25 Years in the ICU What Every Patient Should Know!

Hey everyone, today's uh podcast is a very important one. You know, you've heard me talk a lot about sort of the the issues with the medical system and how sometimes it can turn patients into numbers and treat them as commodities or revenue streams. And that's exactly what this is about. And so this is uh an interview with an ICU nurse who's seen things from the inside. Um without giving away too much, it's uh it's very disturbing and very concerning. And so I think this is something that's very important for people to know about, pass on to your friends and family so they can properly advocate for themselves and for their family members before they get into situations like this where it's very difficult to get themselves out of again. So, please do uh take a look at this and then send this out to people who uh would would benefit by knowing it, which I think is pretty much everybody to understand what they need to do to advocate for themselves before they get into these difficult situations. Also, uh just to remind you guys, I'm going to be in Montana for July 4th this year with Bellis Steak and Butter Gang. And if you wanted to go and check that out, discuss this and many other things to do with um health and u protecting yourself in the future both with your own diet and also through medical advocacy, then uh check that out at sbg.events and I'll see you there. Thank you everyone. Hope you enjoy the episode. Hello everyone. Uh thank you very much for joining me for another episode of Plant Premd. I'm your host Dr. Anthony Chaffy. Today I have a very special guest, um, nurse Jennifer, who is an ICU nurse at a major center in America, and she has, uh, some very interesting and, um, unfortunate uh, stories to tell us about some of her experiences working in a major hospital system. Jennifer, thank you so much for joining. >> And thank you for having me. >> Oh, you're very welcome. So we we spoke online and and um Jennifer actually saw some you know pretty disturbing things in her unit that that sort of touches into a lot of things I I talk about and how medical system is somehow some sometimes misused and and patients are not treated um and given the autonomy and um respect that they deserve and sometimes that comes with poor outcomes but it but it can profit at the hospital greatly and unfortunately that's something that that you've seen a lot of. So if you if you wouldn't mind please tell us a bit about your story and um and the things that you've seen. >> Sure. I I've been a nurse for um probably close to 25 years. I've been working in transplant for a little bit over u five years in lung transplant specifically. Um and I mean I want to be upfront and say I'm certainly not here to advocate that nobody goes through with the process. Um, but I think what I found is that in the process after the transplant has taken place, a lot of patients and families are really not aware of the process and the complications that can o occur. Um, and it becomes very difficult to navigate that process once they're already in it. Um, decision-making process when they're family member is very sick and they've lost their mental capacity to make decisions. And so I really felt obligated to my patients um to come forward with information that kind of gives them the opportunity to be aware of those things prior to the surgery taking place so that they can navigate the process if they ultimately choose to do it. Um that they can be a little bit more prepared for some of the potential complications that can occur. And so so what are some of the things that that you've seen when some so in in your department as you said sort of a minute ago before we came on you deal with only thoracic sort of issues mostly lung transplants lung cancers things like that um and obviously when people get a lung transplant they're you know maybe they've had COD or fibrosis they're it's very difficult they're almost always on oxygen And it's a very difficult life. But then what happens after that that when people get their lung transplant um obviously they're expecting sort of a new lease on life but then what what is the reality? >> Yeah. And so I mean there are circumstances where people do have better quality of life but there's the scenario where patients have very long hospital courses and they end up developing multiple other issues and it's not my place to say whether they think that scenario is better or worse than what they were experiencing prior. That's why it's it's very difficult for me to give my opinion of of what someone else thinks is quality of life. I feel like it's only my place to say these are the things that could happen and it's your decision whether you think that's better or worse than than what you were living with prior to the lung transplant. But um the idea that patients go into the transplant and they have their short period on their ventilator and they are extabated and they go to rehab that happens sometimes. Um but more often than not they're not able to be extated. They end up having a tracheosttomy. They end up requiring a feeding tube. They decompensate. um they have mental status issues from a lot of the medications that they're on, the narcotics, the anti-rejection medications, and they ultimately require a lot of other antiscychotics to manage that. Um the chronic medication that they get placed on, which they'll be on for the rest of their life, have a lot of pretty significant