,720 --> 00:50:49,320
THAT IN THE ICU?

1404
00:50:49,320 --> 00:50:52,120
>> YES, I THINK THAT MANY

1405
00:50:52,120 --> 00:50:54,120
ICUs, I KOOBT SPEAK, I'VE BEEN

1406
00:50:54,120 --> 00:50:56,560
TO YOUR ICU BEFORE BUT I CAN'T

1407
00:50:56,560 --> 00:50:57,960
REMEMBER THE EXACT LAY OUT OF

1408
00:50:57,960 --> 00:51:01,400
THE ROOMS BUT MANY ICUS, I'M NOT

1409
00:51:01,400 --> 00:51:03,040
SPEAKING ABOUT YOURS BUT MANY

1410
00:51:03,040 --> 00:51:05,400
ICUs ARE LIKE SICK BUILDING.

1411
00:51:05,400 --> 00:51:06,560
THEY'RE SICK BUILDING BECAUSE

1412
00:51:06,560 --> 00:51:10,600
THE DESIGN OF THE BUILDING

1413
00:51:10,600 --> 00:51:13,240
CREATES SICKNESS IN THE HEALING

1414
00:51:13,240 --> 00:51:13,520
PROCESS.

1415
00:51:13,520 --> 00:51:14,840
NOW THAT'S THAT EARLIER, FOR US

1416
00:51:14,840 --> 00:51:17,280
TO BE TRUE HEALERS WE CANNOT DO

1417
00:51:17,280 --> 00:51:19,800
IT, WITH SCIENCE ALONE, IT WON'T

1418
00:51:19,800 --> 00:51:21,440
WORK, PEOPLE.

1419
00:51:21,440 --> 00:51:24,000
WE HAVE TO HAVE TOUCH FIRST AND

1420
00:51:24,000 --> 00:51:25,000
TECHNOLOGY SECOND.

1421
00:51:25,000 --> 00:51:26,840
THE BEAUTY OF THE TECHNOLOGY IS

1422
00:51:26,840 --> 00:51:28,760
IT CAN COMPLEMENT THE HUMAN

1423
00:51:28,760 --> 00:51:30,960
TOUCH BUT IF WE DESIGN A ROOM SO

1424
00:51:30,960 --> 00:51:32,440
THAT IT'S 2 TIGHT AND WE CAN'T

1425
00:51:32,440 --> 00:51:34,800
HAVE A FAMILY IN THERE AND THE

1426
00:51:34,800 --> 00:51:36,600
FAMILY CAN ROOM-IN LIKE WE ARE

1427
00:51:36,600 --> 00:51:38,320
DOING BEAUTIFULLY WITH THE

1428
00:51:38,320 --> 00:51:40,680
PEDIATRIC ICUs AS YOU POINTED

1429
00:51:40,680 --> 00:51:42,760
OUT HENRY WE CAN HAVE THE FAMILY

1430
00:51:42,760 --> 00:51:43,720
THERE, HOLDING THEIR HANDS,

1431
00:51:43,720 --> 00:51:44,920
LOOKING IN THEIR EYES AND CREATE

1432
00:51:44,920 --> 00:51:46,360
THAT HEALING ENVIRONMENT THAT WE

1433
00:51:46,360 --> 00:51:47,920
NEED, BY THE WAY, WE SHOULD

1434
00:51:47,920 --> 00:51:49,920
NEVER GO BACK TO NO VISITATION

1435
00:51:49,920 --> 00:51:50,480
AGAIN.

1436
00:51:50,480 --> 00:51:52,680
WE KNOW THAT PPE WORKS, IT WAS A

1437
00:51:52,680 --> 00:51:56,320
WRONG THING TO DO TO OUR

1438
00:51:56,320 --> 00:51:59,080
PATIENTS AND IT INCREASED OUR

1439
00:51:59,080 --> 00:51:59,520
BURN OUT.

1440
00:51:59,520 --> 00:52:03,160
SO WE SUFFERED WHEN FAMILIES

1441
00:52:03,160 --> 00:52:03,800
WEREN'T THERE.

