Episode 48: Interview with Dr. Jonathan Reiner

Welcome to wisdom from the aerial view, the podcast for those who wish to learn how to crush their anxiety and find meaning and purpose in their lives. Today we are very, very lucky and very, very honored. We have a very interesting conversation that are about to happen with a very wonderful guest. I'm going to let Mark Klein, who wrote the book on which this is all based, to introduce our guests and then we'll go from there. Mark.

Yes, well, thank you, Enid. Good morning. And it's great to see you as always. And we are very honored to have my good friend, Dr. Jonathan Reiner, who is professor of medicine and surgery at the George Washington University Medical Center, directs the cath lab there. He was also the personal physician to the Vice President Cheney's. This is actually very timely since, unfortunately, We recently lost Vice President Cheney. John's been involved in the White House medical unit for many years. And he's also a CNN medical analyst. And I will tell you that it is not rare for somebody to call me go, hey, you know that guy, Dr. Jonathan Ryan? yeah. He goes, he's great. I love him on CNN. And that's always what I hear. And I tell John that all the time. John's a very good friend of mine. And I'm very grateful he's here. And he's got insights that very few people have. I like to say that John saves lives like most of us have lunch. And that's no exaggeration. I always tell him he's the best doctor I know and then he gets mad at me. But I've been a doctor a long time and this is all very accurate. So John, thank you so much for joining us. We're very grateful and thank you for coming.

Thank you for those kind words. I wrote every one of them for you. It's a pleasure to be here with you, Anita.

Yes, absolutely.

Yeah

You did, he mispronounced a couple of them, you well, we're delighted to have you. I'm going to start, Mark. I'm going to jump right in. I'll tell you why. I'll tell you why. Because here I am with two doctors. it's a paradox. So I was doing some research, doing a little bit of research. I was, I thought about this all night and I'm so glad that I had the opportunity to do that. But while I was, Mark said that we're going to have my friend John Reiner on, I said, well, that's terrific.

So go ahead. I think you absolutely should as always.

Hahaha

You were waiting to say that. You've been waiting to say that.

That really is terrific and I'm gonna tell you why. I have a brother who's older than I am, so he's 104, and he's a skeptic. He's a skeptic about everything. But he was watching CNN one day and he said, there was this doctor on, I couldn't believe it. He said, all of a sudden I just kinda trusted him. I said, really, what about? He said, he was talking about what's going on in medical and I started to trust him. His name was John Reiner and he said, He had a New York accent, so maybe he's one of ours. And I said, well, maybe he is. But I looked up a couple of things and I saw Dr. Reed Tuxen. I'm sure you both know who he is. He was at NIH, National Academy of Medicine. He's now the co-founder and chair of a thing called the Coalition for Trust in Health and Science. And I thought, trust, isn't that interesting? My brother talked about trusting this doctor and trust seems to me something that Maybe we've lost some faith in nowadays, trust in science, trust in medicine. And I just wanted to quote Dr. Tuxen, because he said something interesting. said, if you come, let me read this. He just said, if you come back to the defining responsibility for the health professional, the patient-physician relationship has always been sacred. If your patient does not believe in science, if your patient does not trust you as the clinician or the institution,

Yeah, yeah, I'm sorry.

then the therapeutic relationship between the doctor and the patient is fractured. What about that? We're talking about trust. Can we trust medicine nowadays? Can we trust science, Dr. Reiner?

Yeah, so trust is the basis for which every relationship with a patient is based. Mark knows this very well.

We have lost Dr. Reiner. can't trust the internet is one of the things we've learned.

Can you hear me, Enid?

Yes, I can.

