Death Work and Palliative Care in the Afterlife of Slavery: A Roundtable Discussion with Alua Arthur, Dr. Karla F.C. Holloway, Kelsey Henry, and Marie-Fatima Hyacinthe

March 01, 2021

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February 23, 2021

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02:20Testing,
05:17Welcome,
05:20everyone.
05:22I am Anna Reisman.
05:25I'm the director of the Program for
05:29Humanities in Medicine at the Yale
05:33School
05:39of Medicine.
06:31Currently, she sees patients as a primary care physician with the Alameda Health System Division of Ambulatory and Preventive Medicine, a regular contributor to the California Health Care Foundation blog and working on her next book projects.
06:47I met Dr.
06:53Grubbs in 2009 at a conference of
06:55policy makers,
06:57journalists,
06:59health care professionals celebrating
07:0310 years of narratives in health.
07:06She was one of the speakers.
07:11She spoke about how people of color
07:15are popular sources for harvesting organs.
07:19We'll talk about this later this afternoon.
07:23I've been a fan of her writing since then.
07:28You may have attended a roundtable in
07:302020 where Dr.
07:35Grubbs spoke on black academic medicine.
07:40She was featured as the ground round
07:45speaker in internal medicine last week
07:47here at Yale.
07:50I'm grateful for the opportunity to
07:53talk here last week.
07:58I am grateful for our ASL providers
08:01and transcriber.
08:03Welcome,
08:05Vanessa.
08:07Thank you for your generosity in coming
08:11back after last week's disaster for
08:13those who were here.
08:16Here we are.
08:21Give us an overview of the book.
08:24Dr.
08:27Vanessa Grubbs: When I was a primary
08:29care director,
08:31I met my husband.
08:34He had been on dialysis for five years.
08:38Through the course of our relationship,
08:43I got a look at what life is like for
08:48someone living with end-stage kidney
08:53disease as well as the kidney
08:56transplant system.
09:00I got a sense for why there are
09:03racial disparities.
09:05My decision was to donate a kidney to him.
09:10I wanted to pursue research.
09:12I was doing research naira.
09:15Different field and wanted to shift
09:21that over to working on how to solve
09:24these disparities.
09:32I ended up going to nephrology fellowship.
09:37I became a nephrologist.
09:42It changed how I saw nephrology and
09:45how people received my work.
09:50I had no idea the kinds of things
09:54that happen within nephrology
09:59. That's what led me to write the book,
10:03to have this as a platform to educate
10:08people about the realities of
10:10nephrology disease and end stage kidney disease.
10:15Thinking about dialysis and transplant.
10:22Anna Reisman: Thank you.
10:26That was a great outline.
10:29I wanted to start with some questions
10:31about you and Robert,
10:36who becomes your husband and how his
10:40kidney disease affected your early
10:42times together.
10:44There were two scenes that stood out
10:49to me that gave you a glimpse and you a
10:53glimpse of living with end stage kidney disease.
10:58You were interested in each other.
11:00You had a date.
11:03You called him the next day.
11:05It was early afternoon and he was
11:08groggy and you were surprised that he
11:12was at dialysis.
11:17You felt awkward that you had interrupted something.
11:20On another early date,
11:22you were out Dr.
11:28having drinks.
11:34You didn't know about the nausea,
11:36vomiting,
11:39and shortness of breath he would deal
11:40with as a result of drinking.
11:47Those seem to be your first inklings on
11:50how to live as a person with dialysis.
11:54Dr.
11:56Vanessa Grubbs: Like many people in
11:58residency training,
12:03we're so inundated with the day to day
12:07of taking care of patients in the hospital.
12:12I'm embarrassed that I was more
12:16focused on the numbers and orders and
12:19those details than finding out what it
12:22was like for people who were on dialysis.
12:25I did my training
12:34at the County Hospital.
12:37Most of those who came in on the
12:40kidney service who had issues with
12:44dialysis were mostly black men.
12:47Their access had failed.
12:53They had issues with their outpatient
12:56dialysis units.
