Flatline to Lifeline With Dr. Long
Consider a world where increasing survival rates in patients typically deemed dead on arrival could be the norm. Is dead actually dead? Is it an assumption or a fact? In Flatline to Lifeline we explore the very real potential for survival within the medical field of trauma and near-death experiences.
During his 50-year career, Dr. Long and his team radically altered the approach to trauma care by applying simple principles in profound ways. We hope to educate the general public and inspire medical practices worldwide to acknowledge and adopt these life-saving approaches to trauma care, because when the need is greatest for the patient, saving time saves lives.
Flatline to Lifeline With Dr. Long
Beyond the Bedside: How Advocacy Transforms Care
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In this poignant and insightful episode, Dr. Bill Long and host Will welcome special guests, producer Lindsey Kealey and organizational guru Esther McDonald, for a candid roundtable discussion as Season Four of Flatline to Lifeline begins. Moving beyond immediate shock trauma, this conversation delves into the vital role of patient advocacy when facing life-threatening medical scenarios.
Lindsey shares her deeply personal and current journey navigating her husband's rare and aggressive leukemia, revealing how the knowledge gained from producing the podcast has unexpectedly equipped her to understand complex medical terminology and advocate effectively with oncologists. Esther recounts her own experience with her husband's stage four pancreatic cancer diagnosis, highlighting the emotional impact and the critical need to seek second opinions and fight for necessary treatment.
Dr. Long emphasizes the profound importance of human connection and bedside manner, drawing on Hippocratic principles to illustrate how a doctor's empathetic presence and clear communication can build trust and positively impact patient outcomes. The team explores practical strategies for patients and their advocates, from the power of simply asking questions and taking notes (even recording conversations with permission) to the often-overlooked value of expressing gratitude to medical staff. This episode underscores that while the medical journey can be isolating and overwhelming, an informed and empathetic advocate can make all the difference.
To learn more about these life-saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.
Follow us on X @DrLongPodcast
Producer: Esther McDonald
Technical Director: Lindsey Kealey, of PAWsitive Choices
Editing and Post Production: Adam Scott of Atamu Media Productions
© Flatline to Lifeline 2025
Episode Introduction
Speaker 1Consider a world where increasing survival rates in patients typically deemed dead on arrival could be the norm. Is dead actually dead? Is it an assumption or is it a fact? Welcome to Flatline to Lifeline with Dr Bill Long. This podcast explores the very real potential for survival within the medical field of trauma and near-death experiences. During his 50-year career, dr Long and his team radically altered the approach to trauma care by applying simple principles in profound ways. We hope to educate the general public and inspire medicine worldwide to acknowledge and adopt these life-saving approaches to trauma care, because, when the need is greatest for the patient, saving time saves lives. Welcome to Flatline to Lifeline with Dr Bill Long.
Speaker 1This is a different episode as we start season four, and so I'm going to start with these questions why are you here? Why are we here and how can this conversation we're about to have, how can it help you? For this episode, we're going to do something a little different. We're going to make this a conversational episode, and to do that, we're going to welcome our most excellent producer, lindsay Keeley, and our hype specialist and organizational guru, esther McDonald, to the conversation. They're going to be here with us, with Dr Long as always, and myself, and we are going to actually hit the topic of what happens when it all goes wrong, and you have to. You are either the patient or the family member of the patient and you have to advocate and you have to be there to process the information when the doctors make rounds and when the chips are stacked against you and a life-threatening scenario is occurring. So everybody, welcome in Lindsay, esther, dr Long, say hi to everybody, hello.
Speaker 2Hello, will and Bill and Lindsay, it's great to be here, Thanks Will.
Speaker 1Thank you guys. I'm going to lean heavily on you because, you know, without gilding the lily too much or giving away too much, esther, you have been through some pretty trying times, to say the least. Lindsay, you are currently going through something pretty significant. Dr Long, obviously you have treated many, many patients and been in some very difficult conversations. So this is our intro and this is what you're going to be hearing about, and I think that the answers to these questions will become very evident. The question of why you, the listener, is here. Obviously Dr Long has value. He has value in his medical knowledge, he has value in his understanding of the medical system and he cares deeply about the value of the patient's life, and I think somehow you connect with that. Why are we here? We're here to share some of the things, because we have a connection to Dr Long, either by way of family, friend or just being a colleague in some manner or another. We know he cares, and how can this conversation help you? Hopefully it can give you some easy steps during a very difficult time in order to get the information that you need so that you or your loved one can be in the best possible chance for survival with the best possible care. Welcome to Flatline to Lifeline with Dr Bill Long. Welcome to Flatline to Lifeline with Dr Bill Long.
Speaker 1For three seasons, this podcast has explored unexpected survival outcomes and how Dr Long and his team of nurses and other trailblazers began to replicate these unexpected outcomes by applying available technology and simple principles in new and profound ways.
Speaker 1The pursuit of these unexpected outcomes became a mission for Dr Long's team over his almost 50-year career. We shift the conversation from immediate shock trauma into body-specific and regional trauma that occurs within the body, never taking our eyes off the prize of saving time saves lives, but we're going into different types of that Prior to it. It's important that, as we discussed in the cold open, that we bring in our friends and our colleagues to have a roundtable discussion and let's set that off right now. So, lindsay, because you are our producer and you are currently experiencing something that we we don't wish on anybody and we're here to support you through. But why don't you take it away and just kind of give us a little bit of what this podcast has meant to you, what Dr Long has meant to you and how that's transferred over into your relationships that you're dealing with right now?
