Anne Biccard — Holding My Breath Further Exploits of an ER Doctor

what's your dream what's your goal what's your motivation what's important to you what's your passion what can you do to change the world this is what's involved conversations with thought leaders and change makers from around the world hear stories of hope and inspiration to help motivate people like you to live your life find your passion passion and live your dream together we can all bring positive change to our world now here's your host David Watts once again it is mix FM I got a great guest on the show for you at the moment I've spoken to her before and and honestly I thought with her job I wouldn't be talking to her again in a hurry and suddenly I am who am I talking about well my guest is Ann Picard she is the author of the first book that we talked about the saving a stranger's life the diary of an emergency room doctor and I have no idea how she's done it but we're gonna find out she's just released another book called holding my breath further exploits of an ER doctor and welcome so good to have you back on the show it's really lovely to touch you again and thanks for inviting me right so now for those who may have missed out on the on the last conversation your first book saving a stranger's life that was like if I recall sleeping in the middle of COVID wasn't it in and somehow you managed to write this book and it was both incredibly personal and it was touching and there was humor in it there was sadness in it and now suddenly I see there's another one out so give me a bit of background about Ann here is Ann and how on earth did you end up becoming an ER doctor so um I just sort of ended up in the ED because that's kind of what I ended up doing when I qualified there wasn't a speciality in emergency medicine so people worked in the ED just as a kind of in-between thing or as a part-time thing if they had a general practice while they were qualifying as a specialist and in a different kind of specialty but now there is a specialty in emergency medicine so the people who work in the emergency room now are actually specialists in emergency medicine and I've just kind of been doing it for the last 25 years or more and just ended up being kind of what I do and what I'm good at and so I keep working and as I keep working I keep getting more stories to tell so I keep writing them down and yeah the first book started I kind of started retrospectively for the sort of first day of COVID the first case of COVID that we identified in South Africa which was on the 5th of March 2020 and it's a kind of a not quite a diary format because the stories are from over the last 30 years but yeah just kind of going through the sort of COVID waves as they hit us and really interesting for me to look back at that book and think we were in the first lockdown and we were in the you know in the second and third wave and we've been on this book up to the fifth wave yeah so just it's a bit of a diary a bit of a story about what it's been like on the front line for the last couple of years I've got to tell you that I take my hat off to you and to anybody that works in the emergency department at an emergency room because I've seen firsthand some of the stuff that goes on me how on earth do you manage to not only survive but thrive in that environment and it is incredibly high pressure and then you still make time to sort of keep a diary and to share some of these stories that my mind is blowing I mean do you get time off ever well my structure that I ended up working which actually suits me really well is to work so the first part of the day every day so the kind of six to two slot and but I do that sort of seven days a week so it then works out for me that I still get some time in the afternoon to do some stuff on the farm and I don't have to sit in the traffic because I you know I go before the traffic the hospital that I work has quite far from where I live so it's quite a long drive sadly I really like that hospital so and I also really like my phone so neither of them are shifting and that's the way it's been for the last as I said over 25 years so I just stayed there I moved I moved hospital briefly but I missed my community so much at the first hospital that I ended up going back so yeah so so I travel quite a bit which gives me quite a lot of time to think I've been traveling a car not travel away and that gives me some time to think and you know sometimes it's six o'clock in the morning there aren't any customers and I get a chance to write a bit at work we're pretty busy but during COVID there were a couple of days where we were extremely quiet people just didn't you know when we were sort of waiting for the first COVID customers to come the hospital was really quiet I mean it was almost like all the people that were having heart attacks and strokes I don't know where they went because they didn't come to the hospital so I wrote quite a bit during that time that's sort of when I really started putting things together the stories sort of from over the years okay I mean that I'm just I'm thinking back on that and it almost seems like we spent two odd years in limbo in some kind of a dream and and often I speak to people like okay well how did you get through it and they all give me the same answers like I have no idea no idea how we made it no idea because it was so unprecedented so you wrote the first book and it was a great book and it was a a best-selling book and if you haven't by the way