1442
00:52:03,800 --> 00:52:06,680
I WROTE A PIECE IN CHEST ON THIS

1443
00:52:06,680 --> 00:52:07,760
CALLED MEDICINE AT ITS FINEST,

1444
00:52:07,760 --> 00:52:10,200
WE HAVE TO HAVE THE FACAS AMLYS

1445
00:52:10,200 --> 00:52:11,560
THERE FOR OUR OWN HEALING AS

1446
00:52:11,560 --> 00:52:13,680
WELL, SO YES, WE NEED OUR ROOMS

1447
00:52:13,680 --> 00:52:14,600
DESIGNED LARGE NOWOF THE WITH

1448
00:52:14,600 --> 00:52:15,920
WALK IN SHOWERS ASK THAT THE

1449
00:52:15,920 --> 00:52:16,880
FAMILY CAN BE THERE AND THE

1450
00:52:16,880 --> 00:52:18,880
PATIENT CANS BE WHEELED IN, TO

1451
00:52:18,880 --> 00:52:21,080
GET SHOWERS WHEN THEY'RE

1452
00:52:21,080 --> 00:52:23,880
CRITICALLY ILL ALL THAT IS PART

1453
00:52:23,880 --> 00:52:25,080
OF THE HOW VANDERBILT AND

1454
00:52:25,080 --> 00:52:26,360
ORGANIZED BY THE WAY.

1455
00:52:26,360 --> 00:52:27,280
>> IT'S INTERESTING
WHETHER IT'S

1456
00:52:27,280 --> 00:52:29,280
SCHOOLS OR HOSPITALS THAT'S A

1457
00:52:29,280 --> 00:52:31,400
BIG DEBATE, SOMETHING WE ALL

1458
00:52:31,400 --> 00:52:32,800
REALIZE THAT WE OVERREACTED TO

1459
00:52:32,800 --> 00:52:36,080
BUT WHEN YOU LOOK BACK WAS THAT

1460
00:52:36,080 --> 00:52:38,400
CLEAR TO YOU AT THE BEGINNING

1461
00:52:38,400 --> 00:52:39,560
COVID OUTBREAK WHERE WE'RE SO

1462
00:52:39,560 --> 00:52:41,960
CONCERNED ABOUT THE VIRAL ISSUE,

1463
00:52:41,960 --> 00:52:52,440
RATHER THAN THE HUMANISTIC

1464
00:53:08,480 --> 00:53:08,720
ISSUE?

1465
00:53:08,720 --> 00:53:11,760
>> --IT WAS BASED IN
SCIENTIFIC

1466
00:53:11,760 --> 00:53:13,760
WORRY ABOUT AIR BORNE, DROPLET,

1467
00:53:13,760 --> 00:53:15,440
ET CETERA, WE DIDN'T HAVE WAYS

1468
00:53:15,440 --> 00:53:17,640
TO PROTECT OURSELVES AND WE

1469
00:53:17,640 --> 00:53:18,120
LEARNED PPE WORKS.

1470
00:53:18,120 --> 00:53:20,320
WE NOW HAVE A VACCINE, WE CAN

1471
00:53:20,320 --> 00:53:21,600
HAVE FAMILY MEMBERS IN THERE, I

1472
00:53:21,600 --> 00:53:23,960
HAD A PATIENT LAST WEEK WHO WAS

1473
00:53:23,960 --> 00:53:26,960
PREGNANT, SHE DELIVERED HER

1474
00:53:26,960 --> 00:53:28,440
BABY, COVID, THE BABY WENT TO

1475
00:53:28,440 --> 00:53:31,280
THE NICU, THE WOMAN IN THE ICU

1476
00:53:31,280 --> 00:53:35,600
ON A HUNDRED% OF IO2, PEEPS OF

1477
00:53:35,600 --> 00:53:36,960
20 PARALYZED AND SEDATED, THAT

1478
00:53:36,960 --> 00:53:38,600
WAS THE RIGHT THING THAT DAY, I

1479
00:53:38,600 --> 00:53:41,160
SUN CAME UP THE NEXT DAY, LOOKED

1480
00:53:41,160 --> 00:53:43,080
AT THE NURSE BROOK, AND SHE WAS

1481
00:53:43,080 --> 00:53:45,160
1 OF OUR BEST NURSES, I HAD A

1482
00:53:45,160 --> 00:53:46,680
PATIENT WHO LOST HER HANDS AND

1483
00:53:46,680 --> 00:53:49,520
FEET FROM COVID, HER NAME WAS

1484
00:53:49,520 --> 00:53:52,400
AWE UMKC I HAVE PERMISSION TO

1485
00:53:52,400 --> 00:53:56,040
USE THESE NAMES HE HAD ARTERIAL

1486
00:53:56,040 --> 00:53:57,840
CLOTS IN ALL THESE AND IT WAS

1487
00:53:57,840 --> 00:53:58,280
CRAZY.

