Coffee with John: Recent Episodes
Danish Bhatti
John Bertoni: I don’t know if I’m going to be duplicating myself but did I ever tell you the story? I didn’t see it marked that we had done it before, a podcast about doing Pneumoencephalograms.
Danish Bhatti: No, tell me about it.
John Bertoni: My fourth year of medical school at University of Michigan. We had really excellent neuro radiologists and I wanted to spend time with them. I think I may have been with them for somewhere between a month or two somewhere in that time and I did neuropathology that year. I did a 10 week experience in Newcastle upon Tyne in England with John Walton and Peter Hudson and actually a guy who became a friend of mine from Mayo Clinic and what I really liked was the time I spent in radiology. At the same time there was a neurosurgery resident. I won’t give you his name because this wasn’t really such a well done day that we had. We wer e doing Pneumo-Encephalograms. We did not have MRI scans at that time. And I think CAT scans were just coming in to play. So when we wanted to evaluate people with hydrocephalus, we would have them sit in a special chair. And there was a little square in the back about one foot square that we would actually remove that’s where we would do the LP (lumbar puncture) in their back and we would prep them with Betadine and then wipe that off with alcohol and then do the lumbar puncture after getting a consent form. And I think consent forms might have been mostly verbal then. I don’t know. They were probably not forms or maybe they were just a note saying I got consent. Not sure. Anyway, there was one lady that the neurosurgery resident was going to do a lumbar puncture on. And the idea was you would take off about 10 or 15 cc of spinal fluid and then we would push in 10 or 15 cc of air and we would take out some spinal fluid and then the air would bubble up since they were sitting upright up toward the fourth ventricle. And if you had them just right and you did it slowly, the air would actually get into the fourth ventricle. And then we could then somersault the patient and get the air into the lateral ventricles.
Danish Bhatti: Somersault on a chair or how to do somersault the patient.
John Bertoni: In this chair. Yeah, this is a chair. When in the old days, we used to have them sitting in a wooden chair and then two of us would pick them up and we would actually somersault them with the chair or just the patient. Well it would be a little chair like this that we’re sitting now and we would rotate them. And that’s what I learned in England and I think it was one of the early neurosurgeons that found out I can’t remember his name offhand, that in head tumors cases you could see air in the ventricles in some cases. if the air came in and got into the spinal fluid and they were I don’t know moved in different positions, you could actually get air into the lateral ventricles. And they would use that technique then to identify tumors in the brain in the ventricular system. You know you can imagine Choroid Plexus Papilloma and other tumors that were obstructing the ventricles now and then. At any rate that was the whole point of this exercise. So we wanted to see if this lady really did have normal pressure hydrocephalus. I don’t know the whole history but Lance was telling me about the case. And he was a year senior to me. And he was also from Ohio State University and I’m from University Michigan. And we were arch rivals in everything. So we used to not even want to talk to each other.
Danish Bhatti: But he was working at Michigan University.
John Bertoni: Yes he was in the Department of Neurosurgery as a neurosurgery resident. I was a neurology (resident), maybe he is a couple years older than me because I was like two years away from being a neurology resident. Anyway we were doing this rotation and he was talking to me about his, how great he was. And he was taking off like I think he was filling up, We usually did CSF evaluation when we did that. So we would collect the first tube and send it off to the lab. And I think he was collecting the first tube and I may have told you this offhand once but we were both sitting there. He was in the radiology you know lead apron kind of thing. And the procedure was obviously supposed to be sterile. And he had gloves on. And all of a sudden the lady who is facing away from us and we were talking like this and he was collecting the fluid. All of a sudden took a really deep breath and it was something like she didn’t exhale. And we thought that was kind of strange. So he was sterile. So I went around and I looked at this lady and both of her pupils were dilating to I don’t know maybe about nine millimeters. And I tried to wake her up and she was out and I said she’s fixed and dilated. And he came around and looked. So the question I ask when I talked to our residents or medical students. What’s your next move? What are you going to do when something like this happens? You’re doing a lumbar puncture. Somebody has immediately fixed and dilated her pupils.
Danish Bhatti: Push in (water) CSF back because of the brain stem herniation, trying to push it back out
John Bertoni: Well I know how we could do that. So he yelled at Millie. Millie was the little technician lady that was always getting super excited. So her arms were waving in the air you know. Quick get us some sterile saline or D5W or lactated ringers. I don’t know what it was. So she got a bottle, back then it was a bottle not a bag. And so we ripped off the top of that thing and he says give me a 20 CC or 40 CC syringe. It was glass. So he was holding one end and I was pouring this in. And then he put the plunger or the other end of it and he had a Leur lock adapter. So he took out the Stylet and screw this in and pushed 20 ml of lactated ringers or whatever it was as fast as he could. And within about five seconds we could hear the lady go ahhhhh. So I went around and looked and both pupils were coming down and she wwas starting to respond. And I said, OK the pupils aren’t dilated anymore. And he was on the phone and he got an operating room. He said we have to take her to the O.R. Now He’s a resident. (but) And you know he didn’t have to go through anybody. He just said, get me an operating room and back then the residents did procedures and attendings sometimes were there.
