Current Topics in Healthcare Series: When Doctor Becomes Patient

本站添加: 2026-06-07

[00:00:17]good afternoon everybody good afternoon and so good to see you all here for this wonderful session um so uh I'm so glad to hear you all I or see you all I really really hope that if you haven't already that you will take this opportunity some opportunity this week to get a outside just a little bit take some really deep breaths because the weather is incredible I know that everyone is beyond busy but I strongly encourage you to do it um just for a few minutes take a walk grab a bite to eat outside something um it's beautiful out and you will not regret it so today I am so pleased to be able to introduce you all Dr Evan comb Dr Cohn is a retired radiologist following a 17-year career practicing in Dallas Texas Dr attended a medical school at George Washington University he completed a transitional internship at Fairfax Hospital and Dr Cohen completed Radiology residency and a musculoskeletal fellowship at UVA uh while in practice Dr Cohn was honored to be voted one of the best doctors in Dallas by D Magazine multiple times Dr Cohn is here to share his experience of moving from the position of an actively practicing radiologist to an actively practicing patient while we all do our best to practice sympathy and empathy with those we serve no one anticipates this dramatic shift in perspective I think we can all uh recognize that that dramatic shift um and how startling it must have been so our hope today is that we can all learn from Dr cohn's unique experience both personally and professionally so Dr Cohn we welcome you we value the opportunity to learn from you um one more thing just if you all don't mind usually we just pop in with questions but if we can just get through the presentation unless it's super super urgent and save questions for the end I think we would all appreciate that for this session take it away Dr Cohn thank you very much Dr worker um appreciate that what would you do if you face an acutely life-threatening injury with about 50 mortality I'm here to talk to you today about my experience my family's experience how you as a friend family member uh physician a healthcare team member a medical student can make a difference in people's lives and really try to treat people the way you'd want to get treated and I also hope that you see that life can change in an instant um my story um I'm coming at this story really with two different perspectives I briefly wanted to touch base with you regarding just some of the my experience as a radiologist for 22 years and then being a patient starting in October 2015 and really still a patient wasn't sure who the um uh audience would be if there would be some medical students in the audience I just briefly wanted to just go over some of the things that I learned that I found helpful um and this is just some practice suggestions I learned and and just you know obviously from in my opinion you know just work hard arrive early stay late attend meetings just don't just be a work or be try to um help with your practice and and I think also talk with your colleagues and share good cases and I think it's important to get other people's opinions on things not always but it's also good to get at least as a radiologist it was good to get up out of my chair and go talk to another another colleague and I think it helps you learn and also helps you find things interesting I think also is helpful to continue to consult your mentors for advice um I had a again I did my residency and fellowship at UVA and at least for the first few years I would contact my um previous attendings and just get their opinion on difficult cases and that was very helpful um again some of these things apply a little bit more as a radiologist but I think it's important to you know limit your differential diagnosis to three that was one of my intendings would say you didn't want to give a big list of things you want to be um as specific as possible and along the same line she would say one of my attendance is if you're 95 certain of something call it one way or the other if you're 95 certain that it was um your POS 95 important certain that something was negative call it negative you may be wrong five percent of the time but at least you're useful and you're not gonna be wishy-washy uh and I thought that was very helpful and again it's it's okay to be wrong occasionally and I think you need to be comfortable with that I think it's also helpful to keep up with the literature um I would have uh in practice you know you your practice your education doesn't and when you finish graduating medical school or when you finish your residency or Fellowship it's important to just keep up with the literature so you can keep on learning things because things always change uh I always felt it was helpful to have a niche um you need to be able and you know be able to do everything in in your practice area but it's always helpful to bring something different to the group I was a musculoskeletal rheologist and I brought a lot of pain management injections to my group and and that was very very helpful I think it's important to realize that you know just as in life nothing is perfect no practice is perfect no University department is perfect and I think it's important to realize that and then lastly again treat people the way you'd want to get treated and just want to briefly bring up I started Radiology residency in 1993 and again finished up in 2015 and during that period of time we were using films and went to monitors the slice thickness for a CT was 10 millimeters went down to two and a half it's probably thinner than that there was no commercial uh three Tesla MRI at the time um and now you know it's pretty common used to either have a 1.5 or 3 Tesla and then obviously the mark increase in utilization of Imaging and again I think it's important to realize and that's part of the reason I think we went into medicine that it's always changing and you need to keep up with it and I think that's important so that was just a few brief things I just wanted to touch base on from my perspective um as a radiologist main part of this talk is my perspective as a patient which started in 2015 and I do photography as a hobby and so I'm going to have some photos along the way and photos I've taken so my Story begins October 26th I'm really my family Story begins October 26 2015.