1488
00:53:58,280 --> 00:54:00,760
I SAID BROOK,RY TO TURN IT OFF,

1489
00:54:00,760 --> 00:54:01,960
SHE SAID SHE WILL BUCK, I SAID

1490
00:54:01,960 --> 00:54:05,520
WELL WE KNOW THE DATA,Y THAN

1491
00:54:05,520 --> 00:54:07,280
IT'S WRONG TO THINK THIS IS ALL

1492
00:54:07,280 --> 00:54:07,880
ABOUT HER LUNGS.

1493
00:54:07,880 --> 00:54:09,560
IF WE MAKE IT ALL ABOUT HER

1494
00:54:09,560 --> 00:54:11,040
LUNGS, WE'RE GOING TO SACRIFICE

1495
00:54:11,040 --> 00:54:13,200
HER BRAIN, HER ARMS, HER LEGS,

1496
00:54:13,200 --> 00:54:14,720
THIS WOMAN HAS TO GET HOME AND

1497
00:54:14,720 --> 00:54:18,960
TAKE OF HER BABIES, HER 4 KIDS

1498
00:54:18,960 --> 00:54:21,560
SO WE TURNED THE VENTILATOR OFF,

1499
00:54:21,560 --> 00:54:24,360
SHE BUCKED A BIT, WE TITRATEDDED

1500
00:54:24,360 --> 00:54:25,800
THING AND WE TOOK THEM ALL THE

1501
00:54:25,800 --> 00:54:28,400
WAY DOWN AND WE RESTARTED THEM

1502
00:54:28,400 --> 00:54:31,880
AT HALF THE DOSE, HER WE

1503
00:54:31,880 --> 00:54:33,840
TITRATED IT, HER HUSBAND CAME IN

1504
00:54:33,840 --> 00:54:36,480
THIS PPE, HELD HER HAND, THEY

1505
00:54:36,480 --> 00:54:38,720
MADE EYE CONTACT, THEY MADE THE

1506
00:54:38,720 --> 00:54:40,080
CONNECTION, THEY FOUND HER WHY,

1507
00:54:40,080 --> 00:54:41,920
SHE'S BACK WITH HER FAMILY, IT'S

1508
00:54:41,920 --> 00:54:46,520
THE WAY WE HAVE TO LEARN THAT

1509
00:54:46,520 --> 00:54:48,120
THESE ARE NOT EITHER OR, THEY'RE

1510
00:54:48,120 --> 00:54:49,800
BOTH AND DPR US TO BECOME THE

1511
00:54:49,800 --> 00:54:51,880
BEST HEALERS WE CAN BE.

1512
00:54:51,880 --> 00:54:53,200
>> DO YOU THINK THAT WE'RE
DOING

1513
00:54:53,200 --> 00:54:58,080
BETTER  NOW WITH COVID, AND IF E

1514
00:54:58,080 --> 00:54:59,720
ARE DOING BETTER IS IT THE FACT

1515
00:54:59,720 --> 00:55:01,960
THAT WE'RE TAKING A MORE

1516
00:55:01,960 --> 00:55:03,080
HUMANISTIC APPROACH, IS IT THAT

1517
00:55:03,080 --> 00:55:05,000
WE HAVE A DIFFERENT STRAIN OF

1518
00:55:05,000 --> 00:55:07,480
COVID, IS IT MORE PEOPLE

1519
00:55:07,480 --> 00:55:07,960
IMMUNIZED?

1520
00:55:07,960 --> 00:55:08,800
IT APPEARS WOOER DOING BETTER

1521
00:55:08,800 --> 00:55:11,640
BUT DO YOU THINK THAT'S TRUE?

