Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and the chair of the internal medicine Department at Hennepin Healthcare in downtown Minneapolis, where we cover what matters in the wide world of health, wellness, and medicine. And now here's our host, Dr. David Hilden .

Speaker 2: 0:20

Hey everybody, it's Dr. David Hilden . Welcome to our first episode of Season three of the Healthy Matters Podcast. On today's episode, we are gonna peel back the curtain a little bit and reveal the intense and of an unpredictable world of emergency healthcare . More specifically, we're gonna share what it is like daily for those who tirelessly navigate the chaos and life-saving moments of a major metropolitan safety net hospital. Today I'm joined by Dr. John Cole. He's an emergency medicine physician at Hennepin Healthcare or Hennepin County Medical Center, the county Safety Net Hospital here in downtown Minneapolis. John, thanks for joining us on the podcast today. Thank

Speaker 3: 0:56

You for having me, Dave.

Speaker 2: 0:57

Now, John , I've known you for a long time and you're a toxicologist, you're emergency medicine doctor, tell me about why you went into emergency medicine. It's sort of got a a , a heavy mission emphasis to it, doesn't it? Yeah,

Speaker 3: 1:10

Absolutely. I, I think on a, on a more personal level , uh, when I was a medical student, I liked almost everything that I did. And when I got to the emergency department, I got to do all the things that I learned on all my other rotations. There were pediatric patients, geriatrics, there was surgical problems , uh, everything that I liked all throughout the hospital or in the clinic I got to do in the emergency department. And I loved the variety. The other thing that I really loved was the team sport aspect of it. You're so integrated with your team in , in the emergency department, and I , it feels really egalitarian there. I like that we all are sort of mixed in together and all there right in the mix of it, taking care of the patients together. And , uh, I, I loved that part of it. You

Speaker 2: 1:55

Really are. I've been down there and it is a team of nurses and doctors and advanced practice providers and technicians and x-ray people all working for the benefit of that patient who's sitting in front of you. Let's set the stage of the emergency department that you work in here at HCMC in downtown Minneapolis. And just a brief antidote to start that out, I was in Boston at one of the world's most famous hospitals, and I was being shown around there for a completely different reason. And I was introduced as, oh , this is David Hilden . He's from Hennepin in Minneapolis. And the first question out of their mouth was said, you guys have a great emergency department. And I was a thousand miles away from home. Start us out by talking about the emergency department at Hennepin. Um, how big is it? Like how many patients do you see? Give us, give us a , a little bit of the foundation.

Speaker 3: 2:41

It's a physically really big place. It takes up almost an entire city block, which it's a medical student was a really overwhelming thing. You can

Speaker 2: 2:49

Get lost in the

Speaker 3: 2:50

Department. You can, yeah, I don't remember the exact bed count in the emergency department, but it's somewhere around 60 beds. We care for tremendous number of patients. You know, our numbers were different before covid and they've changed a little bit, but anywhere between 90,000 and a hundred thousand patients a year come through the emergency department. Uh , I worked the other day and we saw 287 patients that day. And it feels every bit of those 287 patients, it's a very, very busy place. That

Speaker 2: 3:16

Is , I often say it's one of the busiest ones between Chicago and Seattle. Am I right there?

Speaker 3: 3:21

I think that's correct. I, when I interviewed for residency <laugh> many, many years ago, it was the busiest emergency department between Chicago and the West coast. Can you

Speaker 2: 3:30

Talk a little bit about the EMS services? We do. Yeah.

