Dr. Conrad Fischer: Infectious Disease Specialist (Raise the Line)
Hi, I'm doctor. I'm the chief medical osteo osmosis.
And on this episode of Razor Line, we're gonna hear from someone who's providing patient care in the epicenter of the COVID-19 outbreak in the United States and frankly around the world, he is Dr Conrad Fisher, an infectious disease specialist.
He's also a residency program director, vice chair of Medicine and chair of the Ethics Committee at Brookdale University Hospital Medical Center in New York City.
He's also a Professor of Medicine at Toro College of Medicine in New York and the author of leading publications to help students prepare for the USM and specialty board exams, including a best selling book, Master of the board series.
Dr Fisher also serves as the president of the Mid Atlantic region of the American Academy of Religion. Thanks so much for being with us here today.
Doctor Fisher. And I can't imagine how much you get done in a day.
That's incredible. Uh, a bit of background on you.
Thank you. Yeah.
Well, have you ever met an un bussy doctor? Doctor?
I, not, not too many of them. I think I've met a few.
They're usually retired. Yeah.
So, so tell us a little bit about yourself and the role you're playing in Brookdale day to day. I mean, you're at the, that the center of, of this.
So, what is it like? Yeah, the most important thing now is because, uh, there's so much fear.
Now, one of our staff said that they said, please, can we work from home, the administrative staff, the program administrators for the residency program, which I'm director.
And I go my darling, you are not paranoid paranoia is when you're afraid of something, when no one's attacking you, when your building is riddled in Coronavirus, when you have 25 deaths a day to fear, walking in when you have a young child at home, you have a 10 month old and you're afraid of bringing that disease home to your child.
That's not paranoia. This is a legitimate fear and we need to talk about that more because the bravery is because people are legitimately afraid.
I'm afraid I was in 10 COVID positive rooms just today. Oh, wow.
And what is that like when you go in there and you're on your 10th 1? Are you thinking, you know, I'm likely to get it.
Do you think you've ever had it or been exposed to it? Yes.
Well, the, the fastest thing to understand it is the visual. How do I feel when I know I have to go to a COVID positive floor?
Here's how I feel. Now, despite that, what I do is I don't think that you need me to talk about personal protective equipment because everybody understands that a face mask, you get an N95 the gowning.
I personally wear a double gown, one in front, one in back gloving. I think the thing that you bring here is what I do.
Even though I'm a board certified Infectious Disease doctor. I ask my residents, I go, I want you to watch me putting on my own personal protective equipment.
Not because I'm such a super genius, but because when people are tense, we make mistakes and this has to be the uh to go on the checklist moment where we don't say I'm so smart.
I know better than you. We say hey, check me now, I'm in a hospital now where we have opened up two intensive care units.
We've opened the whole brand new patient floor and we have what I like to think is a colorectal surgeon stepping up to run a COVID floor cause we had nobody else.
And I have the blessing of having the wonderful chief resident in Psychiatry acting as my intern because we need the staff and I say watch we put this on.
Did I miss anything in my breaking technique? And one is to use that fear to say double check me.
Number two is the wonderful sense of my uh my Ashram of people who actually tie my gown behind me to make sure that doctor Fisher is safe.
Yeah. So on the day to day everyone is frightened.
If you weren't frightened, you have schizophrenia. Do you feel like because I've heard about this protocol out of Wuhan as well, where in the, in the beginning folks were wearing, like you said, just like an N95 and thinking they were good to go and then they realized how contagious this is and how easy it is to get a little bit of the virus inside.
And that can make you real sick, even if you're young and healthy and so, you know, so on and so forth. And so they've started implementing this policy.
And so I'm, I'm really intrigued that you guys are doing it too specifically having a checklist and having partners where you watch me, I watch you, you, you know, if I mess up, you let me know things like that.
How widespread is that? Do you know that other, you know, hospitals outside of New York are doing that?
Now, the concept of the checklist, the problem is it's the right thing to do, but we are all making it up. Unfortunately, on our own, there are 5000 acute care hospitals in the United States.
And even if you narrowed it down, I only have, there are only 395 people like me, which is residency program directors who have to be conscious of the role modeling that we done.
And so there is no centralized plan. There is nothing coming out of our national leaders.
There's no fe a derived plan. And so we are each left in our own hospitals to try to the best of our ability to do what we think is right from the best data, but how much data is there.
So when you said if I've been exposed to Coronavirus, I was diagnosed positive two weeks ago, I stayed up. Uh excuse me.
Uh yes, I was tested and positive two weeks ago. I was very lucky that our hospital was the first and only hospital for 10 days to have an in-house same day test.
That's pathetic. It's pathetic that the hospitals were all left to verify and validate their own tests.