[00:07:32]we were actually at um we were celebrating our an anniversary our 24th wedding anniversary and um we were actually at the Homestead hotel in Far Western Virginia we went there a couple times when I was a resident and fellow and we actually went a couple times when I was in Dallas we just it's a Sentimental place for us and so we were planning on just taking I think probably at the four or five day vacation there this selfie was taken at 10 26 in the morning on October 26th and you can see we're enjoying ourselves um nice fall colors behind us and about an hour after this photo was taken I had the sudden onset of the worst headache of my life I got nauseous I got sweaty and within about 15 minutes or so I'm like I couldn't get comfortable and went out to the porch and went laid down uh Jessica couldn't get comfortable and I knew that I needed to go to the emergency room and I'm not the type of person that needs to go to the emergency room but again I do want to point out this picture I think it's extremely powerful we have this photo of several places in our house um in that you have no idea in life what's going to come your way and um you know this you know an hour after this photo was taken I basically suffered an injury where I was not able to ever get back to work I um and I face a injury with about 50 mortality um so I was taken to we went over to Bath County Hospital Bath County emergency room and it was such it was such a small hospital that I didn't know um a member of getting up there I'm like I'm not sure there's a CAT scan here um they did have a CAT scan and actually I got very very good care in there um after about an hour and a half or so they did get a CAT scan of my head and again for everybody you know for patients it's um it's this is the front this is the back this is the left and this is the right and basically I had a large subarachnoid hemorrhage and basically all this white stuff here are centrally in the kind of the basil or cistern region extending to the base of the right Sylvian fissure extending into the anti-hemispheric fissure all this white stuff is a whole blood um I had uh this it should be dark like this this is cerebral spinal fluid in the temporal horns a little higher up there's a little bit of blood layering along the uh tentorium here and a little bit of blood in the foramen among really bilaterally and a little bit of blood layering posteriorly within the occipital horns I do want to point out because I'm going to show you another CT here shortly that you know everything else there the ventricles are normal size you can see the normal great white differentiation you can see the normal um salsa and gyroide so I had a big subarachmoid Hemorrhage um the common causes for spontaneous silver acronym with Hemorrhage probably about 85 to 90 percent of the time is a ruptured aneurysm um and then about 10 of the time it's probably ruptured vein and then the very small chances it could be arterial venous malformation or amyloid angiopathy um but most of the time it's it's a an aneurysm so I do want to take a step back and and talk about the care I received at Bath County Hospital and again how they likely saved my life the uh one of the people was the CT technologist um I he did an incredible job and likely saved my life and I know that by how we acted and how quickly things moved after I got the CT scan so I remember him Wheeling me back to the scanner and on the way back he knew I was a radiologist and he uh I remember him saying well when we're finished I'll show you the scam and I um I was like oh thanks I appreciate that so I remember getting off the scanner and I remember getting onto the stretcher and I said oh you're going to show me the scan it's like no we're just going to send it off so I was thinking myself that's not good and then um maybe about five minutes later after I'm back in the ER they come in they put a second IV and and they do that just in case you crash uh they need want to put one IV for fluids one IV for meds and within about 15 minutes or so the ER doctor comes in is what he said well it was really good you came in today there's uh you have a subaructor with Hemorrhage and there's a helicopter on its way from the University of Virginia and so I know that he saw the Hemorrhage notify the ER and sent it off stat if he had not done that I could have been there at least two or three hours and you know it's in patients with subarachnoid hemorrhage there's about 50 mortality five zero percent mortality and so and again there was no radiologist there so I just would have went into a pile and again I would have taken two or three hours probably I did contact him maybe six months after and I said I think you did this he said yes I remember you and and I did do that and I thanked him for it and he's actually been an inspiration for me I've given this talk now about a hundred times of that probably about 10 of them to 10 State Radiology technology societies partly basically importantly telling them that they are an important part of the team and that they um that you're not just a button Pusher and you can make a difference in people's lives I also remember the ER nurse you know was being you know was really very nice and she um as I was I remember getting you know getting ready to go off to the helicopter she she asked if she could pray with me and uh you know said sure and I think you know to me she knew how serious seriousness was and and I think any you know any um any prayer is helpful I also remember being in the helicopter waiting for it to take off and I can see it to this day I just remember seeing being there and like I'm not sure if we're gonna make it and she um my wife was not able to come on the flight they didn't want her flying with me so I remember texting her and saying you know um I love you and I hope to see you soon but again seeing your your life flash before your eyes like that definitely um makes you a better person um so you know I clearly was in the right place at the right time um as a CT technologist saw the Hemorrhage um and it did in addition and I think this is partly me trying to control the situation um I asked the ER doctor what's going to happen to me when I was when I'm in the when I get to UVA and they said well they're just going to probably drop you off there I said well I still know people there can I contact them so you said sure So I contacted one of my attendings he he basically you know said I'm going to need neuro angiogram he said you know the people Lee Jensen and Avery Evans were the neuro interventionalists and they were the people that were there when I was there and I said that's great he told them I was coming in he called me back said they're ready for you when you got here so I got lucky that you know I was able to contact them and and they were they were excellent I was lucky the weather was good for the helicopter to fly and um you know that can be a