um side effects that they'll have to deal with. um they may end up on dialysis which not sure that a lot of the patients understand that there's a potential that they'll be on diialysis forever. So they've now fixed their lung failure but now they're in kidney failure forever. Um they can potentially be in the hospital on heart and lung bypass for quite a while and lose their ability to communicate with their family. Um, and so I think it's important too to understand that the family is probably going to be primary decision makers for a period of time um that they may not be prepared to do as well. And [clears throat] and you were telling me as well that that when you look at obviously when you you do your research on uh on on who you're going to get to do your surgery or whatever sometimes you don't have really have options but you know at a major center like where you're at and we won't mention where it is but it's it's a major center associated with major university and so you would think that well this is going to have good outcomes and then you look on the statistics and things like that and they say wow they have these really good success uccess rates, but you're sort of seeing the other side of that. And how and you were saying that that sometimes the statistics can be massaged and manipulated to look better than they are. Is that right? >> Yeah. I I I mean, so the the standard in lung transplant is that um the one-year survival rate is really like a big number that centers look at. And um so that means that on day 365 that you're alive. It means on day 365 you have a pulse. So it doesn't it doesn't look at what procedures you've been through, what devices you're on. Um it doesn't matter if you're still on a ventilator. It doesn't matter if you're still on um what we call ECMO, which is like a heart and lung bypass. It doesn't matter if you haven't been awake. It doesn't matter if you haven't spoken to your family. It means on day 365 that you have a pulse. And if you do on that day, they can conclude that that was a successful transplant. Now, on day 366, you could potentially pass away. Um, but it was still considered successful because you were alive on that day. And so I think it's a little bit, you know, it's truthful, right? We can say yes, this is true, but I think it's a a little bit um difficult to to accept that that's what we consider a successful lung transplant. Um and I don't think the general public is aware of that. >> Yeah. And and so it it just goes by one year is there is there five year survival things like that that they use in >> they do look at those numbers but the one year is kind of what we consider like this is success. >> Okay. Yeah. And so yeah and and obviously they could be unconscious that whole time and on diialysis and having other sorts of issues as well and >> no quality of life outside of that. uh you know just that that stat they were alive on day 365 is all that look at. >> Yeah. >> And something that that comes up there is is obviously informed consent. You know, if you have if if you have a very difficult life and you're on oxygen and you're and you're struggling at home to the point that you want or need a lung transplant, you know, you're sort of in a play in a in a point of desperation as you say and you think, okay, well, this will just get me new lungs and I'll just be like I was when I was when I didn't have this problem and my lungs just were and and obviously that's the goal, I would imagine, but um you're saying that a lot of times they're they're really struggling and and may not even make it home from the hospital and and that would obviously come up with informed consent. I mean these people are not necessarily obviously they're going to be told there's a risk of this. >> Yeah. >> They they might not sign consents. I I mean a lot of us have been in that position where we've signed a consent and it's so many pages and it's like yeah well if you read the fine print it's disclosed that things may not go well right they all say you might die. you might die, but you know, you're hoping for the best because you're desperate. And um often times they the patients don't come off of the the ventilator, they end up requiring chronic ventilator management. And another thing that's very interesting that we found, this isn't new, but um because patients have not been able to breathe appropriately for so many years, it's almost like they've had a change in their brain that tells them that they can't breathe. And so even after they do get new lungs, they almost have to go through like therapy to learn how to breathe again because they're so inclined to think that they can't breathe that even though they have new lungs, even if the lungs are in perfect condition, they they still feel like they can't breathe. >> Yeah. And obviously, I mean, your hospital may not have these statistics, but if Obviously, everyone who goes through these surgeries are going to have to come through your ICU. You're going to at least see them that night. [clears throat] >> Um, even if they go great and go home the next day, which they won't, but if they um if they get that surgery, they're going to come through you. It's it's hard to sort of give a ballpark, but if you had to sort of if you had to sort of estimate, you know, how many people actually do make it home when they have these lung transplants in your department, could you could you make a guess about that? I would probably say in the course