13:03It was a struggle to find a place that
13:05would take them.
13:16As far as what to expect it to be like
13:20in a relationship with someone on dialysis,
13:25I have to give it careful thought to
13:29be involved with someone who was
13:31seriously ill.
13:34Robert told me he had a lot of first
13:38dates and not too many second plus dates.
13:46Most people weren't able to deal with
13:50the situation he was in.
13:52That was sixteen years ago.
13:58We'll celebrate year 17 transplant
14:01anniversary in April.
14:10Anna Reisman: You captured how primary
14:15care doctors and the rest of us
14:20don't know what it's like.
14:26You have this unique ability to see
14:28what it's like.
14:30As a primary care director,
14:34I think it was in grand rounds last
14:36week to see
14:47that you offered wonderful insights
14:49into what it is like for them.
14:51Dr.
14:53Vanessa Grubbs: Before my nephrology fellowship,
15:01I was probably really horrible at this.
15:03Like primary care doctors,
15:07there's so much to think about and
15:10have at least some level of expertise
15:16in the details that a specialist would have.
15:22I think being a nephrologist has made
15:25me a better primary care director.
15:29octor.
15:31There are many people who know a
15:34little bit.
15:37They have kidney failure and can't
15:39take this medication.
15:44Their creatinine was 1.4.
15:47They have some chronic kidney disease.
15:51It's safe to take this medication for
15:54a limited amount of time.
15:58Being a resource for my colleagues in
16:02terms of basic things like blood
16:04pressure management.
16:09I do it very differently now that I
16:11have nephrology experience.
16:18Anna Reisman: I want to talk about your
16:20writing style.
16:33You're a candid writer and are honest
16:38about your feelings on a page as well as virtually. You put everything out there. You put everything out there.
16:44One part I love early on in the book is
16:50your discussion about Robert being a
16:53guy you like,
16:55but is on dialysis.
16:57You are asking yourself and your
17:01close friends whether that should be a
17:03factor in letting things go beyond that first date.
17:08You had so many first dates only.
17:13Dr.
17:18Vanessa Grubbs: That's her in every conversation.
17:20She's a good front.
17:27You mentioned being open personally.
17:30When I set out to write the book,
17:36I was not going to include my personal story.
17:38Robert is a private person.
17:46I was trying to talk to some of his
17:49friends in his life before me to get a
17:52sense of who he was then and what he was like.
17:57People who thought they were close
17:59friends with him
18:05did not share very much.
18:08It was not very fruitful.
18:12My original thoughts about the book was
18:17that I was going to write about chronic
18:19kidney disease,
18:23decision making,
18:24etc.
18:29My literary agent told me they loved
18:31my writing style,
18:34but no one wanted
18:42to read it unless it was a personal story.
18:45I wasn't resistant to it.
18:51One of the things I noticed about other
18:54people's memoirs
18:59is that you can tell when they're
19:01holding back.
19:03I didn't want to come across like that.
19:07I wanted to be really honest about
19:10things I was thinking and feeling.
19:14I did see
19:18it as a potential resource for other people.
19:30I don't think
19:32I was that unusual.
19:34You have to put the male specimen before
19:37your panel of girlfriends to decide if
19:39he passes or not.
19:42Robert had this extra
19:48detail going on that made me second guess.
19:51In the book
20:00, we ask people's opinions to find
20:03someone who says something that
20:06resonates with what we already believe and do.
20:13The girlfriends who were like "he's a
20:15great guy,
20:18why would you hold back?"
20:23You'll find yourself taking care of
20:25him later in life. Don't do it.
20:30Author friend said "
20:33Another
20:37friend said "You'll find yourself taking care of him later in life.
20:39Don't do it."
20:42I decided to take the leap.
20:45To be honest,
20:50one of my friends who was a physician
20:53said "he just needs a kidney,
20:55then he's good,
20:57right?"
21:05Regular people looking at transplant as
21:10a miracle thing that solves all
21:22problems could not be further from the truth.
21:25It is so much better than a life on dialysis
21:27and kidney failure. A lot of things have come up over the years.