if you're listening and you haven't read Ann's first book yet do yourself a favor get both of them because they are brilliantly written and written with humor and compassion it's amazing stuff that's why when I saw the second one land on my desk I was like okay I need to speak to you right away so and the first one was a success at the time you did you have an idea that you would be writing a second book and so yeah I mean finally enough while the book was getting sort of prepared and you know so I had to make a decision okay now I'm sort of done now with this now it's a bit of a thing to say okay I'm gonna send it now like this is obviously it's gonna be edited and etc but this is now I'm as happy as I'm going to be with what I've written and I've you know nothing kind of draws me off taken up what I don't like what I've tried to sort of and being you know my first book kind of finding my feet so I sent it off to the publishers and then funny enough the next morning was a very quiet morning in the ED and I was like and now what am I gonna do I said okay well I can just carry on writing about what I did yesterday you know and so I've just carried I carried on writing sort of from from then so that was another it's been two years since the first book 18 months and I suppose was it in a way therapeutic for you as well to to write these stories down yeah it's very cathartic I mean it really is and it also it's quite it's interesting to me because some of the cases that that I write about we actually present in emergency meets and meetings because they're cases where you learn stuff or they're very unusual and you know it's really nice to teach other doctors with a with an anecdote you know because a lot of those things can be really dry you know so it's quite fun because I kind of write them down as I mean the second book there's a chap that I call the Cheshire Cat he's had such sort of startling green eyes that are greener and greener you know as the as the consultant but he is such an excellent teaching point that we actually use it as part of training for doctors for the emergency algorithms and things that you have to follow because if you stuck to the algorithm with that guy it wouldn't have ended well and he was just a very unusual candidate you'll find him in the second book and why I was when he started to sweat I started to sweat which is what I also teach the younger doctors when your patient starts to sweat you must start to sweat so he got a sort of paler and sweatier and his eyes got greener and I got more and more sort of consultants involved and all of us were scurrying around until eventually the penny dropped and we saved Cheshire from Grim which was great oh that's the other thing show show Grim has remained that's that's a consistent between book one and book two good yeah yeah Grim's always sniffing around always lurking lurking in the background now and writing all of this stuff I mean as you said you literally work seven days a week you're in the emergency medicine department and we talked in the first book about about about your farm and the animals etc etc and just being able to go to a place of of peace like that now how did all of the the collection of animals partner friends how did they take it when you were sort of calmly announced well I'm now busy on my second book a bit of a natural story to tell us so they probably have heard the stories before some of them my colleagues setting up with most of them and they're all debate about who exactly is the favorite physician and who well who's the blue out suit and there's only one of the eyes I pointed out the other day to the tearoom everybody stared at me in amazement as I think of the people who work here and what color their eyes on they were like how do you know I said well I look at them every day I know what color their eyes on so yeah so there's something about who the different people in the in the in the book are but my sort of family and friends interestingly and even my partner that I worked in in in the ed was for many many years he's very dear to me strange enough don't appear really in the book the book is sort of about my work persona not necessarily my home persona so yeah so so I mean they're there in the background the Snoopy's in there and the farm but the story is not really about that it's more about when I walk through the double doors and my colleagues there my people are meeting patients and that kind of thing I mean it starts off most amazingly but but you have to tell us please share the story about the crystal nipple so mr. mr. first customer of the day reports to me that his nipple had moved from its normal place into his armpit he discovered at his armpit later on and so I said wow that's fascinating I've never heard of a migrating nipple before I think we should have a look oh no he says back now it was lost not to move and not to move back so examine him and then and there's no medical possible medical reasons I asked him if he was using any substances and he admitted he was using crystal meth which is quite mind-altering and can give you visual hallucinations which is obviously what he had anyway I'll try to warn him off and tell him that he must stop doing that he wasn't gonna listen to me and then he came back after taking an overdose of of probably I don't know what he actually took an overdose on but he was soundly unconscious and we had to rescue him from grim and it's just an interesting that's also interesting to me how 20 years ago we