ER Doctor Carlan Wendler joins the podcast to provide practical guidance on how to navigate a medical emergency by answering the following questions: What is a Christian’s responsibility when confronted with a medical emergency in everyday life? How can you help a family member or friend navigate the healthcare system? How do I know if I should go to Urgent Care or the ER when I need to see a doctor urgently? What encouragement can you offer someone who is stuck in endless online research for an undiagnosed health issue? What are proper expectations for those who are disillusioned with the US healthcare system?
Christi: Welcome aboard, Carlan. Would you be so kind as to introduce yourself to the listeners today? And I would love it if you would also include the abbreviated version of how you met my sister, Michelle.
Carlan: Sure thing. Thanks, Christi, for having me onto your podcast and for the opportunity to talk about things that are very meaningful to me, especially meeting your sister and marrying her. My name is Carlan Wendler. I’m an emergency physician. I currently work as the chief medical officer of Kibouye Hope Hospital in Burundi in East Central Africa. I am an assistant professor there for emergency medicine at Hope Africa University, also in Burundi. And I’m voluntary faculty at Keck USC here in Southern California, where I did my residency many moons ago.
Carlan: I’m also privileged to provide executive leadership to the African Medical Education Fund, which my brother and I co-founded in 2015 to try to help our African students get scholarships and salary subsidies so that they can continue the work after we go home. I grew up in Southern California.
Carlan: I went to Grace Community Church since before I was born. I became a member there at age 18, and that’s my sending church, or our sending church, I should say. As far as education, I went to UC San Diego, and I studied molecular biology and history there, and then I went to the University of Michigan, at National Champions in football, for medical school, and then, like I said, I did residency at LA County, now LA General, USC Emergency Medicine Residency, and deployed to France in 2012, and then Burundi in 2013, because our team had to learn French. I’m there with a group of missionaries, a lot of doctors, some engineers, a bunch of teachers from Surge Global, which is our sending agency, based out of Jankin Town outside of Philadelphia.
Carlan: I met your sister in 2014 when she was playing piano for a missionary conference put on by our church, Grace Community, and yeah, it’s a longer story, but there was definitely a lot of attention to this, the singleness of this one male missionary, and so there was a lot of, there was a lot of attention around that, which is fine, it’s, but your audience probably knows that sometimes being single generates its own dynamics, and so I was pleased that I got to get to know your sister kind of on my own initiative. She was playing the piano the whole conference, and I noticed her and I was like, okay, maybe I’ll reach out to her because I knew your brother Nate, from before, and had been very impressed with your family, and thought that everyone was pretty cool, and godly. Yeah, so I was like, okay, maybe I’ll reach out to her on Facebook or email or something to start a conversation while I’m back just for these, like, I think I was back for 10 weeks total, and I’d already used three of them before the conference. So I didn’t expect that I was going to be able to really make a ton of progress in just two months back in the States, but this, I think was the last session they did. Her band convinced her to sing and perform a song that she had written and composed, and it was really, it was really touching. It was very beautiful about trusting God in the hard places, and I was like, oh, well, I need to now I need to talk to that girl like today. And by God’s grace, she had put her Bible and notebook down in the seat that just happened to be behind me. I did not know this. This was not planned. It was just haphazard in God’s sovereignty. So after the session was over, I turned around and started talking to her, which I didn’t know at the time was fortuitous because the band and the, like, the short term missions team that was serving the missionaries for that conference, they were told to, like, not initiate conversation with the missionaries because they, they wanted to leave this time protected for us to talk with each other. So anyways, I didn’t know that I was going to have to be the one to initiate, but that was all right. And we got to talk about music and life and stuff. And in the course of that conversation, I was suggesting or recommending certain bands and websites to share music. And she wasn’t able to get on her phone. And so I just, you know, was like, hey, would you like me to text you the name of that band or that website? I can’t remember exactly what it was. And she’s like, oh, yeah, sure, because I’m not getting it right now on my phone. And I’m like, okay, like, what’s your phone number? So that’s how I got her number. I think I was going back packing right after that. So we didn’t end up getting together right immediately. But yeah, we went on a date and it was awesome. So I asked for another date and then one thing led to another.
Carlan: And before I left back for Burundi, we had to sit down and ask kind of like, if we’re going to be serious about this, we’re probably going to need to have you visit Burundi. You should bring your brother or maybe your dad. And so we kind of like sketched out like if this is going to go forward, how does this need to play out? So yeah, in January of 2015, she and Nate came and she loved it. And we took a little bit of time after that to think and pray and fast and seek the Lord’s guidance. And then I think it was actually the day after Valentine’s Day 2015. I called her from Burundi and we had a chat and I told her that I’d be coming back at some point in the next several weeks to America to propose to her. And so yeah, so that’s kind of how we got to that point.
Carlan: I did get to surprise her because I didn’t give her the exact date whenever you’re getting back, but your parents met me at the airport and we went and you know, after I don’t know, 30 hours of travel, I decided to have a Baja fresh with your mom and dad and I talked about my intentions with your sister and they gave their permission and blessing. And then the next day, I surprised her at her home with roses and a ring and proposed at Mission Peak. And she said, yes.And that set us on a life long adventure of service in Burundi in East Central Africa. And we’ve been, we’ve lived on three different continents because we were first year in the States and the second year of marriage. We were in France so that she could learn French and I could learn more French. And then we’ve been off and on in Burundi since then. So eight and a half years of marriage later, we’ve got two kids. Gabrielle is four and a half and they are just lovely, cute, wonderful little joys in our lives. So yeah, I hope I have been brief, but it’s kind of our story.
Christi: Well, and I’ve enjoyed having a front row seat to your whole story, Carlan, and you know that you are the answer to our prayers that we prayed for many, many years for my sister waiting for just the right man to come on the scene and right before you enter the picture, remember my sister telling me, it’s like a barren wasteland. Like there’s no godly men in the picture. There’s no one. I think she was 35 at that point and lo and behold, God brought you the right time and you exceeded all of our expectations. And it’s been really sweet to see how well fitted and suited you both are for each other and seeing how you serve together and raise your kids together and the learning and growing process.