Danish Bhatti: Sometimes, IF It wasn’t a golf day or something?
John Bertoni: Well, we saw something like this. I’m sure it attending would have come in the middle of the day. But I remember operating with a neurosurgery resident in my internship and there was a tumor in the back of the brain. That’s another story. I remember that really well. And he just called up the attending and told him what happened. But anyway back to this lady. We did an angiogram right away in the next room. The Pneumo-encephalography room was in one room and there was a connecting door and we just wheeled her in there. And she had a big glioma a butterfly glioma right across the corpus callosum. Since we didn’t have a scan to see what the problem was, you couldn’t see something like that on a plain x-ray, although we did use plain x-rays to see about shift of the brain from right to left or left to right.
Danish Bhatti: And this is before CAT scans became popular.
John Bertoni: Yes, because we used to you know roughly if you’re age 50 you have a 50 percent chance of having a calcified pineal gland and habenular commissure which you’re in the midline. So if there was more than a 0.3cm shift we knew that there was a significant shift. We were really good at getting that head lined up straight. But since it’s in the middle of the brain relatively you can turn the brain and it wouldn’t move that much. The problem was then seeing the inner table of the skull and you’d just measure with meters stick (not meters stick) but centimeter ruler. And if it was off like three millimeters you know it was or even maybe a little less. Two and a half maybe. So that was that was then. Anyway, I think she did fairly well. People with big gliomas like that don’t do very well even today. But I’ll never forget that. And when I tell other people that they think I’m making it up. I was there and it really happened. And it was amazing how quick it happened.
Speaking of that there was another time when I was in Philadelphia that we had an elderly private physician that wanted to do a lumbar puncture on one of his patients. I think he was a neurologist but he didn’t want to do things like lumbar punctures anymore. So he was I don’t say that we kind of humored this guy but he wanted to do things. And you know, we didn’t think he should be doing those things. So I asked him what he wanted. He said, would you please do a lumbar puncture on this patient for me? And I was probably about your stage, you know having been out of residency about that long. And at any rate, I said no, I think the patient has increased intracranial pressure. You want to do a lumbar puncture to see if the patient has a brain tumor. I say well, why don’t you know; you don’t do a lumbar puncture to find that out? So then he asked other people and everybody I know, said no. But there was one neurosurgeon there. This is the Jefferson Medical College, who said, OK. And he did. And the patient herniated. And so they quickly had to take him to the O.R. and so my chairman came back to him and said what were you thinking about? And he said well, if a neurologist, you know consults me and asked me to do a procedure, I’ll do it for him, you know and he says, well you better think that over twice, because if you don’t think you should have it done on you or anybody you know then why do it?
So anyway actually the people I worked with were really good. This fellow that at least figured out what to do or the other thing he did was the patient herniated. He said, let’s flip her upside down. So we turned her and her head was down.
Danish Bhatti: That was with the resident and the chair has the capability to turn over.
John Bertoni: With that was the resident from the first case, they had the capability to do a somersault because you were able to somersault. Because the other thing that we did is once we got enough air in the upper part of the lateral ventricles, we wanted to get it into the temporal horn. So you had a forward somersault them so that the air would then go back into the temporal Horne’s because that’s where there was a lot of problem with enlarged ventricles and people that had let’s say, Alzheimer’s disease and other things. So anyway that was one of the things I did one day.
Danish Bhatti: All right. Let’s try again.
John Bertoni: You’re going to use your other system.
Danish Bhatti: Yeah
John Bertoni: I find like yesterday when I wanted to say a few things in the middle of the night. I had an epiphany. That means all of a sudden something becomes clear. So in the middle of the night you might say what a great idea. You just had in the morning you listen. You can’t make any sense of it. It’s like I just had this fantastic dream. Try to write it down and the next morning you’re looking at scribble that looks like a Parkinson’s you know really.
Danish Bhatti: You can read it or if you read it, it does not make sense like the idea don’t make sense.
John Bertoni: Either way. You can’t read it or if you can read it. you say “What?” you know because you’re half asleep you may not be out of sleep. So. You were just saying that you’re trying to slow down but you’re speeding up.