of my career, I probably have seen less than 10 go home and be completely back to their normal life. >> Um I don't know exactly how many taken care of to be honest, but um it's very few and and the people that do are very young. >> Those are the ones that seem to do well are the ones that are very young. >> Yeah. And is this is this and and you've been doing this for 25 years. So, you know, 10 patients. >> Well, I've only been doing transplant for five. >> Five years. Okay. So, over the course of five years, um only 10 people have really gone back. And how many? >> Probably less than if I had to guess. >> Yeah. And then how how many would you get a a month or a year? >> So, most of our patients are on the unit sometimes over a year. So, we have a 10 a 10 bed unit and uh they're usually there for a very long time. So, it would be hard for me to estimate, but once we have a transplant patient there, they're typically there for the long run and and even after they transfer off the unit, they typically come back with respiratory failure. >> Yeah. And um so would this be would this be indicative of uh you know programs across the country or or do you think this is more problem with your hospital? >> I I don't know if it's necessarily only a problem with our hospital. I think that trans lung transplants specifically don't do as good as some of the other organ transplants. So I I think that when I look at the numbers across the country, I think the numbers are not as good as some of the other organs. Um but I can only speak from my personal experience of what I'm directly saying. Um I don't know exactly how the other centers do the actual procedure itself. Um but I I want to be careful to just say like this is my personal experience. I I don't want to like say what's going on at other centers. 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Thanks, everyone. >> Yeah, and I suppose it's difficult as well because the as you as you pointed out, you can't really tell how well a department's doing just by that one year statistic, one year survival statistic, >> right? And >> when you kind of go on and you do your research online, it's that's why I'm like struggling a little bit to answer the question because I'm not sure with the way that they evaluate their numbers. I'm not really sure how to evaluate are these patients going home? Are they just making the one-year marker? Are they still in the hospital when they're making the one-year um checkpoint? So, I had a little bit of a difficult time comparing that. It >> would be nice if they had just that. Did this person go home? >> Right. >> And did they, you know, survive? >> Right. >> Right. Where were they at one year? Were they on, >> you know, complete support at one year or were they home with their family at one year? So, I I had a little bit of a difficult time differentiating that. And you you mentioned before we started as well that your department at least was having problems uh to the point that they had to suspend their lung transplants, but then you saw that they didn't um that that didn't actually get like reported. So it could be that there's other departments as well that may be not getting reported that they've had problems too. >> Yeah. I don't I don't know is my only answer to that. I don't know what happened. Yeah. >> I don't I I can only say I don't know about that. >> Yeah. But um how long was your department suspended from doing lung transplants? >> Probably around six months that we weren't doing procedures. >> Yeah. Then coming back on >> able to find information about it. >> And what? Sorry. >> I wasn't able to find information online about it. >> Yeah. Yeah. That's a bit that's a bit concerning too that that there were some sort of um you know restrictions put on the department but then you know a patient can't then go and and find that that sort of is a bit concerning. >> I I wish I had more to say about it but I couldn't I couldn't find the information >> and I I searched >> Yeah. Um so the the other thing that um that you pointed out which I don't think many people would would have even thought about which is that some people that get lung transplants they're they're getting lungs from people who obviously have passed away but how did they pass away and so you're sort of inheriting the problems that they had when they died and sometimes that's that's quite severe. >> Yeah. Yeah, I mean we typically don't disclose and sometimes patients will directly ask to know exactly um about their donor or if they can meet their donor's families. Um, you know, we certainly if they're being treated for something that the donor had, that has to be disclosed like if the if the donor had heepsi or something like that and you know, they have to be treated for that. But um I think that sometimes patients get lungs from someone who perhaps may have committed suicide or somebody that died in a situation that um is, you know, a little bit distur might be a little bit disturbing to the person receiving the lungs. Um but they're being treated for whatever that person potentially died for. if they died in a fire, if they died from a hanging or if they, you know, died from something that is, you know, disturbing for lack of a better way of saying it. Um, so, but you you don't you don't necessarily know that prior to getting lungs, you get a phone call that you got lungs and that they're supposedly going to fit in you. You know, like you think about different sizing of lungs, pediatric