The Intersection of Laughter and Bravery with Lady Glaucomflecken: Part One

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katie Peters, and this is the Brain & Life Podcast. I would say that doing this podcast isn't really work. It is just so much of a pleasure, especially when I get to see you, Daniel, and we get to talk about stuff. But I had to work extra hard on this last podcast, and I just could not pronounce the name of our guest's alter ego. Is just, I know that you have the super podcasting skills, but do you have a tongue twister or a hard to handle pronunciation?

Dr. Correa:
I mean, I wouldn't say anything about super. I end up practicing a lot off the recording so that hopefully I will minimize the number of edits that need to be made by our team. But I always try to stay away from the word phenomenon or phenomena, phenomenon. Yeah, I think it was, I got it right.

Dr. Peters:
Phenomena.

Dr. Correa:
But yeah, it's just sometimes those double repetitive words. And I definitely try, as I was saying, before we record with any guests I practice pronunciation of their names. I'll even change and try to phonetically write it out in our notes.

Dr. Peters:
Me too.

Dr. Correa:
But I still get tripped up during the recording. I just kind of go with it and embrace it, say sorry, hope that the editor gets to it. But what's funny is all those complicated medical words, the medication names, the anatomy, the names of conditions, which I totally get are really annoying and frustrating for many people in the community. I think got drilled in with enough sleepless nights and studying that those words kind of somehow make more sense to me. But then I go with my family members to their doctor's office visits or something like that, and I end up encountering words from a whole different specialty that I'm not used to seeing and sometimes I'm just kind of like, "Ah, why?"

Dr. Peters:
Yeah, I guess we have our sort of neuro-language, and if it goes outside of the neuro-language, then we're like, "Uh-oh, do I need to know what the Lecronon is?" Oh, gosh. I don't even know if I pronounced that right. I think I did. I think I did. I think I did it. Well, because I had to work extra hard on pronouncing it, and the reason why is the name of our guest's Alter Ego, and wait for it, it's Lady Glaucomflecken. I think I did it, Lady Glaucomflecken.

Dr. Correa:
Yeah, I know. It gets me every time too.

Dr. Peters:
Yeah, and I think I did it. It became a long conversation and it was really less about my clumsiness of pronunciation, but rather the guest was just so interesting and had so much to share with us. So, we're going to actually do this podcast in two parts, because it's half the time me trying to pronounce Lady Glaucomflecken. It just makes me laugh. And also because Kristin Flanary, who is Lady Glaucomflecken, it was just so wonderful. She and her ophthalmologist husband, Dr. Will Flanary, who's also AKA Dr. Glaucomflecken, I think I'm doing it okay, are active on X and TikToks or even touring and live comedy shows. And they've shared their views about medicine and the healthcare system. And I think from Kristin's perspective, she really provides a deep dive in how it is to be a caregiver and what she calls a co-survivor, which I just really appreciated that terminology, because her husband had two cancer occurrences and then separately had a sudden cardiac arrest that required him to be in a neuro intensive care unit.
So, she shared so, so much about that unique caregiver experience, but also on how interactions with healthcare providers during those serious, serious situations is so much, and how important that relationship is with the caregivers/co-survivors. And I couldn't be more delighted. We invited our expert, Dr. Jessica McFarlin, who has dual expertise in both neuro-critical care medicine and palliative care medicine to discuss with us.
Hello to all of our podcast listeners here on the Brain & Life Podcast. I would like to welcome Kristin Flanary to our podcast. Now, Kristin has advanced training, so she's got advanced training in both cognitive neuroscience and social psychology, and she's very active on social media and one of her podcasts is called Knock Knock, Hi! She and her ophthalmologist husband, Dr. Will Flanary met at college in Texas Tech University, go Texas Tech, before earning advanced degrees at Dartmouth. They both went to Dartmouth. Kristin has experienced an intimate and varied view of the healthcare system, because she has been married to medicine, she's been a patient. And has been a lay responder and CPR provider to her husband, along with being a caregiver care partner and co-survivor of his two cancer occurrences and also a sudden cardiac arrest. Wow, that's just so much. So, through her social media presence and impactful writing and really unforgettable keynote speaking, she really informs us about everything, about the patient and family experience, and I would say the care partner experience. So Kristin, welcome to the Brain & Life Podcast.