never saw that that kind of thing whereas now if a 20 year old comes in unconscious first thing you're gonna check for is drugs you know and interestingly also in the book is a story about a 70 year old lady who came in shortly after crystal nipple and she was also unconscious but of course I never thought of testing her for drugs I want to talk about that as well and but right now we're just gonna take a short break this is what's involved my special guest is and Picard her second book is called holding my breath further exploits of an ER doctor it is a wonderful book and it certainly takes you on an emotional roller coaster of a journey what's involved it is we'll be back with and Picard in just a bit this is what's involved don't forget to subscribe and leave a review more next and we're back with my special guest and the card talking about her new book holding my breath further exploits of an ER doctor talk to me about the 70 year old lady because if it's the same one and I think it is it's rather interesting yeah she was a fascinating case so she she was also unconscious couldn't wake up did every test I could think of blood test scan her head sugar you know whatever I mean she was breathing but absolutely unreasonable and mentor sent off to the ICU the physician accepted her and I met him later on I think actually the next day in the current and I was like what on earth was wrong with that lady like I was really stumped you know and he said joy he was also completely stumped until her family came in and said oh don't tell me she started using again and he said using what and apparently she wasn't a heroin addict now I mean I just didn't even think of testing her for that kind of thing it just it wouldn't occur to me in a 70-old in my defense most heroin addicts don't make it to 70 you know but this didn't you know if you were 20 that would have been the first test I did so it's interesting how we adjust our expectations according to what we think the patient's lifestyle or you know it's like an unconscious judgment you know ageism whatever yeah sure imagine that that was yeah I mean it is absolutely amazing there's another another one I want to get into in just a little bit but also I mean we've we've come through covered your book covers also more about covered and the the fifth wave has passed and suddenly the country is apparently free again and we're all going to live what is what is your experience been have we become I think maybe we have a lot better at dealing with covert because of the lessons learned and and is it something in your opinion that we've now got a handle on and it's going to be with us forever um so it's a interesting to look back on my own thoughts about covert and sort of evolved because the two previous coronavirus epidemics didn't really affect us in South Africa so those are the the mirrors the Middle Eastern respiratory symptom respiratory syndrome and then the salt so they were both like 10 years apart so they were like you know two outbreaks of coronavirus that gave severe respiratory distress and we well I personally never saw any of those patients so I've heard about them and read about them in journals but there was no sense that it would come here you know those two and then when the corona pandemic began we were all running around like crazy just trying to get prepared we don't really show what was going to happen but certainly for me the third wave was the worst wave and it was like absolute mayhem because we just didn't we we lost our way in terms of what we could do to fix it so you know the medical profession has their spells and their well-thought-out strategies and their plan for whatever we're doing and none of that was working for for covered we couldn't figure out why we couldn't turn the chaperone you know the the patients would come in we do everything that we could think of to try and solve the problem and if that patient was going to die from COVID it felt to us that there was nothing we could do to change that outcome is profoundly disempowering and I think gave a lot of people like post-traumatic stress because they felt like that we had absolutely no agency in that pandemic at all certainly now in the fifth wave we saw a lot of people tested you know maybe 10 a day but they had like a flu you know like a sore throat and a flu and so I can't say whether that's because the virus became attenuated you know it's it became less virulent as it as it evolved over two years or whether it was because people were vaccinated because I mean every person I saw asked if they were vaccinated and said yes so I doubt that everybody was vaccinated because I know that a lot of people didn't get vaccinated but I think that people were worried that we would discriminate against them if they hadn't been vaccinated so they didn't tell us so I'm not sure if it was the vaccine that was attenuating it but certainly this last wave we were seeing please we saw a couple of COVID-19 and we did have some some deaths but nothing like in the third wave the severity of disease was completely different and now we're seeing a real upswing of sort of influenza a respiratory viruses and the COVID tests are coming back negative whether that's because we're missing the COVID-19 because you know it's got a narrow window of being positive or whether it seems to be going away I'm not sure but it's amazing I was just saying it's amazing how in terms of the third wave as well because I had personal experience where people had caught COVID