lungs for small adults. Um, you may not necessarily know that. And sometimes, you know, the surgeons do their best to match. I mean, certainly like they have very complicated criteria for matching lungs, but um you know, not once they get in the O, like that's the final test of do these lungs fit? Is it going to work? Um can they get only one lung from these lungs? Can they get both? And so you don't find that out until after. And yeah, and then that obviously can can lead to more problems in recovery as well. There's some burn vict that's that's sort of surprising because a lot of times when people do you know die in a fire I mean often because of smoke inhalation and fixiation and like that which is going to cause huge problems I would imagine for >> and I mean sometimes I mean there are instances where people get a phone call that there's lungs and and the surgeon determines that they're not viable lungs which is bad for the patient but it is good in the long run. And I mean that does happen where they say we're not going to do this because they're not viable lungs. So I do you know that's not information that the patient wants to get that they got the call but then they can't get the lungs but in the long run it is usually better. >> Yeah. Yeah definitely. Um yeah I mean that that's sort of especially in that condition where you sort of get damaged lungs or you have so many complications afterwards. you know, the person was on oxygen, they were not doing doing well, but at the same time, you know, they seems that in a lot of these cases, they were worse off after they got the surgery. And so, >> somees they are. Yeah. In some instances, they are. >> Yeah. And in which case, you know, you know, patient selection and and sort of surgery selection is very important because you're you you can make this person's life worse um than they had it before. whereas they were on oxygen. It sucked, but at the same time, they they were alive. It wasn't like they were at risk of dying and being on, you know, in the ICU and on on um you know, breathing support and things like that necessarily. And it's um yeah, it's very concerning that uh that that people are then put in that position. It's like it becomes so much more than that I guess is really the issue too because I understand that the patients had a very difficult life prior to the lung transplant and they felt that they couldn't participate in their daily activities or they might not have been able to participate in events. But following the surgery, I'm not like I I I do want to stress that I'm not saying that there's no surgery that goes well. Occasionally there is somebody that's young and does well and goes back to work. Um, but for the most part they're going to spend a significant amount of time in the ICU with breathing apparatus and multiple tubes and their family is going to see them in a state that is very difficult. I would imagine I it's sometimes difficult as a nurse to see people suffer that way and I can't imagine what it feels like for family members to watch their loved one suffer that way and to see them that way. Um they become very confused. They have a lot of tubes in them. Sometimes they require restraints so that they can't pull their tubes out. um you know they suffer they go on dialysis and the post-traumatic stress from that even with the families um I think that they're not prepared for that type of uh situation prior to the procedure taking place and I feel like we should do better as healthc care providers with letting these families know that this patient you're family member I say patient but it's their family member, it's their loved one that they're going to have to be able to walk through this probably without the patient, their loved one, even knowing what's happening. And they're live with a lot of that and have to live with the decision-m process and live with the memories of that. Um, I feel like that's also on the side very underestimated of what happens to these families, whether the patient does well or the patient does poorly or the patient dies. >> And it Yeah, it's um and and I think the the unfortunate thing is too is that hospitals make a lot of money from transplant patients. A lot of money. And >> a lot of money. >> Yeah. It could obviously taking all the different organs, looking at all the different tissue, this could this could amount to millions of dollars for the hospital. And so making decisions based on that side of things, the economic side of things, that may not be the best decision for the patient at that time, that may see them stuck in the ICU and and never going home. um is is very concerning and especially you know as as you mentioned um when we were talking previously that or actually you mentioned at the beginning that you know this this brings about diialysis this brings about other you know um you know procedures and tracheos and emmo and all these different sorts of things that those may actually add to that bill. Uh, I don't know how insurance does these sorts of things, but if that if that bill is going to the family, you are going to pay for every damn thing that they do. >> Yeah. I I mean I I think the way that insurancees pay is very complex and it's different between insurance to insurance. I don't know if everything gets build as a complete bundle or if like each procedure itself can be built separately. Um but the amount of procedures that these patients go through following this the initial surgery