Christi: But anyways, I’ve just so enjoyed being even a small part of watching all of that unfold and you guys even graciously allowed me to come and stay with you all when you are in France and language school. And that was a highlight in my life being able to go and live in your extra bedroom for two months and be a part of that journey with you.0
Christi: So you are a very, very smart man. You know how everything about today’s topic in the medical sphere is definitely your wheelhouse. So I’m excited to hear your wisdom and your life experience applied to these questions. And this topic is not something that people will need every single day. But when you need it, you’ll be thankful that you know it. So it’s not just for people in the medical world. This is something that can apply to all of us. How do we navigate these situations that come up in life with wisdom?
Christi: So I want to start out first by asking the question, what should someone do if they witness an emergency in everyday life? If they see someone collapse in front of them in a store or they see an accident before emergency services arrive on the scene? What is a Christian’s responsibility to care as a lay person? And then kind of a follow-up question to that. Most of the listeners are single women. So is it safe for us to just stop and try to help in these situations? Should we be concerned about our own safety? And that’s a big question, but would love to hear your thoughts?
Carlan: Yeah, thank you for that, Christi, and for those gracious words. It was definitely a highlight of our time in France to have you staying with us as well. And your sister is definitely, next to salvation, the greatest grace in my life. Okay, so what you’re talking about is kind of your good Samaritan situation, right? Some kind of emergency or medical need arises unexpectedly or crosses your path somehow. What is the Christian’s responsibility? And then let’s talk about that in the context of single women. So the, I think in the biggest picture, if I can give just an overview, the Christian ethic is pretty clear. And I think that, you know, we even call this the good Samaritan situation, right? Like the, the parable of the good Samaritan and the commandment to love our neighbor as we love ourself is huge and it’s almost a crushing burden, right? Because it means that we’ve got to treat everybody the way that we would ideally like to be treated ourselves. So if I have a heart attack or I go down, I hope that someone will take care of me. If my child gets injured, I hope that someone will come and help us to take care of them. So it kind of puts this burden on you and you feel like, okay, well, then I need to like, I don’t know how that works. Like I need to always be actively engaged in solving all of the emergencies and critical needs in front of me. And that’s good. And I think we should feel that. I want to temper it just a little bit with what happens in John chapter five when Jesus walks into the, the Greco-Roman Judean equivalent of a super busy hospital at the pool of Bethesda and he heals one person and then walks out. And the text is very clear that they were more than just that one sick person there at the, at the pools of Bethesda. So at least some medical needs do not get resolved in God’s timing immediately. And you can argue those are chronic medical conditions and we’re talking about emergencies. But I think what I want to say is that it is, we shouldn’t feel crushed by the need. I think we should feel motivated to be in step with the spirit. So if you’re, if you’re prayed up and you’re walking in step with the Lord, I think that you can, you can rely on His guidance in moments where you’re going to be at, you know, that equip ways, right? So it’s, say it’s late at night and you’re walking to your car and you have to go a block because you had to park far away from your friend or family member who lives in a, not so nice part of town. And there’s someone strung out on the ground like in an alley, are you, are you going to go into that situation and assess this person and figure out what kind of help they need or are you going to like kind of glance at them, make sure that they’re breathing and then continue on? Like it’s a little bit, I think I want people to feel that they don’t have, you don’t have to put yourself at substantially elevated risk in, in biomedical ethics. We talk about scene safety is the first thing. So even before you look after the patient, you’re looking at, are there down power lines somewhere? Is there a fuel leaking out of the car onto the roadway that could ignite like we don’t want to add more victims to the equation?
Carlan: So I don’t want to, you know, encourage people to take unnecessary risks. But when we look at the story of the good Samaritan, the good Samaritan did put himself at some risk, right? Like there were, there were robbers that were willing to beat up people and leave them for dead on that Jericho road. And he stops and dismounts his donkey and spends time to clean the wounds and put them in on the donkey so they’re going to go slower than they otherwise would. He pays out of his own pocket. It does cost us something to love. That’s the balance that we’re trying to, that we’re trying to take.
Carlan: So with that being said, as the big picture, are there like specific things that we can do to help in those situations? So obviously if you’re living in America, you’re in a real telehealth resource context where you can dial 911 and call for help to come help somebody. And hopefully they’ll get there quickly. So this is especially true. You said you know, you witness a car accident and there’s no emergency medical services on scene yet or emergency services. So what do you do? Certainly I have called 911 from my car on the freeway multiple times. Like I can’t stop because I’m in, you know, the number two lane or something like this. But I see there’s a person wandering around next to the freeway like that person’s at substantially elevated risk of getting hit by a car because they’re crazy trying to cross a freeway or not in the right mind. And someone needs to assess that. But I can’t it’s not me because I just you know went by at 65 miles per hour. I’ve called 911 on accidents where I don’t see anybody else there yet. And often I mean, I think dialing 911 for those of us who have never done it feels very intimidating. And like it’s the kind of thing that you should never do unless you’re personally having an emergency or needing police presence. But the reality is you’re going to get connected to a dispatcher. And if you say there’s a car accident that I just saw on the corner of you know, Main Street and first. And it looks like there’s two cars. You know, I was on the other side of the road. I haven’t assessed anything else yet. I’ll often tell you like thank you. We’re already aware of this accident. If you can provide you know, if you’re emergency medical services, you are welcome to go act within your scope of practice. But we have people on the way already, right? It’ll often be a less than one minute phone call for you if you’re just calling in to report something. If you are calling to report something like that you’re able to get a little bit more involved. And let’s say you’re at the pool and someone falls in and drowns and you know CPR or rescue breathing. Call 911 and then you’ll stay on the line with them as they kind of coach you through what you should be doing next. So that’s kind of the first step. The first level is get help, right? You calling 911 is the way to marshal more resources into the equation. So don’t fear to do that. I would also say that there’s a few things that you can do that are going to lower your barrier to being able to offer that kind of care. So like let’s say you are on surface streets and there’s a car accident in front of you and everything stops right and a crowd starts to form. You’re not going anywhere because the cars are are going to be blocking traffic or whatever. If you have gloves in your glove box like vinyl or nitrile glove in your glove box and you know how to stabilize someone’s c-spine because you did a basic first aid course with the red cross somewhere and you put on your gloves and you go over there and you help to stabilize someone’s neck while they’re lying on the ground after they get out of the car or whatnot. Like you’re doing a service that doesn’t usually cost you too much but it’s a little bit of time. But having those gloves is going to like it’s not going to be so icky like oh do I need to like touch blood with my hands and get involved? I know that there is one of my one of my friends or acquaintances who lives in New York as a single woman she carries the naloxone nasal spray in her hers because apparently on her footpath commute there’s enough people who have overdosed on fentanyl that she’s concerned and if she has this she can just give it right there.
