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Emily Silverman
You're listening to The Nocturnists stories from the world of medicine. I'm Emily Silverman. Today's episode features a very special guest, Dr. Mike Abernethy. Mike is a clinical professor of Emergency Medicine at the University of Wisconsin, helicopter flight physician and former naval engineer EMT and military officer. I first met Mike when he submitted a story for our live show in San Francisco in June of 2022. Our team was immediately struck by Mike's innate storytelling talent, and invited him to come to the bay to perform on stage and it was a really amazing experience to watch the story come to life for a live audience.

A few months after the performance, Mike and I sat down to talk about his work as a helicopter flight physician, the concept of pre-hospital care and the differences between the United States and Europe and how they approach this really important part of medicine. I came away from the conversation feeling like humanity is safer because Mike exists. And I hope you enjoy his story and our conversation as much as I did. Before our chat, take a listen to Mike's amazing performance on The Nocturnists stage. Here's Mike.

Mike Abernethy
It's January 2021. I'm working in a busy emergency department, small community hospital in Beloit, Wisconsin. We just got pummeled by a midwinter snowstorm. And, I tell you... we're busy enough between overcrowding, understaffing, and now we have COVID. I'm seeing a lot of sick COVID patients. But the thing that's really hitting us, is the fact that, because of the pandemic, they have shut down all the primary care clinics. And, as the safety net for the healthcare system, we see everyone who comes.

Now, I'm the guy you want to see if you've been in a horrendous farming accident, in the middle of nowhere. If you're bleeding out from abdominal aortic aneurysm, or if you need flown across his state while on ECMO in a helicopter, but I'm not cut out for Primary Care. God bless 'em.

So, the night goes on. We have a couple motor vehicle accidents (just fender-benders), a couple ice-related falls. And, as things progress, we get into the real meat, the real bread and butter of Emergency Medicine: a seemingly unending parade of chronic abdominal pain. Snotty kids with fevers, urinary complaints, and diarrhea. I'm sitting at my desk; I'm staring at the clock on the wall and it's not moving. I'm getting too old for this shit. I put my head down. I fantasize about just quitting and retiring early.

The problem is: I am chronically exhausted, and that makes everything a hundred times worse. It's not like I don't try to sleep. I set aside time; I set aside a place. But my mind just doesn't shut off. My wife describes it best. She tells me, "You don't sleep. You wait." So morning comes, and with it, my relief. Jessica's bright-eyed and smiling. I apologize for the dismal state of the Emergency Department. I make a sincere effort. I said, "I'll hang around and help you clean things up." She just sort of crosses her arms; eyes me up and down, says, "Mike, you look like dog shit. Go home; go to sleep." Yeah, if it were that easy.

I go to the locker room. I put on my old coveralls; put on my army jacket, and I walk out to my truck. And the wind is howling; it is cold. And I just sit there for a minute, trying to decompress while the truck's warming up. And I must have nodded off, because I'm awoke by this buzzing noise, and I'm fishing through my pockets. It's a text from my wife. She wants me to stop by Walmart on the way home. It's like, "Oh God, I don't want to go to Walmart," but what am I gonna do? Go home and go to sleep? So...so, I pull into Walmart. And remember, this is Walmart, 7:30 in the morning, Sunday, Beloit, Wisconsin. And the place is hopping. As I get out of my car, there's a fight going on, two cars down. The police are involved. I walk in the front door... My paramedics are wheeling out a patient. Apparently, a young lady just had a seizure in the fresh produce aisle. Kids running amok, unsupervised. And I see Mikey, one of my ER regulars. He's drunk as hell, arguing with this green-haired cashier about something.

So, I've got my list. I work my way through. I got peanut butter, I got diapers for the grandkids. I've got milk, I've got bread. Self-service checkout, I'm scanning my items... And I look over, and near the exit, this dude sort of standing there and he is staring me down and making me uneasy. I don't need this crap. So I bag my my items, and I walk out. And I walk right past him. And as I do, I hear "Hey, mister!" And this guy's big. He's like 6'2"; 300 pounds. He's wearing a leather jacket, camo pants. I just keep on walking. He goes, "Hey, are you Dr. Abernathy?" And I stop. Because, he's got me. My army jacket, over the left pocket: big stencil "Abernathy". Uh,... So, I turn around and I look and... Well, there's a lot of people here, If something goes down, there's going to be witnesses.

"Yeah, I am. What can I do for you?" He goes, "My name's Emil Jones. Do you remember me, Doctor? It was a long time ago. I was just a child." And I'm thinking, I got nothing here... And, he doesn't say a word. He starts to unzip his jacket, and I'm thinking, "Oh, shit." He reaches in; he pulls down his shirt collar. And he has this hideous scar. It's the length of his neck running from his earlobe down to his sternal notch. And the ER doctor in me, my first reaction was, "Whoa, dude, that's a wicked scar."