Kristin Flanary:
Thank you. Thanks for having me. I'm excited to be here and nerd out about brains too.

Dr. Peters:
Let's do it. Let's do it. Absolutely.

Kristin Flanary:
It's been a long time since I lived in that world, but I still find it all really interesting.

Dr. Peters:
Well, good. I'm glad I actually did, one of my fellowships is in cognitive neuroscience and my other one's-

Kristin Flanary:
Oh, nice.

Dr. Peters:
... in neuro-oncology, so I look at neuro-oncology through a cognitive lens a lot of times. But this is about you, so where are you joining us from today?

Kristin Flanary:
I am at home in Portland, Oregon.

Dr. Peters:
Oh, wonderful. I love Portland. It's such a great place. Tell us a little more about yourself. I gave a short introduction, but we'd love to learn more.

Kristin Flanary:
Yeah, like you said, my husband and I met in college, and then we got to play the fun game of trying to do basically our own couples match, except that I was not in the medical system, so we were on different application calendars and all this stuff. But I went to graduate school and he went to medical school, and by some miracle at the very last minute it was all very dramatic. He actually got the very last interview spot and then was waitlisted, and then literally two weeks before classes were going to start he got a call that he got off the wait list. The last person who'd been accepted had decided to turn down their spot. So, we were all set to go our separate ways, and that was very sad and all of that. And then all of a sudden that wasn't happening anymore, so that was very exciting.
I was in the psychology department studying cognitive neuroscience and social psychology, as you mentioned. I specifically was looking at emotion and various aspects of emotion regulation and our emotional biases and things like that. I was in a PhD program, decided that after all research is not the life for me, and so decided to, I was three years in at that point and I took my research and turned it into a master's thesis and mastered out it's what they called it.
Then I still had a couple of years, because he ended up taking five years, because at Dartmouth at the time, I don't know if they still do this, they could split their last year into two years so that they would have time for whatever they wanted. If they wanted to spend time with family or they wanted to go and do medical missions somewhere or whatever. We decided, well, since I have two years and we're in the middle of nowhere in New Hampshire, I'm just hanging out, let's go ahead and start our family. We knew we wanted one eventually I was like, "Now's as good time as any, I'm not getting any younger." So, we had a baby in med school, which is not what you're supposed to do, but most of what we have done is not what you're supposed to do.
And then he ended up, it was a good thing he split his last year. He did that because he was still trying to decide what he wanted to do, but it worked out, because he ended up getting cancer when our baby was almost one. And that was okay. It was testicular cancer and all he needed was surgery. And so we got that done, but it was all so fast. The day he went in and got diagnosed, that afternoon we had our ultrasound appointment to get him diagnosed, and then that evening he was in surgery. It was all like, ah, just super fast.

Dr. Peters:
It's truly whiplash. I know that for my own patients. And you're sort of holding, and you had a one-year-old, is that true?

Kristin Flanary:
Yeah, she was with us, obviously. We were not around family up there. None of our friends had kids, because again, we're in school. Very few people have decided to do that. And so yeah, we brought her with us. The appointment, she's on my lap and I'm just like, "Oh my gosh, am I," in my mind at the time I thought, "Am I going to have to raise this baby by myself?"

Dr. Peters:
Oh, no.

Kristin Flanary:
I know it's one of the "good cancers," but when you hear the word cancer, nothing about that is good. Nothing feels good. We took a little comfort in knowing that it was one that's easier to treat and has better odds, but still, you just never know. The statistics don't matter as much when you're on the other side of the interaction, when it's your family that's dealing with the cancer.

Dr. Peters:
I totally agree. I always say cancer always breaks the rules. It's better to be prepared.