Carlan: Things you can do to prepare. I would say you know gloves and Narcan, leaving yourself some margin when you need to drive somewhere so that you’re not like headed to that crucial job interview blazing down the freeways or the roads to get there right in the nick of time. Like that just lowers the barrier to being able to get involved and to be helpful. So I would say never do anything that’s outside of your training like if you’re a paramedic then there’s a lot of things that you can do while waiting for the the on call paramedics to get there. If you’re a layperson maybe you know hands only CPR because you did a training where you know how to hold c spine or you know how to hold pressure on a bleeding wound. Like these are things that you can do that will help that don’t require a medical degree or nursing degree. But yeah within your scope of practice like what you’re trained to do you’ll be covered if you do it in good faith that you’re trying to help somebody and the legal because I think we also sometimes like oh you know I’m I got to get in I’m going to assume if they have a bad outcome you’re pretty protected in America in in it varies a little bit state by state but in the U.S. you’re pretty well protected. Even if you’re on an airplane that if you’re doing what you’re trained to do and you’re doing it to the best of your ability to help somebody even if there’s a bad outcome you’re not going to be considered viable. So feel free to help. Yeah I don’t know where I heard this maybe it wasn’t a CPR class but what is the device where if you ever have to do mouth to mouth it’s you know protects you what’s that thing called. There are one way valves in masks that you can use so like if you’re in a setting where there’s an automated external defibrillator often those are the ones that are going to shock your heart if you need to be shocked. Often in those there’s a mask I used to carry one that’s like a little fold up version just in plastic but it has a one way valve in it so that if you do have to do mouth to mouth no air is going to come back from that situation into your mouth and it’s a little plastic you know it’s stereotypically put in between you and the patient that’s something there’s they make them little key chains it’s like a little folded up thing so I carried one of those with me for years I never had to use it but the AED often has a similar thing that’s a little bit more robust in the sort of in the packet with the AED and those ones again are going to walk like any person can it’s going to give you the instructions put the patches on and there’s pictures on the patches of where you put them on the person’s chest and then it’s going to tell you you know plug it in and you plug it in it’s going to say we’re analyzing the rhythm and then it’s going to say we need to give a shock so you know move everybody away from the patients who are not touching them and then push this button and those are the good ones right if somebody goes into cardiac arrest and they need to be shocked they have a good chance if they get that shock quickly they have a good chance of coming back like you are going to dramatically improve their chances of survival if you can do that so yeah if if anyone if any listener is interested I would strongly recommend there’s first aid and basic life support training courses from the Red Cross all the time many hospitals put these on on a regular basis but you can give yourself just a little bit more training and it’s as valuable to reduce your anxiety around the situations (because it is a fearful thing) it’s as useful to reduce your anxiety as it is to give you technical skills of what to do in those situations so just running through it a few times in a practice seminar will help you feel better about it if you ever have to do it good point and you might need a refresher course. I know I took CPR a long time ago but you know I’ll need to remember how many beats per minute and all of that so it’s good to refresh on that. I’m sure youtube videos too, if you if you’ve been through the training already and you just need to refresh some of the information, you could probably find that online. The Americanheart dot org the American Heart Association I think that their refresher courses are are almost all online like you can do the the written part online and then you can do like a zoom call to talk with somebody about about what you’re going to do and you can maybe demonstrate some skills like doing CPR on a pillow in your in your house kind of thing for them to know that you remember what you learned so it’s easy. the barriers are low.
Christi: One thing that you brought out, Carlan, that I thought was really good is you said don’t be crushed by the need but be led by the spirit and you experience that in Burundi because you are confronted with overwhelming need all the time Burundi is considered a third world country that one of the poorest countries in the world and so you could be overwhelmed by wanting to help in all situations. But I like how you also brought out Jesus’ example too of just healing one person. Doing what you can, praying- and if you feel convicted in in a certain situation of “I really should be helping that person” then like you said being prepared and being willing to do that even though it might not be super convenient and it might set you behind in your schedule or all of those other things in your life seeing a need and being willing to meet it is so important. So let’s say it’s not a stranger, someone you don’t know that you’re just seeing laid out on a sidewalk. Let’s say you were called on to help a family member or a friend navigate an emergency or needing to go to the hospital or the ER. How can you help in that kind of a situation?
Carlan: You experienced this a little bit not too long ago in your own family of you have to prepare someone to go to the emergency room with kind of acute onset symptoms so yeah I think there’s two components of that. One is getting the person to medical care and the other one is visiting the person while they’re in medical care. So we’ll talk about that first one first. I think that the things that you can do if you’re a family member or like a roommate or someone that you’re close with is experiencing some medical symptoms, the things that you can do to help them: one obviously if they need just like practical assistance like you should drive them to the emergency room. We at the LA county hospital we call it the homeboy drop off. Like you don’t need to like just dump them out of the door of your car in front of the ER and say, “hope you can save this person’s life!” and like peel out and get out of there. hopefully you can drive them and they’re not in such dire straits that you can actually accompany them into the emergency room or the hospital where they can seek care because these situations if you’re having an emergency and you need to go to the hospital unexpectedly affects your ability to reason and collect information when you’re under a lot of stress. And so just having someone there is going to reduce anxiety is going to help them think more clearly and you’re going to assist in that. you’re going to go to the orientation desk and you’re going to say we need to get to the emergency room or you’re going to notice those big red signs with white letters on it that says emergency and you’re going to follow those to where you need to go to get to the emergency room. So just being there to provide that just practical assistance is a lot and that’s good.