21:33Sometimes I think about what that
21:36friend said to me.
21:41I guess in some sense she was right.
21:45Lots of things have come up where
21:49we've been in that caregiver role.
21:51It's a joy for me.
21:54I want to be someone
22:22care for someone I deeply care about.
22:24I want him to have the longest and fullest life possible.
22:26Most of us have seen people who become ill.
22:28Till death do us part partners leave.
22:31I think that was in part how
22:38Robert and me coming together was different.
22:41I was already in medicine.
22:49I wasn't afraid of every little thing.
23:07Anna Reisman: That's great.
23:09Building off of that, I wanted to take one question about
23:12your writing style.
23:15When you write about Robert,
23:17you write from his point of view.
23:27, which is really interesting.
23:30There's no question that u
23:36you know his experience.
23:39This is someone you know and are
23:40incredibly close to.
23:45I'm assuming he would tell you
23:49something and you would read it back to him.
23:51Dr.
23:54Vanessa Grubbs: Oh yeah.
23:56He's a private person.
24:00I'm amazed that he was willing to be
24:02so out there.
24:07The way I was able to gather so much
24:13information was . . . he loves trains.
24:24We have family in New York.
24:27It's a long trip there.
24:31I would turn on my recorder and ask
24:33him questions.
24:37He has a tendency to be brief in how
24:39he answers things.
24:42I asked him to take me to that place.
24:45"What did you see?
24:46What did you smell?"
24:53It is really interesting.
24:55This might happen to be
25:01in these more real reality shows.
25:05You forget someone is recording
25:07.
25:11There were a couple of moments in
25:17there where I was taken aback at how
25:21honest he was about what he was really feeling.
25:25One of those moments in particular I rmmbr
25:32emember in the first chapter when he
25:35was talking about
25:39being told either he'd get a catheter or die.
25:47He woke up with this catheter in his
25:52chest and felt like . . . he was 26 at
25:58the time . . . he thought he was
26:01starting his life and had all these
26:03career plans.
26:05"Who's going to date me with this
26:07thing out of my chest?"
26:14I had never heard him say that.
26:19We were coming up on ten years of marriage.
26:28I had him read things
26:33to get his approval about whether or
26:36not I could publish what I said.
26:44I remember a chapter . . . I can't remember
26:46the number.
26:48I'm writing about how we argu
26:55ed how to celebrate our transplant anniversary.
27:00I wrote this chapter from my point of view.
27:13I had him read it.
27:23We had the fight all over again.
27:25That led to how I ended up writing it. That's the way it goes. People say a thing, mean a thing,
27:27and someone else hears it in a
27:29different way.
27:33You react off of that and not the reality.
27:38No one remembers exactly what happened.
27:42That's how that part came to be.
27:49One of the chapters I was so happy to
27:58write was the chapter where I had surgery.
28:25I h
28:27ad never experienced a kidney being transplanted into someone. I felt fortunate that my surgeon . . . I emailed him and told him I was working on this book.
28:31I asked him to watch a surgery.
28:33He said "sure,
28:35come on in!"
28:37I got all the scripts.
28:39I may have gotten to cut something.
28:43Not tissue.
28:45I'm no surgeon.
28:52I watched a donor nephrectomy and
28:54walked across the hall
29:02to watch it put into the recipient.
29:05It was such a gift to see that and
29:10imagine me in one room and Robert in
29:17the other and write about it from that standpoint.
29:19At the same time, it was
29:23weird.
29:31Imagine you're that body lying there
29:33unconscious and people are positioning
29:36you and doing all sorts of things they
29:38need to do.
29:40You have zero awareness.
29:48I would have had to write it
29:53differently and with less detail than
29:55what I was able to thanks to that experience.
30:02Anna Reisman: Those were really good chapters.
30:08Can we take a step back and talk
30:11about when you went through the
30:13evaluation for the kidney transplant
30:16and the people you dealt with.
30:21This is starting a conversation about
30:24people who are black with kidney disease.
30:32Dr.