treacherous uh thing if it was too cloudy and then I was obviously brought to UVA which has an excellent neuroriology and neurosurgery department and then you know I was taken to UVA where the a lot of the medical team remembered me for my time at the hospital there so and my wife was able to um utilize that a little bit when needed she you know we knew that uh we knew slash know the chairman of the Department of radiology things like that and they the neurosurgeons and neurologists so that was I was very lucky so you know I I kind of go through that it's I this is you know my perspective of my story but my family could easily have have be telling their side and they have a different perspective and some of those things are you know I I do remember talking to one of my daughters probably about a year or so ago and I said you know I think I remember talking to you when I was in the um community hospital she said yes we did talk and I wasn't I wasn't sure should I remember it and I wasn't sure that was gonna be the last time I was going to ever speak to you again um and again luckily I am here um but I think for all of our family it's um brought more reality to how life precious can be again I was being very cool and collected in the community hospital and um as Amy had to go you know go back to the hotel to get ready to drive she asked the nurse you know it was a serious and the nurse said uh it it is definitely serious and he could die and you ought to get your daughters who were in college at the time to UVA and then my wife basically had to drive that three hours in the mountains not sure if I'd be alive when she got to UVA um and there was no good cell cell phone coverage so obviously very difficult time so at UVA and this stuff is basically um from the chart with what my wife and family told me but they did do a CT angiogram a catheter angiogram all with negative for aneurysm I likely had a ruptured vein um and then this was the CT I want to show you that this was taken at 123 in the morning on October 27 so about maybe 13 hours after the initial CT and in the interval they placed a extraventricular drain through the right frontal region into the foramen railroad good location but in the and then there's a little air there but in the interval the ventricles have increased in size you lose that great white differentiation and you lose the sulfite dry right except for that left frontal region so I my brain was very swollen at that time and um again there's a little bit more blood in the ventricles so you know again to me it shows how this is how scary it was and how lucky I was with all the things you know being in the right place at the right time and you know again from my family's point of view there was um it was a difficult time for them um but that you know they had to become my Advocates normally as especially as a physician I could advocate for myself in this case I couldn't and the um a couple of things and they were relatively minor but just some examples but my wife had said maybe about three or four days into the my hospitalization she said I was able to still see things I normally wear contacts and she said does he still have his contacts in and they're like let me let's check I don't know so they checked and I still had my contacts in so that was a good thing to get rid of they also I wasn't eating very well so they wanted to give me supplementation and they um I guess they were started giving me ensure my wife is like you know he's lactose intolerant that's probably not good for them he said yes they said yes that you're right and so they switched me to something else but you know it's I think that it's always important to have Advocates um it's very helpful um and so I was very lucky that my wife and my daughters could be my advocates um you know at the time my wife had said that she was you know she couldn't do much at the time and the only thing really she could do was was pray and she said she went to you know UVA Chapel very often and she actually said that the there was a chaplain resident there and we've tried to find out who it is I I'm still working on it but there was a chaplain resident who um I guess talk with my wife and gave her a card and said if you need me let me know and I guess it was one time my wife was very UPS you know very upset and she contacted the chapel resident and they she said let's meet here in the chapel whatever they went and met in an office and they prayed and made me Amy found it very very helpful it's another person who was very inspiring um and so I've actually given this talk now to chaplain residents um probably about 15 20 times um so you know that's again I think it's important to realize that there's so many so many parts of the team that can make a difference on uh the success and the outcome of the patient including chaplains including nurses including medical students including Radiology technologists you know and at the time my family and medical team didn't know if my deficits would be permanent I was definitely speaking you know they told me I was speaking slower um I was weak physically slower and you know at the time they didn't know if that was going to be become permanent or not so you know they the um the another thing they did to repeat Catherine andream just to confirm I did not have an aneurysm they uh and that was also negative I was there for two weeks and I don't remember I was I don't remember any of it um which is kind of a weird thing uh this is me leaving the hospital and you can see that this is where they shaved my head to put that drain in and they took it out they didn't want me flying so they my brother came in and drove with my wife with me in the passenger seat we drove to uh from Virginia to Dallas and um again I don't remember any of that uh I started Rehabilitation November 30th 2015 so just about a month after my Hemorrhage probably a week or two after I got home and it was six and a half hours a day for one year uh four days a week and I actually finished on November 30th 2016 by chance uh and it was two hours of PT two hours of Occupational Therapy two hours of speech therapy with a half an hour from lunch and the you know it was mainly working the things that was mainly working on my cognitive and trying to improve my cognitive cognitive abilities um in addition working on my balance and others and my speed and things like the physical speed some of the things I remember from my Rehabilitation uh I do remember getting a couple eegs which is where they put some probes on your head to see if there's any seizure focused patients with subaraching with Hemorrhage are at risk for uh they're at risk for um seizures so they had me on anti-seizure medicine until they proved that I didn't have seizures but that was kind of a weird thing they were putting probes on your head um I did do a neuropsych exam I think in January of 2016 and then another one probably the summer of 2017.