Speaker 3: 3:32

They , uh, provide almost 90,000 ambulance runs a year. So almost, almost one for one in terms of emergency department patients, although that's not what our emergency department is made up of. Um, but that they're, they're extremely busy and they , uh, they deliver patients all over the metro. So

Speaker 2: 3:48

Listeners, I want to call your attention, since we're talking about the Hennepin EMS service, that we had a bonus episode at the end of season one of the podcast where we did a ride along with leaders from our Hennepin EMS department. And we talked to some paramedics, we talked to some firefighters. It's a great showcase of what our paramedics and other healthcare professionals do day in and day out. Please describe for us, John , what does it mean to be a level one trauma center? So

Speaker 3: 4:13

A level one trauma center essentially means that we have all of the available resources to take care of any trauma patient that you would ever need. And those resources are determined by the American College of Surgeons who verifies if you have those resources available. And then your state trauma system designates you as a level one trauma center. So the American College of Surgeons comes to Hennepin , uh, does a review, looks at our capabilities , um, and you can see them all on their website, but it's, it's a , the whole swath of healthcare from top to bottom. Interestingly enough, one of the required specialties to have there to be a level one trauma centers is internal medicine. You , you're called ,

Speaker 2: 4:51

See we're Oh , we're , we're actually useful.

Speaker 3: 4:53

Maybe you're on the team. Yep . Um, but it's in-house trauma surgeons, obviously in-house emergency medicine physicians, and then immediate access to any other specialty that you would need to take care of, a traumatic injury. So things like orthopedics, neurosurgery, radiology, all those sorts

Speaker 2: 5:12

Of things. So 24 7, you can care for anything that comes in. Exactly,

Speaker 3: 5:16

Yeah .

Speaker 2: 5:16

And not every hospital has this designation, correct?

Speaker 3: 5:18

No, it's, it's rare. There's only a handful of hospitals that do. We were , we are the oldest one in the state of Minnesota. I have trouble keeping , uh, track, but I think there's only five level one trauma centers in Minnesota. And that includes our colleagues up in Duluth and Rochester. So in the , in the metro area here, at least for adults, I think there's just three.

Speaker 2: 5:37

So we also work at a hospital that I often refer to as a safety net hospital. We are a , a unit of the county of Hennepin. Right . What does that mean? What does it mean to be a safety net hospital to you when you are the first line that people come in to see?

Speaker 3: 5:50

I think, you know, that's exactly it. I , I've, I've looked at this over, over the years and , and I , to my knowledge, I can't find a , like a academic definition of a safety net hospital. Other than that, everybody sort of agrees that we take care of anyone who walks through the door regardless of their ability to pay. And that we help everyone who needs help when they come to us. And that, for me, when I was choosing a residency and choosing a specialty was, was just almost required in terms of what I wanted out of a career as a physician. That was always to me why I wanted to go on this journey from the very start.

Speaker 2: 6:24

I love to hear that, John . And tell me then how you've been here many years now, <laugh> , I , I won't say how many, but you , you're not in your , you've been here a while .

Speaker 3: 6:32

Well, in , uh, I , in some ways I've, I've traveled the least distance to get here. 'cause I was born here. You

Speaker 2: 6:37

Were born at this hospital?

Speaker 3: 6:38

I was born at this hospital, yeah.

Speaker 2: 6:39

Oh my gosh. And now you are caring for the people who come into this hospital. That's true, that's true. Including other people who are probably being born at that moment. And when you get a, a pregnant woman coming in, in labor,

Speaker 3: 6:50

I'm a NICU graduate of this hospital.

Speaker 2: 6:51

Actually , you are a nicu . So listeners, NICU is the newborn intensive care unit. You look pretty good. They did a good job with you.

Speaker 3: 6:58

They did. Okay. Yep . Yep . I, I think there's a, I had a neurosurgical problem actually when I was born, and , uh, I think that there is a chance that the neurosurgeon who I was a resident for 27 years later, it definitely wasn't attending neurosurgeon at the hospital when I was born here . When you were born. Yeah. I never was able to get the records to figure out if he ever rounded on me. But

Speaker 2: 7:20

It's true . And we do like to , uh, we, we , we do like to consider ourselves a family, but this is taking it quite to the extreme. We're all , we're looking for people who are actually born in our hospital, <laugh> . That's to be our doctors. So the patients that you see, describe who's coming into that front door. You said everybody who, regardless of their ability to pay. So what does our patient population look

Speaker 3: 7:39

Like? All of Minnesota. Uh, and I think that is really true. We really are a statewide resource. So we take care of obviously a lot of the people who live in the neighborhood around us, which is true of any hospital. You know, when we recruit prospective physicians, one of the amazing things we always get to talk about is we, we really have a tremendously diverse patient population that we're honored to care for. We care for trauma patients who come to us from all corners of the state too, and sometimes even the Dakotas and Western Wisconsin as well. And so we , we really, we take care of everybody.

