{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/s17sn02d89/manifest","type":"Manifest","label":{"en":["Dr. Drew Miller"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2021-03-24 (created)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Subject"]},"value":{"en":["Covid-19 (topical term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["Kansas","Kearney County","health officer","Tyson meat packing plant","Vapotherm","N95","family medicine","PPE","telemedicine"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/198/981/small/DrewMiller%283-24-21%29.mp4_1689793405.jpg?1689793405","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100625/file/198981","type":"Canvas","label":{"en":["Media File 1 of 1 - Drew_Miller_(3-24-21).mp4"]},"duration":2048.28,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/198/981/small/DrewMiller%283-24-21%29.mp4_1689793405.jpg?1689793405","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100625/file/198981/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100625/file/198981/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/198/981/original/Drew_Miller_%283-24-21%29.mp4?1689793404","type":"Video","format":"video/mp4","duration":2048.28,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100625/file/198981","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100625/file/198981/transcript/46428","type":"AnnotationPage","label":{"en":["Transcript of Dr. Drew Miller interview [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100625/file/198981/transcript/46428/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Morgan Weiler: All right, just hit Record. I'm going to have you start with giving your full name, and then you can also give your title, please.\n\nDrew Miller: Okay. Drew Miller, MD. Let me start over. I'm still out of breath from running back over here.\n\nMorgan Weiler: It's okay.\n\nDrew Miller: Drew Miller, MD, FAAFP. I'm the chief medical officer at Kearney County Hospital in Lincoln, Kansas, and also the Kearney County health officer.\n\nMorgan Weiler: Great. Then where did you attend medical school?\n\nDrew Miller: I attended med school at University of Kansas in Kansas City.\n\nMorgan Weiler: Then where did you complete residency?\n\nDrew Miller: I completed my residency at Via Christi Family Medicine residency in Wichita, Kansas.\n\nMorgan Weiler: Great. Can you speak a little bit about your current position and what you do on a daily basis?\n\nDrew Miller: Sure. I'm one of five family physicians here at a critical access hospital, that is Kearney County Hospital. We cover the hospital and the clinic, which is a rural health clinic. All five of us do obstetrics with operative obstetrics, so we do our own C-sections. Two of us also do endoscopy. It's definitely full-scope rural family medicine.\n\nMorgan Weiler: Yeah. Can you speak a little bit about your position as the health officer?\n\nDrew Miller: Yeah. I became the county health officer last April, certainly after the pandemic had started. We had a health officer previously, and just as timing had it, that transitioned right after the pandemic started. As it was, I was not familiar with the health officer role until after the pandemic started. I think somebody said, \"Hey, I think we need some more help with this COVID-19 stuff. Would you be willing to jump in and be the health officer?\"\n\nDrew Miller: Early on, my role was just answering a lot of questions about COVID-19. Before that, we had our county health nurse and our emergency department manager who were helping make the decisions, the early decisions about COVID-19 management, and they were getting a lot of pushback from the community. It was felt like if I jumped in, the voice of a physician ... and I've been here 10 years, so one that had been here for a while ... it would maybe help stabilize the process.\n\nDrew Miller: Early on, it was just giving support to the decisions that the county health nurse and the emergency department manager had already made. The role as a county health officer in this past year has been some policy and regulation setting, because during a pandemic we have some authority to make some guidelines and resolutions, but mostly it's just been about education.\n\nDrew Miller: I've written an article for the paper. Not every week, but most weeks over this past year I wrote an article, a quick article of where we're at with regards to COVID-19 and what our recommendations are. Early on it was like how the infections are ramping up around and where we're at from a hospitalization standpoint.\n\nDrew Miller: Then when it was in our peaks, it was trying to explain to people why we had such significant restrictions in place, to help them understand. Then late in this process, it's been vaccine education and encouraging people to get vaccinated. Those articles were also published on some of the social media websites, around the county health social media site and the emergency management site and the hospital site.