Danish Bhatti: I think what I mean is that I’m slowing down in the sense of I’m becoming more focused on what I want to do. And it’s something I want to talk a little bit more about. But as I am trying to focus into things that I want to do. The speed that at which I am progressing in those things that’s where I’m picking up I’m trying to get rid of things that adds inefficiencies. I think we’ve talked about one inefficiency before it was task switching that if you’re doing one task and you’re in the middle of it you switch to the task you have to go back to the background and review where you’ve been unless you’re starting over and then. But the problem is if you leave it in the middle and then you come back to it a few days later you know if you come back it too soon enough the same day maybe you’re fine. But if you come back to a few days later you’re not sure where you were and what the flow of that part was. So you have to pick it back up. And that was one inefficiency and then the other inefficiency that I feel is that in the past I used to waste too much time in trying to get it done without having the proper tools. I think if you use properly, tools that are designed to make your job easier. If you have the proper mic if you have the proper pen or recording camera or proper setup or proper space; speeds up the things that you can get done within a few days or few weeks especially when you combine it with focus if you’re focused at it and you know you’re going to just get it done. So to give you an example let’s say I decide I’m going to record some podcast. So I immediately start looking what tools I need and then I go to that sound recording place in the library and do some testing and do some test recording and do some editing at home. I soon realize that it’s wonderful it works awesome but it’s so far and it will require a special scheduling and special time out of my time and your time and Diego’s time to get it done and I say okay well what do you need. I need a good recording mic. So I look up and I find a good recording mic for a 120 bucks. And now if I go through crystal (admin) and have it bought through department it will take another two weeks to get it done. I don’t have time like that. I say to hell with a hundred bucks I’ll just go and on the way back home that day I wouldn’t waste time on picking up which one to buy. I say okay What’s my budget 100 bucks. Okay. What’s the best I can get around that time. I find it quickly within a day. You used to take me weeks to find a good mic in the past. Now I don’t waste time like that anymore. And then on the way back home I stop at Best Buy and I just you know pick up the mic and say okay it’s 10 bucks cheaper at Amazon but I don’t waste time for waiting for Amazon. I wanna get things done and I pick up that mic that night I record some podcast that within two days I record some lectures within next week. I’ve recorded the Diego’s podcast, your podcast and I already have everything done. I would not have even selected a mic in my past life that fast and let alone if I go through crystal, I wouldn’t have a mic to get things done. So I don’t want to waste time on these inefficiencies anymore and I’ll just say okay this is what I need to do this is and I’m gonna just get this done now. It’s not like I have an idea of podcasts and I’ll think about it. Once I come back from Pakistan next month or something. If I have an idea and I truly believe in it and it fits in with my focus. I’m just gonna go and get it done. You know I will worry afterwards. How would the recording look, I want to get music and how would I edit it. I learned it as I do or go through and even if it’s not the best piece possibly. Who cares. At least I’ve just got to get started on it and I we keep getting better as I do it more and more often rather than being perfect and doing it first and then trying to do it. So you know I’ll just start with the where I am right now with the tools I have and I keep building up on tools and keep building up on work flow and keep building up on my expertise and do it better and better. That’s what I meant was I’m speeding up which I’m slowing down and focusing on what I need to do.
John Bertoni: Well I’d say first congratulations on doing something rather than analysis paralysis where you never find a perfect solution. You want to be let’s say the perfect is the enemy of the good. If you wanted to be perfect you’re doomed to fail and you will get nowhere. So if I say I want to go by horseback from here to some mountains. So I’ve got to find now the best horse and I’ve got to find the best map and I get you know you spend a year you could have gone there and back in a couple of weeks but a year you’ve gone nowhere so brilliant. So you’re saying I don’t want to waste any time and you want to begin now and I think that’s almost always an excellent thing to do. If you say well I want to learn how to do brain surgery let me just go in and operate on someone’s brain. No no wait a minute. You’ve got to think about that. You’ve got to know you gotta get training certified all that stuff. But yeah you have some accomplishments and once you have that then you are reinforced in your goal. So I’m writing down some of your ideas here on this left piece of paper and on the right some of mine and you said to start I’m speeding up while I’m slowing down. And I wrote down I have to learn to say no to say yes which is kind of the same thing. This focus is key. I agree with that task switching is inefficient when you’re on a roll when you’re getting something done. When you’re amazed even though it’s not perfect it’s really pretty good. Then it’s kind of you get into the flow state that book I was talking to you about. Just hard to read. It’s hard to get into the flow of the book but it’s worth every bit you can do. If you’re on a roll. If you’re getting it done stay with it. Something will get done and then you improve as you go. So I think you’re doing the right thing. Sometimes there are better ways but you’ll learn as you go. Besides that you get experience.