Okay, what I was saying is that trust is the foundation for the doctor-patient relationship and trust is built on truth. Mark knows this in his long career. Patients only trust you when they believe you're telling the truth. The other central element of trust is has to do with the patient understanding that you care about them. think Teddy Roosevelt said that no one cares how much you know until they know how much you care. So patients need to understand that you care about them and that you're going to tell them the truth. And when I sort of unexpectedly started doing some of these hits for CNN right at the beginning of the pandemic, all I was trying to do was show people that I cared about what was going on and what they were going through. And I just wanted to impart to them the truth, not a spun truth, but the awful truth, the hopeful truth. I'm not an epidemiologist, I'm not an infectious disease doc, I'm a cardiologist, an internist and cardiologist. So I think people wondered what is a cardiologist doing talking about COVID and my... My special sauce was very simple and not that special. I just wanted to tell the truth and and and that's what I do. That's what I do with my patients and and that's what I do with my with my with my friends and that's what I wanted to do with with the public at large. So I'm glad that at least you know some people came to appreciate that.

Yeah, you know, I have friends who don't often watch CNN, but do sometimes. And they may not agree with the politics or whatever, but universally they appreciate Dr. Reiner's perspective because I think when you have that, when people believe that you are not trying to fool them like John said, or in some way deceive them, or you have a different agenda. So one thing that we agree on is that, and we've talked about this a lot, that as a physician is really only one thing you have to pay attention to, and that is do what's right for the patient. If you always focus on what's right for the patient, the rest will work out. When doctors get in trouble is when they start thinking, well, if I do this, maybe I'll make more money. I'll get more famous. I'll have more time off, whatever it is. When you take your eye off the ball, that's when you get in trouble. And one of things I admire most about John is that that's never happened. He always has his eye on the ball. It's always about the patient. There is never... I don't think it ever enters his mind, anything else. And that's why he comes through the way he does on TV. And certainly, I'm sure his patients all feel the same way. I've actually been a patient of his. Now, it's a little different because we're such close friends, but still, it comes through. And so I think that is the role model for medicine. I tell him this all the time. You know, one of the things, so that idea of trust, it comes from a very deep place. He's not making it up. And patients know, you can't fool patients. They know when you know what you're talking about and they know when you're telling them the truth and when you're not. Would you agree with that?

Oh, yeah, know, 100%. There's this great book about the 1918 influenza pandemic and written by John Barry. It's called, I think, The Great Influenza. And what he says in the book is that at the beginning of any major health event,

I read it, right?

and particularly something like a pandemic, in order for the public to do hard things, like back then wear a mask and sort of separate from each other. And again, back now in 2020 do the same thing, or get vaccinated and take care of each other in order. to get the public to do difficult things, the public has to trust those that are telling them these recommendations. And trust is built on the truth. So if I violate the truth in a relationship with a patient, maybe fatally fractured their trust. Why would you put your life or the life of a loved one in the hands of somebody who you don't trust and who has lied to you. And what I tell my fellows, I teach interventional cardiology to fellows and have for 30 years. Yeah, so think of me as I'm a closed chest surgeon, right? So there's open heart surgery where the patient receives general anesthesia and gets put on a

Just tell them what interventional cardiology is.

respirator and the chest is open. They're supported with heart lung bypass and then various things can happen. You can sew in new valves or you can graft new blood vessels onto the heart. Very invasive, about a week in the hospital, a lot of recovery, a lot of risk. I'm an interventional cardiologist and I do a lot of the same things, but I do it through a puncture in the leg, about the size of a pencil. And so there are complimentary skill sets. work with sort of invasive cardiac surgeons. But what I say to my fellows is everything starts with the truth, the good and the bad. If things go wrong during a procedure, the first thing you do is you go out and talk to the family and tell them exactly what happened. That's the first thing. People will forgive adverse outcomes. They will not forgive a lie. So everything starts, everything starts, everything starts for the truth. And as Mark said at the beginning, everything has to be patient focused. Every young doctor who's learning how to do these procedures is always asking what, what to do or how, how are they going to fix it? I tell them, no, no, no. The first thing that you need to think about is why, why am I going to fix this? And then what can the patient expect, you know, from this procedure? then you can figure out the how. So, you know, these are sort of elementary lessons that we try and teach. Some people get it, some people get it less well. And I think when talking with the public about public health things, Americans are generally very reasonable people. And when you tell them the truth, the vast majority of people will really consider what you're saying to them, as long as they understand that you are motivated by their best interests, not by yours. And I think in the, yeah, let me just finish. I think in the public sphere now, know, it's, you know, when I look at somebody speaking, I'm often wondering about whose interests are they benefiting, mine or theirs.