Speaker 3Thanks Will, certainly so. I have a really unique journey. I'm currently on unexpected. Certainly, I began this project and I was very excited to learn more about the medical field. My background is in education. I teach child development and human development and family sciences classes.
Speaker 3I used to be a kindergarten teacher and my husband still laughs at the fact that when my students would come up and show me their wiggly teeth it would make me very queasy and I couldn't even look at that. So even the smallest amount of blood would make me sick. But when you flash forward and now I'm working on this project where I'm hearing you Will and you, dr Long, talk about people who you know they have their chest being shot and they have their guts, you know, spilling out due to different trauma scenarios and I've had to acclimate to that. And, the amazing thing, I never knew it. When I joined this project. I never knew that I would need this information in the future for my husband. He's currently battling leukemia and a very rare and aggressive form of it. It's called MPAL.
Speaker 3You know multiple phenome acute leukemia and the fact that I've done this project, the fact that I've learned about medical terms, we've talked about different blood products and they give him transfusions here at the hospital most days. It really has set me up for success as I'm having to now navigate this really scary season of my life. But I feel more grounded and I feel more equipped because I've listened to the two of you have really rich conversations in which you will are being an advocate, kind of like I am, by saying, dr Long, would you explain that again to me? Would you slow down and maybe go to? What does that term actually mean? And that's something that I have found is so valuable and important for me to do as I speak with oncologists on a daily basis.
Speaker 1That's awesome to hear that, that you know we accidentally equipped you. I know that I didn't. I know that I didn't do anything. I simply asked, because I didn't ask Uncle Bo what the words meant, because I literally just didn't know.
Speaker 3It's an important thing and I know the first, the first meeting, when I had the oncologist sit down with us and they were going over chemotherapy and bone marrow transplants and all of these terms were being thrown around, I felt really scared. Honestly, I was, you know I really limbic and when I, when I remembered okay, slow down, be an advocate, ask the questions for the by the time I had my second meeting, it was really helpful and grounding. So it's an important thing to do when you give yourself permission to do so.
Speaker 1Dr Long, you had something to respond to there.
Speaker 4When I was in medical school and I was learning all this terminology basically Greek and Latin for anatomy, you basically talk about biochemistry. You're learning a whole new language and they pointed out to me. They said the language of medicine changes from an average working vocabulary of 7,000 words per person that they use on a regular basis to 23,000. So you have to be able to sit there and take medical terminology, even anatomy, physiology, and convey that into everyday language so that the person who is listening understands what you're talking about. That means you have to find out what kind of job they have, what kind of education that they have and what amuses them, spend enough time to sit there and understand where their mind is and what they've been conditioned to think about things, so that you can sit there and have a conversation about their life and their loved one's life and to see whether or not they're going to buy into what you're trying to do for them.
Speaker 1That brings up a great topic of bedside manner and yesterday, when we were all talking shop and preparing for this episode, you specifically brought this up out of nowhere and you talk about, or I asked you about.
Speaker 1You know what it's like for you when you come into a room, like you hit that door and, to be fair, on the other side of it nothing good is waiting for you as the doctor. There's only, there's only a problem behind that door because the patient has something wrong with them, and then you know whoever is with them their family member or or friend advocate they're also, they're having a problem as well. So everybody's tensed up and you hit the door and you you kind of mentioned that there were two kinds of ways to go about it. You we always casually put it under the guise of, or the term of, bedside manner. It was really, really moving to Lindsay when you described that you go back and just describe what you were taught, how you were taught and what the meaning of that actual doctor visit was. Like you said, you're taking a 23,000 word vocabulary and dumbing it down for us regular folk at 7,000, but we're under high levels of stress, right.
Speaker 4So the important thing about medicine, which seemingly is increasingly forgotten, is that it goes back to the days of Hippocrates, when he was describing what it's like to be a doctor. And two things One, listening carefully to the patient, asking questions appropriate so that you can understand what the patient was concerned about and what their symptoms were like. And the second was the laying on of hands, which means the actual sitting next to the patient, holding their hand, touching their hands and physically examining the patient establishes a rapport that you can't do with words alone, and so in the course of my 50 years, I've watched people basically never come in the room, talk to the door and say you got this wrong, we're going to do this, and they never examine the patient. They're relying on x-rays and other things to make the diagnosis, and so there is no human connection between the doctor coming in to say you know you need to do this because I'm telling you need to do this, and the patient is sitting there saying who's completely subject to the power of this person, telling them that something is wrong with them, and then this is what needs to be done, and there's a lot of psychology in here, but there's also the human warmth. That goes with trying to get the patient and their family, who's usually present, to understand what you're talking about.
Speaker 4And everybody talks today about nonverbal communication, and so you learn like a dog and a cat watching you. I mean, a dog learns to know what your moods are by your non-verbal communication. When you start talking, they talk and tell by the intonation of your voice, the volume of your voice, whether or not you're upset or not upset. Well, humans are not. There are any different. We're all, in a way, animals and we we can. We can interpret when somebody's trying to communicate, how they're interpreting and whether or not they're really trying to communicate with us and explain things or whether or not they're just going to say this is what you need to do and there's no answer. I'm the authority.