they were in hospital and then you hear okay no they they stable they they seeming to get better and the next second they were gone and that that to me was was quite shocking because you think okay they're gonna make it and then the next second bang yeah we had a lot of that kind of thing you know both colleagues friends you know people I know socially you know that they were hoping for the patient to be discharged things were looking better and then either got a massive common embolus or had a heart attack or you know something happened to them and it was just came over certainly for us during COVID times if we had a patient in the hospital because don't forget the casualty doctor not only has to look after the ED but if there's an emergency in the hospital you have to run to the water so I see you to help because often it's after hours and there isn't the doctor who's actually looking after the patient may not be in the hospital so you're the sort of first cool and they put out a kind of a thing on the like a loudspeaker to call for help and you have to run there and help and I mean we literally were zero percent successful you know when we started doing CPR on patients who had you know advanced COVID disease we just couldn't you know we just had no success I mean we had to try but you just knew that it was futile you know it's whatever happened to those patients whether it's a central cause of death you know something in their brain or whether their heart just came up whether they got a massive plot you know we don't we still don't know because also they didn't do post mortons on those patients so we don't actually know what they died but it was pretty frightening to be as you say thinking somebody's gonna be going home tomorrow and the next thing you call to recess and the poor people in the ward all looking at you with big eyes because they you know kind of page them to they've got to know the last ten days are suddenly killed over you know not nice for anyone yeah and I mean I just again and still my heart goes out to all of you guys who who were on the front line and seeing that every single day and that's why I was amazed the first time around that you managed to write I'm amazed again did you manage to avoid the virus no no I didn't I got it it's very interesting like my personal theory I guess you could call it about viruses is it's very much to do with your own immunity and how tired you are and how many sort of particles of the virus you're exposed to so I don't think it's as simple as you know things like Ebola which you know you're exposed to it you either get it or you don't these kinds of things are you obviously exposed to it all the time I mean I was exposed to it for 18 months and you know I wasn't doing anything differently but I was just exhausted I'm during the third wave I just saw so many people meant to do CPR on so many people it was just too many viruses I guess that I was exposed to and I was physically exhausted and I went to work and my colleague who's got an eye for covert did you look a little bit sick I said no I'm fine just like I think you need a covert test and I said no no I don't need a covert test I'm fine I'm wearing an N95 mask anyways I'm not gonna give it too much she said over here you come did the covert test just like so rapidly positive she just she just shook her head and said sorry go pack your stuff and go you have to leave so I had to wait in the car park for the next doctor to come and hand over to them then I was all for a week I wasn't really sick but it was weird I had like absolutely I still have absolutely no sense of taste or smell at all it was like a neurological thing and the other thing that was really bizarre is that for about two or three months after I had proper COVID I had like short-term memory loss it just completely crazy you know I'd see a patient and they'd go down to x-rays and they'd come back and I'd look at them and I think I don't know who you are and I've never been like that I've always been like very good at holding everything in my head at any one time and not forgetting about people or forgetting to people you know give people scripts or whatever it was definitely like a neurological thing it was like a it's like you put something down and you know it's there you reach out to pick it up and it's gone and it's just an empty space and you know there shouldn't be something there but there's just nothing you know such as that is that was very weird you know I'd look at my phone and think yeah I find the guy near seven o'clock this morning it must have been about a patient but I have absolutely no recollection of what it was about you know luckily the ED is not a place where you have to follow stuff yourself the next day but I didn't get a few strange looks from my colleagues patient appendix I'm like what guy with appendix then the person who spoke to me five minutes ago and I'm like okay just remind me so this this thing would tie in with with the the elderly lady taking Viagra well she didn't take the Vibra her husband took the Vigra so but she didn't know so he was having a heart attack and the cardiologist wanted to give him a particular drug that you can use to dilate the heart vessels but it's contraindicated if you have but if you have taken Vibra in the last 12 hours so he was having the heart attack at 10 o'clock in the morning and I didn't get I couldn't get reception in the room the research room so I went outside we had already spoken to his wife and told her