30:34Vanessa Grubbs: I was thinking about my surgeon.
30:37I gave him a signed copy of the book
30:41to thank him.
30:45I mentioned him in the acknowledgements.
30:51I
30:57was completely positive about him,
31:01but not Robert's surgeon.
31:03It wasn't OK.
31:05A lot of flks
31:12olks take offense when you say anything
31:14that's not glowing about
31:20them or someone they work with.
31:22At the end of the day,
31:26I wanted to be able to stand firm and
31:31acknowledge that no one could point out
31:33a lie in my writing.
31:37"This is the truth.
31:39This is different."
31:43Going back to the day that Robert had
31:48his followup transplant evaluation,
31:52he had been on the list for several years.
31:58It's amazing how ignorant we are in
32:37general about what happens in this
32:39whole process. I blame the transplant world for that. I feel like it leads to more distrust. This gets back to giving people reality to prevent them from informing themselves based on movies.
32:42We thought he would get a pager and would get a page the next day to come back to
32:44the hospital and come to the hospital to
32:46get a kidney.
32:48It's not that way at all.
32:53I didn't get everything right in the
32:55piece I wrote about that.
33:02That was some of the transplant
33:05people's criticism.
33:09I was a primary care director.
33:15If I didn't know better,
33:17it was because they didn't talk to us.
33:54It was a case in point about
33:57how at the county Hospital we were never
34:01engaged in helping a patient get access to a kidney transplant. That was the point about it being one-sided. Each person came into the room and said
34:03something specific about him as a black person.
34:05County Hospital we were never engaged in helping a patient get access to a kidney transplant. That was the point about it being one-sided. Each person came into the room and said something specific about him as a black person.
34:09The one that was the most ridiculous
34:14was the transplant nephrologist who
34:17responded when Robert asked
34:22[
34:29vd
34:32ideo cut.
36:11] [Kicked out of Zoom meeting.
36:14Rejoining now.
37:04]
37:09I don't think any of them acknowledged me.
37:13It was strange to sit there and be cp
37:17ompletely ignored.
37:20They said these strange things.
37:25They were inconsistent.
37:28You got one presentation to a larger
37:30group that was invited.
37:34You got close to the top and had
37:36these one-on-one meetings.
37:41They would say something different to Robert.
37:53I don't think any of them acknowledged me. It was strange to sit there and be completely ignored. They said these strange things. They were inconsistent. You got one presentation to a larger group that was invited. You got close to the top and had these one-on-one meetings. They would say something different to Robert.
37:55In the clinical setting,
38:00it's hard to know what others are experiencing.
38:11If someone without medical training goes to see
38:13the director,
38:17they probably assume the director is
38:22that way with everyone.
38:25They would have no idea if the person
38:35is much warmer with someone from a
38:38different group or if they're taking these ridiculous
38:40race based algorithms into mind for
38:42their care.
38:51Most of what happens is not so blatant.
38:56We already know that's not the case
38:59outside the exam room.
39:07Anna Reisman: I'm glad you brought up
39:10race-based algorithms.
39:12I wanted to talk about that.
39:14You've written about that.
39:22with the GFR in your book and elsewhere.
39:26Explain to people what that means and
39:31how it affected Robert's experience.
39:34Dr.
39:37Vanessa Grubbs: I don't know how it
39:39affected Robert.
39:41When in medical school,
39:44these equations didn't exist.
39:46I'm old.
39:51My first day of nephrology fellowship,
39:55our director told us of all things we
40:01needed to know presented us with these
40:04equations and where they came from.
40:11That's where I first saw this "if
40:13African American,
40:19" correction.
40:21At the time,
40:23it was about muscle mass.
40:31African Americans had higher muscle mass.
40:39"What about a frail black woman or
40:42white body builder?"
40:50They said it was a good point and flew
40:52by to the next thing.
40:56I thought I was by myself in thinking
40:58it was not OK.
41:00Really,
41:04it wasn't until I wrote my book and
41:12saw Dorothy Roberts TED talk where she
41:16mentioned her experience with these
41:19equations of kidney function and lung
41:25function that I realized I wasn't
41:27completely insane. Someone else noticed this.