Speaker 4And that's been the big change that I have seen in medicine and I think we've lost something, because the idea of a doctor establish a rapport with a patient to undergo an operation which is life-threatening and under semi-elective circumstances has to establish an element of trust. If you don't have trust, you can't go anywhere. And if a patient doesn't trust you, even though they have to accept the operation because they think they have no other choice. It sets off a whole different hormonal response in the body in a defensive motion situation to protect themselves when there's no trust. And so for doctors who don't sit there and try to develop this rapport and know and a physical communication with the patient, you become like a car salesman you're selling something and the and the patient has to decide whether I'm going to buy this or not buy that.
Speaker 4But you want to. If you want to have the patient compliant, even when they're under an anesthetic, working with you instead of against you, you have to shut down this hormonal and psychic response. For them to sit there and one of the to basically get through the operation so that you have a successful outcome. It's not more complicated than that.
Speaker 1I totally agree with you, by the way, on the establishment of trust. Although it's a loose connection, there is a similarity in between a coach and player relationship, where you are required to quote, know the information and assist, but the establishment of trust is either is either the gateway or the impediment to growth in that relationship.
Lindsay's Journey with Her Husband's Leukemia
Speaker 3So what are the?
Speaker 1ways, specifically relationship. So what are the ways specifically? Just one or two things specifically that you would do. That immediately disarms that room. What would you? What do you do when you walk in that room, uncle?
Speaker 4Bill or Dr Long. Well, you come into the room and introduce yourself and shake your hand, ask him a few questions. Then you ask them can I sit down on the bed next to you? An invasion of somebody's space. When you sit down on the bed, that shows that you're at their level. You're not tall. I'm six foot four inches tall and I'm not looking down at them. I'm basically almost at the same eye level as they are.
Speaker 4When you sit down in the bed with them and then you reach over and touch their hand, while you're touching the hand you can almost feel the temperature of the hand, whether or not it's cold and clammy, because they're really upset, or it's relaxed. You can tell that. Sometimes you can even take the pulse while you're talking to someone and find out whether it's fast or how slow or irregular. You get a whole lot of information just in that laying on of hands, even before you begin to touch their body, to find out where the painful spots are and examine to see whether or not any organs are enlarged by palpating the abdomen, doing the range of motion of the extremities to see whether or not all the joints are intact.
Speaker 1All these other things Go ahead Will Well no, I just had a question in regards to this, because we still have to hear from Esther, but I wanted to hear, like you said, you're breaking that barrier. Or in TV the fourth wall, the hand reach out and sit on the bed, or in TV the fourth wall, you did the hand reach out and sit on the bed. Now, lindsay, the reason I'm breaking here is just because, lindsay, offline you brought up something about all of your interactions because, like you said, this was unexpected. This was very sudden that you and Thomas were thrown into this, but there was one specific medical professional amongst all of the ones that you have met. So tell me that experience and what the ones that you have met?
Speaker 3So tell me that experience and what it did for you and Thomas. Well, it makes me a little emotional, especially hearing Dr Long talk about, you know, pulling over a chair or sitting on the bed and touching the patient's hand. And the reason why it chokes me up a little bit is because I had an oncologist one of his first oncologists sit down next to me and of course she made that human contact with Thomas. But then she turned her chair around and she put her hand on my shoulder and she said this is hard and I'm here to answer any questions you might have. And that meant so much to me and it really, like Dr Long said, it took me out of a flight or fight state.
Speaker 3Whenever someone I talk about this in my college classes whenever if you're a teacher or you're a parent and you need to have a conversation with the child, if you're staying above them no, I'm not 6'4", I'm more like 5'4" but if you are staying above a child it can kind of have that threat response. You see someone over you, but as soon as you sit down next to them, they can kind of feel more at ease and that is really powerful to get on their level and trust is huge. I love the quote people don't care what you know until they know that you care, and one of the ways that you show them that you care is by being alongside them and next to them and reaching out.
Speaker 1Thank you. Thank you, that's awesome. All right, now let's bring in our hype specialist, okay, organizational guru, esther McDonald. She's the one that keeps us afloat.
Speaker 2Very kind of you Will.
Speaker 1I'm just a kind person there you go Moving on. You've experienced some of this difficulty in your life to a pretty extreme fashion and I think we would all benefit the four of us here. But whoever tunes into this, I think, would benefit from what you experienced as well. So, just, I'm going to give you the floor. Take it away, and you and Uncle Bill just hammer it out. Solve the whole thing. Take it away and you and Uncle Bill just hammer it out, so solve the whole thing.
Speaker 2Here we go.
Speaker 2Well, I think it's important to recognize the fact that everybody has a different journey as they walk through a medical challenge, whether it's short or long.
Esther's Experience as Patient Advocate
Speaker 2Mine tended to be very long, longer than expected, as my husband was diagnosed with pancreatic cancer and it was already stage four when we found it, and so there was a feeling of betrayal by the medical community. Although recognizing that pancreatic cancer is one of the hardest ones to discover and find, we did not have an oncologist who sat down and put their hand on our shoulder. What we did have was somebody who ran out of the room saying they'd never seen this before, came back several minutes later it felt like hours to say we don't know what this is, but you need to go home and take care of things. So then we got a second opinion, because that's what you do as you become an advocate. What I did find was my husband was probably one of the most independent, well-read people I knew, and when it came to being involved with medicine, it was overwhelming for him, and he did what people do, which is go on to Dr Google, and that was the last time he would approach his medical condition online. It was so overwhelming.