that he was having a heart attack and then I said to the cardiologist I can't give the drug because he had Viagra and she said what time did he have Vigra I mean if it's 10 o'clock if it was before 10 o'clock last night we can still give him the drug so of course being an idiot I said to his wife what time did you take the Vigra and she was like what Vigra oh sorry sorry wrong patient sorry sorry oh and it's it's weird I also you know it's only times I've said this before but I despair for us males I really do and when we come back though there was there was another part of the book that that I found interesting very interesting story about the lady who was looking for something to sort of knock her out make her sleep and you sort of we're giving large quantities of that we'll talk about that though when we come back my special guest is and Picard she is an emergency room doctor at a large hospital and her second book called holding my breath further exploits of an ER doctor back in a bit we'll be right back with more what's involved David would love to hear from you to leave a voice message visit what's involved calm and click drop me a voice note and we're back what's involved with and Picard author of holding my breath further exploits of an ER doctor so tell me about that because just the way you'd written that when you know you're waiting for this lady you'd given her this this intravenous shot and you sort of went to the bottom of the bed and you thought okay well she's gonna be out like a lot and she wasn't yeah people respond to that drug quite differently it's interesting so it's a it's what we call an induction agent it's a thing that makes you go to sleep for anesthetics so it's a kind of white substance called propofol it's what Michael Jackson was using and the problem is that if you overdo it even by a mil or two you can stop breathing so I'm always reluctant to give too much but you have to give enough that the patient's asleep and it varies from person to person so it comes in a 20 mil solution and I used to get to use about six mils and then I had a couple of people so I never sedate the patient without having a bag to breathe for them in case they get too deep and I had to use the bag a few times which makes me a bit edgy because I'd prefer not to have any complications so I cut myself down to four mils for them and that seems to be the magic number seems to get them to sleep but not so deeply that they stop breathing but this lady just gobbled up that drug I mean she had a terribly bad dislocated fractured ankle so her foot was literally sort of facing the other way and she was howling in pain and every time I'd give the drug she would go to sleep and as I touched her foot she'd open her eyes and say I'm not sleeping and then I'd go back and give her a little bit more you know and eventually I'd given her like enough to put two adults to sleep and she wasn't gonna sleep you know because this obviously used the drugs to sort of metabolize the drug in a different way maybe she was on other medication that sometimes that speeds up your liver enzyme so they process the drug quicker you know but I would always be more reluctant you know mostly that drug is used by anesthetist so the anesthetist has the plan to put you on a ventilator in any case so they just give it the whole syringe because they want you to go to sleep so deeply that you don't move and don't breathe because they're gonna put you on a ventilator to breathe for you to have to put somebody on a ventilator in order to just relocate they just look at a child you know and she was just I've never seen anyone use that medication and such it eventually I gave the sister the syringe and I said as she put it in I'd switch the drip on full so it rushed into a system and I just relocated it as she like glazed over in the two seconds opportunity I had because previously the time it took for me to walk around from the drip to the foot of the beach was a wakery wow it's but this is this is what what amazes me and I there must be I mean amidst all the heartbreak and yes you've got some some human sometimes you're not you're not always successful but that's that constant kind of adrenaline rush it must it must also take a toll I mean yeah it's nice to feel the rush but that must take a toll on you as well surely you see the interesting thing is I'm actually not really a person that likes adrenaline things so even though I ride a motorbike etc I'm actually I'm not a like a crazy fast driver or I've never done any sort of extreme sports I mean I was reading the other day about these people who do skydiving so they they throw their parachute out the plane and then they jump out the plane after it and then they have to like skydive down get that little you know parachute on their back and then open the parachute it's a sport I was like who would do that I just don't get that I'd never go skydiving or bungee jumping or any other sort of adrenaline sports I'm not really a person for adrenaline and in fact if I had to go back again I may not have chosen the ED because I'm not a person who likes adrenaline I'd prefer to have a nice calm day with everything under control but you know it's kind of what I ended up doing and then you know you sort of get used to it and it seems less I think the thing that is really quite scary that you use not if people come in and the patients already you know passed and you are just trying to resuscitate them I think the scary thing is when somebody comes in who