[00:23:32]and that's really the only exam where they have as long as far as I know that they have controls of where you should be and um you sit there for four or five hours doing different exercises with a neuropsychologist and the um it just it was a draining exam and I was about two standard deviations below the mean and it was two standard deviation below the mean for both on both exams I was trying very very hard to try to get back to work and so in addition to doing this uh six and a half hours a day four days a week I was like what else can I do and so I I thought okay let me do some brain games with my phone so there's a couple Lumosity and a couple other games that I would do and then I also thought it was a really good idea to and stimulate it would stimulate my brain to relearn Spanish I do spend learn Spanish in high school or college and hadn't really used it after that for like 20 years and so I uh started doing that and I'm still doing that and it's been a lot of fun and it's really good for me to be able to work on the conjugation and the different tenses um and useful uh in Texas if you have a brain injury you have to voluntarily not drive until you're cleared to take the driving test again by your physician and therapy team so I was not able to drive probably for at least six months and then you know how to take the driving test and that was you know it definitely gave me more autonomy if it was again nervous the first time I was driving again and then I actually started giving this presentation to patients at the end of my Rehabilitation and one week and I just wrote down what I was going through and I made a PowerPoint and at the rehab place I was at the therapist would give a talk to the patients once a week and so I asked them you know towards the hand of my therapy I said you know can I give it to the patients that said sure and I I you know it was It was a uh it's been very fulfilling and like I said I'm now over about a hundred times I've given the talk so and I think that also goes to I mean a lot of my time now is setting up presentations giving a presentation learning Spanish and so you just never know how your what's life's gonna bring some of the things that from my rehab that some of the issues that I've felt like um that that I've found or kind of figured out for myself one is you know you don't know how you would have performed prior to the injury it's not like you go to the rehab place right before your injury and have something to shoot for you just don't know there are controls so that was one thing that was extremely helpful um well it wasn't helpful it was extremely difficult that I just didn't know what to shoot for and all you can do is is just try your best and improve because you just didn't know uh and it was really hard to know how it's progressing and in fact there were some times where I just declined it was I remember doing some studies uh some tests and I was getting like 85 on it and then the next day I was at 50 had no idea why and I was towards the end of my therapy and I think that was one of the times where I was like it kind of became clear to me that I wasn't going to be able to get back to work you also don't know how much function you're going to have at the end of the at the end of the your rehab and I think that can be difficult again you don't know what to shoot for or when the when your Plateau is going to be and I remember it was really uh I was nervous the first time doing things like drinking coffee and exercising and driving and things like that and um things you now take for granted for a normal person that they were not easy for me especially when I first started up again and for me this is really an invisible disease if you saw me you wouldn't be able to tell that I have you know things going on and it's it's just it's not a it's not a visible injury I actually gave this talk to the radiology department at the one of their Banquets and one of my attendings came up to me at the end and he said you know I appreciate your your uh perspective they had a son who had a brain tumor had brain surgery and was having cognitive issues and they said that the sun sold them told on my one of my attendings that he was he was upset he was like I I almost wish I had a broken leg with a cast so people can see that I have an injury and it's just it's something you just can't see and I remember at times I have you know a little scar I think from that drain that they placed and sometimes I'm thinking okay it would be nice for people to see it um but it is what it is and again I look at it as a blessing and a curse mainly a blessing but it is it can be difficult and this was a slide that I uh found on the internet and so from you know for me you know what a lot of people with brain injury look fine what's above the water is all you see what you don't see is everything else going on and I'm just going to hit the stuff that I have the fatigue the headaches difficulty processing memory problems concentration issues sleep disturbance probably some personality changes and I but I think this applies to so many things and I think it's important as a health care provider or just in general as a person to realize what you see especially in this Facebook World um what you see everybody looking fine and everybody looking good is not usually in the case um there's a lot of stuff going on in patients with cancer psychiatric issues um and I think it's just important to knit to remember that what you see is not always what's underneath so a big thing for me was you know the big question was could I back get back to work or not and because of these continuous symptoms fatigue cognitive issues and headaches and as a physician we take the Hippocratic Oath doing no harm and especially as a radiologist if I miss consistently missed cancers how many animals and appendicitis I could be killing people and given all that I was never released to go back to work and in January 2017 I had officially retired so I'm really at