like for instance just an example of like potentially if if you have a lot of bleeding during the surgery right they do a sternotomy to place the lungs and so your chest is open and if there's significant bleeding they can't close the chest because you'll bleed and you'll develop compartment syndrome around pretty major organs and so they have to leave the chest open so that we can drain the blood. And that requires you to go back to have your chest closed, but now it's been open exposed to infection. So now you have to have a complete wash out and you have to have your chest reclosed. Um, obviously you have to be on pretty significant sedation to h come back from the O and like certainly we wouldn't want you to wake up with your chest open. So it requires significant amount of um medication to keep you completely sedated. Um pain control and then you know if you're going to stay intubated for more than like 7 to 10 days you can't keep the breathing tube in. So you end up needing a tracheosttomy. But now we're getting to day seven or 10 and now you need to be fed. You can't can't not have anything. So they start to initiate either something through your IV, but they prefer to feed you through your gut because there's complications if you don't feed through the gut. So you go on these tube feedings that cause pretty significant diarrhea. Um and then you know you go through this significant diaresis process. So you kidneys take a hit. Your kidneys probably take a hit from your blood pressure being so low. So now you're being initiated on dialysis. So like it keeps the steamroller keeps going through. Now you need a dialysis catheter. You have a central line. You have a you have a pulmonary artery catheter in your neck because we're monitoring your cardiac numbers so that we can treat your hemodynamics because you probably had a bad heart when you went into lung surgery because your heart pumps against lungs that are not good. So you probably have significant right heart failure. So the steamroller as you keep needing procedures and as you keep requiring more interventions and then you probably need daily broncoscopies because you probably have a ton of secretions in your tra. So it just keeps adding up adding up adding up adding up adding up. And I think the patients also are told that I that they have some obligation to the donor, right? They don't want to nobody wants you to give up treatment because that's not really fair to the donor that they gave you these lungs. We could have given these lungs to somebody else, but you got these lungs and now you want to stop treatment. So that's also a another thing in the background that it's like sort of feels unfair to the family when they've been through enough, but they have to think of the donor. Mhm. >> So the procedures just keep adding up and adding up and you tend to wonder where is the financial benefit of this versus what is fair to the family. >> Yeah. I Yeah, there really needs to be a better way of keeping these statistics so that people can well a so that we can keep track of these things a little better and say hey are these people getting home? Are they having any quality of life? >> Yeah. >> Um and and the patients can see, okay, well, there's um this percent chance you're going to live be alive at the end of a year, but there's only a 30% chance that you're going to go home and be alive at home at that one year. So that I mean that's that's a that's much clearer information that would be very important to make that sort of decision. >> Yeah. >> Yeah. and for patients to really have this disclosure because when they hear that they'll you know this many people survived I don't think that they know what that number means survived and it's everyone's own personal opinion what they think quality of life is so I try to be careful saying or your quality of life is going to be poor because everybody's opinion of what their quality of life or what they want as their outcome um might be different. Um but they should be given the definition of what that means. You know, are you in the hospital? Are you on a ventilator? Do you want to be on a ventilator forever? Do you want to be on dialysis forever? Do you want to be on some of these anti-rejection medications forever that you might not, you know, you'll have the complications of of this medication forever? Um, I'm not certain that it's being really disclosed what it means after the surgery >> and let the patient decide whether they think that's better or trying to optimize what they have >> now. I don't know what the answer is. It's going to be different for everybody. But I feel like as healthc care providers, it's our obligation to say this is what it is and it's your decision whether you want to do that. You might be able like you might not have these complications but the likelihood that you're going to have significant complications after a lung transplant is higher than not. >> And you should know that. And yeah, I I do wonder how they do, you know, sort of the the informed consent or if they're just doing just the raw statistics. Well, the this is the percentage that, you know, of people that will be alive after a year and but you'll have a you know, when when we're neurosurgery, we try to give people actual percentages based on not only the department's averages, but sort of more national averages or or or international averages. And so we might say, look, there's there's a 5% chance of something catastrophic