is looks okay from the outside but you can see the things that are going to go wrong in the next couple of minutes that's that's the kind of adrenaline that we should on because you have to act and you have to do something about what's going on you can't just stand in you know so yeah so that that and that does take its toll it really does it makes you very tired now now and during the course of these last couple of years and the sort of second book etc etc as I said earlier grim remained a theme there so when we come back I want to I want to talk to you a little bit about grim and if your relationship has changed at all over the last couple of years my special guest is and Picard and her book is called holding my breath further exploits of an ER doctor will be back with an in just a bit hey like what you're hearing share the podcast with your family and friends and spread the word this is what's involved and we're back with my guest and Picard talking about her book holding my breath the further exploits of an ER doctor and yeah tell me and tell me talk to me about grim because you know in the first book he was almost and so for those of you may not have read and first book or don't know what we're talking about when we just talk about grim the grim Reaper the big D is you and refers to as grim so and has the relationship changed at all what really hey you know it's a funny thing I was reflecting in the second book while I was writing with I didn't actually write that down it's strange to me that I I see the grim Reaper as a male energy rather than a female energy I mean I'm not sure why that is and the second thing is there's kind of a scoreboard between us and for some reason he's on the left top and I'm on the right top so we've got you know if one goes to him then that name goes on that side of the school board and and then one goes to me and you know they mean evens for the day and some days I'm up on grim and it's always good to get a point on the board I mean the the underlying thing is he's always gonna win isn't he you know at the end of the day there's no escape but it is nice to to give him a little tussle every now and again and hold fast you know literally to to the leg and arm of the patient while he's got the other leg and arm and he's just like no no no this one's mine so yes it's kind of just a way of structuring the kind of possible outcomes in my head and also it's a familiar adversity so you know you sometimes you can see that you you've lost this battle before you even start it you know and it's just a way of understanding it I guess in my head you know I can only do the best I can I'm not a magician you know but to me that and that was the thing that resonated so much with me is is by by giving grim this this character this these male energies and stuff you know and and seeing him as an adversary you know just to me that rings so true it's like not this time buddy not this time and you're right we don't always win and we sort of running out of time and we always do this but share with me another story and maybe one of the stories that the later the more recent stories and maybe one way you got a point on the board sure okay well and guess it was a good one actually because he was he was my most recent term when from from from grim so he was a young man who came in during the third wave his wife had part of COVID and he was he was very anxious he said to me was feeling very anxious and he was feeling bit short of breath and a bit last-headed but nothing specific you know so I thought maybe just a bit anxious pulses up a bit but there's not really much to find so we did some blood tests on him and then the x-ray I gave him a tablet to make him feel a little calmer like a tranquilizer and I came back ten minutes I had to check on him and he's say when he came in his pulse is about 140 which is quite fast if he had a temperature I'd let that one slide but he didn't came back to check on him he's actually sleeping but he's pulses now 160 so I was like that's pretty strange so I woke him up and I asked him again through the history has he had any symptoms nothing no pain no chest pain my abdominal pain hasn't had specifically thought he was compensating for something so I asked him specifically is he vomited blood is hadn't been still known I know examine him he's got no pain nothing even did a rectal exam just to make sure there was no blood anywhere nothing so I said okay that's okay blood pressure still holding so that's fine I come back in five minutes time and now his blood pressure is dropping and he says to me he's really not feeling well and he's looking sort of pale and his eyes are looking even greener and luminous more luminous and so I called the cardiologist cardiologist looks at these juices are keeping sisters are you know just a compensatory very fast heart rate he doesn't think there's something primarily wrong with his heart and I said well I think you know he must be compensating for something but watch you know we've done all the tests there is nothing to be seen I've done an ultrasound on him I've done an x-ray I've done examining thoroughly I've done bloods I can't figure it out and so what you do then if the patient's blood pressure starts to drop is that you you actually give them a drug to stop their heart because sometimes their heart goes into a very irregular fast rhythm and because it's going so fast actually don't pump properly so now the protocol says that's what you must do so I give him the drug I stop