\n\nMorgan Weiler: Do you think, by being transparent and giving an article every week, that helped the pushback a little bit?\n\nDrew Miller: I think it helped. I got random messages or phone calls or people would pass things along from people not from the county even, and they would say, \"Oh, yeah, I've been reading your articles every week,\" because they get the Lincoln Independent paper for whatever reason. \"I've been reading your articles every week and I love reading them,\" and plenty of people in the county and the community said, \"We really just appreciate the education. We don't know what to believe, what not to believe. It's helpful to have a trusted source giving consistent information.\"\n\nDrew Miller: In the paper and on our websites we'd also publish our data, so current active cases and percent positivity and number of hospitalizations and things like that. It did not completely eliminate the pushback by any means, but I think it helped to have consistent and honest communication. It helped.\n\nMorgan Weiler: We're a year out, but early on during the COVID-19 pandemic, how did that affect your work? Then if you want to talk about the progression over the last year.\n\nDrew Miller: It completely turned my work and my job upside down. I can remember early on, because some of us were gone for spring break. After we came back from spring break, school got canceled, businesses are shutting down. The governor put in lots of restrictions and the stay-at-home order. The first thing we did was our clinic has an overflow building. It's a FEMA trailer basically, that as we grew in physicians and providers, we moved some providers out here to the FEMA trailer just to have enough clinic space and clinic rooms.\n\nDrew Miller: We turned this FEMA trailer, which has 12 exam rooms, into our COVID testing area. We moved all our wellness stuff that we were trying to continue to do into our main clinic, and our sick clinic, we called it, came out here. At first, because we didn't really understand real well about exposure and transmission, we didn't want our physicians and providers that were exposed to COVID to be seeing our healthy patients, in an attempt to keep our healthy visits healthy.\n\nDrew Miller: We just had two providers, one physician, one PA, who started doing all the COVID evaluations early on, and that got too busy pretty quickly. Then we added another PA and then another physician. That was myself, so I was the fourth one to join the COVID team, we called it. Our COVID team, really we stopped doing all our regular patient visits, and we just did COVID evaluations and testing and follow-up.\n\nDrew Miller: I do OB, but for a couple of months I stopped doing all of my OB. Again, in hindsight it looks like overkill, but at the time we just weren't sure what our exposure risk and what the transmission risk was for the patients. Then we just turned this trailer into our COVID trailer. We had plastic sheets hung up, and we did all our COVID evaluations behind these plastic sheets.\n\nDrew Miller: We did a lot of telemed visits early on, telemed follow-ups as far as our COVID. We would test everybody for COVID, and then we'd give them a telemed call and follow up with the results. Then if they were positive, we did another telemed visit within three to five days to make sure they were doing better, see how they were doing. Then if they were sick or we were concerned about them, then we'd have them come in for an in-person evaluation and then checking their vitals, things like that. For probably three months we've functioned in that way with two separate teams, our wellness team doing all the other stuff, and then the COVID team doing all the COVID evaluations.\n\nDrew Miller: As we learned more about transmission and that it was respiratory transmission, the contact transmission was becoming less and less of a big deal. Also just the psyche of those four COVID providers, it was just hard to stay amped up on COVID all the time. We began to reintegrate our team. We eventually got to where all of our providers, five physicians, five mid-levels, were taking turns seeing COVID patients, but we have continued even 'til now to do all of our sick visits in this FEMA trailer outbuilding, so to speak.\n\nDrew Miller: One of the things, a really good thing that came out of it, is that we changed our acute care visit process and our triage process. Basically, you don't have to talk to a nurse now to get scheduled on our acute care visit. We just have more available visits. The patient calls and they're sick, whether it's COVID symptoms or not, they just get put on the schedule and evaluated by a provider. It's turned it more into an urgent care type clinic, and we just, all providers, rotate through covering that.