Mm-hmm.

So I have to quit, I'm No, no, sure.

I have a question, staying with the trust, I want to get to something else. To me, it was the heart of what I want to talk to you about, we talked about today, but let's just finish up on the trust. And I've mentioned this before. I have a question. So you have a patient who has a, let's say a very serious medical condition and you've done everything you can and they're not about to leave this earth immediately, but this is going to be a problem going forward. And I'm sure they said to you, okay, what do I tell my children or what do I tell my significant other or whatever? And My feeling, and I'll tell you, has always been, I would always say to patients, tell them the truth, because if you don't tell them the truth now, they're never going to believe you're going forward. Have you had that similar situation? What do you tell patients about how to communicate the severity of their illness to their loved ones?

I actually, I actually often tell them, and there are a couple of components of it. first of all, for people who have a serious illness, but which can be treated. And let's say I tell somebody that they need open heart surgery, to fix their heart. I tell them that if I'm telling, if I'm giving them a path towards recovery, even if it's not the path that they were hoping for, I'm not giving them bad news. I'm telling them they have a problem and this is how we're going to fix it. And that's how they should talk to the family about it. And you know, for, people with maybe problems that can't be fixed, they can often be, you know, they, there is often treatment to help them feel better and live longer. And that provides hope. Right. You give people hope and hope if not for a cure, for a better quality of life for as long as possible. and from people and care from people who do care about them. So I think that the most important thing in, in, in circumstances, as you described Mark is giving people hope. And even, even with a, with a dire, diagnosis, there's often a little bit of hope. have a really, really close friend that you know, Mark, was told. long time ago, you she was suffering from a form of cancer and she'd been in the hospital for many weeks and looked like she could die. When she asked her, her oncologist, have you ever seen anyone survive from where I am right now? and he said one person.

Who knows if that was even true, but he said one person and that was all she needed. And, and, know, her, her hope when she was, you know, stricken with this illness, you know, many years ago was to see her oldest daughter go on her first date and her oldest daughter now is about to have her second child. So I believe in the power of hope. think it's powerful.

You know, it's interesting you say that, because one thing that we different John does a lot of acute care. He's little like I said, he's saving people's lives every week. It's no exaggeration. We're going to get into that in a minute, because that's really to me what he brings a point of view that's so interesting. just to get just to finish up on that, I had a practice where I saw a lot of people with cancer. Right. And I would diagnose people at their very first instant. Right. They came in to the office and they were fine or what they weren't fine. They were concerned. But they left knowing that their life would be permanently altered in one way the other. And I always said the same thing. I always felt my job, who's the first doctor that's going to give him the news. And I wasn't going to treat them, but I was just giving them the diagnosis. We used to say, everything is treatable. There's nothing that's not treatable anymore. There's all kinds of stuff out there. Let's just focus on the first thing. We're going to make your appointment to see the surgeon, the oncologist, whoever it's going to be. We're going to do that together. And I would literally pick up the phone. You can't do this anymore, by the way. It's almost impossible. But I would pick up the phone and I would call the surgeon or the oncologist myself right there in the office. And I wouldn't let that patient leave till we had that appointment because then they have something to grasp onto, right? If you just people say, you have cancer, you know, go find the doctor. That's cruel. That's just cruel. So, right. You know what I mean, right? Anyway, enough of that. want I love listening to you, but I want to turn if it's okay with you, Enid, to to what John does every day and what he gets. Yes. Because you can't get doctors on the phone. It's nearly impossible. It's so hard.

Yeah.

Yeah, yeah, I just want one quick question. Why can't you do that anymore? Wait.

Why can't you do that anymore? You said...

goodness.

You can't. mean, people don't answer the phone. The doctors aren't available. They're all super busy. I won't say it's impossible, but it is super duper difficult. Right. It's really, really hard. You know, doesn't mean you don't try, but I've had...

Yeah, that gets back to trust. Okay, just rest my case. It gets back to trust. Yeah.