happening, you know, some sort of large bleed or stroke or or having severe damage from the surgery where you may not ever beat the same person again, you know, or or maybe work around the brain stem. It could be, you know, 20% 25% or something like that. Um, and that they will will not, you know, be the same person on the other side of this. And so, you know, I I wonder if they they doing that as well because I mean I if I were going into that and they said, "Look, there's a there's a 70% chance you're never coming out of the hospital." I'd be like, "No, thanks." Yeah. I I'll stay here with my eyes saying, "Thank you." >> Yeah. I I don't know. I don't know what's I all I know I'm speaking from my own personal experience is that when I'm dealing with patients and their families one-on-one, it's very clear that they were not aware that these are the turns that they could potentially take. I think that even when they're told, well, this could happen or that could happen, they believe upfront that it's so temporary that it's like, well, if it's going to save their life and they're going to come home, we're willing to go through that. But I don't think that they necessarily understand that it's not going to be a temporary, well, he's on dialysis for one day or he's confused for one day or a week. this might be your new reality >> um forever and what that means. So, I'm here because I want to advocate that we need to do a better job of making sure that people know that because it's pretty painful. It's it's pretty traumatic and god forbid the patient does not make it, the loved one does not make it, the family is going to live with some pretty traumatic memories of a very long time period of going through kind of the unthinkable. So, >> and and that's very important and and so, you know, you I really appreciate you trying to bring this to light for people because I it's not something that that most people would think of. I didn't realize that that lung transplants were this um problematic and and again, we don't really know if it's if it's um you know, maybe this it's more problematic in this department. Obviously, they were, you know, sort of put on suspension for six months, so there seemed to be some problems, but they're active now. And so, presumably, the board thought that that was that they were >> Yeah, they made they made some changes to how the procedure was um the actual procedure itself was was completed, but um I'm not necessarily sure that we're having significantly better outcomes. >> Yeah. Yeah. Well, and and it doesn't sound like it. And um just having just having the fact be that that that people will be stuck in an ICU for a year or more than a year. I don't think I don't think most people are are are expecting that as an outcome. And when when you talk to a lot of people, I've known people that have had complications in surgery. And pretty much every time they they say, "Well, yeah, I knew there was a risk, but I I you know, I you know, people say, "Oh, yeah, there's a risk, but you'll be fine." And um that's probably the wrong way to to consent somebody. I mean, you have to you have to give them the the sort of the stark reality like, "Look, this could this could end up in these sorts of conditions." and um and so that they can they can understand that hey if something does go wrong that's okay well I expected that this was a this was a chance but it sounds like people are not not really getting that and because if they're coming in and they're saying hey we we were not expecting this you know obviously that >> I think that it's very very difficult prior to actually experiencing the interventions it's it's very difficult prior to that to say Well, I'll try those interventions and if they don't work, like how do you come up like how do you quantify? Well, I'll I'll do diialysis for one month and if it doesn't if I don't, you know, get better, if I'll stop treatment then or I'll be on ECMO for three months like where do you come up with that number? You know what I mean? Where you say, I'm going to make a plan for this prior when I'm of clear mind. It's it's very difficult to do that until you actually experience being in the bed, having a breathing tube, having a feeding tube, you know, being on dialysis, having emo canulas, like how do you even understand that? How do you wrap your mind around that prior to ever having experienced it? And then typically the patients themselves are so confused and delirious and sometimes combative that you can no longer communicate with them and see now now you've put them in this position and now it's only up to the family to make the decision of how far do we keep how far do we keep going >> before he's not going to suffer anymore. like and I think that most people will say I don't mind suffering if I'm going to come out on the other side. There's no guarantee of that. We don't know what the length of time it is. Um you know certainly you can only be sustained on ECMO for so long but I mean we're seeing patients on it. sometimes a year, sometimes longer than a year. >> And >> so, >> yeah, it's sort of a sort of a morbid thought, but you know, you mentioned that that families are being sort of almost guilted into continuing care because saying, hey, we could have given this long to somebody else. Um, and then maybe there's other sort of pushes as well. But you have to sort of wonder, you know, do you you have to sort of wonder if the hospital or the team is sort of trying to compel