So, no, the checklist is what we should be doing. Are we doing it everywhere?
No. Is there a national coordinated plan?
No, you have a, one of very hardworking, intelligent, committed people who are trying to do the best they can. But do I know for sure that what we're doing is better or even as good as the other 5000 hospitals or the other 305 95 residency program doctors?
I hope so. But I don't know.
Has there been any effort on the state levels? I recognize that federally it hasn't happened.
And that's, uh, both, uh, sad, disappointing, but also not surprising. How about the state level?
Have you seen any sort of coordination with governor, you know? Governor Cuomo's leadership.
Yeah, Governor Cuomo is certainly, uh, outstanding when it comes to a stand up fight like this. He's a strong guy.
Uh, he, um, uh, provides a sense of confidence because he's, doesn't sugarcoat problems. Uh, but there are things he can't do.
For instance, Governor Cuomo, he's very hands on. He's on with our CEO.
How can I help you? How are you doing down there?
Do you need PPE, but the guy can't 3d print nurses and what we're at now, we're at an issue where we have an enormous nursing outage that is very, very desperate.
And how do you get through even moving the beds? It's like a tetra ski.
And by the way, it's better to laugh than to cry because if you felt the horror of the situation, we have 10 people a night who die.
And what it needed is a coordinated federal response if you or I were AAA captain or major in the army. And we got shocked or some, one of somebody that we were in Iraq, the, our patient would be airlifted out and flown to Rammstein Airbase or AO Airbase in Italy or Insulin Airbase in Turkey or the other places that we have in that region.
And we would have been flo had ill people flown out to where there was medical care. And I do not understand why our federal government cannot fly of nurses who wanna volunteer to come into New York.
And in fact, put them through having to go through an agency nurse where they have to go and say I have to be paid for A B and C.
So the response should be to put a busload of 50 nurses on a private jet on a jetblue plane at our doorstep. Yeah.
How about tonight? That makes perfect sense.
And, and you know, I guess this whole issue, I think that there's almost two conversations happening. One is this conversation where you're describing the, the painful reality of seeing people die and the need for nurses tonight.
And then this other reality where I think folks are looking at the flattening of the curve in New York and saying, hey, maybe it's time to reopening our, our economy.
Uh We might have kind of gotten past the worst of it. So how do you respond to that?
What are your thoughts on that? Uh If mm politics could be sued for malpractice, that would be what you would do.
It's bad. Let's stop it in coronary arteries.
Now, I wouldn't talk this way if it wasn't so much a physician audience. But this is like telling people to use AZT monotherapy for HIV.
It's like saying to use steroids alone for Wagner's granulomatosis. What kind of analogy do we have when somebody makes an irresponsible statement like that, these people are gonna die.
I'm immune to Coronavirus. OK?
And we put our frontline people mo as best we can. I go into the rooms, I don't let the intern go into the room is not immune.
The resident who is immune goes in with me. But this thing about opening up, we have 20 to 25 people a day diet.
Do you know what it is to run a code? People don't take that.
They take that for granted. Even the senior physicians, you and I, we're the professors.
We're not running one code an hour, one dead person an hour. We have to say I'm terribly sorry that you're back to Fisher.
Um No, you couldn't visit your mother today. Rishi because there's no visitors allowed.
And it must be terribly painful for you to have to be separated from the people you love. And I know that your mother didn't pick up the phone when you called and I saw you recall bec but I, she couldn't pick up because we were coding her and tried to bring her back and I'm calling you back on your mother's phone because I saw your name popped up and I saw that you're the same as the emergency contact person in the chart.
And that conversation is happening 25 times a day in my hospital and to open up the country for the economics of this is irresponsible.
Yeah. II mean, I couldn't agree with you more.
I think that it's disappointing that there's still states that are, that never shut down in the first place and have been and, and continue to stay open.
Uh Even right now as we speak about this, that's that what I just relate to that happened 18 hours ago. People called in and the cell phone rang while chest compressions were occurring and the epicenter of this in Brooklyn Queens and the Bronx, we have received no ventilators from the federal government and our hospital, our leadership is going crazy trying to do the right thing.
They're desperate to do anything they can. That's right.
And they're getting the best support the state can give them. But what we needed was certainly, if we had worked on having a standardized test, our PCR and our blood antibody test would be ready by now instead of people still scrambling for testing.
Yeah, it's, it's abysmal and it's gone. On for months and especially the antibody testing as well.
You know, you mentioned you're positive and it would be good to know. Uh I was gonna ask you if you knew if you're IgG positive or if you have any sense on that.
I don't know that I'm IgG positive. I'm going to press next week because my outstanding chairman of pathology was gracious enough to um go with the pressure I should say, go with my request, my begging to get um PCR testing for all the staff.