But then, something from the back of my mind... it hits me. Oh my God; it's him!

Now, I've been doing this for 35 years. I've seen well over 100,000 people. But I've only seen one child that injured, that lacerated. Only one. And he's dead. He has to be.

It's 1999, I'm working at Beloit Memorial. It is a stinking hot July night. Things are off the rails, as usual. A car comes screaming up to the Emergency Room entrance. A couple gets out. The man is holding the body of a young child, absolutely limp and covered with blood. The triage nurse rushes him back to the recess room, and I get bits and pieces of the story. This is three-year-old Emil. Somehow, he was jumping on the couch, playing, fell backwards, put his head through a plate-glass window, lacerating his neck. Bled like stink. So here I am, looking at this child under the surgical lights. He is more pale than the sheets he is lying on. My tech immediately begins CPR; I work on an airway. The nurse... Bam! She nails an IV...Thank God... starts infusing IV fluids. But when anything hits his vascular system, it just gushes out of this massive neck wound, soaking my scrubs. Oh God, oh God. So I spend the next five minutes, frantically, using every tool in my box to try to stop the bleeding from this neck.

I do. I get it under control. And about the same time, we got two units of packed red blood cells. We infuse those... Couple more rounds of CPR. And then, it was like magic. Like a friggin' chameleon, he goes from this ghostly pale to this, almost ruddy, pink color. "Hold CPR." We feel; he's got a bounding pulse. First hurdle's cleared. We spend the next few minutes further stabilizing him. Something about him is bothering me though. With all this noxious stimuli... everything that we've done to this child.... He's not moving. He's not breathing on his own. I get out my penlight. I check his eyes. "Oh, crap." His pupils are fixed and dilated. I've seen this play before, and I know how it ends.

I make arrangements to transfer him to the regional trauma center, while I tend with the rest of the emergency department. And about thirty minutes later, the helicopter comes and takes him away. The rest of the shift is an absolute nightmare: disaster after disaster. By morning, I am just totally spent. I vow... You know, I'm just going to forget this shift ever happened.

"Hey Doc... Hey Doc, you okay?" And I hear her Emil's voice. And it's like, "Oh I'm sorry, man. I was just spacing out. I just worked a night shift." He goes,"Oh man, that's okay. I understand. I don't want to take any more of your time. But my mom is going to be so thrilled when I tell her that I met you again. And I just wanted to say..." And he takes my hand, in his two very large hands, and looks. He says, "I just want to say thank you." And he walks out.

So I've got my grocery bags. I go out through the parking lot. I'm in a daze. I'm trying to wrap my head around what has just transpired over the last five minutes. The wind is howling. I'm oblivious to the weather. I've just seen a friggin' ghost.

So, I get home. I go through my normal post-shift ritual: strip off my clothes in the garage, get a shower, get something to eat. I check in on the wife. I look in; she's asleep on the bed amidst a pile of grandchildren and dogs. I'm not going to bother them. I go to my office; lay down on my trusty Naugahyde couch. But there's something different. My mind is amazingly, and mercifully, quiet. I lay down. I fall asleep. I don't wake up until the next morning. Thank you.

Emily Silverman
So, I am sitting here with Mike Abernethy. Mike, thank you so much for coming onto the show.

Mike Abernethy
Oh, it's a pleasure to be here.

Emily Silverman
So, Mike, your story blew me away. And I think a lot of people in the audience really, really connected to... not just the story itself... But the way that you told it, you were just so present in that story. I really felt like I was in that grocery store with you, and in your insomnia with you, and in that memory of the interaction that you had with the child years and years ago in the emergency room. So, wondering what was it like for you, the onstage experience?

Mike Abernethy
It was very different. What I learned...There's a difference between writing a story.... I could write a short story about this exact same incident. But yet, delivering it verbally to an audience... Wow, a whole different animal. Although I've been storytelling my whole life, you know; it's part of medicine. But to do it on such a scale was very eye-opening.

Emily Silverman
Did you have any storytelling experience, outside of just being a doctor and, kind of, reporting on rounds? Because I got the flavor that maybe you're someone who comes from a family who's really good at storytelling or, you know, something like that? Because it just seems so second nature to you.

Mike Abernethy
Yeah. I really believe... Medicine, especially Emergency Medicine, there are so many rich stories associated with it. And, not only in Emergency Medicine. I have a long history in EMS. I started as a teenager, as a volunteer ambulance attendant. And, to the right audience, it really lends itself to stories. And then for those who are outside of the profession, there's this huge curiosity over what we do. So, I think over the years, yeah, I've been, sort of, telling stories about some of my experiences.