Speaker 2: 8:11

We have two helipads, we have dozens of ambulances. People are literally coming from all over the place. I really like what you've just said though, that, that the , the patients we serve look like Minnesota. They look like the state that we live in. And I really liked how you put that, John . So that sets the stage pretty nicely for what our department is and what it does. We've been talking with Dr. John Cole, emergency medicine physician at Hennepin Healthcare in downtown Minneapolis. We're gonna take a short break, and when we come back, we're gonna get into some of the specifics of a typical day in the emergency department. Stay with us. We'll be right back

Speaker 4: 8:47

When he up in healthcare says, we are here for life. They mean here for you, your life, and all that it brings. He healthcare has a hospital HCMC and a network of clinics both downtown and across the West Metro. They provide all the primary care and specialty care you would expect to find. But did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and that their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 9:26

And we're back talking to Dr. John Cole of the Hennepin Healthcare Emergency Department. John , let's talk about like a typical day in the emergency department. Now, many of us grew up in med school during the show, er, at least I did. So I don't know if that's reality or not, but tell us what a typical day is like.

Speaker 3: 9:44

Uh , things being atypical is what's typical. Uh, we are, we are the only specialty that's defined by our patients. We don't hang a shingle and say, we take care of hearts here. Right? We hang a sign that says emergency, and the patients decide what the emergency is and they come to us. And , uh, that is one of the fundamental things that's just different about emergency medicine. Uh, it's one of the reasons I love it. It's also one of the reasons it's stressful. But I think because of that, it's hard to define what would be typical. There are some things that are, that are somewhat predictable, right? We, we see frostbite in the winter. We see heat stroke in the summer, and there are times of day that are typically busier, right? It tends to quiet down around three in the morning, and then it's slowly starts to pick up through the day. By noon it's really hopping. And then, and from 3:00 PM until at least 11 o'clock is easily the busiest time of day, that's when our waiting room gets really, really full. So

Speaker 2: 10:38

How do you manage that from a pure logistical model there ? You've got a certain number of staff there. Yeah. You've gotta care for the routine stuff that's coming in all day, you know, and during tho those hours and then an ambulance shows up.

Speaker 3: 10:51

Yeah. We, we've, this is one of those things that I'm, I'm definitively mid-career now. I'm , I've accepted that. And this is one of those things that has changed so much during my career. So when I started in emergency medicine, the doctors work in the back and we take care of patients in the rooms and the people are in the waiting room because that's where they can wait. And our mentality has completely changed and rightfully so. So now when you come to the emergency department, you check in at the desk so we can get you in the electronic medical record. And then frequently the first person you talk to is one of the attending emergency physicians. We meet you with a nurse. There's usually one doctor and two nurses working up front . And part of that is to begin the triage process. And right, triage is just French for sorting, but it's, it's to make sure that if you are able to walk into the emergency department with a heart attack or a stroke, the best trained person to pick that up sees you right away so that we can identify it and get you to your time dependent treatment as soon as possible. The downside for the patient experience part, and this, this always pains me. And as I've gotten older, it , this is not easier. Triage also means that sometimes you have to wait. And I feel terrible about it. I, I feel like sometimes the hugest part of my job is apologizing to patients for how long it's taking . But those things that are time dependent have to go first. And so the ambulance with someone who's bleeding or a heart attack or a stroke, always has to go to the front of the line, even if the line is 70 patients deep.

Speaker 2: 12:22

Do you find yourself explaining that more and more , uh, delve into that a little bit more, because I think most people who are listening can relate to, yeah, I went to the emergency room and I had to wait five hours and they get upset. Or maybe they don't get upset. But tell us more about that process.