Speaker 1You're saying that WebMD is not a useful place for someone under medical duress.
Speaker 2I would say that it just heightens their anxiety because it becomes they are everything that's being described, when in fact they may only be one thing. And so, as the information became overwhelming and it felt like he was not going to be able to even get up from the computer based on what he had just read, I think the sense of hopelessness can happen very easily for a person who has received the diagnosis and perhaps did not get the reassurance. So then it became my job as an advocate to find a second opinion. The second opinion was less than the first, which was we're just going to watch and see and you're thinking this is stage four cancer, we're just going to wait and see.
Speaker 2At which point it became an important thing to and unfortunately had to literally go to researching who the best doctors were in this field. That particular doctor became our final doctor that my husband trusted and that was important. But his first comment to me when the insurance wouldn't cover it, was get yourself a lawyer. So that's the road we had to take, and we had to even go to the Department of Managed Healthcare in the state of California to be able to get the treatment that was needed. And fortunately this expert did something not dissimilar to Dr Long, which was when I said why should we stay with you? He said because I use standard medicine in non-standard ways. Consequently-.
Speaker 1Isn't that the perfect way? Because for three seasons we've said that Dr Long and his team were looking for unexpected outcomes using existing technology in new ways.
Speaker 2Right and it became huge. So I think it's important to understand that, as an advocate for any family member, taking notes is important. Family member taking notes is important. Being informed is important, deciphering and discerning which knowledge is going to serve you best, asking other experts, much like what we've recommended. It's not a field you're familiar with. Begin to ask people and don't be afraid to do that.
Speaker 3And then the other thing is yeah. No, go ahead, Go ahead.
Speaker 2Well, I think the other thing that's important is it's both your journeys. You know you are a part of the diagnosis. You become not just a team member but you become a person who begins to observe and note and help the doctor diagnose, because many times the person who's actually diagnosed with whatever medical condition, they don't remember everything that's happened to them. When they ask the question how are you feeling? Oftentimes they'll say great, when you know in fact they've just come off an evening that has been horrendous.
Speaker 1Yeah, they feel great now.
Speaker 2Or they don't want to reveal that they're feeling awful because we all want to get better, and if we say we're getting better, we believe that might make a difference, and so doctors frequently have to interpret that, or the person who is their advocate can say and share yeah, well, let's step back just a moment now.
Speaker 1I think you bring up a really good point, that the patient advocate, the family member, who's really going through it. Lindsay, what you're going through right now, you're not suffering from leukemia, but you're suffering from leukemia. You got the diagnosis too, just like Esther said.
Speaker 1You're sitting in it, you may not feel the pain, you just absorb it in a different way and you know offline. Yesterday you said something you know. Like Esther said, taking notes is very important. I mean, we carry these devices in our back pocket all the time, Every time you said something great.
Speaker 1Every time a doctor walks in the room, you ask them permission can I record you? And you let them say their spiel and you hit record so that you can transcribe it later and actually take definitive notes on what exactly was said. Because, as the patient advocate, what you're doing in these snippets is you're putting together their view of what is going on and you have to be able to ask them those questions so that they can give you an idea of what the progress is, so you can start to trend and chart things. But it's recording things and, Esther, as you said, your experience is different from hers, is different from other people's, but obviously you are in it with the patient and it is very difficult and one's capabilities outside are not necessarily what happens when you become the patient. Like you said with Bob, like he's well-read, he can handle everything, but medically, like it just swamped it, Like whenever it's tax season, I feel this incredible urge to not do them because I don't like it.
Speaker 3Right.
Speaker 1So that's a simplified version of it, but it's just that my brain just goes no, no, and so maybe that was Bob.
Speaker 2That and the fact that oftentimes when people get diagnosed whether it is a short-term or a long-term, which in itself is complicated when there's no end, there's no finite and you live through that.
Speaker 2I think it's important that what I experienced with Bob was that he felt like his body had betrayed him.
Speaker 2It was a I can't wait to get things out of my body, and every test and every delay and taking care of the problem is anxiety producing and the person's ability to filter, because oftentimes, when they do start chemo and start different things, their filters for their anxiety get sometimes erased or dulled and so their responses are exacerbated. And I think that between the feeling that your body has betrayed you and there's no definitive answer and this could go on for a long time then as your advocate and caregiver, I encourage people to find joy every day, because it is complicated to live in a hyper-emergency state, and I also encourage people to find somebody who they can download with outside the family and when I say download, I mean literally just listens, doesn't give advice, doesn't give platitudes, doesn't say things like it's going to get better. Attitudes, doesn't say things like it's going to get better. It doesn't say any of that. Just let you download with how frustrating, and even as a caregiver, you can be frustrated with yourself.
Speaker 1That's where you open up the book of Job and you go hey, I need three buddies to come sit with me and remind me that this sucks.
Speaker 2Yes, that's exactly what it is.
Speaker 1Just come sit with me and tell me exactly what I know. I'm pissed off, this sucks, and I just need you to ruminate on that with me, yeah.
Speaker 4I agree.
Speaker 1Yeah, just agree. You go, man, this sucks. And if you repeat that every fifth minute and the other person just goes yep, that's enough. What's funny is in that analogy I actually do think it's in the Bible, for a reason is it's the perfect picture of exactly what is supposed to happen in a grieving process, followed by exactly what every human being does for all time, which is go in great intention, execute really well for about a week, and then during the second week, you go hey, man, what'd you do to bring this on?