1522
00:55:11,640 --> 00:55:13,200
I PRESUME ASTERISKS A

1523
00:55:13,200 --> 00:55:14,760
COMBINATION OF THOSE THINGS?

1524
00:55:14,760 --> 00:55:17,120
>> I SURE THINK WE'RE
DOING

1525
00:55:17,120 --> 00:55:17,920
BETTER.

1526
00:55:17,920 --> 00:55:20,680
HOW CAN I EXPRESS THIS, 1 OF MY

1527
00:55:20,680 --> 00:55:22,520
FORMER FELLOWS BUD O'NEILL IN

1528
00:55:22,520 --> 00:55:23,280
NEW ORLEANS AND BATON ROUGE WAS

1529
00:55:23,280 --> 00:55:24,960
IN THE HEAT OF THE PANDEMIC AND

1530
00:55:24,960 --> 00:55:27,040
HE SAID WES, HE SAID I LOST MY

1531
00:55:27,040 --> 00:55:27,400
WAY.

1532
00:55:27,400 --> 00:55:31,320
HE SAID, I HAD THESE PATIENTS

1533
00:55:31,320 --> 00:55:32,960
SNOWED, DEEPLY SEDATED, I KNOW

1534
00:55:32,960 --> 00:55:35,880
THE BUNDLE WORKS, THE DATA ARE

1535
00:55:35,880 --> 00:55:38,400
SOLID, 400 PAPERS, 40 NEW

1536
00:55:38,400 --> 00:55:40,440
ENGLAND JOURNAL JAMA LANCET

1537
00:55:40,440 --> 00:55:42,200
PAPERS I'M GOING BACK TO WHAT I

1538
00:55:42,200 --> 00:55:44,160
KNOW WORKS AND HE SENT ME A

1539
00:55:44,160 --> 00:55:45,840
PICTURE OF A WOMAN INTERNATIONAL

1540
00:55:45,840 --> 00:55:47,200
CLASSIFICATIONIGATE BAITED AWAKE

1541
00:55:47,200 --> 00:55:49,360
HOLDING UP A SIGN THAT SAID GET

1542
00:55:49,360 --> 00:55:51,920
YOUR VACS, TELLING HER FAMILY TO

1543
00:55:51,920 --> 00:55:54,440
GET THEIR SACK SEEN AND SHE WAS

1544
00:55:54,440 --> 00:55:57,680
AWAKE AND ALERTOT VENTILATOR

1545
00:55:57,680 --> 00:55:58,320
WITH HIGH [INDISCERNIBLE].

1546
00:55:58,320 --> 00:56:00,960
WE ALSO HAVE DRUGS I HELPED

1547
00:56:00,960 --> 00:56:06,040
DESIGN THE CODE BARRIER STUDY

1548
00:56:06,040 --> 00:56:07,720
HAD IS VARICITNIB, WHICH IS FDA

1549
00:56:07,720 --> 00:56:08,920
APPROVED NOW, I HELPED DESIGN

1550
00:56:08,920 --> 00:56:11,680
THAT STUDY SO WE HAVE DRUGS,

1551
00:56:11,680 --> 00:56:13,440
THAT AND STEROIDS OR IL6

1552
00:56:13,440 --> 00:56:15,000
BLOCKERS THAT WE KNOW IMPROVE

1553
00:56:15,000 --> 00:56:19,320
SURVIVAL AND WE CAN COUPLE THOSE

1554
00:56:19,320 --> 00:56:21,720
MEDICATIONS WITH THE BUNDLE AND

1555
00:56:21,720 --> 00:56:24,560
SAY THIS IS HOW YOU CARE FOR

1556
00:56:24,560 --> 00:56:25,720
SOMEBODY WHO'S CRITICALLY ILL.

1557
00:56:25,720 --> 00:56:28,520
WE DON'T WANT TO GO BACK TO THE

1558
00:56:28,520 --> 00:56:33,240
1990S FOR HEAVY BEIN, ZO USE

1559
00:56:33,240 --> 00:56:34,560
THAT TERESA MARTIN GOT WHEN I

1560
00:56:34,560 --> 00:56:35,800
HAD NO GRAY HAIR.