Speaker 3: 12:37

It's , uh, it's, I've had to have that conversation more and more since the pandemic. Um, there's, healthcare resources are incredibly strained all the way through every level of the system, right? We are boarding patients in our emergency department much longer than we used to. This is one of the ways that we've had to just adapt care and really change the fundamental way that we practice in our specialty, because there's just not physical beds for them to go up to upstairs, partly because the patients who are upstairs don't have physical places to go back out into the community. It's just backed up at every step of the healthcare system.

Speaker 2: 13:12

This is a national phenomenon. Yes . And you experience it first.

Speaker 3: 13:15

And we, we, right. And, and some people refer to emergency medicine as being the proverbial canary in the coal mine because it's such a dynamic environment. We feel what's happening in the community first because it comes to us first. It's why people who are really interested in public health frequently choose emergency medicine as a specialty, because we see the public health emergencies evolve as they happen. And that is really, really challenging. And it, it, that backs all the way down to people who are there for just, you know, they work in a restaurant and they cut their hand with a knife. And I have to explain to them why it's taking four hours to get a space and someone who can numb them up, clean their wound, and stitch them and get them on their way, because we just don't have the resources always to get to it right away. And I feel terrible. It's one of the worst parts of my job.

Speaker 2: 14:04

And you work in a situation where the front door is always open. In other words, the inflow, the faucet is always on, right? Always, always, always 24 hours, seven days a week. But the outflow where patients can go to is not open, right?

Speaker 3: 14:18

There is no unit in the hospital that functions in that way. Everybody else gets to say, we're full. And, and we don't, both by, by law and by philosophy. Right? Right. Like , by our very nature, we, we always wanna remain open. But it does get very stressful and it, it tests our resources sometimes, you know, it's so dynamic. It's not like you can just call nurses and doctors from home and say, Hey, come in and pick up a couple of extra hours. 'cause by the time you do that, sometimes the wave of stress has passed. So you just have to sort of flex on shift and do your best to accommodate. It's very challenging sometimes.

Speaker 2: 14:53

So one minute you're seeing someone who cut their hand. Next minute you're seeing a child who isn't breathing well, next minute you're dealing with a heart attack. And then the next minute you're dealing with somebody who's in a car accident. How do you and your team, not just the doctors, but the nurses and every, how do you decompress and deal with the stress That must be at a fever pitch all the time.

Speaker 3: 15:15

Um, I , uh, I , I saw one of your previous guests , uh, was Dr. Colon, and he talked about , uh, diversifying your coping skills. And I think that is really, really smart advice. And it's something that, I don't know if I directly took it from him at some point along the way, but that's what helps me. Uh, exercise helps me a lot. Being outside in nature helps me a lot. I always feel like Minnesota is the most perfect place in the world, except that it doesn't have mountains. It's the one thing that I miss from my decade living in Colorado . No one's perfect. No, no, no one , no, no place is. Um, but , uh, being outside makes a huge difference for me, time with family, my career before medicine was as a musician, playing music, listening to music is really therapeutic for me. But I think everyone finds their own ways to de-stress, whether it's family, exercise, hobbies, what , whatever, whatever it is. And I think diversifying them is, is really, really important.

Speaker 2: 16:13

That's a great tip. Um, so John , are you able to turn it off when you leave?

Speaker 3: 16:17

Some days it's easier than others. Um, some cases are really hard to let go of. Um, the really, really hard ones , um, never really go away. I, I can, the really, really hard ones, I remember what room they were in. Sometimes I remember what they were wearing. Sometimes I remember the actual day and shift. Like I can tell you right now, I , I won't. But I can tell you what shift I was working exactly what day, what day of the week, when I cared for a young man who overdosed and died in the stay room . And , uh, those, they, they become part of you. I think they are. It's sometimes trite, but I think it, it's, the analogy about scars is true. They become part of you and part of who you are, but the really hot raw feeling after a really hard case , um, or, or, you know, when you have a great day and you get to have that where you pull someone back from the brink. I think that's hard to turn off too. That that's , um, I wish I got that every time. But there are times where you come home and you're like, I can't believe that happened. That was so amazing to be a part of. And then you have trouble getting to sleep so you can go to your meeting in the morning. So I , I don't know. I haven't figured out yet how to always turn my brain off. But I think all those coping strategies , uh, are, are sort of my go-tos