How to Be an Effective Medical Advocate
Speaker 1How is it your fault? And then you overcomplicate it or you try to start fixing the problem and I can only speak to this from. I've had multiple orthopedic surgeries, so I've been through very long and extensive rehab process. Processes, um, like one. At one point it was two years of physical therapy over three surgeries um, to try to get back to a playing career. And it was during that that I that I can actually maybe bring some value to this conversation where you go as the patient, where you all of a sudden get diagnosed with this injury and you feel betrayed by your body.
Speaker 1It's like now I can't do the thing that I'm supposed to do and you're like you have this unknown end. They tell you, okay, here's how we're going to fix it. They tell you, okay, here's how we're going to fix it. Maybe it's like we'll get you halfway there and then you have to work over time for 12 months to an unknown result, and so every single day, all the work you're doing is to an unknown result and a hope, and it's undefined and it's just sitting out there in the ether and literally what I ended up figuring out was the only way to stay sane was to literally build a sliding scale, uh, of a pain in progress. So every friday I would mark on the calendar like where I was for that whole week and like where I ended, and then the next Friday I would look at it and go where, where did we get? How did I do in this seven days? And I'll compare where I am now to where I was seven days ago. And I didn't put a goal in for the next, for the next week, it just I'm literally just monitoring it and going where was I last week compared to now? And just continually asking that question and all of a sudden I could see that there were very minute gains, but they were still gains. That helped me make it a little bit systematic when when it had an open end and no definitive outcome. So we'll swing it from that.
Speaker 1Uh, back to dr. Long you've been the doctor, I've only been the patient. Esther and lindsay have have watched or are watching this unfold or are watching this unfold. So let's take it back to just that relationship, the human contact and connection. And for the people listening, whatever the scenario is, you've taught us how to connect with a patient. I don't know if this has ever been asked before, so maybe I'm super smart, but I doubt it. What can we do to connect with the doctor? How do we make the doctor who stands by the door start to be the doctor that comes to the bed, start to be the doctor who sits on the bed? Is there anything from the patient or patient advocate perspective that puts the doctor at?
Speaker 4ease. Not trying to be funny, but basically you have to lure the doctor from the door into the room. My wife will give you fresh baked chocolate chip cookies if you come in the room and examine me. You think it's absurd, but for some doctors that is a major lure but for some doctors that is a major lure. You're telling me that the chocolate chip cookie angle can get you better medical care. If the doctor's hungry and he's got a sweet tooth, okay.
Speaker 1So there we go there. Doctors are human okay so they are, they are okay, so food actually works and I'm assuming you trap more flies with honey. That principle always helps as well.
Speaker 4It's a game, as you know, of psychology. Will you have to find out what motivates people and to motivate people, not have them do things out of fear, but they do things because they want to Big difference.
Speaker 1Esther, you had something.
Speaker 2Well, I think, as an advocate, every person who comes in contact with the patient, whether it is a doctor, a charge nurse, a medical assistant, a CNA, whoever's in the hospital, can become kind of on your team if you are thoughtful and kind. But not necessarily you don't have to acquiesce, but you can be appreciative. And I think Lindsay has probably the most favorite sentence I've heard about being an advocate as well as getting people on your side, on your team. Lindsay, what is it you have decided works best?
Speaker 3What gets thanked gets repeated, and so I've noticed that when a certain doctor does something, or a nurse or someone who's supporting your loved one, when you say, wow, that means so much to me, thank you for, and then you explicitly state what it was they did that was meaningful. That happens again. One of the doctors offered me a book about leukemia and I said that meant so much to me. This really brings me a lot of peace, Thank you. A couple of days later she brought me another book, One CNA you know I'm living here I don't know if I've mentioned that yet, but there's a little bench bed in the corner of the room that I sleep on and one CNA brought us a few extra towels one night and I said you know, those extra towels really count. And next thing, you know, every night we get a big stack of, you know, the fluffiest towels in the hospital.
Speaker 1So I think, really being appreciative, it's amazing. It's amazing what being nice to people and acknowledging the things that they are quote required to do, but acknowledging that they've done those and that they were helpful it actually makes people want to do them more.
Speaker 2I think it also helps them feel acknowledged as opposed to being the person who is unseen as opposed to being the person who is unseen. And I think in the medical field, particularly at any field but when you're walking this journey, there are so many people that feel unseen because they don't have an MD behind their name that it is the unique family and advocate and patient who honors everyone, because everyone is making a difference on that team. But, Lindsay, you also have another statement that I think just encapsulates being an advocate.
Speaker 3Okay, I'm wondering if this is the one Use gentle pressure relentlessly applied. Is that?
Speaker 2the way it comes to mind.
Second Opinions and Working with Medical Teams
Speaker 3Yes, and so I think there is this balance of it's almost like I'm both the good cop and the bad cop in a sense, right, so I'm thanking them. I'm grateful authentically. And also, if my husband is in a lot of pain and we've pressed the call button and we said, hey, we need some pain medication and we're waiting and it's not coming in a timely manner, I walk out in the hallway and I find someone and I ask we need this, or you know, and I find another nurse and then they can ask the charge nurse if it's not in the orders. And I think you just have to be relentless and persistent, but you can do it in a way that's kind and appropriate. I love that.