Kristin Flanary:
Yeah, because you always kind of, your mind just naturally goes to assuming the worst, or at least that the worst is a possibility, and that's really scary. So, that was a bizarre experience, and I remember while he was in surgery I was in the waiting room. Thankfully a couple friends took the baby and put her to bed and babysat for us. But I was just in the waiting room, and the TV was on, and there's maybe two other people in there that I don't know. And it was just the weirdest, even at the time I was like, "This is the weirdest way to do this. My world just got flipped upside down. It's just a few hours old. I'm still trying to figure all this out and let it sink in, and then the world is just carrying on as though nothing is happening, and I'm just in this room watching some inane TV."
I don't know, it's just like it's the weirdest disconnect. You feel like you're in the twilight zone or something, but that all went well. His surgery was fine. He didn't need any further treatment, just had the orchiectomy and everything just sort of carried on. It was obviously a psychological challenge, to be in your 20s and be dealing with cancer, that felt very odd and it was hard to swallow, but it was the best case outcome. So, overall we felt very lucky and just kind of carried on. And then we went to residency, I say we, it is we. I didn't have to go to see the patients, but I very much experienced medical school and residency as well. We were in Iowa at that point, just because we didn't want our kids to be too far apart. We knew we wanted more than one, so we were like, "Well, I guess we have to have another baby now." We had a baby in residency, so we had one in med school and one in residency.

Dr. Peters:
Wow.

Kristin Flanary:
It's just like I said, we never do anything the way you're supposed to. We had that baby, our second baby, and when she was about a year old he got cancer again in the other testicle, and it was not a reaction. Again, all he had was surgery. It hadn't spread. It was a completely separate primary cancer in the other testicle, which is exceedingly rare. He should have bought a lottery ticket instead, I don't know. But he had that one, and then that one was a lot more difficult, because it was more consequential.
The first one was no fun. But the second one, now we were looking at infertility. And we had two kids, but we were like, "Are we done with two kids? Do we want to try to bank sperm and maybe?" So, we had those decisions. And then it also meant that now he would be unable for the rest of his life to have generate his own testosterone, and so he'd be on hormone replacement therapy forever. And that, again, at this point I think we're 30, so that's a very daunting word forever to have some medical dependence for the rest of your life.

Dr. Peters:
And two rare things happen. I mean, I have not really heard cases like that. Folks, this is AB normal, this is not normal.

Kristin Flanary:
Yeah, exactly. That one was obviously very, very difficult. And that one actually, we don't talk as much about that one because of the rest of the story that I'll get to in a minute, but that one actually took a good seven or eight years to get his testosterone levels where he needs them to be. Part of that was due to insurance. Part of it was due to no one telling us when something new came out that ended up being the thing that worked for him. And so, it took us several years to stumble onto that.
So, it was really hard, because during that time he's trying to do residency, he's trying to apply for jobs at the end of residency, we're moving once he gets a job, all of this stuff while he is just completely depleted of testosterone. And I never appreciated or knew beforehand just how much testosterone does in a male body. You hear about the sex hormone effects and stuff, but it does so much more than that. It's like his energy, his mood, other things that are a little less noticeable, like bone health or whatever. But it does so much, and it really, really, really impacted our whole family really for many years to have him on that roller coaster.

Dr. Peters:
And it's not just physical fatigue, it's actually mental fatigue. From your cognitive neuroscience perspective, people are just like, "Mentally I'm having a slowness and a function." And this is why when I have patients who have had treatments that will deplete their testosterone, I'm so quick to, "Let's check it and let's get it corrected." Because if you don't get it corrected, you can have a lot of cognitive, and it's a mental fatigue.