this new normal and and some of those things as new normals I have to focus on one thing at a time I cannot multitask and I used to be very good at that I was again I was doing a lot of pain management injections and with that I would be reading a case the technology will come in say there's a patient on the table like get up go do that and you know injection or procedure come back and just start up where I was and I I cannot do that now I really just gotta I can only do one thing at a time um I had to process my thoughts before I respond and I had difficulty when I'm interrupted and that makes it really difficult for me to interact in groups and you know it's interesting I think in some ways I'm a better listener then I um than I think most people probably because I have to sit there and really concentrate on what people are saying then process it and then try to speak but by the time I I get something out usually someone else is already talking um and I talked this over with my wife and and we I catch you know said if somebody if we're with a couple and they ask a question to both of us it was happening where she would answer all the time because she was processing better than I was because she just let me occasionally answer and and she's done that and she's been incredible and that's a big help I do struggle at times in a social setting where I'm aware I don't want to be having being a brains injury Survivor as my only thing I can talk about so I you know it comes up in the conversation later that night I'm like oh did this come up too much it's just something I think we're always tough on ourselves and I just try to be aware I don't want to be solely talking about my myself as a brain injury Survivor I do get frustrated that I can't remember important things in people's lives um I do have to write a lot of notes to myself but and my good friends understand that I am at this new normal and then you know I make at least probably two or three mistakes a day that I know of my wife knows more of them but the bigger mistakes in some ways helps me kind of reinforce that there was you know I probably make at least a couple times a week that there was no way that I could work um so I want to now kind of transition to the second part of the talk uh kind of what people say and what's helped me through the process uh this is a photo of my wife and two daughters my wife's in the red so some of the things I like to hear and again this is more initially but uh I liked it when people said my thoughts and prayers are with you prior to my Hemorrhage I always kind of thought that was a Cheesy thing to say but having gone through this I think that the I can tell if people mean it and if people mean it I think it's a very very nice thing to say I also appreciate it when people were saying again this is all more when it was acute but they were laying candles for me or adding me to prayer lists and again it was just very very thoughtful that people cared about me um in some ways actually I just want to take a quick thing I do remember a time probably maybe six months after my Hemorrhage I had to go by the hospital um in the evening one night one time I can't remember why and there was a Night Nurse night secretary who I saw very frequently when I was working she hadn't seen me but again this is probably six months a year out and she was just so happy to see me and was just so uh heartwarming to me that she that people cared cared for me um and I appreciated that another thing that I I did find that uh that my family has felt that we we it was more helpful when people were just volunteer help um rather than saying let me know what I can do for you so we've done that my family's done that now where we're just if somebody's going through something we'll just say what night can we bring dinner by rather than saying let me know what I can do for you let me know what I can do for you puts more of an onus on the person going through the issue and I think that's just very helpful uh also it was really really nice I used to get I would you know get more acutely but texts phone calls cards from people who I worked with and it was just very uh very heartwarming to me it was actually really nice as you mentioned in the introduction I got voted one of the best doctors in Dallas for the probably 15 years prior to my hemorrhage and there's only about 10 Radiologists a year that get it and the Physicians the referring Physicians have to write your name in and I always was just very proud of that but I actually got it for the three years following my Hemorrhage um and it was you know it was very nice and especially knowing that I cannot practice now it really makes me feel good that I knowing that I was a I know I was a really good physician that the patients and the clinicians appreciated my um the work that I did and um yeah but I can't do it anymore and that's just that's the way it is uh I appreciate when people understand like again my new normal that they understand that I make mistakes that and some people said I'm just glad you're around that people understand that I get antsy I get tired and they've you know they've it's it's nice when people understand this new normal I have a quick funny story on that one I went to one of my friends invited me to the Dallas Stars game and during the first period he's like oh I know you get tired so if you have to leave early we can and so uh I said you know actually I took a nap today so I'm good but I appreciate it's actually my talk and so after the second period he's like oh do you want to leave I'm like I'm okay thank you he said well I want to leave um so I was like okay that's that's all good but again being funny but I do really really appreciate it when people understand that and then this one really I think is really uh this next one how are you doing today I really like that uh it was I found this in a book by Cheryl Sandberg who is the CEO of Facebook and she wrote a book called option b about how her uh her husband passed