41:39The EGFR is the estimated glomerular
41:41filtration rate,
41:43or how much blood per minute the
41:45kidneys are filtering.
41:50If they were not working as well,
41:56they would not filter blood as quickly.
42:00This is where these equations come from.
42:04They use a simple blood test,
42:06creatinine,
42:09to start.
42:14Our bodies produce a steady amount
42:16each day.
42:19We should get rid of the same amount
42:21each day.
42:22It's an estimate.
42:30The creatinine is produced from the
42:32breakdown of muscle tissue.
42:35What they noticed in this study that
42:38was published in 1999 was
42:44(it inc
42:47luded
42:50black and white people)
42:53. They noticed that
42:59the black people in the study had
43:04higher creatinine levels at a given age
43:07than the white people did in the study.
43:17They believed it was because of muscle mass.
43:19In the original paper,
43:22they quoted three
43:28small studies that didn't prove
43:31anything about muscle mass by race.
43:33That stuck.
43:35No one questioned it.
43:38For 20 years,
43:43we were using this equation which
43:47considered things that affected how
43:51much creatinine the body made and how
43:53fast the kidneys got rid of it.
44:02The ultimate equation includes gender,
44:03age,
44:07and race (black or not)
44:12. That went on to the next generation
44:14of the equation.
44:20They used race as well even though
44:23the study was more diverse.
44:26There was 5%
44:32Latin and Asian identifying people.
44:35There were 10000 participants.
44:42They decided there to set up their
44:46analysis as black versus other.
44:49That's nothing objective.
44:53Someone's decision to set up an
44:54analysis
45:00of these robust statistical values.
45:06In the original study,
45:11they never talked about how the black
45:13people in the study were
45:16poor,
45:19had diabetes,
45:21high blood prssre
45:26essure compared to the white people.
45:30These factors are things that we know
45:37by themselves associated with kidney function.
45:40Instead of them talking about that aspect,
45:44they boiled it down to race.
45:48I had been writing about it,
45:51talking about it over the years.
45:55When I started out in medical school,
45:58this didn't exist.
46:02Now it's being taught to medical students.
46:09I respect the blindness of medical
46:11students in this generation.
46:16We were raised to believe that race was
46:18a social construct.
46:22This racism was not OK.
46:27They were at the forefront of
46:32creating a movement to force a
46:34conversation about these equations.
46:36Initially,
46:38I was being blown off.
46:47I'm a bit surprised that it got to be
46:54a movement.
46:57We had a better replacement
47:05, another blood test that hasn't been
47:08celebrated across all the labs in the country.
47:11It's more expensive and takes longer to get.
47:19This could have been done and had been
47:21done before.
47:26We had to engage in this 2-3 year
47:32battle and a whole taskforce of the two
47:35major kidney organizations to come to
47:38the conclusion that race shouldn't be in there.
47:44They went back to the study for
47:50the large equation including 10000 people.
47:55They pulled everyone's data and gave
47:57us a new equation.
48:00We could have done that from the beginning.
48:04Why did we need to fight back and
48:06forth for years?
48:09The equation has been changed.
48:13There's an effort to get people to
48:16replace that in how labs are reported.
48:20This notion of race Dr.
48:24Vanessa Grubbs: Logical meaning is insanity.
48:29The social scientists in the PhD
48:31world know that
48:35this is some shit we made up.
48:38We made up race.
48:42It is not anything that has valid
48:45reasons behind it.
48:47We keep trying to prove it.
48:51Originally,
48:53it was to help make people
49:00in colonizing other places and
49:02slighting
49:07making
49:09j
49:15people thinking there were groups that
49:18were inferior and needed to be enslaved.
49:30make
49:33people think there were groups that were inferior and needed to be enslaved.
49:39I could go back to the part about
49:42Robert unless you wanted to move on to something else.
49:48Anna Reisman: I appreciate the
49:52explanation and baffling fact that
49:56there's still such controversy about it.