My question When I’m doing such things is I want to step back and say OK what are the real important things in my life. And I think I need to put the priorities in first and you know Stephen Covey is good at that. He says there are urgent things that are unimportant and important and there are important things that are urgent and not urgent.
Stephen Covey So he has a matrix where he looks about what’s important and then on the other axis is what’s urgent. And of course if somebody is lying on the floor and you come upon them. You have to do something urgently and what’s important and do the ABC and save her life. But we have a lot of things that are important that we tend to put on a lot of people like me might put off this building of course for the residents. But you know that’s an important thing and you’re going to just dive in. So I think that’s great. The day to day stuff that gets in the way is my problem and I’m happy. I don’t keep up with my e-mails and I need to find a way. I think you do it when you have a moment. You go through your e-mails quickly. I need a program where I can in a sense push the email to the left to dump it, to the right to save it, down to I don’t know. Do something else with it in between you know I’ll look at it later or something. So that I can quickly go through it right now on my phone. It’s hard to read even on my computer. Should it be a way to look at 10 of these on the big screen and you can just tap. You know I’m not just deleting all these things and there ought to be a delete and unsubscribe. Because I got something today that I want to unsubscribe and it took me to another site. It’s some sort of a bogus or I don’t think it’s a legit Web site but they’re trying to sell me something. So I need a younger person’s advice or more savvy with emails and things.
Danish Bhatti: Well I have some thoughts about all that you’ve been saying. I’m going to start by saying this. You used to tell me in the past that you think you know you have this e-mail problem you can’t keep up with it and you know I used to you know unthinkably agree with it without paying too much attention to it but I guess what I wanna say is that I don’t think not responding to email is a problem and I’m going to go into this core details of what’s been going through in my mind over the last few weeks to prove that not being able to respond to emails. I have eighty six emails I need to reply to and I have not. I have emails from two months ago I have not replied to because no they’re not. This is an email. And they just take away my focus while I’m going to waste this time when it’s not important to me right now. If it ever becomes important to me I’ll come back to it. If it never becomes important me. Well Okay so what.
John Bertoni: I wish our president would have a filter like that.
Danish Bhatti: For me the top most important thing is one focus. A burning desire to get one thing done. And I don’t have space for anything else until that is done. And I don’t have space for four rooms or four corners or a list of things I actually do. There is no list of thing. There’s only one thing to do on my to do list. That’s it. The idea that has been becoming a common theme among many people who are important to me which is the idea of focus.
Muhammad Ali Jinnah (the founder of Pakistan) This idea that I’ve been seeing in random order I’m going to tell a few things that inspired me. So for example I was reading this book on Jinnah the founder of Pakistan and you know you had many good and bad things about him but one thing he said. So the main point was that in 1935 he made this large speech to the Muslim League which was a Muslim Party of India. And this is something that I read in that speech stuck with me. And he says that I’ve heard this idea before. But the way that he said it. And the point in the history when he said it means a lot. You know he says that I don’t remember his exact words but what he was saying was that when you are trying to make a decision, think really hard. Look at every aspect of it. Ask everyone and ask yourself and then make your choice. But once you have made a choice once you have decided you have to give it everything that you’ve got. There is no stepping back. There is no second guessing it. There’s no questioning it doesn’t matter what doubts have been created what new information comes into light. That is your focus. You need to just burn it into the ground no matter what now you have given. You have to give your life to it. And you know the bigger more challenging the idea the harder you have to push. And then you can not second guess yourself after. That is the same thing that I heard in this documentary Jiro Dreams of Sushi where this 90 years old the only Michelin 3 star sushi chef in the world who says that once you; he’s 90 years old, he became sushi boy at age 14 or 15 when he ran away from his home. And he says the same thing. He says once you pick up your profession you have to give everything to it. You cannot question it. You cannot change your mind. You cannot play around and things like that and you have to give everything to it. And that was the time a few years ago when towards the end of my residence I was thinking you know do I want to be an entrepreneur, do i want to do this, do that, become a neurologist. But listening to that and I said, click me its like you know I have come to a certain point, for whatever reason. But this is what I’ve got now. I should now decide that I’m going to give everything I have to neurology and movement disorders. And it doesn’t matter. You know why movement disorders? Yes I will come up with reasons. Yes I think I do. But the main point is it doesn’t matter what the actual reason was, why you’re in movement disorders.
John Bertoni: Someone once told me reasons are for other people. There are some body says why you’re doing this. You tell them but you’re already made up your mind. You don’t need the reason.