\n\nDrew Miller: Back to COVID, though, our first hospitalized patient was a worker at Tyson, the Tyson meat packing plant, a Hispanic 50-some-year-old male, and he came in. He was sick, sick enough to be on oxygen, but he really didn't progress very much. We had him in the hospital for three to four days and send him home, but it was just it was like flying blind as far as trying to treat more severe COVID illness, without having much information.\n\nDrew Miller: Our next one was a much more sick patient. I called over to the ICU, the intensivist physician. It was a locums intensivist physician at St. Catherine's Hospital in Garden City, but that really helped to form a good relationship with the intensivists over there. They're 30 miles east of us. They really helped us to start developing our protocols for how to treat COVID-19 inpatients.\n\nDrew Miller: We realized very quickly that the more that we could do with these patients here and keep from having to transfer them, the less likely they were to be intubated and the less likely we'd risk them de-stabilizing while we transferred them. We developed a protocol, and really tried to keep our COVID inpatients in the hospital here in Lincoln as much as we could. For quite a while, again, it was just those four COVID providers that were seeing all of our COVID inpatients. We had a lot of learning as far as respiratory care in those early months.\n\nDrew Miller: Also, we first went from nasal cannula to BiPAP, and then we found that other places were having good success with heated high-flow oxygen, so a foundation called the Patterson Foundation gave us a pretty substantial gift which allowed us to purchase a couple of Vapotherms, which is heated high-flow oxygen, and a couple of ventilators. We had just more respiratory equipment available to take care of these patients as we tried to keep them here.\n\nDrew Miller: Let's see, what else. Another thing probably that's worth mentioning right here is we live 10 miles west of a meat packing plant, the Tyson meat packing plant, which is a huge employer. They're across the county line so they're actually in Finney County, but we see a lot of their patients. Early on, it was so much to do with the Tyson meat packing plant.\n\nDrew Miller: We took a couple of trips over there to talk to their administration as far as what kind of interventions they were doing and how we could best test their employees, or symptom-screen their employees and see the ones that were sick. Then there was a lot of positives in the meat packing plant early. There was a lot of conversation about how long they need to be off and making sure they were supported and paid when they were off work.\n\nDrew Miller: Part of what happened, there's a large Somali population that works at Tyson, and there's even more nationalities than that but the Somali population we were really involved with, and they had a really hard time coming over to be tested in Lincoln at our hospital. We did a couple of days where we did outreach visits in their neighborhoods.\n\nDrew Miller: We set up shop in their apartment management building, and we had two nurses and two providers over there. Then we had interpreters, and the interpreters were literally just going door to door saying, \"Are you feeling okay? Do you have symptoms? If you have symptoms, we're doing testing over here. Come on over and we'll test you.\" That was wild. I mean, it felt like international medicine in a way, doing outreach visits in the neighborhood apartment complex.\n\nMorgan Weiler: Interesting. You've answered a lot of my questions, which is really good. Earlier you mentioned, when you had those four providers giving care in your COVID clinic, that it took a toll on all of you. Can you talk about that work-life balance, with COVID and then your clinic?\n\nDrew Miller: Yeah. It was really challenging. We talked about decision-making fatigue a lot, because it felt like, early on especially, we were making decisions that felt heavy and had profound impact, and they were all the time. You're trying to decide. When we were limited on our tests, we were trying to decide who had and who didn't have COVID by their symptoms, and who to test and who not to test. As we know now, COVID has a huge variety of presentations. I'm sure we missed some early on in that process, but it was always trying to figure out who to test, who not to test.\n\nDrew Miller: We were really limited in our PPE, so we were trying to conserve PPE. We had people making gowns out of cloth, and sending them to us or mailing them to us so we didn't run out of gowns, and reusing our N95s. It just felt like every decision was hard. We didn't have what we needed to test. Then there was phone calls for calling people back with results. It was just long days.\n\nDrew Miller: The work-life balance was nonexistent for awhile, I would say. My family would probably confirm that also. Then on top of that, there was questions from the community. There was questions from community members, from commissioners, from school board members, from all kinds of people, on top of that also.