Well, it's just it's a problem with the system, but I don't want to get that. I don't want to go. I want to hear John. so, you know, as I said before, Joe, you know, Dr. Reiner is an interventional cardiologist. And what does he do every single week? He he sees a lot of people with acute heart attacks often in the middle of the night.

Yeah.

and he saves their lives or at least prolongs their lives. And this is a dramatic thing he does all the time. So I want to talk about what you actually do and when you do it and that you're not saying you don't have bankers hours and what you do and what it means to you personally, what you've told me about what you get out of doing this. So explain to the people who are listening what I'm talking about, what you're doing and what it means to you and why you do it.

Yeah, so I'm a kind of a trauma doc for the heart. And when someone has a heart attack, heart attacks are typically caused by a blockage in the supply of blood in one of the coronary arteries, which causes heart muscle to start to die. And untreated, it has a very substantial acute mortality rate. And people often, when they present with a heart attack, have this kind of pre-morbid panic. There's something about your heart losing function that brain understands is a big deal. And the most satisfying thing I do, which is also the most arduous thing I do, is I take care of people with acute heart attacks, what we call acute myocardial infarctions, acute MIs. And that happens, that doesn't respect, you know, banker's hours. That happens. at all hours of the day and night. In fact, in this past week, I was in the hospital at midnight on Monday night and Thursday night, I was there until three o'clock in the morning. And it's the most satisfying thing I do because when you restore blood flow in these arteries, and typically I do it through a puncture in the wrist, we thread these thin catheters and balloons up to the arteries and then implant metallic stents, are like mini scaffolds to prop the artery open and restore blood flow. Patients typically get better very, very quickly. And so quickly that they, when they enter the room, they're afraid they're going to die because they might. And when they leave the room, sometimes they ask if they need to spend the night, can they just go home? because they feel so much better. Mark once told me that I was addicted to the gratitude. I think of this all the time, because it kind of haunts me a little bit. And I think that's true. I'm a little bit addicted to the gratitude. But it's incredibly relevant thing. It's the most relevant thing I do is take care of the people who are having cardiac.

cardiac emergency. So, and it's the most irreducible part of what I do. There are, you know, cardiologists who do what I do and they at some point in their career, they just stopped doing the procedures and then they do just office work. I don't know if I'm ever gonna be able to do that. I'm wondering if when I stop doing these procedures, whether I'm just gonna have to quit because it's the core of what I do.

So.

So we talk about this. This is why I was so glad that you agreed to do this with us, because we talk every week about purpose and how our purpose is, at least in my view, to make this evolution from selfish to selfless, from inward focus to outward focus, turn the camera from the selfie outward. And we often talk about how that is the most gratifying thing you can do. When you can help somebody else, that's where the joy comes in. It has been, I think I've told you this and our listeners all know she's been feeding the hungry of all ages for mostly elderly for many, many, many, many years as CEO of Meals on Wheels now has another foundation. called the National Foundation to End Senior Hunger, which she started and is the CEO. And so she's been focusing on helping people. And she not only does it on a macro level, she does this on a very personal level with people who, and I won't go into your personal life, but. Believe me, she takes this into a very personal level, which she cares for people directly in addition to doing this stuff. So you two of you are the emblematic, are the role models, the poster children of... A, taking care of other people in one way or another, but understanding what you just said, that doing so is an addiction. When I said that it's addiction, of course, you know I wasn't insulting you. I was admiring you because I have such great admiration for the both of you because you do very similar things. You spend your lives literally in one way or another saving lives, extending lives, improving lives, and you both keep doing it because you realize that's where the joy comes from.

So, you know, just let's talk about that a little bit more.