Danish Bhatti: You don’t need a reason anymore exactly once you have made your mind, doesn’t ,mean you drop the reasons. So then another thing I heard was this interview I recently heard from a guy forgot his name. He is a designer I think like industrial designer and he has a very successful practice and he worked with Apple in the early Apple days and the first Macintosh 1980s and he left Apple 1985. What did he say when before Steve Jobs was fired. I think at 19 wisely or something. No this is it. And nobody knows who’s back. So it’s an international designer. So the podcast person you know I listen to a lot of podcast on design these days is my becoming my focus and passion. So the lady asked him what was it like working with Steve Jobs. And he said something is like you know Steve had some good idea some bad ideas you know some great ideas I’m not so good at ideas but he would get stuck on something you know it would take a lot of effort on your point, you have to really show him that he’s wrong before he really let it go.
John Bertoni: Right.
Danish Bhatti: Once he was stuck. He was just stuck. He was saying it in a neutral or maybe slightly negative way but I actually took it as a positive way. It kind of linked me to that idea that I had was that great people once they are stuck on an idea they’re just stuck on this idea. everybody can say you wrong it’s not going to work. This is horrible. This is an impossible and not doable. Nothing fazes them. Once they have decided they have decided that they’re not we are going to get it done. I don’t care if it’s impossible. I don’t care how hard, I don’t care if you know it’s like Elon Musk deciding that we should all be we should have a commercial travel to the moon. It was like are you stupid? are you crazy? you know he is stuck on that like you know eight years ago ten years ago when he said I’m going to make electric cars. Like that’s not possible. It’s like you need batteries the size of a room and that is like no I’m going to get this done.
John Bertoni: Did you just hear that Tesla went from 0 to 60 faster than all the other cars.
Danish Bhatti: No I had not. Just they broke the record now?
John Bertoni: Just in the last week or so. Can we take a break here I may need a break and then let’s continue.
Danish Bhatti: Sure.
Danish Bhatti: So I think we started doing this coffee to chat about things. I don’t know. I don’t even know why but we started doing it in a flick and we were talking about. I think we realized that there are many topics that interest us both which are way beyond medicine topics about success how to solve the problems of life why people make mistakes why people make choices that do philosophy, mythology, psychology history.
John Bertoni: Right.
Danish Bhatti: We have read similar greek authors and things like.
John Bertoni: That the epic of Gilgamesh together. Yeah.
Danish Bhatti: So that was the primary purpose that we were talking about ideas that were dear to us that we felt important. And I felt I was learning a lot and I hope you felt you were teaching me a lot. It was like a mentoring relationship outside of medicine about life in general not just Movement Disorder.
John Bertoni MD John Bertoni: No, I enjoy these very much not just enjoy them but I find them very valuable. I learn a lot if only to clarify my own thinking. But you actually are wise beyond years and you understand a great deal and you come from some different traditions and I come from. We’re like in many ways. We just you know my father came across was prejudiced against and fought uphill battles and into a country that claims to be the melting pot but it is very parts of it are very resistant to change like all human beings are. But in the end result of sharing ideas and our heartfelt aspirations and being honest that’s what this world needs. That’s what this country needs. And you know this is I think what we should be doing what I should be doing.
Danish Bhatti MD Danish Bhatti: I think what I was thinking was that this primary purpose was so important that we had so far protected this. We have kept people out of it. We thought about inviting people but we never took it seriously because I’m consciously or subconsciously we wanted the conversation to keep flowing without getting damaged by someone unusual. So not something doesn’t get spoiled.
John Bertoni: Right.
Danish Bhatti: It’s like finding a pristine lake in your backyard and not telling anyone about. So let’s not muddy the waters here. I think the same should hold true. You know we started recording it just because I wanted to keep the memoir. And I think I’m making a podcast out of it in preparation to making an audio book out of it maybe eventually a paper book because I think many of these ideas that you share are worth reading about by a lot of people and there might be some other people interesting in the same topics. But at the same time that should not make us forget the primary goal. So we get. So that was one of the reason that I don’t want too much technology to come in if we get a sound room. We go there and then the whole floor is gone. Now we are sitting in these dark dinge room you do all hunched up in front of the microphones worried about is it recording not recording and is it flowing in and then the conversations is done dies out.
John Bertoni: I know. No we lose the point. We’re doing this for I agree. And so you can think my mind just raced as you can imagine. OK. The name of the book is “East meets West” for you know conversations between you know.