1561
00:56:35,800 --> 00:56:36,200
IT WAS WRONG.

1562
00:56:36,200 --> 00:56:37,560
AND PEE HAVE TO SAY THIS IS NOT

1563
00:56:37,560 --> 00:56:39,440
HOW TO TREAT A HUMAN BEING EVERY

1564
00:56:39,440 --> 00:56:41,600
DAY WHEN THEY'RE CRITICALLY ILL.

1565
00:56:41,600 --> 00:56:43,120
EVERY DAY ASK MYSELF WHAT'S THE

1566
00:56:43,120 --> 00:56:44,440
NEXT RIGHT THING TO DO.

1567
00:56:44,440 --> 00:56:48,200
>> I'M LOOKINGA THE MY
INBOX FOR

1568
00:56:48,200 --> 00:56:49,400
MORE QUESTIONS, FROM FROM OTHER

1569
00:56:49,400 --> 00:56:52,240
PEOPLE, TELL ME WHY YOU THINK

1570
00:56:52,240 --> 00:56:56,640
COVID IS DIFFERENT FROM OTHER

1571
00:56:56,640 --> 00:56:57,720
VIRAL PULMONARY PROBLEMS OR

1572
00:56:57,720 --> 00:56:59,720
PATIENTS AT THE ICU, WE HAVEN'T

1573
00:56:59,720 --> 00:57:01,680
SEEN NEARLY THIS MANY BUT YOU

1574
00:57:01,680 --> 00:57:03,360
CERTAINLY IN TENNESSEE SEE A

1575
00:57:03,360 --> 00:57:05,080
FAIR NUMBER OF INFLUENZA

1576
00:57:05,080 --> 00:57:08,520
PATIENTS IN THE ICU, WHY IS

1577
00:57:08,520 --> 00:57:09,160
INFLUENZA DIFFERENT FROM COVID

1578
00:57:09,160 --> 00:57:12,440
OR IS IT JUST WE'RE NOT REALLY

1579
00:57:12,440 --> 00:57:14,560
FOCUSING ON INFLUENZA PATIENTS

1580
00:57:14,560 --> 00:57:14,880
FOR INSTANCE?

1581
00:57:14,880 --> 00:57:17,920
>> IT'S NOT MY OPINION,
THAT

1582
00:57:17,920 --> 00:57:18,320
THEY'RE DIFFERENT.

1583
00:57:18,320 --> 00:57:20,240
THE DATA SHOW US THAT THEY'RE

1584
00:57:20,240 --> 00:57:20,840
DIFFERENT.

1585
00:57:20,840 --> 00:57:21,640
DATA THERE'S A BEAUTIFUL PAPER

1586
00:57:21,640 --> 00:57:24,320
IN JAMILA AMIA COMPARING

1587
00:57:24,320 --> 00:57:25,160
INFLUENZA WITH COVID.

1588
00:57:25,160 --> 00:57:29,200
I'VE TWEETED ABOUT THIS, AT WES

1589
00:57:29,200 --> 00:57:30,720
ELYMD, CAN YOU FIND THESE DATA

1590
00:57:30,720 --> 00:57:33,360
WHEN THEY COMPARE INFLUENZA TO

1591
00:57:33,360 --> 00:57:34,320
COVID, THEY'RE VERY DIFFERENT

1592
00:57:34,320 --> 00:57:35,720
AND THE LARGE PART IS THE

1593
00:57:35,720 --> 00:57:38,320
VASCULAR NATURE OF THIS DISEASE.

1594
00:57:38,320 --> 00:57:39,960
THIS DISEASE, YOU KNOW OUR

1595
00:57:39,960 --> 00:57:40,640
ENDOTHEL YAWM, I THINK ABOUT

1596
00:57:40,640 --> 00:57:42,160
BACK WHEN I WAS A MED STUDENT

1597
00:57:42,160 --> 00:57:44,320
AND I THAT TOLD US RECOGNIZE

1598
00:57:44,320 --> 00:57:45,600
ENDOTHELIUM ON I HISTOLOGICAL

1599
00:57:45,600 --> 00:57:47,480
SLIDE AND THAT'S REALLY ALL IT

1600
00:57:47,480 --> 00:57:51,080
DOES THAT LINES THE BLOOD

1601
00:57:51,080 --> 00:57:51,320
VESSELS.