Kristin Flanary:
Mental, emotional, just like everything. It just do not feel good at all. So yeah, that was pretty tough. I mean, kudos to him for, that just shows you what kind of a person he is. He's still doing all of these things. Not to mention some comedy on the side. He's coping with all of this through humor while also working full time and raising a family. So yeah, it was a lot. It was just a lot. So that was, I think three, three and a half years between the two cancers. And then I think four years go by. And then, so the second, I should finish up the second cancer, actually. He had that surgery again, he got the second orchiectomy. That all went well, didn't need any other treatment other than the hormone replacement therapy. And all clear after that one. So, we're like, "Okay, can't get any more cancer, because don't have any more testicles." So we're out of that. We're out of those woods.
And just carried on, again, we're just 30. We still have a lot of life. We're building a life really at that point. And then four years later, May of 2020, it was Mother's Day, we had a weird COVID lockdown version of Mother's Day, and we couldn't really go anywhere, but we just kind of celebrated. And then we went to bed that night, and then at 4:45 in the morning, I woke up to him making some very odd, scary sounding noises. And I'm not in medicine. I don't know, bodies are gross. I like thinking about them, but I don't like dealing with them. So, I didn't know what was going on, but I knew that it didn't seem normal, and he wasn't responding.
I thought at first that he was just snoring, and so I just kind of pushed him to try to get him to roll over and stop snoring, and that didn't work and he didn't roll, and he didn't respond to that at all. Then I started shaking his shoulder, like, "God, wake up." Because again, I'm just thinking he's snoring. Didn't respond to that. And then I started getting a little bit concerned, like, "This is weird." And so then I really tried hard to wake him up, and he wasn't waking up. And so then I was slapping his face, nothing. I was shouting his name, nothing.
Then I didn't know what was going on at all. And it's May, 2020, so of course I'm thinking, "And he's making these weird respiratory sounds." So of course I'm thinking, "Is this COVID?" And so, I don't know if he can hear me or not, but I tell him just in case, I'm like, "I'm going to call 911. I'm going to get help." And so, I grab my phone, I call 911 and tell her what's going on. And she says, "Okay, I'm going to walk you through CPR." And I was like, "What?"
I have the recording and you can hear in my voice that I'm like, "Wait a minute. What do you mean CPR?" Hadn't occurred to me that it would be a hard thing at all. I knew nothing, nothing at all, and I was sort of in shock once all this is happening. But she walks me through it. Thankfully, it's not a very complicated maneuver, but I did have to do it for 10 minutes before-

Dr. Peters:
Oh no.

Kristin Flanary:
... the paramedics got there. And a few months prior to that I had had neck surgery for a cervical disc replacement. And he's over a foot taller and 100 pounds heavier. So between all of that, and I'm hypermobile, which was why I had the surgery, just that perfect storm of factors coming together. I could not get him off the bed, so I had to do CPR on the bed. And I did that for 10 minutes because it took them ... They got to our house. It didn't take that long for that, but then they had to suit up. They had to put on all the COVID-

Dr. Peters:
Oh, that's right.

Kristin Flanary:
... PPE, hoods, shields. They had those gas masks from when they fight fires, just crinkle suits that they were wearing. It sounded like potato chip bags when they walked, and it was just like head to toe PPE. And so, it took them a while to be able to get all that on, and then they had to break down the door and they came in.
And so then, long story short, they end up, they shocked him five times before they got a heartbeat back. They gave him, I think three rounds of epinephrine and amiodarone, the five shocks, but they did get his heartbeat back. He had been in V-fib. And rushed him off to the hospital. All sorts of things happened there both to him and with me. But again, just to try to make a long story a little bit shorter, they ran all sorts of tests. Everything was coming back negative. He went to the ICU and they kept him basically, I don't know, you probably know the terminology better than I do, but essentially like a coma, right? And they did targeted hypothermia treatment, so they cooled his brain down, and the rest of him. And because it was COVID I couldn't be there, so I was just-

Dr. Peters:
That is so hard.

Kristin Flanary:
Yeah, I was just having to get a phone call once a day, maybe twice if I was lucky and persistent.

Dr. Peters:
And taking care of two little kids?