Speaker 1I love that. I mean, maybe it's just personality built in. I never had a problem asking for things. But I do think a lot of people get this idea that because they don't know as much as the doctor or the nurse, that therefore their complaint or their question isn't valid or important enough. And that voice, that patient and patient advocate voice, is extremely important because you're just gathering information.
Speaker 4Yeah, the other thing is is how you ask the doctor. This is what you're talking about. It's so important because a number of patients get very aggressive, or especially their families, and go and say you have to do this, you know, and get in their face and want to get into a fight. Well, it's like getting in a fight with a referee if you're in a baseball game, they don't toss you out of the room or out of the game, but it just hardens the doctor's attitude. Do I really want to help these people that much or do I want to come back and sit there and go through this abuse again? Because some of these patients can get very abusive? I abuse again because some of this, some of these, patients can get very abusive.
Speaker 1I mean the patients and their families. I'm going to oversimplify things here for a second. Okay, uh played baseball and coached baseball for a very long time, uh, and you know like 35 plus years and uh, I can count total of zero times I saw an umpire reverse his call based on how loudly or aggressively the coach disagreed with the original call. And what you just described is that the diagnosis is not going to change, no matter how upset you are about the diagnosis. So taking it out on that doctor and telling them what they have to do is a diminishing return to begin with. It's just wasted energy.
Speaker 4A lot of people don't understand that, but it's a very valid point and the idea is you want to have the patient and their family and the doctor and the nurses all on the same team, working together cooperatively to get an optimal outcome.
Speaker 1So with that can I make an analogy? Yeah, Okay.
Speaker 1We've all been on a plane, okay, and everybody puts the pilot as the most important guy, and rightfully so. Okay, but those stewardesses, the flight attendants, they serve a role too, and to treat that person as though they are an underling of the pilot is not appropriate. They are part of the team, they are part of the pit crew, of the doctors and nurses. They have a role, they are serving that role and fortunately they are only quote waitresses or waiters unless there's an emergency. But to take away what their job is during the emergency devalues who they are and what their role is. So in nurses it's the same way. Yeah, you should be able to go ask them for something is the same way. Yeah, you should be able to go ask them for something. But the importance of their job is that they're there to help save your life. So don't, under any circumstances, get that twisted.
Speaker 1That person is there serving a very important role and you treat them with respect and as a human being, that's vitally important and that's what you did actually with your crew is you gave those nurses a voice that they didn't previously have and that's what created that really good symbiotic relationship within your OR.
Speaker 1So I think to Lindsay's point, to Esther's point, to your point, you know, treating these people like humans and establishing that connection and that gentle, relentless precker, I think it all yields the emotional connection that we want, because then you become not a name on a paper or a number or a diagnosis, you become a person that they know and they're coming to check in on.
Speaker 4In some ways we are seemingly becoming a nation of bullies and you've got, unfortunately, the press.
Speaker 4The media thrives on that because it causes controversy and increases listening and readership of the newspapers. But by and large the bullies love to sit there and show dominance and that gives it gives them a thrill that they can dominate somebody. And maybe it starts in the playground and it never gets corrected. But by the time they get to adults usually the bullies are it's almost you can't take them down or whatever. There's no way you can reason with them because they have. They have a fixed emotional and psychological response to their behavior and it can arise anger in the nurse, it can arouse anger in the doctor and it takes an unusual person to be able to put that off into a corner of the mind and of the emotion centers in the brain, to sit there and say they're acting because they're afraid. You know I can work my way through this so that this does not get out of hand, but I have seen screaming matches in the hallways between patients and doctors and their families unfortunately, I believe you, Esther.
Speaker 1what did you have?
Speaker 2Well, I was just thinking the other side of that coin, bill, because you've been really good about this. Explaining this is asking for a second opinion shouldn't be something that a doctor takes personally or a medical team takes personally, because what you're asking for team takes personally. Because what you're asking for really is a validation of that particular medical professionals opinion and treatment plan. And oftentimes people are afraid to do that because they're afraid if they ask for a second opinion on something that that makes them feel like they're not trusting the doctor. And my encouragement is no, you're just validating. I mean, we get a second opinion and a third opinion and a fourth opinion to paint our houses. So when it comes to the medical world, it is difficult sometimes to ask for that. But I think it's also important to explain it in a way that the doctor feels validated, not doubted, but also it's not wrong.
Speaker 4I think what you're saying is very true. The issue is that the doctor should basically offer, especially for a high tension situation, whether it's emergency or otherwise. But emergency, you don't have much time to sit there and get a second opinion. But under elective circumstances you tell the patient and family. I would encourage you to get a second opinion and the family is usually so disarmed and the patient is so disarmed by that offer that they say well, who would you recommend? Some of the skeptics will say one of your cronies. He said no, you can sit there and call somebody at a competing hospital. You can call somebody at the local university or up at the next, the next university and in another state, I don't care.
Speaker 3But if you want a second opinion.
Speaker 4I'll help you If you want me to help me, do that. I want it to be affirmed that what I'm offering you is the correct treatment. It costs nothing to do that.
Speaker 1Well, you're also speaking from a place of humility, which you have expressly said that some doctors have a difficult time with. Okay, and so be it. I mean, when you're an expert in your field, sometimes it is hard to come down out of the clouds. Okay, so let's give that allowance, just as you, the doctor, are giving the patient allowance, or the patient advocate allowance for the stress that they're under. Okay, so, in return fashion, yes, you should. The doctor should offer the second opinion or encourage the second opinion. The doctor should offer the second opinion or encourage the second opinion.