I appreciate that. I appreciate that. One of the things I like most about it, other than just sort of the wonderful clinical effect it has on people right away, is that almost every patient I treat who's having a heart attack is anonymous. These aren't typically people I'm following in the clinic, although then they might come back and follow me afterwards. But people who come in for these cardiac emergencies are 95 % of the time new to me. I know nothing about them. I don't know if they I don't know, you know people link me with you know with with prominent patients, but I have this incredibly diverse diverse practice and my The the times I come in in the middle of the night more on weekends. I Don't know anything about these people. I don't know what they do for a living I don't know if they're here legally or illegally or whether they have insurance I don't care. And I don't care. there's, it's, it's pure medicine. I don't know. I have no idea if they have insurance. I never ask. It doesn't matter to me. It doesn't matter to me. We're there and it's just not me. When I come in at night, there are about a half dozen other people come in, know, docs, nurses and technologists come in to also do the procedure. So you think about it. You present. because you're in trouble. And literally the emergency room pushes the panic button. It's not really panicking, but you get my point. But, and they activate this pathway and a half dozen strangers come in to take care of you. And if that's not an act of love, I don't know what the definition of love is. Mark and I have spoken about this so many times and Mark basically has dedicated his life now to trying to to fix this problem, but the problem in the last decade is that this country has become bifurcated. And I've always wanted to live in a place where it's just us. in this sort of microcosm, in this just sort of micro environment of the hospital and cardiac emergencies and

The place I do these procedures is called the cath lab. In that environment, there is no us versus them. It's only us. And we act as a community. So I hear a little bit of an echo, by the way.

community. So, I hear a little bit of echo by the way. Yeah, think that's my fault but I'm not exactly sure why. I don't know exactly what happened but something happened.

Okay, that's okay.

think it is, yeah.

And anyway, I love this because it's, it's, it's what I wanted to do when I was a medical student. wanted just to take care of people and, without any of the baggage associated with insurance and, and who could pay and, none of, none of this nonsense, no, no bureaucracy. This is just, it's just pure care and I love it dearly.

Well, I must say, I'm going to... Can I just say one thing, Mark?

You know, it's obvious to me, I mean, we spend a lot of time together. It's obvious to me. anything you want, of course.

I just want to say one thing. I've fallen in love with this man. There's no question about that. But I want to go back to this podcast is all about relieving. That's all right. I'll tell her, you know, whatever. Get a number. But we talk on this podcast about relieving stress. And I can't think of anything more stressful than what you both do for a living. Dr. Ryan, how do you relieve stress? There's got to be stress.

I'll have to report that to his wife, by the way.

Tell me how you, on a personal level, relieve the stress. When somebody's called me to the hospital to save somebody's life in the middle of the night, you've got to be in the most stressful situation that anybody could be in. What do you do to relieve your stress?

I don't think it's that stressful. When you understand the components of something that you have to do and you have control over a lot of the components, that's not that stressful. It's high stakes, but not necessarily stressful. You focus on the job at hand. And the other thing is, particularly at night in these emergency cases, where you don't really know a lot about the patient. To be honest, I'm not saddled with understanding the backstory. In fact, I don't wanna know the backstory. I don't wanna know who's waiting in the waiting room. I don't wanna know how many kids or grandkids they have. That actually becomes stressful to me. In fact, I almost need to make the patient disappear. There are baseball pitchers that talk about making the crowds, crowd noise disappear and then just focusing on the catcher. And I think at least I try and make almost the patient disappear and I'm focusing on the problem. And so that's how I go about it. And the more I know about the patient, the more stressful it is. Years ago, I tell the story of years ago during Cherry blossom festival a patient this was visiting Washington as a chaperone for her middle school Daughters, you know spring break visit to DC and She was a nurse the patient was a nurse in her Like early 50s, maybe late 40s early 50s and she had a heart attack while while visiting DC with the middle school class and her your 14 year old daughter in the waiting room. And I knew that she had a 14 year old daughter waiting in the waiting room. And that haunted me in my head when, you know, when she actually had a cardiac arrest during, during the procedure and I could not get that out of my head. And I needed, I needed that voice that, and that dread of potentially having to walk out and tell this kid,

that her mom was dead when she did not die. So I like doing these high risk procedures with sort of minimal data about the back story. I want to learn all of it afterwards. And then there is typically a point in the procedure where things sort of are under control and you're moving in the right direction that if the patient is awake, I'll start asking them questions about what they do. And it also helps to relax them. If I'm talking about what they do for a living, they must instinctively understand that I'm not so worried about them anymore. So, yeah.