Speaker 2: 17:38

Long before there was a pandemic. I have often thought of a group of my colleagues that have a , such an esprit decor . Such a sense of camaraderie has been our , my colleagues in the emergency department. I've seen you all crying together , uh, not in front of the patients and all that, but I mean, I've seen you all supporting each other. I've also seen you guys laughing harder than almost anybody I know. And then I've seen you in action around a patient with steely faces on, and, and your brain's working hard. And, and then later you seem to support each other really well. And then a pandemic came and you guys didn't have a minute off. A lot of people did. Um , I , I mean, at least we, we , we did a reset on our careers. Yeah. People in healthcare, particularly people in the emergency department, never had that. So I think it's incredible , um, how the group of people who choose to do emergency medicine has been able to frankly cope with all these times. I know it's been hard.

Speaker 3: 18:34

Yeah. The pandemic, I can't speak for everybody. It, I felt it a lot. Uh, you know, I had the disease and was sick early on, not sick enough to be hospitalized, but sick. Uh, and that was scary , uh, when we didn't really know what the disease was. And you never know among your colleagues, right, who has what going on at home, who they're worried about bringing it home to, or, or who's vulnerable or , or them or if they're sick themselves, right? Not everybody wears their medical history on their sleeve. And so that was a, a , a very stressful time. And then all of the fallout that made our regular job hard too, right? So trauma didn't stop, right? Car accidents didn't stop. Tragedy did not stop. We still had heart attack , strokes, death from trauma during the pandemic. And even things as simple as telling someone that their loved one died without having the normal human interaction of being able to see your face because of a mask. It was really dehumanizing in a , in a lot of ways. And I think that was really, really, that was hard for a lot of people. We do, we do feel the gamut of emotions in emergency medicine. There's no question.

Speaker 2: 19:41

You really do.

Speaker 3: 19:42

The highs are high and the lows are low.

Speaker 2: 19:44

So John, we've been talking about your life as an emergency doctor, tell us a story. Tell us about a few patients that you've seen.

Speaker 3: 19:50

So I, I , I'll start in with generalities first. And one of the things that, you know, people talk about what's rewarding in emergency medicine, and I'll start with something small that actually is big first. And that is the incorporation of treating opioid use disorder in a more patient-centered way in the emergency department. Back in 2018, at the urging of a colleague, I got my X waiver to start patients on buprenorphine. And since then, it's, many things have changed, but now it's part of the regular practice of emergency medicine. And I must tell you, one of the most rewarding things is meeting a patient who's in opioid withdrawal, telling them that we understand their problem and we can help them with their problem. Not just to feel better today, but to help them start on the road towards whatever their goals are for treating their substance use disorder. And I have been fortunate enough to meet people who I started on buprenorphine who came back. And I have to tell you that in and of itself is one of the most rewarding things,

Speaker 2: 20:44

Helping people with substance use disorders, particularly opioids. It,

Speaker 3: 20:48

It, it just, it's, I never saw that coming when I picked emergency medicine as an adrenaline seeking 26 year old. Yeah . And , and now it is maybe my favorite part of my practice, but , well ,

Speaker 2: 20:57

That's fascinating. I didn't see that coming. Didn't 'cause the opioid epidemic is huge.