Danish Bhatti: There’s a very funny Indian movie by that name. It’s about the first generation Brits who were born to Indian parents who make it to England. so they’re trying to blend in there has such a strong upbringing within traditional Indian culture. Although they were living in England and at the same time they had a meeting all these friends and neighbors who are Brits and it’s kind of a clash. So yes that’s a very nice one movie watch actually.
John Bertoni: Well I mean the people that I’ve seen in from India in Britain you know, they have a wide circle of friends. They are sometimes very highly educated. They’re struggling with the changes like in their country in India or nearby countries. It’s the same three or more generations may live in one home that when somebody would, lets say there’s a widow in the family where they just live with everybody else and they are a good source of wisdom for the children. You know when the children is being scolded, the widow – the grandmother might say Let me tell you what your father was like when he was your age you know and then you see the child sees the whole flow and the big picture. They tend to be like running little tea shops or their tobacco nests or they just have a place where you can buy all the newspapers or whatever. They find a way to make a living. And just like we all do. And nowadays it’s getting less so because people are not so much into discussion groups. They’re into their own phones. They’re into the virtual reality of the games. And it’s not a real communication if it’s not face to face. I don’t think because then you get all the nuances. you get the gestures and all the things that movement disorder specialist notice. How much are they paying attention. Are they not giving your eye contact anymore. Are they getting distracted. You know all those things that you can’t get over the phone or certainly you know device.
But back to the main point. There is also in America. I know where it comes from. You’re telling me about the details. You can focus too much on the details. There’s a saying The devil is in the details. You know Satan – the mastermind of following things up. If you get too much into the details and not the main point. If you over analyze something you ruin it. You know just plant the tree. Let the tree get the sun. Get the rain. Let it adapt you know stay out of the way. Don’t poison it. Don’t over trim it. Don’t do too much do it just let it be a tree and we tend to wreck things.
I heard something yesterday that was stunning if all the insects in the world, the class of insects or whatever they call it the Genus or the class, When you look at the forms of life; is one of the largest ones in our planet. If they all disappeared all life as we know it would be gone in 60 years. They figured because they pollinate the flowers and without them there would be nothing you know no nutrients in the soil because they work the soil and the worms and you know, all the worms are probably in separate I don’t know, but however if mankind were eliminated the whole world would flourish in 60 years. There would be a better than it is today would be more natural there’d be less damming of rivers and the fish could go upstream and breed and go to the sea and all those things so yeah you can screw it up and the devil is in the details and we think we’re helping the world and we’re, antibiotics, chemicals. Village life family life his world is. So I take back what I said about getting a studio and making it even better.
Danish Bhatti: I think we shouldn’t have a studio in our department a recording or the media room. I’m actually thinking about applying for a fellowship grant with the American Board of Psychiatry & Neurology.
John Bertoni: I say go for it. That’s a great idea. It’s something that is very much needed. We educate people without knowing what the goal is. We don’t measure progress. We just kind of figure we know how to do it because we’re liked by the students or another thing I would ask you to consider very carefully. The more of the education you do the less time you’re going to have for publications unless you find someone in the institution. This grant should contain some connection to education or research. Because like if we take really good care of patients and we’re doing a review of nutritional deficiencies as we do it we can find what percentage of non PD patients have deficiencies in vitamin B12 and so on and then we can do the same thing with the blood that’s tested with people being identified for the non PD patients. We can look at the patients that we suspect might have because of weight loss or something. But the amount of information we could do if we had a little help in education would be very valuable and very applicable, scalable as you say for others institutions.
I think if we’re going to be examining and looking at our health care system we’re going to have to come up with something in the next 10 years that’s going to be affordable but really good. This is the kind of thing we got to do in training other people to recognize the most important and the most common neurological problems that people in family practice, the people in medicine for example or other specialties. If we can show them what neurologists can do can you give them a hint can go out to the small towns in this state and other states. That’s huge. Once you get so go for it. But I would ask you to put in a piece so that this is educational research and for our (PD) symposium of 600 people, if we get these people started now get some education experts say OK we want to talk about not having the next or the senior or the middle career or the young upcoming doctors but we want to educate the patients and see what we can tell about those. And then we might find that people that didn’t go to the symposium and follow them and see if the number of times they go to emergency departments the number of times they need to be hospitalized is different.
I mean if you do it right you can be promoted. Not that’s the most important thing but if you are not promoted you’re in trouble. If you are promoted, then you have a team of people that you can. It gets easy once you get started. You have. It’s like they all do their own thing and they’ll be able to help you make your reports in your studies and you’re ultimately the kind of teaching that you do better. And I think at an academic institution if you’re not taking advantage of that even though it’s hard to get started it’s a mistake. You know there are people who are interested in doing this and are looking for projects like this. Go for it. I think you could have a good chance. Have you had any recent ideas that you put on your back burner or get them all the time. And I need to write them down. But I think the podcast idea is a great one. I would like to see a video thing eventually but I don’t want to go there now.