away suddenly while on vacation it was just a small section in the book but basically she was writing she said she didn't like it when people were saying how are you doing she's like my husband she wrote the book my husband passed away I'm not doing well I'd rather people say how are you doing today and that one word today just makes all the difference and you know I think that's extremely helpful I try to remember that um but I just think that one word how are you doing today and for me it makes a huge difference as well especially if I haven't seen anybody and again more recent to my retirement but if somebody says how are you doing I wrestle with myself do I start telling some of my problems and why I can't work and things like that but if someone says how are you doing today it changes the whole thing it's it's going to be a good day we're gonna I'm spending time with my wife my my dog and things like that uh and you know I I appreciate it and I would be nice if people recognize that it it's hard uh to have this new normal I don't think anybody I've ever had anybody say this but it would be nice if people said you know I know it must be frustrating to have this new normal or I can only imagine what you're going through it would be it just these kind of things would provide validation and it's better than that's okay we all forget things and I've given this talk probably to about 20 brain injuries Survivor groups and as a brain injured Survivor We and I hate to Hate say hate but we really kind of hate that because what that that's okay we all forget things is your person's trying to be nice they're trying to make you feel like oh it's not that big of a deal but it puts you on a defensive and if somebody says that I just kind of you know just don't engage um because what I'm going through what brain injured survivors are going through is totally different than this normal age in process and I just think it's important as a person to listen try to validate rather than tell your problems um to another person so what's helped me through the process the definitely my family and friends the medical rehab staff did a great job the rehab patients were very um very inspiring there was they just were happy to be alive I definitely made good decisions I've had to make practical changes there were some books that I really like including happiness makeover and I've had to adapt my goals and I'm going to go through these here in a sec this is a photo of my wife in the red of my two daughters and this was taken on October 26 2016 exactly one year after my Hemorrhage and just a few things I want to point out I could have easily not been in this photo this 50 mortality one out of two people would have died and I'm extremely lucky that I'm I am around and my wife has been incredible that we've had you know it's definitely been a role reversal she's you know some ways she's more empowered now um but she's we've had to work on our communication to just work through this new normal and how it affects both of us and it's just been she's been great and my two daughters have been very good and understanding that they you know they just I'm at a new normal it and I'm just not where I was I think it's important to try to make good decisions because you never know when you're when things are going to come up the one of the things you know disability and life insurance you never anticipate having to use it and I think it's important especially as a physician to get disability insurance um and life insurance but definitely disability insurance nothing that helped us was we lived and continue to live within our means and you know that's I think that's just important because you never know what's going to happen I think having an outside interest of in photography and spending time with my family helped with this unexpected transition and then being a doctor was not my sole identity I try to be a good person and and all these things help make it easier on the unexpected transition so some of the Practical changes I've had to make I have to get extra sleep I write things down all the time I primarily use my iCal and I put tasks down for that day and appointments and um one things that I've I've had to do is if I have an appointment I look at it the day before and I put an alarm on my phone so today my time it would start at 11 11 o'clock so at 10 30 and 10 40 I put alarms my phone just to make sure I don't forget things because I have a problem with time I really I almost have to be OCD and to remember things and being routines and some of those you know rituals it's um one of the things I take an inhaler in the morning and so and then night so when I go into the bathroom I open a drawer to the inhaler and the drawers open I know I need to take the inhaler but sometimes if the drawer is closed I don't know it I can't remember if I took the inhaler and closed it or if I just I totally forgot to open the drawer so sometimes I take four pops instead of two and that's okay um I've had important emails read and that's again another additional responsibility for my wife and then lastly it was interesting like I said I had problems with time and uh I started giving this presentation term my time at rehab and I wound up going um a week early to give the talk and they said oh it's next week and I was kind of upset about it I was talking to one of the other patients she saw I was upset she said you know I look at things or my mistakes deadly or my mistakes fatal if you know if I forget my medicines over three four days or if I walk in front of a bus that's a fatal mistake or deadly mistake but if not you don't like making the mistakes but just keep it in perspective and and that's been a helpful thing to me there's a book that I really like called the happiness maker I've read it before I got hurt and then after and it was by MJ Ryan and it's kind of a Buddhist way of looking at things and a couple things she had in there that I really like is she said you don't know the end of the