Carlan: I would say the other things that you can do that I appreciate as the emergency doctor when family members or friends come with patients, is if they have like reviewed the story a little bit with the patient beforehand often that means that we can get to the crucial information a little bit faster so are you having heart you know are you having heart attack symptoms or are you having chest pain or are you having jaw or arm pain or back pain, like how long has it been going on, how did it start, what were you doing? these things,when you have to answer them for the first time, require you to think about it a little bit but when you answer it for the second for the third time you kind of already have your script rehearsed in some ways. I’m an assistant professor and a professor so I get the chance to go in and interview the patient after a medical student or resident or both have done the interview and oftentimes I’ll get a little bit better information than those students of mine and part of that is that I’ve been working for years so I know questions to ask but part of it is just simply the fact that the patient is answering the question for the third time and they’re giving a little bit better information. So if you can review those symptoms and kind of… you know you don’t have to be a doctor to understand what kind of symptoms go together. Like if you’re having vomiting are you also having diarrhea or you vomiting blood. Those are things that as the patient starts to think about them will help them to give a better a better history and 90% of the diagnosis is in the history.
Carlan: Other things you can do that I would recommend… like you’re a trusted friend or family member of this patient but that doesn’t necessarily mean that they want to discuss all of their health information with you so I would say it’s kind of our responsibility when accompanying family and friends to at least offer to step out of the room when the nurse and the doctor are there or to give them the chance for that kind of privacy. So that would be something that you can just discuss on your way in like, “hey you know you’re probably talking to a doctor about some sensitive information. Do you want me there or can I go get a coffee for you while you’re talking to the doctor?” And so give them the opportunity and you’ll know the relationship well so you’ll know if it’s the thing where you don’t even need to offer you just need to do it to get out of there then you’ll do that. but we want to respect patients’ privacy and I would say don’t be shy about accompanying them into things if they want you there. If the patient wants you there then you should be there. There are certain things that, like, if they have to put in a urinary catheter for example, most people are not going to want their roommate to be there for that. But some will and just you can position yourself so you can be up near their head and so you don’t have to see anything or or be in the way of anyone. But that’s the other thing I would say: try try not to get in the way of the medical care so sitting up towards the head of the bed giving access to the sides of the bed and a visual line of sight to the patient. Be aware if the nurse comes in and and checks in that’s often a signal that he or she needs to do something with the patient and so you can offer to to step out if necessary to try and work with them.
Carlan: This kind of fits more into visiting the patient but maybe into that initials phase because most likely if you are well enough to walk into the emergency room waiting room you will be well enough to wait a little while to be seen. Most ERs are very busy some of that is unfortunate and the effect of the way our financial model works in American medicine. but if you’re in the waiting room for a little while it’s an opportunity for some people to get on their phone and they start doing some some reading online and that can be helpful it can also be harmful. I would say when the doctor comes in if you’re like, “you know I’ve been doing some research and I am thinking that this is probably cancer” then maybe leave the diagnosing more to the doctors. I don’t want to call it a pet peeve but to to call 15 minutes of reading online “research” when you’re in a context with people who’ve been doing this for a living and have spent years of their life and tens of thousands or hundreds of thousands of dollars on education that can come across hard sometimes to the the doctor. And it can sometimes in the worst case scenario set you down on a trail of investigation that really wasn’t necessary for the patient.
Carlan: Now I say that and I want to quickly follow it up with saying doctors are not perfect and we’re not impeccable and we don’t see everything and we don’t necessarily know people the same way. and so a good example of a friend or a family member of a patient really helping out with the medical stuff is to say you know she’s just not acting herself, like she’s stumbling over words or her speech doesn’t sound about right, her face I know it doesn’t look that messed up but like normally she smiles a lot bigger- you know, subtle details about how the patient lives their normal life that we who are meeting her or him for the first time we are not going to pick up. So you have a lot to add especially for those neurologic things or the like psychiatric functioning of the patient. so if I can summarize this, get permission to talk about health care details with the patient, review their symptoms, take the time to escort them through and walk with them through the process, and then if you have good content to add relevant details to the evaluation those would be things where I think you can really be a help to the system and to your friend or your family member.
Christi: Yeah, very, very practical points, Carlan. I really thankful for how you walked us through just that whole process from entering a ER to maybe a longer term stay in a hospital. I liked how you talked about just even the stress of the situation and how having somebody there even if you can just pray with someone, read Scripture to them, remind them of truth in the moment, that can help lower that stress so much. And also, you touched on online research and I kind of want to go down that rabbit trail briefly here because that can be a temptation with the internet so accessible. And you have some symptoms and you know you just put that into Google and find out what exactly do I have and you can get answers all across the board. So there’s a place for it being a useful tool but it can also be harmful and people can get stuck doing all their own research and coming up with all different answers. So for someone who’s kind of stuck in just doing all their own online research, would you have anything you would tell them or encourage them with?
Carlan: Yeah, I think so. Thank you for bringing that up, and I’m particularly grateful for you talking about praying and reading Scripture or reviewing Scripture with your friend or family member while you’re on the way and and getting to the emergency room or getting to the hospital. While you’re waiting in the waiting room, that is a much better use of your time than frantically searching online. Now like you said, there’s that’s the emergency situation where something came up in the last 30 minutes that needs to be addressed quickly and you’re like washing your face, putting on closed-toed shoes and clothing that’s going to work well in the hospital. And you’re getting to the hospital right. The longer term issues, like I have these stomach issues or I have this twitch in my arm… what do I need to know about this temptation to go online? Because it’s convenient, it works on your time schedule. For most people who have a primary care doctor, what I’ve been hearing recently is “my primary care doctor can’t see me for six weeks” and that’s a long time if you have a new symptom or something that’s bothering you to wait to talk to somebody about it. So yeah, absolutely there’s the temptation and it’s not wrong because they internet readings that you can do are not always wrong so they’re sometimes helpful. Now with the advent of artificial intelligence or mass consumption like chat GPT you can type in a question saying ‘I’m having chest pain, sweating and I feel nauseous- what could my symptoms be a sign of?’ and it’ll give you a nice list of things including a heart attack that would be consistent with those symptoms so then you have to decide. And that’s the the hardest thing about the internet readings that you can do is that they are trying to be accurate- in the good faith ones, you can go to Mayo Clinic, Cleveland Clinic, Web MD. E-medicine. These are some sites that are vetted that are trying to do a good job. There are a whole bunch of fly-by-night websites that have their own particular bias or perspective but they also have to do so in a regulatory environment where they don’t want to be liable for giving you bad advice or for missing something important. even I’m going to give a disclaimer in the middle of our talk that the opinions I express and the viewpoints are only my own and they do not represent necessarily any of the of my employers or people that I work for and with. and then this is all meant as general medical commentary, this is not specific medical advice to any individual about what to do they should do. They should take care of their health with a physician who knows their story individually, right? So that disclaimer aside the websites are also like “we can’t not tell people that it’s possible that they have cancer as a cause of their symptoms because it is theoretically possible that they have cancer as a cause of their symptoms so we need to mention that” but when you tell someone that their symptoms could be cancer you immediately change the equation for that person because you ignite a whole bunch of fear. You activate memories of their aunt or their grandfather or whoever else in their family had cancer. You put a lot of things in play for the patient at really a premature point because they haven’t done any of the evaluation or workup that would lead them to know. Now if you say I have a terrible looking mole that’s grown, it’s doubled in size and it’s got really irregular borders and it’s all kinds of different colors yes that could be melanoma and you should get that seen quickly not slowly.