Danish Bhatti: (like) the fellows.
John Bertoni: Yes, the fellows. I mean look for what you’re going to be doing with this blended learning thing. You know if they go to lectures that we can provide them. We can do 20-30 minute lectures easy. You let us know what you want us to talk about to what end. We can do pre-test post tests whatever you want to do. So you and me quarters for 40 minutes. You compare it down to 20 minutes or whatever you want 30 minutes. I’d like to be part of that. And the fellows would be really good. Look at what Becky Just did.
I think you will look back in your career when you’re my age or not even that old and say I’m glad I did this. Look at what I learned. Look at what we built. Look at what we’re doing. Cooperation between the countries that you know the United States has learned how to do what you guys do. This chronic care organization, you want to take care of diabetes and hypertension. Do it, do it at the grassroots level. Get these people control it. That’s cheap. That’s volunteers. That’s getting the data that’s we know controlling hypertension and glucose levels is what we need to do. I mean the problem with people in small villages is they get worse when they become more like the United States. They get fatter they eat more sugar. They don’t exercise as much. You know what I mean. So I think prevention is what we really need to do. Problem is we have to say notice something.
Danish Bhatti: I’ve been thinking about this challenge over the last few weeks, of most, when you are listening to something because you want to gain something from it. When you have this conscious awareness that every moment every interaction you have when to get something out of it; something that’s worth while to you. And it becomes hard to then pick what you are listening to. (right) and problem is that there is this weakness that we have that just because it’s written in a book that is reliable and it is important to us and is right or just because these days just because there is a YouTube video of it or just because somebody said so in a podcast then a) is that it is right. We just presume it is. and b) does it even make sense, is it logical. C) is it even worthwhile and important. Because everybody is trying to sell something, everybody’s trying to sell what’s important and then even what popular beliefs are, may not be true. You know if an author is believed to be really good. He may actually may not be, he has just fooled enough people to become popular. That’s the challenge I’ve been having since my visit to Boston because I was with Aqueel my friend and that’s a good thing about our friendship that We challenge each other’s notions and believes. So I was showing him some things I liked on YouTube and all that and then he started challenging me. Not only that he doesn’t agree with what you’re saying but he challenged something more basic more core was that why are you believing him just because he’s on a TEDx stage and standing there and saying something. And now what he says is prophecy or is the Word of God (so to spkea). and you just going to take it in.
I mean look at all these TEDx events that are everywhere, there can be one Omaha and you get invited and you say something and all of a sudden what you said is important. And before going on to work at that stage what you said was not important. How are we picking our heroes that we are trying to model ourself against? And in this day and age a lot of heroes is being created by media by government by agencies for a certain propaganda for a certain notion. People are, how you say, in the Greek kingdom in the Greek world when an empire used to die they used to make a God out of him and that phenomena is being relived in this culture in some ways and you only have to die you just did something, enough to be selected by the people who could promote you in media or social media and make a god out of you or make it someone important person out of you. When you have no content then you have nothing of. So how do you select who you want to listen to, how you select, You can’t have a bullshit filter all the time. And how thick of a filter do you need. I mean it’s you will be bombarded all the time by all this useless scenarios and noises. So how do you select the right. How do you select how we would listen to?