Kristin Flanary:
So, after I did the CPR and they took him, I should say it took a little while after I did the CPR and I was packing him a hospital bag. And I didn't know. I was really thankful in retrospect that I did not know the statistics about cardiac arrest at that time, because that would have been even worse. But I just thought, "He's healthy. He's completely healthy." Other than that his heart just stopped for some reason. And he hadn't taken anything. Nothing was unusual. I was like, "Surely he's going to, whatever this is, he's going to come out of it." Because I didn't even know at that point what it was. I just knew that I had had to do CPR. I didn't find out that it was V-fib and that they got his heartbeat back and all of that until they had already left with him in the ambulance.
In the meantime I was just trying to make sure my kids didn't come out of their room. I had told the 911 dispatcher. I was like, "They're asleep in the next room. I don't want to scare them. I don't want them to see things that they can never unsee. They're only eight and five at the time, so really formative years for something like that." So, thankfully when the paramedics got there they shut the door. Because I had told them which door they were in, and so they just shut the door and then the door stayed closed, because we had done all that sleep training, which really paid off in that moment. They had a little clock in there that would turn green when it was okay to get out of bed. And thankfully they were following that.
So, he gets to the ICU, gets his body and his brain cooled down for, I think 24 hours. Then it was a matter of once they woke him up, is he going to be able to follow commands? Does he have at least that level of brain function? And so, that was a big, I had basically 36 hours between when it happened and when the sedation was able to wear off enough to do this test to just wonder, "Okay, he's survived, but now what? Is he going to continue to survive? And if he does, is he still himself? Does he still know who we are? If he does remember all that, can he remember how to do his job? Is he physically capable of doing his job? What is this going to mean for our life and our family? Who knows?" Just get to wonder about that for a day and a half.
And then once the sedation did wear off and they could do the test, he was able to follow simple commands. And so everybody was like, "Whoo." It's like a big collective sigh of relief there. And then he just kept waking up a little bit more and more, and finally he was able to speak and do all of those things. And he asked where I was, so I know. And so they let him FaceTime with me, and he was in that amnesia loop after a cardiac arrest. It's kind of like 50 First Dates. He just kept saying, "What happened? Why am I here?" And I just had to keep telling him. So, it was at that point I felt like, "Okay, you're still in there." After talking to him I could tell he's still him. He remembered things. At that point, that was the first time that I really felt like, "Okay, this is actually going to be okay." And so, that was nice. And so let's see. He went in on a Monday morning and then he was home by dinnertime on Thursday, and he was just completely physically and neurologically intact.

Dr. Peters:
That is so amazing. And so, I mean, guess what, Kristin? I'm going to say everybody needs to learn how to do CPR, you know, everyone, right?

Kristin Flanary:
Yes.

Dr. Peters:
It's truly your early intervention. That's why he was able to come home. Kristin, you are a gem, a true gem.

Kristin Flanary:
Oh, thank you.

Dr. Peters:
I really appreciate, you spent so much time with us. And I just want to say thank you for really sharing your experiences and your unique thoughts about being a caregiver, a parent, a wife, a loved one, and also a co-survivor. So, you have to check out Kristin at her alter ego Lady-

Kristin Flanary:
Glaucomflecken. Yeah, Glaucomflecken. You can go to Glaucomflecken.com and that sort of houses everything we're doing. But yeah, I'm also on social media as Lady Glaucomflecken or Kristin Flanary, either one, you'll all come up. And then yeah, if you go to our website you can see everything that both me and my husband are up to.

Dr. Peters:
Well, that is so awesome, and thank you again. You've spent so much time with us. I really appreciate it.

Kristin Flanary:
Oh, thanks for having me. This is fun.

Dr. Correa:
Can't get enough of the Brain & Life Podcast, keep the conversation going on social media when you follow @brainandlifemag, or visit brainandlife.org. As your hosts, we would also like to hear from you on Twitter, @NeuroDrCorrea and @AudreyMathMDPhD.