Carlan: I don’t know if I’m coming through here but there’s a need to do some evaluation to know, so you can go down a rabbit trail and you can get lost in doing internet reading about these kind of things. So the summary of that would be that I don’t want to tell people not to use good resources because I use good resources online all the time. Not maybe for the same reasons but there are good resources online and we don’t need to be ignorant or avoid them. But I guess the rule should be what is it doing in your heart? And I’ve told patients this on questions about you know vaccinations or questions about chemotherapy or treatments… the the world has given us the internet, God has given us the church. At our church there’s at least one physician on the elderboard who has committed himself to serving the population of our church the congregation in regards to the care of their souls and spirits but as well as their bodies. He took up an oath when he graduated med school just like I did to take care of people. He’s on the elderboard and there are several physicians at our church. I think that God God grants us relationships in which to resolve these things so even if you can’t see your primary care doctor, if there’s someone in your life who has more expertise than you on these things, I would say talk to these people about it if you can’t get to see your doctor. Set up that appointment for six weeks from now with your primary care doctor even if it seems like you need an answer sooner because once you have an appointment it’s easier to accelerate that appointment. And you can say if you have any cancellations can you call me. Get something rolling and who knows six weeks sometimes, I mean in my life six weeks can go by super fast and I don’t realize. Like you know, we’re already entering into the third week of 2024 and I mean like where did that time go?
Carlan: So yeah, I would say as much as possible choose people over the internet and choose Christians who can advise you. I mean, we all know somebody even if it’s like a nurse from a different church that you know, that’s a great person to ask, “are these should I be worried about, these symptoms, how fast do I need to see a doctor about them?” So good and I really liked how you talked about it’s a matter of your heart too. Where’s your heart in all of this if you are spending in an inordinate amount of time and all you have to show for it after months and months of internet research is more fear and worry and no solutions or answers. I think if you fall into that category you need to probably stop the online research, pray and then try to find a person a medical professional to go to let their years and years of research and experience guide you. If you’re finding that your only fruit from your online research is just anxiety and worry and no solutions it might be a good idea at that point to… not give up, you know, you’re not going to just give up and be like “okay, I’m just resigned to these symptoms the rest of my life” but finding a different path that’s not going to be such a a battleground for those other negative fruits in your heart. and I just want to say thank you for because there are patients and people who struggle for a long time with an undiagnosed illness and that is a really hard place to be in and the way our medical system is set up is not great dealing with things that don’t fit the pattern very easily. So you know I’m an emergency medicine doctor- we’re obviously worried about the the first 15 minutes of everything and how acute and you know critical is your need for resuscitation or diagnostic care.
Carlan: If a listener has one of those situations where they’re they’re struggling with some chronic symptoms, they’ve seen a doctor or maybe two and they haven’t gotten an answer my strong advice to those people would be to find a doctor you trust, a primary care doctor you trust and then stick with the same person for at least six months, probably a year or or two would be a better advice. because they’re going to get like 15 minutes to see the first time. You know what we what we did is we’d schedule for 30 minutes to see a new patient in an urgent care where I just was working so I would get 30 minutes but in that 30 minutes I need to assess the patient, do the history, the physical exam, and then I need to order labs and studies and they need to do all of the charting necessary to care for that patient. I need to do it all in 30 minutes for someone who’s maybe been living with something for multiple years so that’s just not realistic that we’re going to be able to get it done. So if you can follow with the same person now you start to build up that background and they know,” okay well the first time I saw this patient I thought it was x y and z so we did these studies and these tests to try and figure that out and it wasn’t x y or z so now I’m thinking maybe it’s q r and s so we’ll do those studies and we’ll do that about next and so those data come back in three months or whatever and it’s not q r or s so now I’m going to be looking at t u and v”. And you’ll make progress with the same person whereas if you if you jump from provider to provider provider one is going to think it’s x y and z, provider two is going to think it’s w x and y, and provider three is going to think it’s you know abc and you won’t make the same kind of progress towards getting to a diagnosis. so find someone you can trust with whom you can establish that rapport and then just stick with them for a while because believe me doctors don’t get through the medical training process by giving up on things easily so if you entrust yourself to someone I think that you can usually have confidence that they are going to take your trust seriously and they’re going to they’re going to advocate for you within the constraints of the time that they’re given to look after you.
Christi: Great helpful points and that kind of segues into our next question. As the listeners can tell going through these concentric circles if we start out with a stranger, we’re at family members and now talking about yourself needing medical care so beyond a primary care doctor when should someone evaluate or how do they know if they should go to urgent care for symptoms or if they should go to the ER what types of symptoms would differentiate between those two?