John Bertoni: That’s really hard. It was always hard and it’s harder now. It’s harder now because if you ask enough people they will tell you who they think that is really really good person. And it may be a rapper. It may be somebody who is really an idiot but everybody likes them you know especially these days the millennials, I don’t know if you’re a Millennial, but as older people say this world is going to hell in a handbasket because we don’t know who the real authorities are. It used to be that you could rely on an institution. Let’s say somebody who is a professor or somebody you know. But now there are people professors of what modern culture or you know there’s probably professors of rap music No they’re OK. It’s a great thing raping. But you know these people are not role models. So to me if you can select what comes into your brain what you’re exposed to. Would that be a good thing? I think you have to if you make a pie chart I like looking at things on paper and sketching them out. Probably the majority of the things that we should spend our time on are liable to be more authoritative like books. People that are scholars, people that have achieved no advanced degrees and good institutions and you read what they write they’re authoritative and you check their sources and they’re correct. But you know you can find two such people that are opposites and they argue against each other you know or those to having tremor is all a phobia. There’s nothing real about it. These are just people with phobias. And then there are other people that say no no this is different. And who knows. But then there’s a portion of what you’re going to expose yourself to that has to be another source. You have to look at YouTube. You have to look at what’s trending. But I think in conversations like this and thoughtfulness gives you an idea that well like we were told in medical school you guys have now graduated but we have something to tell you; half of what we taught you was wrong. You know in 5 years it’ll be proven to be wrong or 10 or 15 years but we don’t know which half, you figured out. So you say half you know that’s just you know maybe even worse. So you say well then I got to be objective. I’ve got to find what I tell people. They want the answer. Do you have Parkinson’s. Do you have orthostatic tremor what the heck is this I got that. You know I just say here’s what I think it is. If you really pushed me. But here’s the certainty that I have. You want certainty you’ve got to donate your brain to science but you’re still using it. So what are we going to do until then it is a hard thing. What news sources are you going to listen to. There’s bias there. The problem that we have I think in the world and especially in this country is people don’t listen to authorities on the other side of a question. The Republicans don’t listen to the Democrats or they don’t vice versa. And so you have to listen to both sides and you have to have a discussion like this and you treat the other guy with respect. OK. Maybe they’re misinformed but some of them are crooks some of them are shysters some of the people are liars and they want to get away with it. Some of them are (I don’t know) murderers, done evil things. But you know we’ve all done evil things. Finding the truth, I don’t know, That’s the tough thing. I think you have to be trying to find somebody that you can believe in. But to what extent can you believe.
Torres-Russotto MD I think that’s look at what Diego (Torres-Russotto MD) is teaching. I think he’s one of the most knowledgeable people I’ve ever met. He’s really shrewd I believe what Diego says but he’s basing things on authorities that he’s trusted. And you know we’ll find out that maybe the best treatment for dystonic tremors is going to be different maybe Botox is largely a placebo thing or in some people. How do you identify the different subtypes? You know we have to learn that we have to be humble enough but we have to do something and we did the best we can without hurting people. But I think you have to stay open minded and I think you have to look at both sides of almost everything. I don’t have a shortcut. I’m hoping you would have one.
You’re celebrating Mother’s Day at your place?
Danish Bhatti: Nothing special.
John Bertoni: I don’t know about you but I love so much to my mother. I mean I love a lot to my father. They’re both gone. But I think it’s worthwhile to just be thankful. I think we’re both very fortunate in having been raised by two loving parents. Not everybody has that and it’s good to not just one day a year to be appreciative. Because if you don’t have a day you may never appreciate. Somebody said we produce greeting cards let’s make up a holiday. Let’s make it Father’s Day.
Danish Bhatti: I hate these day culture in US. I know it’s ridiculous somebody somewhere just keep making up these days. You know like Wear your favourite T-shirt day was the other day in the clinic and people has these strange T-shirts on.
John Bertoni: Yeah I agree with you. You don’t do it just one day a year. What’s special about today. Somebody made it up lesbians. I remember as a child I must have been oh maybe about Alyssa’s age (Danish’s daughter). Where is she now says. I remember I was probably a little younger than her then and I remember my dad was coming home for his work was our home was on the driving range of a golf course. That was really tough. If you tell people this, they don’t believe it but golf balls kept flying into our yard all day long when we’re playing. I’m lucky I don’t have concussions.
Danish Bhatti: you guys were never worried you are going to get hit by the golf balls.
John Bertoni: Oh you just learn to living. You know we just let it be whenever we’re going to play in the yard. Right. I was more in trouble because my brother would sneak up behind me while I was sleeping in the hammock or doing something and throw cold water on him or something or turn the hose on me or you know those kind of things. That’s more immediate. But anyway I remember my dad going into the house. And it was Mother’s Day or Father’s Day coming up and I said why isn’t there a children’s day. Why don’t we have a day. And he was busy and I don’t know he was worried about things like he commonly was and he just looked at me and he said every day is Children’s Day. And then he went into the house you know and I got to thinking what a curmudgeon. You know but then I think oh yeah if you’re a. Yeah. Your everyday Children’s Day. And why need another day.
Danish Bhatti: We need holidays Probably because we hate our work we need a time off of work because we just force to being there and the only way we survive eleven months is because we know we can get one month off. If you really would love your work like you do, you’ll be at your work even on your day off.
John Bertoni: Well you’re talking about do you want to do this grant and you know I think you have to follow your heart follow your desires follow your passions because if you have such a job the pay isn’t important. I mean it’s important because you got to live and put food on the table and educate and take care of your family and all that. But I don’t mind working with a little bit extra but I need time to thinking be and the other things. Um yeah I think we do need time off. We do need to think and go to the hills and meditate and we also take a break here and maybe I can get some more coffee.