his heart it stops it goes back to 180 I give him a second dose of the drug it stops again it goes back up to like 190 and by this time I'm like okay I'm missing the boat now grim is closing in and this is a young healthy guy and something in the back of my head is saying he's bleeding from somewhere he's got to be bleeding from somewhere you know and then I got a blood result back it's called a blood urea it's actually to check your kidney function but if you happen to have a bleed into your into your gut your body reabsorbs the blood as you read his urea was extremely hard in in the context of completely normal bloods otherwise and as I saw that result the penny dropped and I was like he's bleeding for sure and he was bleeding into his jeidinum which is just past your stomach but not yet in your colon so if you breathe into your stomach the blood is very irritant and you'll vomit it up if you bleed into the colon it's very irritant and it'll come out the other side but if you bleed into your jeidinum you can lose your whole blood volume within an hour and no one's in it was so I got the general surgeon to take him to theater they scoped him as an original suit right away found this massive lead I mean he literally bled out his head to transfuse him his whole blood volume and that was just it was just lucky you know and the surgeon later on that evening sent me pictures of the scope and I was like wow I can't believe like that guy survived I mean I actually stopped his heart and his heart was trying to compensate for something he said well just as well you didn't give him that drug I was like well in truth I did give him so I was just lucky you know he was lucky we were lucky but the groom was there he had that guy firmly in his clutches and you know just sorry and the green eyes becoming more and more luminous what was that well I think as he got paler and paler his eyes looked more and more striking and I think as he got more and more worried about what was wrong because you could see that I was really worried I mean I sort of brought the cardiologist he said he was such a polite guy he said oh Jesus man I said he's the cardiologist sorry I didn't get a chance to introduce you like I'm in a bit of Russia I'm trying to establish like is that problem with your heart and then he's like oh hello nice to meet you I said yeah I've got him especially for you he's like oh thank you you know then the surgeon says Jesus man I'm like he's the surgeon he's gonna be taking for a scope right now in fact I'm pushing you to theater like with I'm putting this hatch on your head and I'm running with you on the bed and he's like thank you thank you please to meet you I don't want this guy to die he's such a nice man you know those are few and far between these days mostly people just complain he was such a nice gun and as I said we're almost out of time so so what's what's next before I let you go what's next for for and Bacardi you can stick in the emergency room more plans for books what's happening because I sense this needs to at least be a trilogy yes I'm also feel there is another in fact there is another another book definitely in the in the production line and I think you know hopefully in two years time I'll be old enough to retire from the emergency room I certainly feel about a hundred and sixty years old I think probably more going into teaching I mean I really love teaching I enjoy teaching under doctors I enjoy you know yeah that that kind of thing so probably more into a teaching role than being completely on the front line but and maybe giving something back because emergency medicine's been very good to me you know and those coming up also need to learn you know and um it's it's important to you to pass along what you've learned so they don't have to learn the hard way you know absolutely and thank you and I mean from the bottom of my heart thank you to you and the team that you work with all the people in the health care industry you guys are absolutely amazing and the fact that you can do this seven days a week I take my hat off to you the book is fantastic it's available in a digital format as well isn't it yes yeah it is it is in the first book is also in an like an audiobook then fantastic okay so look out for the first book okay it's called saving a stranger's life the diary of an emergency room doctor you've got to read that one okay and it's gonna take you on a roller coaster take it from me right now as is the second further exploits of an ER doctor and I think in this one and I just since there was more of you coming into yourself as an author there so well done it's a brilliant book I thoroughly enjoyed it thank you thank you so much and thank you so much for the interview lovely to chat to you absolute pleasure there we go wraps it up my special guest and Picard and we talking about her book holding my breath further exploits of an ER doctor if you want to get inside there and see what these people do this is a brilliant way to do it so available in all good bookstores and online wraps it up for me for this edition of what's involved to each and every one of you look after yourselves take care and thank you for listening thanks for listening to what's involved we hope this episode inspires you to find your passion and live your dream don't forget to rate review and share the podcast and to see what's happening what's going on and what's coming follow what's involved on Facebook and Twitter at what's involved thanks again for listening