Speaker 3: 21:02

What I understood about that when I was a medical student was I'm gonna give Narcan and, and wake someone up from the dead. Like the, you know, the , I've seen from pulp fiction. Yeah . Not that I'm gonna talk to someone who has vomiting and diarrhea and feels terrible, and I can give them a medicine that goes under their tongue that feels better, and by the way, protects them from overdose. And the next day, and by the way, is the first step on their road to their recovery. And that I, I did not see that coming. And it is maybe the most rewarding part of my day-to-day job. I love that . But you asked me about typical emergency medicine cases, and I thought a lot about this. And I , I picked two patients. One , and they're both from my residency, actually. The first is a young person who was in their early twenties and was riding a city bus. And , uh, a nurse was on the bus and reported that the patient had a seizure, seizure and then went into cardiac arrest. And they bring this person in. They're doing CPR on a completely healthy young 20 something. Yeah . I mean, it's just the most terrifying thing that you'd ever come across. And there's not a lot of things that can cause that. One of the things that jumps to the front is pulmonary embolism. And once we got a pulse back from, from the first pulse check, we could not get this person's oxygen saturation above 70%. We looked with the bedside ultrasound and saw that person's right. Ventricle was really big, which suggests that there's something blocking in the pulmonary artery. But there was this history of maybe there's a seizure, and if I give thrombolytics right, a medicine to break apart clots, if the seizure was caused by bleeding in the brain, I could, you're gonna make it worse or kill the patient, right ? Yes . Yes . In the interest of China . So it's this classic emergency medicine of being forced to act with almost no data in a very critically ill situation. So we get the patient stable enough, go over to the ct, bring the medicine, get a quick head ct, see there's no blood, give the medicine slowly, the patient starts to recover. And then I'm , I went up to meet the patient who three days later, extubated and is on the regular medicine floor, completely neurologically intact. And I went to meet the patient, knocked on the door, and the patient's, well, who are you and why are you here? And I said, well , I'm just , I'm one of your doctors. And she's like, you're not one of my doctors, <laugh> . I haven't seen you at all through this. And I was like, no, I'm the person who took care of you when you came in. And then she got really emotional and she started crying, and then so did I. And you know, she's like, oh , thank you so much for, I mean, it was just the , like, the thing that you go into emergency medicine for, I will never forget that that was , and

Speaker 2: 23:31

It was not an easy decision. The treatment you give could have caused harm, right. Could have killed this person. Right . Or it could have saved this person's life. And it was the

Speaker 3: 23:40

Latter. We, we acted with the best of our ability. And it was, you know, I i i , if you think when you're a med student, you think you're going see this every day and you

Speaker 2: 23:47

Don't . Yeah. And you're gonna save someone's life. No . Well , and , but you really

Speaker 3: 23:50

Did. But sometimes you do. And I mean, that person hopefully has another 70 years of life in front of 'em . Love it . And left the hospital completely neurologically intact. Uh , short of, of course the terrible psychological trauma of having gone through that, but, but was intact. That illustrated a really amazing part of emergency medicine to me, is you, you do get to have those saves, but you frequently don't get to meet the patient and, and have that , um, that interaction afterwards. That

Speaker 2: 24:16

Really resonates with me, John, because one of the things of medicine, especially emergency medicine, is that you don't often get to see the outcomes of what you do, particularly those outcomes that went well. So what a great story that you were able to reconnect with the patient for whom you had literally saved her life. That's a great story.

Speaker 3: 24:33

I still remember that to this day. Going to red five and meeting that patient. That was amazing. And then the last patient I'll tell you about happened on my last day of residency. This patient was very elderly. And that is part of the germane part of this. I can't say the patient's exact age, but old enough to have had their face on , uh, a jar of jam with Willard Scott announcing their name, <laugh> The patient , um, lived independently at that ripe old age and was showering and triptan fell in the shower. Uh, the patient falls on their side and hits their rib cage . And at that age, right, that is more than enough to cause some rib fractures and a pneumothorax and a hemothorax. So they drop the patient off in a regular bed in the emergency department. I go in the room, I do an ultrasound. I I see that there's the collapsed lung and the blood and the rib fractures. And I tell the patient, the good news is, I know what's going on. Why you have this pain. The bad news is, I think I need to put a chest tube in. And I describe that procedure. The patient looks at me and says, I don't think I wanna do that. And I said, well, if we don't fix this, I think there's a really good chance that you're gonna die. And the patient looks at me and just says, I think I'm ready to die. Huh . And I felt so much my whole training that being a good emergency doc is, is knowing what to do and then help convincing your patient to go along with your plan. And that I , I said, I you do you really, and she clear as day, I mean, like you're , and

Speaker 2: 26:01

She's just saying this to you , totally. Lucid sharp was attacked . Yeah, yeah, yeah. Right .