You know, let me interrupt for one second, John, let me do it for one second, because I want to just explain when John says he's not stressed, the reason there are a couple of reasons he's not stressed. One is he's a superstar at this. He's seen everything. He knows what he's doing. He's shaking his head. But when you have that and it is a superstar, don't listen to him. Remember, I'm a doctor, right? So I've seen a lot of I've seen a lot of doctors.

No, no. I've been doing it a long time. I've just been doing it a long time. There are thousands of people who do what I do.

In fact, his wife and I always joke that when we're together when he's gotten called in, and his wife and I always look at each other, this is that person, the person who's going to be treated by Dr. Jonathan Reiner with an acute heart attack right now. It might seem like it's their worst day. It's their luckiest day that he's on call. He's the one that's going to do it. So, you know, that's a part that I only say that because...

very kind bar.

It's not true of every doctor. Lots of doctors have a lot of stress when they do procedures. But when you're really, really great at it, and you've been doing it a long time, and not only doing it long time, you can do something a long time and do it and not do it well. So that's understating. It's a combination of his incredible concern for his patient, his caring, his commitment to trust, his commitment to doing it the right way, coupled with a hell of a lot of skill. That's what does it. He hears me tell him this all the time. I'm not saying this just because we're on a podcast. He hears me. I tell him this all the time. It's that combination that makes it special. But really what is the most amazing thing to me to watch him is that I know he's not going to quit coming in in the middle of the night for a very long time. Because of this, because he like you, Enid, he found the secret sauce. That's where the joy comes from. Yeah, you might be tired and... I always worry about him that he's working too hard. tell him that all the time, go get some rest, because I am concerned about him and his health. But I understand what we've talked about all the time, what he knows, that the joy comes from... from helping other people and God to do it on that level is fantastic. I will tell you one last thing. He has seen a lot of famous people, right? And I, in my practice over the years, have seen a lot of famous people. And I, although I always enjoyed meeting these people, the vast majority of our practice, both of our practices was regular people, normal, regular people. But you get the sprinkling of these very famous people. So my feeling was, okay, you know, I'm seeing this very famous person, but... you know, the only thing that could happen is that nobody ever knows about it or I end up on the front page of the Washington Post. So that's the danger of taking care of these famous people. he's never, Dr. Ryan never blinks an eye. I don't think it ever bothers him like it did create a bit of concern to me if I, my God, I hope I don't make a mistake here. But I don't think he ever has that go through his head, but it's an interesting phenomenon.

yeah, that all goes through my head. think when you care for someone with a public persona, the best thing any doctor can do is not to treat them like a person with a public persona, to treat them like just the regular Joe on the street. And I think when you try and treat someone in a quote special way, you're biasing their care in a negative way. So I think the best thing you can do is to tell a patient that you're just going to treat them the way you treat everybody. But I want to go back to this idea of community. Can I go back to this idea of community? Because this is what really bothered me during the pandemic. That you would think that in a time of national peril,

Please, please.

Yeah, anything you want.

we could come together as one. The way this country did after Pearl Harbor, or in those moments after the attack on 9-11, where we all felt like we were part of one country. during the pandemic, Healthcare workers in the United States went to work while everyone else was sort of at home zooming for work. Not everyone. If you were fortunate and you had the kind of work that could do that, you stayed safely at home and you Instacarted your food and Amazon what you needed. But healthcare workers went into hospitals every single day. Before we had vaccines, when healthcare workers were getting infected and dying, healthcare workers went into hospitals every day. And I, I was sad to see that the country sort of ignored that kind of, that kind of sacrifice. And when, and when people in this country were asked to do very modest things to promote the pub public health, there was great, great, great division. So. I want to see going forward ways that we can try and

Use these common things to bring to to to promote unity rather rather than division Find find things in this country that we all should agree on you mark and I talk about this There have to be things that we all agree on and and let's start there Let's start there and I think about it because when I look I think about this every day because when I look at my team You know, my team is is white and black and and muslim and jew and and and Christian and gay and straight. And it represents America. So when we're taking care of somebody who's really sick, it's the entire community coming forward to do that. And if more people understood that this actually happens, then I think they would look for ways in their own life to come together to do sort of random acts of goodness, random acts of that demonstrate that they live in a community, that they don't live in a silo. And I love this podcast that you're doing because I think that's what you're trying to show.