Dr. Peters:
Well, welcome Brain & Life Podcast audience, thank you again for always joining us for our podcast. I am of course, your co-host Dr. Katie Peters, and I am just thrilled over the moon to introduce our medical expert, Dr. Jessica McFarlin, and she's going to be discussing the aspects of brain recovery after a cardiac arrest, and also the nuances of what is a neurology intensive care unit, and when does palliative care medicine come into play? Dr. McFarlin is a fellowship trained in both neuro-critical care medicine and palliative care medicine. She's an associate professor of neurology at the University of Kentucky, Department of Neurology, and chief of the Division of Palliative and Supportive Care. Before heading to Kentucky, I was so, so lucky to work with Dr. McFarlin during her neurology residency, and then both of her fellowships, which were at Duke University Medical Center. Her academic practice focuses and hones in on communication training of medical providers and physicians, and the delivery of high-quality palliative care in the neuro ICU setting and other settings in neurology. Dr. McFarlin, so, so welcome. Big welcome to the Brain & Life podcast.

Dr. McFarlin:
Thank you. I'm excited to be here. This is fun. I've been catching up with some of the podcasts as well, so y'all are doing awesome work. Thank you for that. That's cool.

Dr. Peters:
Oh, I'm so glad you listened to the podcast. That gives me chill bumps. That makes me very happy. You take care of patients in the neuro intensive care unit. Can you get us sort of the basic 411 of what is a neuro intensive care unit and what does that look like?

Dr. McFarlin:
Interestingly, it looks different in every hospital. Most of the time neuro intensive care units are in pretty large hospitals. People get transferred there a lot from smaller hospitals when they've had a really serious neurologic brain or spinal cord injury. That could be things like a really large stroke, or a really large brain bleed. It can also be traumas, like traumas that cause brain injury, like a really complicated motor vehicle collision. We also take care of people that have seizures that maybe aren't stopping in an expected period of time. A lot of people are on ventilators in the intensive care unit, so they're not able to speak. They may also have decreased levels of consciousness because of the brain injury. So, it's the patients we're taking care of, but a lot, but they can't speak for themselves a lot of times. So, we're really working with the families really closely in a neuro intensive care unit.

Dr. Peters:
Wow. It sounds like you treat it like many different conditions, but it sounds like it's very serious. How do those patients get to you? Do they come through an emergency room, or do they get transferred in for specialty care?

Dr. McFarlin:
Most of them probably first present to an emergency room. So, oftentimes a family member might find someone less responsive than normal and brings them to the emergency room closest to them. And then the emergency department may do an evaluation and say, "You know what? This is really serious and we need to get them to a level of care where everyone in that ICU is trained to take care of people with neurologic injury." So, it's not just the doctors that are trained, but the nurses and the pharmacists and the techs, everyone caring for those patients.

Dr. Peters:
In this interview for these two segments, we interviewed Kristin Flanary, her, I guess moniker online is Lady Glaucomflecken, and she really told us about her husband, who is Dr. Glaucomflecken, and I'm going to really try to pronounce that old name. Well, I've been practicing. Her husband had a diagnosis. He'd actually developed testicular cancer during his medical school, then residency, but then had another very serious event where he had cardiac arrest that required him to be in a neuro-critical care setting. Where does that come in for you to treat? How is somebody from neurology involved with the heart, but I guess the brain is also involved too?

Dr. McFarlin:
And that's a really great question. When we think about a cardiac arrest, what we know is the heart stops. But what that means to the body is people are unconscious and they're not getting blood flow to the brain during that time, because the blood stops flowing since the heart has basically just seized all functions.
So, in a neuro-ICU we are specially trained to deal with the effects of not getting blood flow to the brain, which in addition to being unconscious means that the brain can swell, the brain can have seizures. It can cause a lot of different other effects that well, if we get the heart restarted, that's great. And the heart may be doing great after that, but the brain is really the thing suffering, as well as the heart. So, it's a combination of the neuro-intensive care team, as well as often the cardiologists watching that patient because it's the brain injury that we're most worried about as far as thinking about how's this person going to do? Are they going to survive? And if they do survive, how do we give them the best chance of a really good quality of life after a cardiac arrest?