50:02You talked about finishing your renal
50:06fellowship and looking for a research position.
50:09You've encountered so much resistance.
50:15One potential mentor you talked t
50:26o rolled their eyes when you said there was racism in
50:28the system.
50:31Did he know the system was racist?
50:34Was it too political?
50:37Was this real science?
50:40Dr.
50:42Vanessa Grubbs: I can't speak to what
50:44was in his mind and heart,
50:50but can go based on what he said and
50:52my reaction to it.
50:57My sense is that if it was something
51:02it was something that was too controversial.
51:07I was in a tough place because of the
51:10health affairs piece.
51:12I stand firm on believing that,
51:16had that article come out before they
51:21offered me a fellowship position,
51:25there would have been a reason why I
51:27couldn't have come into the fellowship.
51:30The piece came out after.
51:34I found out that a lot of people were
51:36upset by it.
51:39They thought I was shooting from the
51:41hip and it wasn't fair.
51:46I was so naive in thinking the
51:50transplant community will see that this
51:56is a director who could see this in our system.
52:01"No I'm not,
52:03what are you?"
52:10When I think about it,
52:13the whole reason I went into
52:17nephrology was to do this research on a
52:22access and disparities.
52:28Our colleagues wrote down this dsprty
52:32identify problems,
52:34but don't come up with solutions.
52:40We need to be somewhere where we can
52:44change how things can be canon.
52:46I've proposed interviews,
52:51observations behind these closed doors
52:54that I have no access to.
52:55I probably never will at this point.
53:02What was I going to say?
53:04The ments
53:13entors refused to support me in this line
53:15of research.
53:18Just because a study doesn't exist
53:20doesn't mean the problem isn't true.
53:31I bumped up against this with the race
53:41correction thing.
53:49I've done a couple little studies.
53:52They were really hard to get published. No one can fathom that there are built-in inequities in
53:54the system. It ended up not being
54:04almost completely de-railing my career.
54:08I had to come up with something I was
54:10interested in that fit my mindset.
54:18My mindset is still bent towards
54:20preventative care.
54:22I looked at periodontal disease as a
54:27risk factor for chronic kidney disease.
54:32I did a pilot randomized control trial.
54:35It was cool,
54:38but it was a no-brainer.
54:42We didn't have to do research studies
54:46to prove that dental care is good for a
54:48person's overall health.
54:54Why can't we just help people be healthy?
55:00Because of the experience of being in
55:03nephrology and being upset with all the
55:05things that happened,
55:08that's how I came to
55:20be passionate about palliative care and end of
55:22life and that became my focus.
55:25I wouldn't have envisions any of this ever.
55:32Little girl from North Carolina.
55:34Here I am.
55:37This is where I'm supposed to be.
55:43Anna Reis
55:52man: One more question about palliative care.
55:59This phrase stuck with me that you wrote.
56:05"I was always taught that transplant
56:09was better than dialysis and that
56:14dialysis was better than death always."
56:16Do you agree with that now?
56:18Dr. Vanessa Grubbs: I do.
56:20I'm less draconian,
56:24less rigid about the thinking.
56:28There's more nuance in the way I think
56:30about things.
56:32I believe if there's is
56:38there's something wrong with
56:45putting someone who's 50-60 years old
56:49on dialysis.
56:55nothing
56:57wrong with putting someone who's 50-60 years old on dialysis.
57:03But I don't think someone who's 80-90
57:09with many problems should be put on
57:13dialysis because their kidneys are failing.
57:17We should manage their symptoms rather
57:21than put them on dialysis.
57:23Most of medicine,
57:25particularly in nephrology,
57:29the tendency has been to think of life
57:31or death.
57:37It does a disservice by considering
57:42what life is like on dialysis.
57:45I can't imagine any nephrologist
57:49taking care of dialysis patients can
57:56tie up someone who doesn't have an idea
58:02of where they're at so we can prolong
58:04their life in this state for a few more
58:07days.
58:12There's something wrong with that.
58:14All those things matter.
58:19I believe we need to be more
58:20thoughtful and honest with people about
58:23what to expect.