1602
00:57:51,320 --> 00:57:53,440
NO THE ENDOTHELIUM IS A ENGINE

1603
00:57:53,440 --> 00:57:55,920
OF PLEADING AND CLOTTING AND

1604
00:57:55,920 --> 00:57:57,160
INFLAMMATION AND WHEN IT'S

1605
00:57:57,160 --> 00:58:02,760
INFECTED, BY THIS VIRUS, YOU

1606
00:58:02,760 --> 00:58:04,840
HAVE A FIRE STORM OF INFORMATION

1607
00:58:04,840 --> 00:58:05,920
AND LOTTING THATTA OCCURS IN

1608
00:58:05,920 --> 00:58:07,040
THESE PATIENTS AND IT DOESN'T

1609
00:58:07,040 --> 00:58:09,240
ANY OUT QUICKLY, THIS DISEASE IS

1610
00:58:09,240 --> 00:58:11,400
SO MUCH LONGER THAN INFLUENZA,

1611
00:58:11,400 --> 00:58:13,560
WE ARE TALKING 3 WEEKS VERSUS 1

1612
00:58:13,560 --> 00:58:14,800
WEEK OF AN ILLNESS AND EVERYBODY

1613
00:58:14,800 --> 00:58:16,000
WHO CARES FOR COVID PATIENTS

1614
00:58:16,000 --> 00:58:19,360
KNOWS HOW LONG THIS ILLNESS IS,

1615
00:58:19,360 --> 00:58:23,200
AND THEN, YOU HAVE ONGOING VIRAL

1616
00:58:23,200 --> 00:58:24,920
GHOSTS AND IMMUNE DISREGULATION

1617
00:58:24,920 --> 00:58:25,400
WHICH DOESN'T END.

1618
00:58:25,400 --> 00:58:27,440
NOW SOME OF OUR PATIENTS SEE IT

1619
00:58:27,440 --> 00:58:29,520
IN FOR ABOUT 90-A HUNDRED DAYS

1620
00:58:29,520 --> 00:58:31,160
AND IT SLAMS THEM DOWN AGAIN, I

1621
00:58:31,160 --> 00:58:32,520
KIND OF THOUGHT THAT WAS BOGUS

1622
00:58:32,520 --> 00:58:34,840
BY THE WAY AT THE BEGINNING, I

1623
00:58:34,840 --> 00:58:36,080
THOUGHT ALL THIS LONG COVID

1624
00:58:36,080 --> 00:58:37,680
STUFF IS JUST A PUNCH OF PICKS

1625
00:58:37,680 --> 00:58:38,880
BUT IT'S NOT.

1626
00:58:38,880 --> 00:58:41,240
I HAVE PATIENTS, WE HAVE SO MANY

1627
00:58:41,240 --> 00:58:44,000
PATIENTS IN OUR SUBCENTER WHO

1628
00:58:44,000 --> 00:58:46,520
HAD NO PREEXISTING ILLNESS AT

1629
00:58:46,520 --> 00:58:49,760
ALL, GOT THROUGH MILD COVID,

1630
00:58:49,760 --> 00:58:52,600
THESE ARE NIH FUNDED SCIENTISTS,

1631
00:58:52,600 --> 00:58:54,400
PEOPLE WHO ARE TRI ATHLETES, THE

1632
00:58:54,400 --> 00:58:56,000
GUY I WROTE ABOUT LAST WEEK IN

1633
00:58:56,000 --> 00:58:59,040
THE BOSTON GLOBE WAS A 21

1634
00:58:59,040 --> 00:59:01,160
YEAR-OLD COLLEGE STUDENT WHO HAD

1635
00:59:01,160 --> 00:59:02,880
MILD COVID, NEVER GOT SICK, AND

1636
00:59:02,880 --> 00:59:03,680
HE CANNOT RUN ANYMORE.

1637
00:59:03,680 --> 00:59:05,680
HE WAS GOING TO GO FOR THE

1638
00:59:05,680 --> 00:59:10,800
OLYMPIC TRIALS, HE WAS RUNNING

1639
00:59:10,800 --> 00:59:13,960
4:15, MILES FOR 5 OR 6-MILES, HE

1640
00:59:13,960 --> 00:59:14,520
CAN'T RUN ANYMORE.