You know, John, would just say one, I thank you very much. And I completely agree with you. You know, in my practice, which is across the street from where John works. I would say, you we live in Washington, DC. you know, when I, when we came into this city, when I came here, it was 80 % black, 20 % white. That number has kind of evened out a bit, but almost everybody I worked with was black. Most of the patients, half the patients were black and the other were like famous people we talk about. So, but when you work with people and you spend time with people, then you don't see any of these divisions. Just what John is talking about, just Dr. Reiner was saying, you don't see it, it's your team, right? You don't look at your team and go, there's a black guy there and a white woman there and an Asian. You don't see that. They're just your team. They're your people. And you will get very close. you know, John loves his staff, the people he works with, loves them. We do anything for them. I felt the exact same way, still do. So the problem in this country is we don't spend time together. We don't mix it up. You're now people more and more working at home and people are on their phones and on their computers and on the tablets. We don't spend enough time together. You know, one of the things this is a complete digression. nothing but but I think about this all the time we need to make people when they're 18 years old join together in some group either it's the military or some other public service or public health whatever And it's a good thing for the country, but the best thing is it gets you to go, oh, well, I thought those people were terrible, but he's a great guy. She's delightful. And, you know, when you spend time with people, realize all these identity divisions, you we've talked about division by identity, they all go away. Once you work with people like Dr. Rhonda does in the hospital, hospitals are, you get really close in hospital because you're on the fire. It's tough. It's stressful. And you don't see those divisions anymore. And that's what we need in this country. So it's a little digression, but I just wanted to follow up on what Dr. Rhonda was saying.

You know, Enid, I'm so impressed with how you've spent your life in terms of dealing with food insecurity in this country. And what we should really be doing is we should be taking high school kids to work in food pantries and to show them the impact of working as a community to help people. Only once or twice a year, our Heart Institute has gone to maybe Food and Friends in DC and packed a thousand lunches or thousand dinners over morning. it simultaneously makes me feel wonderful and makes me feel guilty. And it makes me feel guilty because we waltz in you know, in morning feeling like we're doing great. But, you know, that's, you know, once a year or twice a year, you know, we're visiting the place. And I think in no small part we're doing it because it makes us feel good.

Right, exactly. That's okay.

Whereas, well, it's, yeah, but it's, there's a little bit of a selfish, guilty component.

That's OK.

But that's the thing about what you put. Here's what you said. Why do you do? Why do you do what you do? You addicted to gratitude. It's it's it's fine. It's great. I think this is why to me this is an inborn trait of humans. We know that this is the reason we're here because we feel the best when we do these things. You know, I wouldn't worry about how many lunches you pack. You're saving hundreds of lives every year. mean, you don't have to worry about lunches. Enid's got the lunches, right? What you're doing, she can't do so.

No, no, no. What I'm saying is we're looking for ways to impact the community. I take care of people one at a time. It's a transaction almost. I take care of people one at a time. And I keep searching for ways to impact more than one person at a time. Years ago, we raised a lot of money very quickly to supply defibrillators around... DC, Maryland, Virginia, know, defibrillators are sort of this key, key step in saving somebody who's had an out of hospital cardiac arrest. And I realized that in the, you know, federal city where I work, it's fairly easy to find an AED in a building. They're ubiquitous, but in the rest of the city, in the less fortunate part of the city, in the poor part of the city, it would be very difficult to find an AED. So we, we started giving them away and we gave them away to churches. you know, mostly black churches around the city. gave, we gave a deed to salvation devices to the Salvation Army. We provided them for all the libraries and the, uh, VFW posts and the full and boys and girls clubs. And we, we did that because we thought it was one way to try and do good on it, on a, on a bigger, bigger level. And when I. When I talk to some of my younger colleagues and residents and medical students and residents and fellows, I'm trying to get them to think not just about medicine as a transaction, taking care of a patient, you you're generating revenue and what we call relative value units, which is how medicine is paid for the dirt, the dirty little secret of medicine. Everything you do has a monetary value. I'm trying to get them to think a little bit bigger and How can you impact your community other than in just the number of patients you see every day? And I think if we take that message outside of medicine and we take it into everything that people do in their lives, how can you do something else that impacts your community? I think we build a different place. And it's an apolitical place. It's an apolitical place.