\n\nMorgan Weiler: Yeah. What out of COVID do you think will be permanent?\n\nDrew Miller: I mentioned a little bit. For us personally, the way we handle our acute clinic will never be the same. Before, we had one provider and they had very limited slots. They usually had some of their other chronic patient management or their continuity patients on their schedule too. All the calls had to go through a nurse, and then the nurse decided whether that patient needed to be seen or could be handled over the phone.\n\nDrew Miller: We have pretty much stuck with a much more wide-open acute care schedule, close to a walk-in schedule. It's not really walk-in, patients still have to call, but all they do is call and say they don't feel good, and they get put on the schedule. There's a lot of slots available between two providers, and nobody addresses any continuity things or chronic care things during those visits. That has cut down on our call volume, number one, our phone call volume. It's actually helped cut down on our ER volume as well, we've noticed, as it keeps those mild cases out of the ER better, so that will stay.\n\nDrew Miller: Masks in patient care settings are here to stay, I think, at least as far as sick visits go. It might not be forever with wellness visits and OB visits and stuff like that, but with sick visits, I think masks with the providers are here to stay, nurses and providers, is here to stay. Just more attention to droplet transmission and illness transmission, I think is also here to stay, and I mean that in the best of ways. Hopefully hand washing skills and cleaning skills, and just being cognizant of the way we can transmit illnesses to one another. That's my things I think of right off the bat, anyway.\n\nMorgan Weiler: Yeah. I'm a student. I have a couple of questions about students and residents. How do you see COVID-19 impacting the learning of students and residents in family medicine?\n\nDrew Miller: As you are very well aware, it had a huge impact on learning over the past year. I think that was really challenging for us. We have a lot of students that come out here, and how do we teach students while keeping them safe in the schools? The medical schools had their own guidelines as far as what the students could and could not do.\n\nDrew Miller: I remember early on, I had a student in maybe May, something like that, May or June, and she came out here. She did a great job. She just sat here and watched me do telemedicine visits. We had lots of great talks. I mean, I think it was still more valuable learning than not, than just in a classroom, but it was definitely different than, \"Hey, you go see this patient first, and then come tell me about this person.\"\n\nDrew Miller: We have had students recently again. I think it's getting back to more where almost all of our visits are in person now, or at least the vast majority, where a student can go in first and see them and give a presentation, and much more hands-on again. There was a huge impact in this past year. I hope that the longer-term impact for students and their learning is not significant.\n\nMorgan Weiler: Yeah. Looking back, is there anything you would've done differently?\n\nDrew Miller: Of course. Our major joke is that ... and we even made a YouTube video one time of the four of us talking through how the guidelines had changed. It was a parody, and I'm sure you've seen variations of it, but joking about we say one thing, but really we're saying another thing. Then we're going to say another thing, and then we're going to say another thing. In looking back, as we learned as we went, I don't think there's any way to not do that.\n\nDrew Miller: I do think that our community shut down too soon, because as we saw our community shut down in March, April and May, our case volume was high there because of Tyson and the meat packing epidemic. Then we had a pretty low-volume summer, and then our fall was really where our caseload went up more diffusely.\n\nDrew Miller: In hindsight, I wish we had not shut down so early and closed things up so severely so early, because when we really needed things really tightened up and slowed down, people were tired and grumpy and it took lots more explanation. We got there, but I think we could've gotten there easier if we had not worn them out already. In hindsight, I wish we would've done that. We didn't realize that it was going to take time for significant infection to come this way.\n\nDrew Miller: I would not have split up our team if we did it again, because it was really hard to reintegrate everybody back together. I lost some of my continuity patients, just because they were frustrated they couldn't see me for three months. I missed OB deliveries, and I like doing OB, and I wish I hadn't missed that. Then it was just hard to reintegrate our team together. Our COVID team, our COVID four people, became a really tight-knit group of providers, but it was a bit hard to reintegrate everybody into that. I loved the fact that we had a different building that we could do our acute and our sick visits. I would not do that part any different than I had.