1641
00:59:14,520 --> 00:59:18,760
THIS IS A DISEASE.

1642
00:59:18,760 --> 00:59:20,200
AND NEVER LET ANYBODY SILENCE

1643
00:59:20,200 --> 00:59:21,640
THESE PATIENTS OR SAY THAT

1644
00:59:21,640 --> 00:59:22,920
THEY'RE CRAZY.

1645
00:59:22,920 --> 00:59:23,880
IT'S NOT JUST PSYCHOSOMATIC.

1646
00:59:23,880 --> 00:59:25,520
NOW THERE WAS A PAPER LAST WEEK

1647
00:59:25,520 --> 00:59:28,400
IN JAMA THAT SHOWED THAT PEOPLE

1648
00:59:28,400 --> 00:59:29,480
WITH REEXISTING PSYCHIATRIC

1649
00:59:29,480 --> 00:59:30,760
ILLNESSES THAT THAT'S A RISK

1650
00:59:30,760 --> 00:59:31,960
FACTOR FOR LONG COVID, ALL THAT

1651
00:59:31,960 --> 00:59:33,680
MEANS TO ME IS THAT THEY KIND OF

1652
00:59:33,680 --> 00:59:35,960
GOT A HEAD START TOWARDS COVID,

1653
00:59:35,960 --> 00:59:37,520
THEY WERE NEARER TO THEIR

1654
00:59:37,520 --> 00:59:38,640
DISASTER OF LONG ASHING BUT THAT

1655
00:59:38,640 --> 00:59:41,480
DOES NOT MEAN TO ME THAT THIS A

1656
00:59:41,480 --> 00:59:43,280
PSYCHOSOMATIC ILLNESS, THIS IT

1657
00:59:43,280 --> 00:59:44,240
IS AN ACTUAL DISEASE.

1658
00:59:44,240 --> 00:59:45,760
>> WELL, WES THIS, HAS
REALLY

1659
00:59:45,760 --> 00:59:47,720
BEEN A WONDERFUL GREAT TEACHER'S

1660
00:59:47,720 --> 00:59:49,080
EVENT AND AGAIN, SHOWS THE

1661
00:59:49,080 --> 00:59:51,480
IMPORTANCE NOT JUST OF EVIDENCE

1662
00:59:51,480 --> 00:59:53,160
OF PERSONAL CLINICAL EXPERIENCE,

1663
00:59:53,160 --> 00:59:55,680
BUT ALSO, THE ABILITY TO

1664
00:59:55,680 --> 00:59:56,400
COMMUNICATE TO THE MEDICAL

1665
00:59:56,400 --> 00:59:57,680
COMMUNITY AND THE PUBLIC ABOUT

1666
00:59:57,680 --> 00:59:59,880
THIS, SO THIS WAS A WONDERFUL

1667
00:59:59,880 --> 01:00:00,200
OPPORTUNITY.

1668
01:00:00,200 --> 01:00:02,440
WE HOPE THAT THE NEXT TIME WE

1669
01:00:02,440 --> 01:00:04,960
INVITE YOU, YOU WILL COME IN

1670
01:00:04,960 --> 01:00:06,520
PERSON AND SEE OUR FACILITY AND

1671
01:00:06,520 --> 01:00:09,240
OUR ICU AND BE ABLE TO SHOW US

1672
01:00:09,240 --> 01:00:10,560
IN THE BEDSIDE.

1673
01:00:10,560 --> 01:00:11,840
SO THANKS EVERYBODY FOR

1674
01:00:11,840 --> 01:00:13,560
ATTENDING THIS AND THANKS TO WES

1675
01:00:13,560 --> 01:00:15,320
FOR MEETING WITH THE STUDENTS

1676
01:00:15,320 --> 01:00:16,480
BEFORE HAND, COMING TO THIS AND

1677
01:00:16,480 --> 01:00:17,120
BEING A GREAT COMMUNICATOR.

1678
01:00:17,120 --> 00:00:00,000
THANK YOU VERY MUCH.