the patient or the patient's family to continue on with care so that they can hit that one year mark so that their statistics can look good. And you sort of have to wonder about that as well. >> Yeah, you you wonder about it. I mean, I don't know how much more I can I can't guess what other people are thinking, but I can just say when you kind of follow the decision-m process and you think this I understand that most doctors want the best for their patients. I'm not saying that doctors don't want the best. They go into the field because they want to help. That's what we do. We want to help people be better. But the relationship is not completely unbiased and that's all I can say of you know the patient has to do their research on how surgeons how doctors are paid. Hospitals are paid doctors are paid by surgical volume. They're paid by their um you know they're paid by procedures. So, I think that I have to leave it at that and say you come to your own conclusion of what that means. >> I'm not saying they don't want the best for their patients. I'm sure that they do, but there's money involved >> and it's it's not completely unbiased. So, that's where I have to leave it. There's a lot of money involved and and you have to money involved. >> Yeah. >> Um so I mean this this may be a difficult question to answer, but what what would be some advice, you know, if someone were in this position? Um, what advice could you give them on how to figure out if they're if they're going to be in in an apartment that maybe has has sort of these poor outcomes that are being hidden or what questions they ask or how do they try to avoid these sorts of situations? that the the best advice that I could say is do your best to find patients, friends, family, anybody that knows somebody that's had a transplant or has any information about a transplant. If you know nurses or you know doctors that can help you make a list of questions that you can specifically ask your doctor that you can specifically ask about your own surgery that you can ask about what's going on on the units if you can potentially talk and you know obviously we can't disclose patient information but they can potentially ask their physician if they can talk to nurses on the unit and see what their experience is on the unit, what the culture is on the unit, what their outcomes are, what their surgery will be like, what types of they're going to have to ask hard questions about what are the most complications that you have during your surgeries, what is your rate of bleeding, how many patients do you have that don't come off the ventilator at day 60. you know, you're going to have to help have somebody who understands the procedure itself. Um, if you can coordinate with a physician that can give you information about some really hard questions to ask your surgeon, um, you're probably going to take them a back a little bit when you ask them these questions, but it's really important for you to gather as much information as you can because you're you might not find it online. And when you go online and you see these success numbers, they kind of don't mean anything. Um, because you don't know what criteria they're holding that number to. So, I think the best way is to just talk to people that can give you the information that these are the questions that you need to ask. These are direct questions that you can't dance around. You can't say, "Oh, well, this many people are alive on day 365." like what does that actually mean? How many patients have you performed this surgery on this year that are home? I want that number, you know? So, um, do your best to talk to people that can give you information. >> Yeah, that's um all right. Well, thank you so much for that. Do Do you have anything else that that you wanted to to bring up or raise or discuss about that? No, I think I I just feel an obligation to speak to my patients on a platform that I can reach as many people as possible to say, I'm not telling you that you should not have the surgery. But I'm telling you, you need to go out and do your research and not just Google. You got to talk to people that can give you information, that can give you questions, and you got to sit down with your family and talk about what's we're going to do if this doesn't go well. >> Yeah. >> Know that beforehand. Don't try to navigate the process after the surgery's been done. Don't do that. >> Yeah, definitely. Very good advice. Um, Jennifer, thank you so much for taking the time and thank you so much for for being brave enough to step out of of um, you know, your comfort zone and come out and and to to speak publicly about this. I think that's something that not many people know about even in the medical community and that's very important uh to understand. So, thank you so much for that. >> Thank you. Thank you for having me. Appreciate it. >> Thank you all for joining. Uh hopefully that was helpful and you know do really work hard to advocate for yourself and for your family members as well and try to understand the information and understand what you're getting into before you get into it. Um because after the fact it's um you know you're just playing catchup and it's it's much more difficult. So everybody please do take care of yourselves and your loved ones and thank you so much and we'll see you next time. Hey guys, thank you very much for taking the time out to listen to what I had to say. 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