story and it's a Buddhist story and of a villager villagers horse runs away another Village moves up says aren't you upset you lost your horse and the guy says I don't know the end of the story two or three days later the horse comes back with another horse and so now he has two horses and that's not what ends in the book but the Buddha story continues that the Villager has a son got on one of the horses falls off breaks his leg somebody comes up and says orange upset your son broke is like I don't know the end of the story is what he says and then within the week a war breaks out and the sun doesn't need to go to war because he has a broken leg so a lot of things you just don't know how things why things happen can you kind of just have to deal with that new normal she says every night you should review or you know and I do this a couple times a day what were you satisfied about that day what'd you enjoy about that day what are you thankful for what are you hopeful for sorry and I added hopeful about two years ago so I remember satisfied enjoyed thankful and hopeful so for me you know satisfied good father good husband good son gave a good talk enjoyed talking with you guys today enjoyed spending time with my wife been thankful been live I'm thankful we have a house and a home um I'm thankful my kids and we're happy and healthy um you know again thankful we have a house and a home I'm hopeful that um the this talk went well that we stay safe and healthy so that's what I go through and it actually is very helpful for me because it helps me enforce going through what I did today which is a problem for me So Satisfied enjoyed thankful and hopeful and then you know I've had to adapt my goals and so this was a rehab this was a intake form I filled on my first day filled out my first aid therapy and this was on November 30th 2015.

[00:45:46]in and just want to go to the bottom it says what do I owe my life is like when I leave pate and I wrote down back to normal and function in my job I didn't achieve either one of those I didn't was not able to get back to work as a radiologist I did not achieve that and I did not get back to normal and I'm at this new normal and so I just think it's important to try to set goals but unders you know reset those goals if you can't achieve it so my new goals are you know to be good father good husband um continue to learn Spanish continue to give this talk to whoever wants to listen um my one goal is I hope to give this talk in Spanish one day um so you know I just think it's important to be able to and continue working my photography um so this is a photo I took of the Grand Canyon I got lucky with the clouds so take home points you know reviewed quickly some of the things that I found helpful as a practicing position uh hopefully you know emphasized that the ancillary staff are extremely important uh part of the team in the success of the patient that live life to the fullest they can change an instant we have that selfie from uh again an hour before this happened reviewed what's helped me my my recovery what people say that's helpful and again I just want to reiterate that you know I think it's important to you know follow the Golden Rule and treat people the way you'd want to treat him and you really have an unknown impact on people again for you know for for me just multiple members of the team and probably people I don't even know had such an impact on me but the Radiology technologist the nurse the chaplain resident um and so I just think you again have to be comfortable with that uncertainty of just treating the people who wait you want to get treated that was a good book just to bring us home by Mitch ablum the five people he Meet in Heaven and basically it was a made-up story of a it was a made-up story of a guy who dies an angel comes down and basically shows him five different people he had it uh impact on and he had no idea and so I just think that's a you know um you have to be comfortable with that just a few kind of quotes here at the end with some of my photos this is a photo I took of New York from Brooklyn from Charles Dickens says reflect upon your present blessings of which Every Man Has many not your past misfortunes of which all men have some and so you know to me this is you know try to concentrate on the present try to concentrate on good things try not to focus on the past and on the bad things in your past just keep on trying to look forward and I think understand again going back in this Facebook world that everybody's got stuff um and don't don't you know try not to focus on the bad things in your life at some point you just have to let go what you thought should happen and live what is happening you know I was on this road I hit a fork in the road and I'm now on this new road trying to enjoy the trying to enjoy this new Road um God gave adam a secret and that secret was not how to begin again but how to begin sorry well not how to begin but how to begin again and I was getting said by Ellie weisel it was a holocaust Survivor and I kind of look at this as as you know Adam and Eve were in the Garden of Eden they were kicked out of the Garden of Eden which was Paradise and they're kicked out into essentially real life and in some ways that was a gift that God gave to Adam and Eve that they had to learn how to begin again outside in the real world and then lastly the biggest mistake in life is you think that you have time time is free but it is priceless you can't own it but you can use it you can't keep it but you can spend it once it lost you can never get it back and that was given by Buddha and I just think again going back to you know my that selfie my wife and I time is precious and I think try to enjoy the present and and try to enjoy um the time you have so thank you very much for your attention and happy to take questions Dr Cohn thank you so much for sharing your unique perspective from your experience thank you so it's so clear that you are not standing and empathetic practicing