\n\nDrew Miller: I think in hindsight ... and we haven't had a COVID inpatient here for a couple of months probably now ... but I would have even worked harder to keep patients here without transferring them. Because what we found is that when you transfer patients, they're so hypoxic and so living on a fine line of being able to oxygenate adequately that when you transfer them, move them around, their oxygenation goes down, and they are so unstable and fragile. It's hard. I felt like we were better off just maintaining a tolerable hypoxia here than transferring them and risking destabilizing them in the meantime.\n\nMorgan Weiler: Yeah. I just have two more questions. This one is my favorite. Where do you see family medicine going in the future?\n\nDrew Miller: I loved family medicine in this past year. The thing I loved about it was, as a family medicine physician, with respect to COVID, I walked through every part of COVID with these patients. We did this symptom evaluation, the testing, the calling of the results, the management of mild COVID symptoms at home, talking them through what they could take, what they didn't need to take, how long did they needed to isolate, how long they needed to quarantine.\n\nDrew Miller: We did that, and then when they were admitted to the hospital, then I got to take care of them in the hospital. I knew who in their family was sick, who was mild, who was not mild, how long they'd been sick, what their symptoms were like when they were tested. Also, I knew these families for the most part anyways, and families were frustrated because they couldn't visit these hospital inpatients.\n\nDrew Miller: There was a lot of phone calls to families. \"Hey, this is how your loved one is doing today. A little bit better, a little bit worse. Oh, let's figure out how we can arrange a FaceTime visit so you can talk to them or see them a little bit, or come to the window and see them through the window for a minute.\"\n\nDrew Miller: I feel like family medicine is uniquely prepared to consider the family and the patient and the course of the illness and their ... you know, who, \"Hey, this guy is always pretty flat in his affect. I don't think he looks as bad as he is, this is just kind of his personality,\" or, \"Hey, this person is super agitated. This is way different than normal. I think this person is declining quickly. We probably need to get this person out of here,\" and then having trust with family in a time where there's lots of mistrust and misunderstanding.\n\nDrew Miller: I felt like family medicine was very uniquely positioned in this past year to help the patient volume, not just the patient volume, but help to walk the community through the pandemic. I hope, and what I am passionate about with family medicine, is that I hope that that is just able to be carried forward, not just within from a COVID-19 standpoint, but just in general, that family medicine is uniquely prepared to address all different sides of medicine and the social determinants of health, and all the nuances of these patients and their care. You hit on what I'm passionate about, for sure.\n\nMorgan Weiler: I am too. Any views on important issues in a specialty related to COVID-19 that we haven't addressed that you might wish to share?\n\nDrew Miller: Say that again? Sorry.\n\nMorgan Weiler: Pretty much any other thoughts about COVID-19 or that you want to end with.\n\nDrew Miller: Well, I do think I want to tell a story of a patient. Is that okay? Because I think it's a pretty profound story. In October of last year, we had a 37-year-old male that came in who's a son of somebody that worked at the hospital, and one of our deputies in the community. I mean, so it was a well-known family.\n\nDrew Miller: He came in febrile, short of breath, sick, quite obviously. I mean, we would have said he had COVID before we tested him, but we tested him. I gave him some outpatient. I gave him oral prednisone albuterol inhaler to treat him, try to keep him at home. We followed up with him by telemed a couple of days later, he was worse, told him to come in. He was hypoxic when he came in, so we admitted him to the hospital.\n\nDrew Miller: By that time we had remdesivir and we were using dexamethasone on everybody. We did our standard inpatient therapies, and he continued to progress. I think he was in our hospital for nine days. He progressed from nasal cannula to heated high-flow oxygen to BiPAP. We maxed him out on BiPAP settings, and he just continued to worsen.\n\nDrew Miller: I remember his ABGs were really profound, because his pO2s were in the low 40s, which before COVID, we would've never even thought of sitting on somebody with a pO2 in the 40s, but he was stable, stable enough that we kept him. However, he continued to have fevers and make this stepwise decline.