Speaker 1Here was my trick, because I did this electively five times, five different surgeries, to get my arm working back to the way it should have been, and each time I got the original diagnosis. Now, it was under relatively friendly circumstances, it wasn't life-threatening by any means, but I would always ask the doctor when they would say don't get a second opinion, or even if they didn't. I just had this package question If it was you or if it was your child, who would you get the second opinion from? Because then it puts them back in authority. Yeah, it was like because I literally don't care if it's your crony, I don't care as the patient about the competing hospital. I care about your opinion. If we really plan this out on a simple notebook, you could write out you know different doctors that you researched, whether you know, hey, whether, hey, I need a bone doctor, I need an orthopod. Okay, here's my heart surgeon, here's the lung guy.
Speaker 1Here's the endocrinologist and simple Google search, find your best guys that you think off of that, and then you have just a list of questions that you would ask them. Who would they refer to? And then, if you happen to be in an awful situation, that notepad is sitting right there and it's already got your canned answers, your canned questions and an obvious idea of who you would go to. Because the problem is is that we get in these stressful situations and you, dr Long, you come in and you go. I want you to get a second opinion. I want you to call this other hospital. Do you think that the patient or the advocate has the wherewithal or the faculties, under that amount of stress, to open up the buffet of doctors and start picking and choosing who they're going to get the second opinion from?
Speaker 4At some point in the future. We're going to talk about, though, the environment of trauma when you have to do immediate surgery. No time to get a second opinion on that. You need to stop the bleeding. What's killing you first. So one of the things we got across to all the surgical specialists, anesthesiologists and especially the nurses, is that think of yourself and your family traveling across the United States shortly after they did the major trauma outcome study and did the assessment of performance, and there was only two hospitals that were above the standard of care, and there are eight hospitals way below the standard of care.
Speaker 1What would you?
Speaker 4what would you suppose you are are injured, your family, in a bad automobile accident. One of those states has eight standard deviations below the standard of care. What would you do?
Speaker 4and now think about that so you basically can't apply elective surgical dynamics and communications to the person coming in on you know bleeding to death. You have to do at any cost what is the best for that patient to get them into a stable condition. If you can't do that then you don't belong on the trauma call schedule. And because I had, by contract control, the trauma call schedule, I didn't have control, their privileges or anything else like that. But if they couldn't get themselves in that mindset then they shouldn't be taking trauma call. You want everybody there that's going to give the absolute maximum get that patient through, not because they're a scumbag or you know some other low life or whatever. Every patient, you don't never know who's coming through the door, what they look like, you can't judge by appearance, what you know.
Mindset and Finding Joy During Treatment
Speaker 1They all deserve the same opportunity to get optimal care well, that reminds me of the scene or the anecdote you had about the lady from new york who came in. She received the treatment and she ended up going back and she was the and she was the electrical city manager for the entirety of Manhattan or something.
Speaker 4Yeah, she was in charge of the entire state of New York public utility system.
Speaker 1Okay, yeah, and she got the same care as everybody else and I remember you said she wrote back to you thinking that she got something special and that was what you considered standard.
Speaker 4Yeah, she wanted me to come to to New York, meet the governor and try to help New York develop a state trauma system. That was similar to what she saw happen in Portland and I said I can't go there. I mean, they have to want to invite me to come. I can't go and force myself on these people. You know people have to be willing to listen before you just show up at the doorstep and say you know and make them feel bad or look bad. It doesn't work that way. All right, Dr Long.
Speaker 1I mean we've covered so much just in this roundtable conversation. You know we've seen it from the in this round table conversation. You know we've seen it from the doctor perspective, the patient perspective, and then and two, two women who have been advocates for loved ones, lindsay, currently an advocate. Obviously, to synthesize all this, let's just go back to Esther and Lindsay and just say, like, as we've been going around this conversation, do you have anything to add from what your experiences have been, or even today, where you would go and do something different?
Speaker 3Yeah, if I were to add one last thing. This came from a comment that my husband made, and Thomas never fails to inspire me, to motivate me to change my mindset. He's really been so strong through this whole process. He said and this is at a point where he was nauseous, he has mouth sores, he's fatigued, he's getting transfusions every day. I mean, he's in a really hard space. And he says you know, my earth suit's malfunctioning. And I said tell me more about that. He said at first I felt betrayed by my body. There's cancer throughout my body and in my blood. He said, but you know what, Rather than being mad at my body, I just want to befriend it. I'm like hey, I hear you, we're here to help and you're just malfunctioning right now. I think that boils down to mindset. That's also connected to a concept that I speak about, which is psychoneuroimmunology, and what that means is the way that Whoa big word yeah, I love this.
Speaker 3When I want to sound really smart, I use it. So the psycho aspect means the way you think about things affects your neurology, your brain, your nervous system and it ultimately affects your immune system. So the way your nervous system and it ultimately affects your immune system, so the way that you're processing what's going on in your life, is going to actually affect your health outcomes. And so if you say you know what my earth suits malfunctioning, rather than saying I hate my body, or if you say you know what I'm experiencing discomfort rather than I'm in pain there's slight little tweaks you can make to your vernacular that actually do have an immunological effect. So being positive not toxic positivity, but reframing things in a healthy, helpful way can be beneficial.
Speaker 1Love it Esther.