Carlan: Yeah, that’s a good question and it’s really a nuanced and complicated answer. I think. Even your sister and I have different opinions of how critical our children’s need for medical attention is based on my training and experience like if they’re not actively bleeding or concussed I’m relatively content to let them keep playing but that’s all to say that your your level of knowledge and training in background is going to influence on this. So if I can give the principles out front would be you want to match the tempo of your treatment with the tempo of the disease process so this is a principle that we learned in emergency medicine. If it takes someone a week to get really ill often you have a little bit longer time to get them out of their illness whereas if someone gets sick acutely in just you know like one minute they were normal and the next minute they’re not then you really want to react quickly to that. so that’s why you know we’re all we’re all aware in the media of heart attacks and strokes or you know the ultimate rapidly deteriorating condition is you’re shot in the chest, right? You need to get that person care very very quickly so what is the tempo of the of the disease or the injury process so to the degree that you’re able to assess that I would say go with that so if it’s a quickly evolving thing then go to the emergency room. If you think you have more time or it’s been a few days that you’ve been you know, you started with the runny nose or stuffy nose and you’ve got a sore throat and now you’re having fevers and body aches and you want to see someone then you’re probably okay to go to urgent care.
Carlan: Some practical considerations in all of this and then I’ll give you a list of sort of seminal symptoms that should really just provoke you to go to the ER right away. But some practical considerations. Many urgent cares are not open evenings and weekends and holidays so check online before you go to an urgent care. Emergency rooms are going to always be open 24/7 so the day of the week and the time of day are considerations that would kind of preempt you from going to urgent care. If you suspect you know, and you may not know this and so don’t worry about it, but if you suspect that you’re going to need blood tests and x-rays or ultrasound or CT scan or MRI some imaging you’re probably better off in most cases going to the emergency room. You might have to wait for a while in the waiting room but you can get all of the things done you need done while in the emergency room except maybe the MRI – there’s very few ERs where they’re going to do non-emergent MRIs from the ER l- but for the most part if you suspect that you’re going to require some significant additional diagnostic workup you’re probably better off going to the ER. Some urgent cares are really good about this and there are some called standalone ERs that are not able to do all the same things so that would just be something to think about and to put into your the rest of your considerations.
Carlan: So what are some seminal symptoms some things that like, no matter what, you probably need to go to the emergency room to deal with? So I’m thinking about your audience, so if you’re a young or middle-aged female if you’re having a new different terrible headache so we call like a thunder clap headache that comes on all at once in its intense maybe associated with some vision or hearing issues or nausea and throwing up that would be a go to the ER. We would want to make sure that you’re not having bleeding in your brain. If you have excruciating lower abdominal pain, you know, we think about ovarian torsion so for women who are cycling that’s one of the questions, one of the issues and you know time is of the utmost importance if you’re trying to save the ovary that might be getting twisted up on its blood supply. If you have blood coming out of anywhere aside from you know small cuts and your your normal cycle, if you’re vomiting blood, if you have blood in your stool, if you’re coughing up blood… I suppose if you have a small nose bleed you can handle that at home or at the urgent care but usually if you have abnormal bleeding from somewhere you’re gonna need some labs and you want to be somewhere where they’re gonna be able to stop the bleeding trauma drowning. You know obviously there’s there’s small trauma and there’s big trauma I would say if there’s any notion of reproductive violence that immerse every emergency room at least in California that I know of has a system set up to assess and work with people because the needs when you have you know gender based or sex based violence there are specific physical needs and psychological needs that go along with that that most urgent cares are not going to be prepared to offer and they can connect you to resources but the urgent the urgent cares are usually don’t have that in-house and most ERs are gonna have that in house. I would say suspected intoxication toxicology is another place where the immerse room probably does a little bit better than the urgent care at connecting you to resources and having everything on hand to be able to deal with that because that’s usually gonna require IV medication. I should say usually that’s sometimes at least often enough gonna require IV medication that usually is not gonna be something done at an urgent care although urgent cares very in their ability to do these things.
Carlan: And then lastly, and these are relatively unlikely in your audience’s patient population, but any signs or symptoms of a heart attack or stroke so a new neurologic problem like slur in your speech you droopy face numbness tingling or weakness in arm or leg on one side of your body. The classic description of a heart attack comes from middle aged males so it’s not exactly the stereotypical presentation in a woman or a younger woman but any kind of chest pain feeling your heart beat funny like an a rhythmia, fainting, passing out, those are things that I would say you should certainly at least feel justified in going to the emergency room. If you pass out or if you’re feeling your heart beat funny I would say you can also trust your instincts if you think that it’s bad then go to the emergency room even if it doesn’t fit into my list of things that I just ran through. And if you think that you’re doing okay then you’re probably okay. People have a good sense of their bodies and what’s going on but those are kind of the things that like you maybe didn’t realize that are going to require that workup that’s going to probably be better done in the emergency room so hopefully that’s helpful.
Christi: Yeah that’s a good list to keep in mind. Many people have had their faith in the healthcare system eroded over the past years or decades. So can you give us just how to think through what what does a Bible say about our current medical care model and healthcare system and just how should we think about the whole enterprise of healthcare delivery in the US?
Carlan: Yeah, that is a big question and I wish I had a better answer like an easily digestible answer. In the US healthcare system I think that there’s two strains that I want to highlight out of this. Number one is the philosophy. The current operative philosophy in the world that we live in, in American society we’re in kind of a post-modern almost post-truth moment where the the promises of the modern philosophy or the modern era which was that science and technology are going to continue on unabated and forever progressing us into a better and better state. I think a lot of people found those promises to be inadequate or to the fulfillment of those promises to be inadequate. Science and technology have given us nuclear warfare and we have pollution that you know gives kids asthma as well as worries us about the the purity of our drinking water and you know like there’s lead in and drinking water or there was lead in drinking water in parts of Michigan because of manufacturing. So like all of this technological and quote unquote “scientific advance” has led to some pretty terrible outcomes. I think that medicine has fallen into exactly the same trap where I think that we over-promised and under-delivered for at least a generation and it’s led to some loss of confidence. The media portrayal of doctors has gone from this sort of like almost perfect idealized Norman Rockwell type of doctor to Hugh Laurie’s portrayal of doctor house or the scandals of Grayson Anatomy. I mean maybe these are showing my age but (I don’t know what the current popular entertainment is about physicians and the medical enterprise) but you know certainly general hospital was only a little bit about providing excellent patient care and it was you know a lot about the drama.