58:28We talk about people being dead in
58:32two weeks if they don't start dialysis.
58:36"Here I am six months later!
58:39You said I'd be dead!"
58:42There's a lot that goes into it.
58:44We stop there for the most part.
58:48Over the last few yrs
58:51ears,
58:55I'm happy to be a part of this movement.
58:58We have to talk about what dialysis
59:02is like for people so they can rll
59:04eally
59:11and make a recommendation for them.
59:15Too many of us give them their
59:18options without providing guidance.
59:20It's not OK.
59:23We're supposed to partner with our
59:25patients and their families,
59:28not just present a list of things for
59:30them to choose.
59:36Anna Reisman: Speaking of that,
59:42we'll just talk about this before we end
59:47. I apologize to those with questions.
59:49They're in the chat.
59:52Dr.
59:55Vanessa Grubbs: I don't see them.
59:59There's a separate Q&A.
01:00:03I'm happy to hang on for a few
01:00:06minutes for folks who are going to stay on board.
01:00:14Anna Reisman: I wanted to use what you
01:00:18just said to talk about how we're
01:00:22learning about dialysis now through
01:00:24your new youtube channel.
01:00:27Dr.
01:00:29Vanessa Grubbs: I'm working on my
01:00:31next one now.
01:00:35Hopefully I'll get it up soon.
01:00:37I'm getting better.
01:00:45Because of the things I've written,
01:00:50I have put out a different perspective
01:00:52than what people are used to.
01:00:56Folks reach out to me asking my advice.
01:01:02A lot of them are in states of high stress,
01:01:04anxiety, fear.
01:01:10I tend to answer them one by one.
01:01:12I felt like Dr.
01:01:20having a youtube channel would help me reach more people.
01:01:25One of the things I've felt strongly
01:01:30about is how we talk about patient education.
01:01:34People have to physically be in our
01:01:39clinic in order to receive that education.
01:01:43When you thinking about kidney failure,
01:01:49people don't get symptoms until it is
01:01:51time to start dialysis.
01:01:53They don't want to accept it.
01:01:58They tell us we don't know what we're
01:02:00talking about.
01:02:03They wouldn't come to the clinic.
01:02:06They would run away from it until
01:02:09kidney failure caught up with them as
01:02:13it always does unless something else
01:02:15gets you first.
01:02:17Those people aren't looking for information.
01:02:21If I put it in a more public platform,
01:02:24I thought people would come across it
01:02:27even if they weren't looking.
01:02:30That's my hope.
01:02:40In the intro I just talked about what
01:02:45made me move forward in this direction.
01:02:48The first one is people
01:02:50misinterpreting things I've written.
01:02:57When I talk about not thinking
01:02:59dialysis is not always better than death,
01:03:02I'm talking about frail old people.
01:03:07Not a spry 75 year old.
01:03:11A small population that will not gain
01:03:16benefit in quality and quantity of life.
01:03:21I get quite a few younger people.
01:03:27My next video is about being driven
01:03:29by fear.
01:03:32I'll do videos on the earlier things
01:03:36to help educate people about some of
01:03:38the preventative things.
01:03:44Things will be based mostly on emails
01:03:47I get from people.
01:03:52I hope people start writing to me
01:03:57. I can't do anything specific and
01:03:59hope I don't get in trouble.
01:04:05My hope is to be helpful to as many
01:04:07people as possible.
01:04:11Anna Reisman: Fantastic.
01:04:13Wonderful.
01:04:15I will tell patients to utilize this resource.
01:04:23Thank you so,
01:04:25so much.
01:04:27I love talking to you.
01:04:31Your book is terrific.
01:04:35Anyone who hasn't read it should read it.
01:04:42It goes over all the things we talked about.
01:04:46It goes into a lot of depth and is
01:04:50really good in engaging writers.
01:04:53Thank you for being here.
01:04:57If we could not close this immediately,
01:05:01if anyone wants to ask a question afterwards,
01:05:04we are officially done.
01:05:07[End of Discussion.