Speaker 2In an interesting way. What a great way to frame that, lindsay. Way to go, thomas, because I think for the caregiver and the advocate, that that is the same thing to begin to see it not as a trial, not as a when will this end? Will I make it? But instead, being grateful for the opportunity to be there and again, not a toxic phony, I'm going to wake up and say, isn't it a great day? Because it could suck, but in a sense of being able to understand that it is a privilege to care for somebody and be there for them when they can't always be there for themselves, and that it is.
Speaker 2It is a change of view, perspective, psychoneuro framing that I get to do this, not I have to do this and it's not when will it end, but how can I make this journey better for both of us? I love that perspective shift and it made a huge difference for me, and I think it makes a difference. When you can see life that way, sunsets are sweeter. Sunrises have never looked so good as when you walk this type of journey, and that is true for the rest of your life. In an odd sort of way, you never again take a sunrise or a sunset for granted.
Speaker 1And it's easier said than done, because that doesn't include the amount of struggle and pain that you have to go through to get to that place.
Speaker 2You don't get there without going through struggle and pain, because otherwise it becomes off as a phony. Oh, look at me, I can be Miss Sunshine, and nobody needs Miss Sunshine in the room. Look at me, I can be Miss Sunshine, and nobody needs Miss Sunshine in the room. Nobody needs that. What they do need is care and compassion for yourself and for the one you're advocating for, and that I think it is not normal for us. We have to actively become that.
Speaker 1And nobody gets to do it 100%. Yeah, you're not doing the pippy long stocking. Everything's great all the time, all the time.
Speaker 2No.
Speaker 1But you're also not sitting in the cynical death sphere.
Speaker 2And you're not angry at the patient. It can get easy to get angry. Why is it taking you so long? How come, I mean, you wind up involving yourself in a part of that person's physical journey? That, oftentimes, is just horrendous.
Speaker 1I mean let's not mince words here, but let's be real. When your significant other, or when your child even gets sick, feel bad for them, you empathize with them. On about day five it starts to get annoying yes not because there's anything wrong with them.
Speaker 1They're. They're healing their body, betrayed them. You know, using that phrase it just takes time. But it doesn't mean that the, the weight, the extra weight that's put on you isn't bothersome and it becomes. It becomes an impediment. It doesn't mean that from their side, the continuing sickness leads to a bad mood sometimes and therefore that can be annoying.
Speaker 1Like it is what it is, it's difficult. It's hard get your friends together and have them come sit with you and remind them to man, this sucks esther, you once told me, give yourself permission to feel whatever comes up for you today.
Speaker 3so if that's gratitude as you look at the sunrise from your hospital room, if that's frustration and anger or sorrow, that's what today might feel like, and just give yourself permission to feel that way.
Speaker 2So important yeah.
Closing Thoughts on Patient-Doctor Relationships
Speaker 1Love that, all right. So let's wrap it up with a professional in the room, with a professional in the room, dr Long, after going through all of this and you brought up both your doctor experience and your patient experience and then hearing what Lindsay, esther and I have shared, along with what you have shared, what would your last pieces of advice be for the general public? What would you last pieces of advice be for the general public? What would you want them to know that gives them a better chance in their relationship with the doctor, in their relationship with any diagnosis, whether it be an acute trauma incident or something that is life-threatening and long-term. What do you want to?
Speaker 4impart on people. Well, there's two worlds that we're talking about, I think one is the elective world, where the patient comes into the office and you're planning on a source of diagnosis and treatment and that initial interview is usually done with the patient, sometimes by themselves, many times with a family member present, and the rapport that you develop with them has to lead to trust. And if that doesn't happen, then it doesn't usually work out well, especially because complications will occur. You'd like to think they're 100% avoidable, but complications will occur, human error will occur, doctors will make mistakes, nurses will make will occur. Doctors will make mistakes, nurses will make mistakes, radiology will make mistakes.
Speaker 4The question is how can you recover from that and move on and not get loose sight of the objective, which is get the patient better and the positivity of the initial relationship? I guess it's almost like a dating relationship it stays on for a long period of time before you start off on the right direction. But in trauma you don't get that because, say the patient, you don't get a chance to talk to the family, you don't get a chance to talk to the patient. Usually you know if they're bleeding to death, they're intubated, they can't talk, they're in coma and they wake up a few days later. But the family comes and it's helpful in the ICU, for example, to take the family in and go and show them some of the x-rays, some of the CAT scans, sit down with them, teach them a little bit and they will respond to that, because now you're getting the family to be a part of the game plan.
Speaker 4As a cardiac surgeon from Iowa once told me. He said you make the patient fit the game plan or you make the game plan fit the patient. There's a lot of people who have a set game plan in their mind for everything and they try to make the patient fit the game plan. But every patient is unique and consequently the game plan should fit the patient and it's an important distinction. The more you think about it, getting everybody to buy in is huge. Sometimes a patient wakes up three weeks or a month later and they've not been a part of the decision whatsoever.
Speaker 1That's heavy. Well, we thank you for stopping by and thank you for spending the time with us. I hope we answered the questions of why you, the listener, are here, why we are here and why this conversation was important. Thank you for joining us on Flatline to Lifeline with Dr Bill Long. We hope to see you again soon with our next episode. As we start talking about specific regional trauma within the body and the examples that Dr Long continues to produce about unexpected outcomes for survival, remember when the patient's need is greatest, saving time saves lives. Thank you for joining us on Flatline to Lifeline.
