Medical Murmurs Podcast

Marisa Prelack is a pediatric neurologist with the Division of Neurology at Children's Hospital of Philadelphia, with a particular focus on the care of children with epilepsy. 

“[I see] absolutely crazy things. A lot of patients ask me why I went into this field and I tell them, well, I get to be a detective. I get to play with kids and I got to reassure or try to reassure parents.”

We talk cases. A boy with temporal lobe seizures experiencing the sensation of deja vu. A child with“Alice in Wonderland” syndrome who thinks she is shrinking. The toll that headaches can take on a child and their family. What it’s like to support a family as a child gradually loses neurologic function.

Family and Community Medicine Physician and Associate Professor at Penn, Dr. Judy Chertok in Ep 12 of Medical Murmurs Podcast, Medical Student Edition. Dr. Chertok talks about the richness of relationships in Family Practice, and how that drew her to the specialty. She was interested in many more specialized areas during medical school, but ultimately wanted the variety and flexibility that Family Medicine offered. 

“I think in family medicine you have to be comfortable with ambiguity. You have to be comfortable, not necessarily knowing everything at that moment, being comfortable looking things up, being comfortable asking questions of colleagues, of specialists,of all kinds of people. And I think you have to really thrive on the variety and the unpredictability. And other than that, the qualities of a great family doctor I think are interpersonal skills. I think at the end of the day, much of what we do does come down to interpersonal skills.”

“When we look at applicants, we are really interested in people who have a commitment to service. . . .people who have had those experiences, people who've worked in free clinics or had other sorts of service oriented things. And so I think as a medical student, if you're interested in primary care, getting involved in those primary care experiences during medical school and first of all try it on for size, making sure that's something that you like.”

Family and Community Medicine Physician and Associate Professor at Penn, Dr. Judy Chertok in Ep. 11 of Medical Murmurs Podcast. Throughout her career she has been involved in providing care for those who are struggling. In medical school she co-founded a medical clinic for  homeless people  in Harlem, New York. Now she spends part of each week running a clinic for people with opioid addiction and opioid use disorder. She talks about some miraculous outcomes with the clinic’s team approach and suboxone.  “He’s living on the streets, he has Hepatitis C, he uses IV heroin every couple of hours. He’s really struggling . . . and now he is housed, in a relationship, he has a new job, he has a child. His life has been completely transformed.” 

For Chertok, medicine is all about the relationships, and that is what drew her to family and community medicine. Chertok talks about the remarkable continuity across generations in family practice. “I did have a patient who I followed for seven years, and during this time I have cared for her children as well. And then when her child got pregnant, her child during the pregnancy as well as her granddaughter. So I take care of three generations of this family as well as actually my patient's mother often gets admitted to the hospital where I work. So I take care of her as well. So four generations of a family that I know really well. . . and unfortunately my patient, um, had an event where she ended up in the intensive care unit. And I was there with her family at the bedside the night before they withdrew care and I was at her funeral with her family after she passed.”

Allergist + Immunologist + Asthma specialist Payel Gupta, Medical Murmurs #medicalmurmurs Ep 25: “I was always that kid that was sneezing and itching, I had eczema. And then I also had asthma. And I always felt different. I always had my inhaler.” Then, at 12, her own mother had a severe asthma attack while at home with the kids, and died from it. We talk about why both food allergies and seasonal allergies are becoming more common. The anxiety for parents of children with serious food allergies. New treatments which have revolutionized the management of asthma and allergies. Dr. Gupta talks about an asthma patient who lived with a daily fear of death from her asthma, who is now totally controlled. “So I always wonder, if my mom had had these biologic treatments, where would she be now?” With this episode a change in format, combining the medical student content with the main episode, so we cover all the usual questions about who is suited to this specialty, how best to match, how to build a career.

Jack Jallo is a neurosurgeon and spine surgeon at Thomas Jefferson University Hospitals in Philadelphia. 

"The sacrifices that you were expected to make in terms of your personal life were fairly significant. I think that's still the case. I think neurosurgery residents are still some of the hardest working residents in the hospital."

"I think we've come a long way in the field and most people do well now, but not everyone does well . . . the illnesses that you're taking care of are very significant or life changing for the patients that you're treating, and you have to be willing to take care of patients that may be on the path of actively dying. And your intervention is to try to prevent them often just from dying and you're not always successful. You have to be resilient enough to accept outcomes that are certainly beyond your control."

Jack Jallo is a neurosurgeon and spine surgeon at Thomas Jefferson University Hospitals in Philadelphia. A laminectomy gets an octogenarian back to ballroom dancing. Training with a high-speed drill, to get through an egg shell without perforating the membrane inside the shell. “The appeal of neurosurgery is the combination of the acuity of the diseases that you're managing, but also the delicacy that's required.”

Dr. Alex Vaccaro is an orthopedic surgeon who specializes in spine surgery including traumatic spinal injuries. He is the Chair of Orthopedic Surgery at Thomas Jefferson University in Philadelphia and the President of Rothman Orthopedics, one of the leading orthopedic institutions in the United States.

In this Medical Student Edition of Medical Murmurs, Dr. Vaccaro talks about both the sacrifices and the satisfactions of orthopedics. The long commitment in training, the satisfaction of definitive fixes and the thank you letters which come with those. He talks about differentiating yourself as a residency applicant. And what it takes to build a satisfying and sustainable career. "You have to have a purpose. You have to have the ability to master that purpose and you have to have autonomy."

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Dr. Alex Vaccaro is an orthopedic surgeon who specializes in spine surgery including traumatic spinal injuries. He is the Chair of Orthopedic Surgery at Thomas Jefferson University in Philadelphia and the President of Rothman Orthopedics, one of the leading orthopedic institutions in the United States.

We talk about the importance of hope. "So when his mom says to me, will my son walk again, I say, you know something, I don't know the answer to that, but I hope so because time will tell . . . I have patients come in who are paralyzed, but we've intervened early and I've seen miracles, I call it miracles because I've sent patients paralyzed that have walked out of rehab.

"You know, you operate on someone, they become a family member. If you have a complication with a patient, they move into your house. I mean you, you have to make sure they're doing great."

Dr. Vaccaro describes the measures Rothman is undertaking as the COVID-19 lockdowns are scaled back, and elective orthopedic and spine surgeries resume. "If you walk through the door, it's like a gauntlet. 'Hi, let me take your forehead temperature. Hi, let me take your pulse oximetry.' We test all the patients we operate on 48 hours before. So every patient gets tested. Potentially people are less likely to come out with a nosocomial illness now than six months ago with this much generalized precautions in place."

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Drs. Mert Erogul and Joshua Schiller are emergency physicians based in NYC. They talk about the highs and the lows of a life in emergency medicine, how they chose their specialty, who might be suited to a life in EM, and suggestions for how to match. Being Prepared to work anywhere, any time. The importance of resilience, flexibility, when to roll with the punches and when to take a stand. The blessings and pitfalls of pattern recognition. And much more.

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Drs. Mert Erogul and Joshua Schiller are emergency physicians based in NYC and creators of the Airway Stories podcast (airwaystories.org). This episode, we change the format a little, to share some stories about being an ER doc in New York City in the time of COVID-19. Patients who seemed to have pulled through suddenly coding. Text messages on a cell phone while a patient dies. The eerie silence of the ER.