Carlan: So all that to say that our faith has been eroded and we’re in kind of an anti-institutional moment already where people are asking questions about is the way that we’ve been doing things in the past the best way to do them into the future. And that’s a valid question and deserves to be answered but what it means is that the deck is a little bit stacked against the medical establishment from the get go because of these broader societal trends and the over-promise under-delivered right…. because we haven’t cured all cancer, we haven’t immortalized human beings, and I know there are people seeking to do that through technological means. But the truth is that only happens through a spiritual means and we’re all going to exist forever somewhere so yeah I think we failed at fixing everything through through technology and science and research and so people are like okay well then what does what does it have left to offer and so that’s been an opportunity for people with really intractable or difficult to treat diseases or problems to look elsewhere. To look outside of medicine which is good- I mean, we should be looking outside of medicine to solve the most critical problems in our lives which is our our lack of reconciliation to God and our lack of reconciliation to other people, which is what only saving faith in Christ offers. So there’s something good in placing less confidence in medicine to fix all the ills of personal individual life as well as society, so that’s that’s a good thing.
Carlan: I guess what I’m saying is that we need to view medicine in its proper place which is health care is only ever going to be capable in its best possible form of caring for people and when it’s done correctly in pointing people to reconciliation with God. so this is why Christian health care is… you know I’ve obviously committed my life to combining faith and health care together and training Christian medical professionals in Burundi and hopefully having an influence on my my students and residents here in the U.S. in that direction as well. But health care is a way to take care of people. You know Jesus was involved in health care and you can have consummate confidence in Him even though like we said He didn’t heal every person who came across His path who needed healing. He came preaching the good news of the kingdom of God and healing the sick so seeing seeing health care as a part of a broader equation of caring for people, showing them practical love, and existing in God’s world is a crucial component to that. That’s the one philosophical sort of stream- I think that there’s also an economic kind of stream that the way health care is set up in the U.S. is really complicated. It’s this complicated mesh of public and private funding, of self pay and insurance, and competing interests.
Carlan: And then there’s privatization of some of that thing where there are groups seeking to make a profit on health care involved in the whole provision model in America. So there’s just a lot of competing interests and it’s just messy right, just like everything else is in economics, it’s just messy. So to have some knowledge of that… like I was talking about the urgent care scheduling 30 minutes for a new patient, you know, for an established patient it’s like 15 minutes so you’ve got 15 or maybe 20 minutes to see the patient, perform all the testing necessary, write up the charge, follow what the results, get them the medications and treatments that they need… the reason why it is like that is because the economics don’t support it to go any slower. So it has to be moving that fast in order to to stay afloat and that’s unfortunate. On the flip side there are economic incentives for other things, right? Everyone’s trying to sell you something, the advertisements that you’re seeing in your social media feed for this or that dieting and exercise program or these supplements or whatever like it’s all commercial at a certain level because that’s how we’ve organized our society or that’s where we give our attention at least. So it’s a an opportunity, so obviously this can sew mistrust in everything and then you’re stuck, right? Because if you never trust anybody then you’re just on an island by yourself so how do you get out of that?
Carlan: And I’m gonna come back to that statement I made earlier that man gave us the internet, man gave us the free market but God gave us the church so as much as you’re able connect to people in your church setting who care about you and are gonna look after you and are gonna do so in a manner consistent with your best interest. I’m telling you to advocate for yourself, I’m also telling you to be this for other people. I’m sure that there are some nurses and probably some physicians listening to your podcast so for those of you out there like make yourselves available to serve your brothers and sisters in the church to help in this regard and if they know you as a provider they can trust…. I mean, you can’t trust the system but you can trust people within a system to the degree that they’re trustworthy. You know them, so I want your your listeners who can be to be an example and to be a resource but I want the listeners who are not in medicine or have any special healthcare expertise to know that the Christian believers like your brothers and sisters in Christ are your best resource for these things and there are a lot of believers in healthcare it is concentrated for people who look after each other and who are motivated by love and compassion. So it ends up being enriched for believers even if the popular portrayal is a bunch of you know immoral self-absorbed people were all sinners. But there are a lot of saints in medicine too so I would say pick those people to seek out and let them guide you in the rest of the system.
Christi: Thats’s helpful. Would you say that there’s any place for being careful of taking advantage of someone’s training and expertise outside of paying them for their services? You know, just presuming that we go to the same church so I don’t have to actually go to your clinic, I’m just expecting help outside of that. What should we keep in mind?
Carlan: Yeah, I would say your audience is intelligent enough to know when they’re trying to replace going to a clinic and when they’re just trying to get advice on where to go or when to go. So if you’re you know the result you’re seeking is a prescription or a diagnosis please give that provider the opportunity to do that rightly. So if you’re saying you know I have these palpitations and I’m feeling my heart beat funny or I have this abdominal pain, the provider needs to at minimum push on your belly or listen to your heart so that’s not usually the kind of thing that, “oh you know, I just happen to have my stethoscope and in the middle of church I’m gonna stop so I can listen to your heart like that’s probably not gonna happen so be kind, be gentle and gracious with your providers by giving them the opportunity to do it rightly. But you know and certainly you can abuse this, um, access.
Carlan: I have found I think I would rather encourage people to ask and the providers can kind of direct them say like hey I should probably see you in clinic or could you make an appointment and come in to see me. On this question let the provider kind of guide that a little bit and if you’re a provider don’t be afraid to say like, hey I really really need to do a knee-cagey to figure that so do you want to come in to the clinic or can I refer you to my friend who actually has a primary care clinic because you know if you go to talk to a pathologist or a radiologist about your palpitations they’re probably not going to have a clinic where they can do those things for you so they’ll need to refer you to somebody else. sometimes people ask me, “like, my oncologist recommended this chemotherapy regimen for my stage 4 you know pancreatic cancer, what do you think?” and I’m like, “I think I’m an emergency medicine doctor and you should definitely listen to your oncologist because they specialize in that stuff and I only specialize in the complications of chemotherapy, when it goes wrong you know.” Respect as well and the provider will tell you… that’s what I tell people, it’s like, “I’m not the guy for your question on the particular chemotherapy regimen that you’re going to be prescribed.” So I would say probably more people are afraid to ask then they need to be. There are a few people who are definite abusers of this. I’ve encountered those folks and that’s on me to to know how to redirect them and help them to do it in a right way.