Dr. Peters:
Yeah, so that was a lot of the questions that she was contending with. And I will also reveal that this all occurred during the COVID pandemic for her, so she couldn't necessarily be at the bedside with her husband, so it was a really challenging thing. If somebody, let's say the heart is doing well now, a patient has had a cardiac arrest, but you're watching them from a neurology perspective, what are you watching for? What are you doing, and how are you treating or protecting the brain?

Dr. McFarlin:
If a patient survives the initial arrest, meaning they get that really good CPR like she provided to her husband, or they get those shocks that sometimes if this happens in the community we see those defibrillators that people have access to. If we get that and they're lucky enough to survive, because a lot of those people don't, and they make it to the neuro ICU, there are some things we can do really quickly initially to try to improve their outcome. And not outcome just surviving, but surviving and being a thriver. Some of those things are understanding why it happened, seeing what we need to do to care for the heart.
Some of them are things like making sure that we avoid things that are going to hurt the brain. So, things that hurt the brain are things like seizures. Things that hurt the brain even more are things like fevers. We definitely try in a neuro ICU to avoid seizures if we can't to see if they're going on. We want to make sure we're avoiding fevers. We want to take care of the rest of the body too, because we want to make sure that nothing else becomes ill in the body. If your brain's not getting oxygen, that means that other parts of your body wasn't getting oxygen. So, you're also at risk for damaging your kidneys, damaging your liver. We're watching all of those different organ systems to keep them from becoming ill as well.
And oftentimes we're using machine to breathe for the patient. And while we're doing on that, we're also examining the patient to help the family understand how do we think they're going to do. And we're being patient. I think patience is a huge part of caring for cardiac arrest survivors in that short term first few days, and not being too quick to make a judgment about prognosis.

Dr. Peters:
Do you see, when you're examining the patient and you're communicating with the family, what are some signs that the patient's going to recover? What are those maybe early signs or later signs while you're patiently taking care of the patient?

Dr. McFarlin:
Yeah, so I would say for me the physical exam is really important. If I see someone that comes into the neuro ICU and within those first hours to days they are opening their eyes, they are starting to really move purposely their arms and their legs, those are really good signs for me. Other signs that are still good and are a little more subtle if someone's not awake yet is we're watching for what we call someone's cranial nerve. So, are their pupils reacting? Are they coughing? Do they seem irritated by the breathing machine that's in their throat? Those are signs that we might be getting a good outcome that we're really watching for in those first hours to days.

Dr. Peters:
Yeah, I think that's so important. And how do you, and you not only specialize in neuro-critical care medicine, but also in palliative care medicine. Can you tell us a little bit about the facets of palliative care medicine and what that means for our listeners?

Dr. McFarlin:
Sure. So, palliative care is a specialty branch of medicine, just like cardiology is, or neurology is, or oncology and cancer are. We are specially trained in taking care of patients and families with serious illness to help improve quality of life, to help think about prognosis and understand someone's prognosis. And to help understand how do patients and families work to make decisions based on what's important to them in their life, their goals and values. That's something that all healthcare providers do, but in palliative care we are specially trained to do that alongside a patient's regular doctors.

Dr. Peters:
That's wonderful. I mean, I work with many palliative care medicine specialists, and there's even some that are embedded into our program. I'll give a shout out to Dr. Maggie Johnson, who's one of our palliative care medicine trained physicians, but also does neuro-oncology for us. Dr. McFarlin, Jessica McFarlin, this is so wonderful. Dr. Jessica McFarlin, thank you so much for sharing your insights and expertise with us. And of course, thank you so much to our listeners.

Dr. Correa:
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life Magazine for free at brainandlife.org.

Dr. Peters:
Also, for each episode you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at (612) 928-6206.

Dr. Correa:
You can also find that information in our show notes, and you can follow Katie and me and the Brain and Life Magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea.

Dr. Peters:
And Dr. Katie Peters joining you from Durham, North Carolina, and online @KatiePetersMDPhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health, and each thrive with our own abilities every day.

Dr. Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find the Brain & Life Podcast. See you next week.

The Intersection of Laughter and Bravery with Lady Glaucomflecken: Part One

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