Speaker 3: 26:04

Totally lucid the patient. And I'll never forget this, this patient looked at me and said, do you know I'm old enough to have watched my children die of old age? Ah , I'm ready to die. Ah ,

Speaker 2: 26:17

Ah ,

Speaker 3: 26:17

It just hit me like a ton of bricks. The patient was just so ready to end their life, not, not in a wanting to end their , but was like just ready from when it would come that patient's only concern was suffering. And the patient looked at me and said, I really just think I want to go home. And if I die at home, I die. And I said, okay, okay, okay. I really don't wanna have that happen to you. How about this? How about I just have the nurse put a , an IV in you and we give you some medicine for pain and we bring you into the hospital and all we'll do is just give you medicine for pain if things hurt. And if you die from this, you die from this. But we'll make you comfortable. That's it. And she said , okay, as long as nothing hurts. And the trauma resident came down, told 'em to plan, trauma team was on board , patient agreed to go up. But that patient taught me such an important lesson. And I'm a little embarrassed to admit that I learned it so late in my residency of my job isn't always to do the most invasive thing. It's to meet the patient where they're at and help them succeed at their goals of care. And I, I still, I think about that patient all the time when I think about like, well, I know what I think is right, but what is, what is this patient's goals? And it translates all the way down now to my patients who have substance use disorder of saying, okay, maybe you're not ready to completely stop using fentanyl, but how about we talk about a way for you to use it safer so that you can live a longer, more healthy life?

Speaker 2: 27:52

Those stories just illustrate the wisdom that comes with your experience. And I'm so glad that now you're able to teach the next generation. 'cause Dr. Cole does exactly that. Thank you for those. So if you had a magic wand, John, and, and could make one problem go away that the public faces, what would that be?

Speaker 3: 28:10

Based on what I see in the emergency department, and I'm gonna umbrella this under two things. It's, I think if everybody had adequate access to the mental health and substance use disorder resources that they need, we would have a lot fewer emergencies. My, my job would be easier. I'd have to have less hard conversations with families. Triage would be a lot less busy there . There'd always be accidents and , and tragedy and that sort of thing. But I think a lot of our patients come to us because the system has failed them on those two fronts in a huge way. And if we had those available to people, I think it would relieve a lot of suffering and it would make the emergency department a lot calmer.

Speaker 2: 28:52

So if you could wave that magic wand a second time and make one problem that the hospital or that the emergency department is facing go away, what would

Speaker 3: 29:01

That be? I'm gonna pick the easy answer and , and and solve the boarding problem tomorrow. <laugh> ,

Speaker 2: 29:06

The boarding patients that are living are boarding in the emergency

Speaker 3: 29:09

Department, right? Once we agree that the patient needs to be admitted, they just go up to their bed. And once the patient needs to be discharged from the hospital, there's just a magical place that they can go to in the community where their needs can be met. When

Speaker 2: 29:20

That happens, the heavenly choirs are gonna start singing for all of us, aren't they,

Speaker 3: 29:24

Jeff ? That would make life better for everybody if we could do that. Thank

Speaker 2: 29:27

You, Dr. Cole for sharing your insights experience with us today. It's been great having you on the show today.

Speaker 3: 29:33

Thank you for having me.

Speaker 2: 29:34

Listeners, I hope you can appreciate the tireless work of Emergency Healthcare Professionals. We're off to a great start with season three of the podcast, and we've got another great one coming up in a couple of weeks. So I hope you'll join us for that episode. And in the meantime, this is Dr. David Hilden saying Be healthy and be well.

Speaker 1: 29:52

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden. To find out more about today's episode, check out the show notes, and to find out more about the podcast, visit healthy matters.org. Please remember, we can only give general medical advice on the show, and every case is unique. If you have a more serious or pressing health concern, please contact your physician or call 9 1 1. The Healthy Matters Podcast is brought to you by Hennepin Healthcare and produced by John Lucas At Highball Executive Producers are Jonathan , CTO and Christine Hill . Until next time, be healthy and be well .