\n\nDrew Miller: One day I talked to him. I said, \"Hey, I think we're going to need to transfer you. We're just barely keeping up with BiPAP.\" I called all the hospitals. We called all the hospitals in the area. Nobody had an open bed short of Kansas City, which was a six-and-a-half-hour, or by air ambulance a four-hour, flight. We felt like he was unstable enough that that was not really an adequate option, so we kept him.\n\nDrew Miller: The next day he was worse. Again I said, \"Hey, I think this is even worse than yesterday. I really think we're going to have to transfer you.\" Called the hospitals, and St. Catherine's Hospital 30 miles away had a bed available. We arranged the transfer. I talked to the family, I talked to the patient, and I remember him saying, the guy that was sick, on BiPAP, said, \"Am I going to beat this thing?\" I was like, \"Yeah. Yes, you are. Let's do this.\"\n\nDrew Miller: They're a faith-based family, a strong faith-oriented family, so I prayed with him in the room and then the family on FaceTime prayed with him. Then we intubated him, because the intensivist wanted him intubated before we transferred him. In the process of intubating him, he rapidly decompensated. Just the process of taking the BiPAP off and getting him tubed, he got super hypoxic and then bradycardic, and then he coded.\n\nDrew Miller: I just remember we had three people in the room, three of our staff in the room, and we got more people in the room. We got the CRNA. The CRNA was already in the room, but we've got another nurse and another aide. Everybody jumped in and helped, and we started doing compressions and our ACLS protocol. We coded him for 45 minutes, and all during that whole time, he stayed in basically PEA. He was pulseless. We got the auto CPR thing going on him.\n\nDrew Miller: We were giving him all the meds, following protocol. His sats, from what we could see, were in the 30s. It was dire. We were about ready to call it, which at 45 minutes is longer than we would normally run a code. He was young and healthy, everybody knew him, so we're working hard at it. We finally got a very faint femoral pulse, so that re-energized us and we kept going. We got him on a drip to bring his blood pressure up, and kept adjusting his vent settings.\n\nDrew Miller: Anyway, long story short, we got a pulse back and a blood pressure back. I got a gas, and his gas ... I don't have it in front of me ... his gas was awful. I remember his pO2 was in the 30s and he was obviously very acidotic. I called the intensivist. He said, \"That gas is not compatible with life. Keep trying.\" We kept working on him, because we still had a pulse and we still had a blood pressure. We got another gas 15 minutes later, and his pO2 is coming up to in the low 40s and his acidosis was resolving a little bit. The intensivist again said, \"That's not compatible with life, but if you get it a little bit better, we'll take him.\"\n\nDrew Miller: We kept working on him another 15 to 20 minutes. We checked one more gas, and his pO2 was in the 50s now. His pCO2 had come down, his acidosis was improving. I called the intensivist again and he said, \"Okay, send him our way.\" We had this guy on multiple pressors, intubated, maxed out on vent settings. We transferred him to the hospital 25, 30 miles down the road. He was there a few days, and they then transferred him to I believe it was St. Luke's hospital in Kansas City.\n\nDrew Miller: Long story short, he eventually got a trache, was transferred to a rehab hospital but then weaned off the vent, and was discharged home six weeks later. He's a guy I still see in my clinic. He's still struggling with shortness of breath and a long impairment, but he's on room air. Trying to get his strength back, hopefully at some point trying to get back to work. I mean, it's like a near ... not near. It's a miracle that he lived, and survived a 45-minute code with no pulse and low oxygen sats that whole time.\n\nDrew Miller: I don't say that story to toot my own horn by any means, because he was super sick, but I do think family medicine had a unique part in that because we knew the patient, we knew the family. We knew these guys, we knew these people, and we were going to fight long and hard for him, which there's a lot of stories that don't have a great happy ending, but this one has a wonderful happy ending. I think it's a good story of a team effort and a very persistent and compassionate approach to a patient, that hopefully that saved his life.\n\nMorgan Weiler: Thank you for sharing that.\n\nDrew Miller: Yeah. It's my favorite.\n\nMorgan Weiler: I'm almost speechless.\n\nDrew Miller: It's my favorite story from the past year. It's just it's a fun story in the midst of some not-so-fun stories.\n\nMorgan Weiler: Well, thank you, Dr. Miller.\n\nDrew Miller: Yep.\n\nMorgan Weiler: Let me stop the recording.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100625/file/198981#t=0.0,2048.28"}]}]}]}