If you help drive somebody to an appointment, it doesn't matter if you have the same political point of view. If you're delivering meals to them, it doesn't matter if you have a different political view. And in my world, if you're taking care of people in the middle of the night, it doesn't matter what they feel about social issues. I don't know how we teach that, but I'm still trying.

Well, you know, we're all trying and that's, know, why are we doing this podcast, you know, and for that exact reason, to try and get us to a point where, you know, I have a friend of mine who's a, he raises, he's a great guy, he raises tons of money for one of the political parties, I won't mention which one. I'll just say, but you guys would like having lunch with him, so we'll leave it at that. But he,

I got it.

Maybe, maybe.

Yeah, no, you would, you would. he calls me Switzerland, right? Because as John knows, I have my views, but the most important thing is what he's talking about, what Dr. Reiner is talking about. got to, these very human things that to two of you.

Ha Markekleinmd (43:12.2) who I look at you two and you're just, like I said, role models for how people should live their lives. That's what gives me hope. what Dr. Ronner saying is bring us, concentrate on the things that we all have in common. The rest of it is noise, taking care of each other, caring about each other, looking out for each other. These are the things that not only are right, but they bring us joy. the two of you know that better than anybody. Taking care of others brings joy. I think we're out of time now. We have been. one of our longer episodes, certainly worthwhile. And I just want to say personally, personally, John, that I can't thank you enough for doing this. I have goosebumps listening to you. I do. And even though I talk to you all the time, for some reason in this setting, it just brings it even more home. So you're a wonderful human being and honored to be your friend. And that's how I feel about Enid also. So Enid, will let you wrap this up as always.

I know, I know.

will and I this has been go ahead yeah go ahead

before I let it unit speak, just want...

I just want to say happy birthday,

Thank you. Well, we all have birthdays, Okay, you need, the floor is yours.

Yeah, we do. As the oldest person on this podcast, I want to say that one of the reasons that I even decided to do this podcast with Mark, he convinced me, is because I thought that we're all in the same boat in many respects in that in my work in ending hunger or trying to, and hunger is a growth industry, particularly nowadays, I always thought that I was curing a disease too. And the disease is hunger. And it is a disease, but it's a disease that has a cure. unlike so many other things, we have a cure. The cure is facing us right in the mirror. We are the cure. And the one thing that I think all three of us have in common is that the one thing we know we need to do, particularly nowadays, is to have some courage. The courage of our convictions, the courage to stand up for the things in which we believe, whether it be left of center, right of center, whatever, politics, take the politics out of it and put the person back into it. And we're all doing the same thing. when Mark said that he, was friendly with you, thought, my goodness, that's somebody that I think we need to talk to. You both, to me, are my heroes. You've been saving lives for all of your lives, for all of your professional careers, and I've been standing here just watching you and marveling at the ease with which you talk about saving lives every day. Well, you do that. And I think that what you've exhibited is something that I think is lacking in so many people, and that's the courage to stand up for what we believe in, to stand back. Take a few breaths and say, know what? We can do this if we work together. And I want to thank both of you for doing what you do and for being on this podcast today. I thank you. You're lucky, Mark. He's your friend. You know what? Now you're my friend too. I thank you both. I wish you the best of Thanksgiving holidays. I know you're spending Thanksgiving together and that's wonderful because it's a friends giving and I think that's important. I thank you both. Mark, it's your, I always give you the last word. It's yours.

Yeah, well, you you're my hero, Enid, for what you've done. So John and I will say, well, medicine is easy, right? Honestly, what you do is quite, I have done, continue to do is quite impressive. But anyway, both of you, I love you both. I can't thank you enough. It's been a wonderful, wonderful, it's been a joy for me to do this. Actually, I knew it was gonna be great, but it even exceeded my expectations. So thanks a million, John, and thank you as always, Enid, and thank everybody for listening. We'll see you next time.

Thanks for the opportunity.

Peace.