I was a very early and prominent supporter of test the staff, get them out of the hospital. Get to keep your 7 to 10 days out, get out and then you come back.
I have a residency program with 93 residents. 33 of them have had Coronavirus.
I'm happy to say that only seven are out sick, take your 7 to 10 days out, come back in. They either uh also the residents man, they stepping up, you know, even uh three weeks ago, we knew this was gonna happen and we're like, look, you're gonna have a vacation now.
There's no place to fly to. We voluntarily.
I go look at this, I'm not gonna order you to uh one guy at a wedding with 400 people. I'm not gonna order you not to can to go places.
I'm not gonna order you. I'm gonna ask you to do what's right for humanity do.
It's right where there's a love of medicine, there is a love of humanity. And will you consider pushing off your vacation?
Every single one of them? Did it and the guy canceled his wedding because the guests don't wanna come anyway.
So, uh they're going out and they're coming back in. And I do wish though that we had easy testing for the antibody right now.
So we don't just have to assume it. That is what today's uh uh problem of the day.
The other big problem is intubation. Uh You've got to, again for a medical audience here, you've got to be able to have a capacity, not just to run uh R RT S rapid responses.
You've got to be able to have capacity to have those anesthesiologists there in the debate. And the problem is they are overwhelmed.
You're doing a 10 dead an hour, uh a 10 dead a night means more than one code. That's the negative outcomes.
What about being able to get up to intubate those people in 5 to 10 minutes? So that is desperately needed.
So we need to change our paradigm and we now need to immediately train more people to intubate. So we're using our ed residents for that and we're even asking some of the medicine residents to intubate just as the safety and they're like, yo, Conrad Conrad, come on, you don't wanna put that response, let the residents I'm like, I'm not putting it on them.
First of all, they volunteered because these people are fundamentally heroic. The other thing is this, think of it, like the volunteer fire department.
We don't wanna to replace the pros. But if your house is on fire, I'll take whoever I can get.
Exactly. And I think it's an interesting analogy because I think a lot of people don't recognize that the house is still on fire.
I think a lot of folks look at the data and think, oh, maybe the fire is going out. And in fact, I think one of the concerns is that not only is the house still on fire, but it's burning all over the nation now rather than just in one area.
And so let's look at that, let's look at the DSM for that. A fixed persistent belief if it doesn't hurt you is called delusional disorder.
OK? But if you have a fixed persistent belief and you're not taking care of your activities of daily living called social isolation, rapid expansion of testing clinical trials instead of the Hey Ya Ya Ya Voodoo of hydroxychloroquine or the QT prolongation.
Torsades de Pointes. Hi, I need a ICD.
Can you give me hydroxyurea and Azithromycin? I want to see if I get my implantable defibrillator two D.
So if you want to actually study these things, it's not delusional disorder, it's worse. That's called schizophrenia.
It's in the DSM. OK.
So those people who say not to study these things with a clinical trial to just make statements about drugs that are unproven to not have testing available, to say that more testing is available than is actually available.
This is a, this is a psychiatric illness. Well, maybe on, on that note of a psychiatric illness, um, I'll ask you, are there any other final thoughts you have for, for med students and residents that are just entering the frame?
Maybe they're not there yet and maybe their hospital doesn't look and feel like New York. But it might, what would your advice be?
Your calling is sacred? Because some people will look at the world and say, how can this have happened?
And for those who are believing people and I don't often speak this way in scientific organizations and say, how can there be this suffering and pain, divine and cosmic forces of goodness and truth and beauty and hope reach the earth continuously but only to the level of the human heart and mind and the implementation is up to you.
So if you want to help me and you're not in a position to be able to send nurses or send PPE, but you wish to help the fundamental yearning for goodness, to help the other people in our community.
Our world study medicine, study continuously study even the things that are not COVID learn about Wagner's granulomatosis.
Thank you, Doctor Fauci. OK.
And then what you do is you learn about it and you'll learn my God. There's an the body that's developed, that attacks on willebrands I can use for TTP.
The protector of the world. Fall not into despair because despair saves neither this world nor the next.
Are you not? But stand up and fight?
That's a very inspiring, inspiring message. I appreciate the eloquence with which you conveyed it.
That's amazing. Yeah, Conrad Fisher, I can see how you're, you're gifted in many ways.
Conrad, it's pretty impressive. I well, thank you.
Hey, listen. Thank you so much for being with us today.
Doctor Fisher. I know that uh your, your day is very busy.
So you know, these minutes that you spend with us are, are very treasured. I'm doctor is Asai.
Thank you for checking out this episode of raise the line. You can join osmosis in raising the line and flattening the curve to strengthen our healthcare system.
Go to osmosis.org/covid-19. Thank you so much.
Take care.
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