Christi: So you’ve worked not only in the US health care system but you’ve also worked in Burundi and other nations. So what can we learn from the health care delivery and providers of other cultures, other nations?
Carlan: Yeah, it’s interesting right because the US model is kind of a mishmash of everything and so in France, that’s a socialized medicine, right, single paired to the greatest degree that will take care of everything so they decide what kind of care they’re going to offer all their citizens and then if you want something other than that then you have to pay out of pocket. But they cover a lot of different things and they pay high taxes to get that. In Burundi it’s almost entirely private pay, unless you’re a child under five or a pregnant woman, you are going to have to pay cash for whatever care you receive. So it’s totally different economic models in all those places, all of them are relatively effective at getting people the care that they need within the resources that they have. So obviously France’s GDP per capita is something like 40 times that of Burundi so they get a lot more care but even in Burundi I would and so I guess the thing that I would say the lessons learned in Burundi… one thing I really like about how things work in Burundi is that every patient admitted to the hospital comes with another person. In French it’s called “the guarde-malade”, like the guardian of the sick person and their role is to do a lot of the basic nursing care. So they make sure that they have food to eat in accordance with the doctor’s orders, they make sure that they can toil it so it’s like every patient has a permanent live-in visitor with them. The impact of visitors is really interesting, right, they help accelerate recovery, they reduce length of stay. There are studies that show that in the ICU they reduce patient anxiety and the incidents of delirium.
Carlan: There was a post I remember seeing a study after COVID… you know we stopped visitors from coming to the hospital so there was a post-op like a surgery study that showed that once the policy went into place because of COVID that they couldn’t have visitors anymore, patients’ satisfaction went down. They stopped walking as much after surgery, so like a really like palpable impact on patient care and I think that we’re so committed to avoiding contamination or bringing infections around the hospital or getting infected in the hospital and we’re so worried about getting in the way of things and bothering the nurses or whatnot complicated in the situation that sometimes we stay away. Like sometimes patient privacy, like we want to let them heal on their own and there’s certainly some patients for whom they just would rather be alone and left to rest in their hospital. But in Burundi that autonomy bias is just not there. They are so communal or so community oriented, they’re so relationally rich that it’s unthinkable that someone would go to the hospital without having another person with them there in the hospital. I really like that model, I think it’s beautiful. Obviously we’ve built the hospitals such that the patients can have their “garde-malade” with them at all times and so that’s a societal expectation but I think that that social component of healing is much better understood in Burundi kind of by default. It’s almost a byproduct of their poverty in material resources that they are rich in relational resources so that’s one thing I would love to encourage listeners in. Something a lesson I can bring back from Burundi to the US is that patients need friends, they need friends and family members, they need visitors.
Carlan: So to the greatest degree that you’re able to, and without obviously interrupting the provision of care in other ways, is just to visit people. Bring balloons you know we prefer things that don’t have strong scents or that people could be allergic to so keep you know don’t wear your your most pungent of perfumes and bring balloons or succulent instead of flower. Because we keep hospitals cold due to concern for spreading infection, it’s gonna be cold in the hospital in sterile so make it warm with your presence. And yeah work together I think that’s I really do appreciate that about the the Burundian mindset is that we go through all of life together and so don’t hesitate to be there and be that positive impact on someone’s hospitalization. If they need help with the finances…. like I just feel like we are so individualistic in the US that we could really use a boost of the community orientation that Burundi has to offer so that’s one thing I really love about Burundi in they all help each other. We’re part of the same family at the end of the day. It reminds me of an episode we did a few back on bearing one another’s burdens and how that as believers, that’s what we do. We help carry the load by being a support and an encouragement. That looks different for different seasons situations but yeah if someone’s in the hospital, what a special way to care for them, to give of your time and your attention and your love. And I think it’s really neat like you talked about Burundi having that family member with them and just makes me think of that person getting exceptional care when it’s coming from someone who doesn’t know them but someone who has their best interest at heart. So that’s really special that they they have that model.
Carlan: There are studies in the states that say that when, I mean… this is this may be an area for more research… but some studies that show that when the doctors and nurses are being observed like, I remember we’ve seen one where the hand washing like doctors washing their hands before they evaluate the patient if there’s a visitor in the room it like substantially increases the likelihood that the doctor is gonna wash his hands or her hands. So I think that’s just kind of a funny little caveat and you know poking fun in my own profession a little bit for not always 100% of the time doing hand hygiene. The accountability that is a little, they call it the hot the effect…. right, like, you do better when you’re being observed doing your job. But yeah, you absolutely right what you said that joy shared is joy multiplied and grief shared is grief divided so having someone to go through the hard time of the hospital with you… or you know, some people go to the hospital because they’re having a baby and that’s a totally joyous, wonderful thing so you know being being there and doing it in community…. I think that there’s a sense a longing for that in Americans. I think social media has taught us that it’s not enough to connect online to people, that we need real life connection. And with COVID certainly the social distancing was terrible and was costly in a lot of ways but hopefully at least it showed us that you know what’s the opposite of social distancing: social approaching is crucial for our overall wellbeing because God made us as one integral creature and we are to love Him with our heart so mind and strength and love our neighbors as ourselves. And that means holistically.
Christi: Well, Carlan, so many helpful practical heart level wisdom that you offered and I’m just going to be excited to hear how it’s applied and useful to the listeners. And for those who want to learn more about your nonprofit where you’re seeking to raise funds to go towards African medical doctors so that they can stay and take care of their own people best after you and other doctors pull out so that that whole system doesn’t fall by the wayside, if they want to donate to that or learn more about that I’ll link your site in the show notes. And then even if people have questions to you for medical missions or other questions I’ll put your email there so that they can contact you, reach out to you and I’m sure you’d be able to offer some guidance there. But thank you so much for coming on today and sharing with me and the listeners and yeah just so grateful for your time.
Carlan: Happy to be here, Christi. Thank you for the opportunity and the privilege to address your folks and I pray that you can all be smiling at the future more and more as time goes on and as you listen to podcasts and go out there and love your neighbor.