radiologist I loved hearing how much you've grown personally beyond that and recognizing your identity Beyond a radiologist or a physician as a result of such a traumatic experience and taking that unanticipated road um as I mentioned during my intro I really hope this has helped to Enlighten us all both personally and professionally we can all you know cognitively appreciate that patients and Learners we serve have you know often complex lives beyond what we see you know the tip of the iceberg if you will um but it really it was really helpful to hear your perspective and and uh from your unique experience are there others who have any comments or some questions that you might like to ask Dr Kohn um Dr Cohen this is Lee learman I'm the dean of Virginia Tech curling School of Medicine thank you so much for taking us through your experience and and how you're living your life productively um I I wrote down the the Seth of things because I found myself uh traveling to the same place in my own appreciation log at the end of the day but I didn't think of it as those four components so I really thank you very much for that I was curious around you know the unique perspective of of physician experiencing what you did and whether you know in the in the possible future of returning to a prior practice what would that have meant to you uh what what you took out of that experience no and I think that that's a great question um you know I think you know I tried to be uh I'm not sure um you know I tried to always try to put myself in you know and I hate to say always but I did always try to put myself in the perspective of especially as a radiologist I try to put myself in the perspective of the referral position or the patient and I think that's important because I would be sitting there sometimes like if I saw uh a finding I was I kind of wrestle with myself okay if I was the patient or the physician what I want to know and most time I would get out I would call go ahead and call them and I'll err on the side I'm um aside of that so I I'm not sure it would have changed much and I hate to say that because then I was like okay what did we just spend the last hour on but um you know I think going back to trying to treat people the patients and the clinicians the way you'd want to get treated I think um being communicative um I think that's what I would say I appreciate it in your thank you I appreciate that your your Iceberg uh that you showed with respect to um folks who've had an experience such as yours but I but I think you know that is such a common way of thinking about or a useful way of thinking about anyone we might meet and how they present themselves uh I don't know if folks have had a chance to watch that empathy video from Cleveland Clinic it's old now but it does a very nice job of popping up some of the backstory of each person that's just wandering through a health system on a on a typical day that's reminding us of all of the uh new all of the kind of richness of their experience and in some cases suffering or joy that we don't always experience in just our first impressions yeah thank you I think it's an it is an interesting actually that the people again I think it's just important to one of the as a brain injured Survivor like I said earlier and I don't mean to be negative but the the oh I forget things too it is just it people don't understand what I go through again knockout wood you know I can I can live by doing these routines I can live a normal life relative with this new normal but I think you'd be nicer if people understood and try to validate and again I've gone to some Physicians office and and like oh you know you look good and I'm like you have no idea you have no idea the stuff that I have to do I have to write a note to myself you know that's if I'm going to position on Tuesday I write notes to myself okay we'll write down what I want to ask them they have no idea what you're going through so I think try going back to your empathy I think it's important to be try to be empathetic um and try to validate what the person's going through uh oh I have one other thing sorry go back um on what you say how you would change things just going back to your other question one thing that I always did ask because I would do a lot of pain management injections and I would do them on a local anesthesia would probably take me three four minutes to do to do a pain management injection one of the questions I would pretty much always get always ask is how we what kind of work do you do and I did that to try to get people to talk about themselves because if you get to somebody to talk about themselves it gets their mind of off what you're doing but having gone through what I've gone through I would not ask that question now because for me especially initially I'm pretty young this happened when I was 48 49. somebody asked me that question and I say I'm retired somebody I gotta look like oh you must be rich and if I got that look I'm like well I had a brain I had a brain and you know brain bleed um so that would that would be one thing that I would change is is maybe ask him what what's your typical day what's your typical day like or things like that again they're little things that can make it little things that you say as a physician or a person can make a big difference and how you treat a patient or how they take it thank you sure thank you Dean lemon I have to say that's one of my still one of my favorite videos that empathy video and I was going to mention it also um if you all have not had a chance to review it I believe the dean uh posted a link right in the um in the chat uh but it is it is worth the watch for sure and it's very short well we are right at time thank you all so much for being here again please get out there take some deep breaths outside it is absolutely gorgeous out there um and thank you Dr Cohn for this uh fabulous uh shift in perspective for us all my pleasure thank you enjoy the rest of your day everybody thank you