Emily Silverman
So, you said you started off as an ambulance attendant as a young man. Then you went into Emergency Medicine. But you also have this unique flavor to your work, where you are one of the world's most experienced helicopter flight physicians. So I'm wondering, for our audience, what is a Med Flight physician, and what does that work look like?

Mike Abernethy
Well, it's interesting, comparing the United States to the rest of the world. In the United States, our pre-hospital care is primarily EMTs and paramedics. You very rarely see a physician. What I found out, through my forays in social media, and my travels... Boy, the rest of the developed world does quite a bit when it comes to pre-hospital care. Many of these have physicians who are not only integrated, they specialize in the subspecialty of pre-hospital care. Working outside of the hospital, in the environment. If you go over to the UK, Germany, Scandinavia; it's the standard of care. I've been doing this as a civilian flight physician for 33 years, and I have yet to find another flight physician in the US, or otherwise, worldwide, who has been doing it continually. It's not saying I'm the best, but... I've just been doing it a long time.

Emily Silverman
I didn't realize that there was such a difference between the United States and parts of Europe, with this idea of pre-hospital "in the field" care, whether that's... Something happens in the community, or you're trying to get somebody from A to B. Why is it the case, do you think, that in the United States that work is done by paramedics and EMTs, and not by physicians? Because, the more I think of it, the more I'm like, "Well, why isn't there a physician role?"

Mike Abernethy
Ah, that's one of my passions. That's probably an hour long conversation. But, it all comes down to money. In the United States, up until the 1960s, there really was no pre-hospital care. The fire departments... Over 50% of pre-hospital care was provided by funeral homes; you had the ambulance hearse. But then, they realized we need a higher level of care, so they came out with this idea of EMS, and an Emergency Medicine Technician. But the problem is, there's never been any uniform funding. In the United States, you can cross a township line, and go back in EMS history forty years. You can have an incredibly well-funded, well-trained city Fire Department; state of the art pre-hospital care. And then again, you cross a township line, and here you are; you have a volunteer, basic level EMS system. (These guys are having bake sales to keep the lights on, because their county or their township doesn't fund it.) In the United States, it's highly, highly different - not only from state to state, but from county to county, and even within a given county. It's money. I go to Ireland or England, where you have the National Health Service. The paramedics are employed by the National Health Service; these entities are funded by the National Health Service. In the United States, we make this bizarre line in the sand when it comes to hospital versus pre-hospital care, whereas that doesn't exist in a lot of other places. It's a continuum. And I'm not saying you'd need a physician on every pre-hospital call; you don't. But they are integrated into the system, and it's sort of a tiered response, depending on what's needed.

Emily Silverman
So, as a young man, you knew you wanted to do this kind of work. And then it sounds like you found that, in the United States, there weren't so many opportunities to do that, as a physician. So, is that why you went over to Europe? Was it more that you were searching for the opportunities, and just had to go outside of this country to get them?

Mike Abernethy
Well, it's interesting now. I was sort of confined to the Midwest: the idea of "this is the way we do it", in our community, in our state. And then there were national conferences, and you'd interface with other people. But it really wasn't until the advent of social media... I was amazed at the people I found. There was a whole conference series, for about six years, called SMACC (Social Media and Critical Care), where we had this whole tribe from around the world. And it just really opened up my mind, and then it opened up opportunities. You know, I'm 63 years old. This has only been, really, within the last ten years that I have done a lot of the international work, and it's really due to the advent of social media. It's made the world just incredibly small.

Emily Silverman
Wow. So how does it work? Like, you're on Twitter and you see somebody in Europe tweeting about being a helicopter doctor, and then you send them a DM, and say, "I want some of that," and then they invite you over and then you go over and do the training? Or how, exactly, does this work?

Mike Abernethy
Yeah. As you know, on Twitter, you have communities. We have our group of the pre-hospital care people. And you start to talk with them, and post with them. And then, hopefully, as I said... We had conferences. Some of these people, I've had relationships with. Two years, and then I finally meet them in person. So yeah, it's just been wonderful. And, as a result of that, I have regular trips. I probably spend one week every other month over in the UK or Europe.

Emily Silverman
And what do you do there, exactly? Paint a picture for us.

Mike Abernethy
Ah, okay. So, sometimes it's just going over... doing some lecturing. I'm involved with a great group called ATACC (Anesthesia, Trauma, and Critical Care). And this course... It's a three-day course, that's been going on for, probably, thirty years. I met the people on social media, met them at conferences, and then I found out about this course. And it's like, "Oh, my God, this is exactly what I dream of pre-hospital training, and how it should be." And, I took the course as a candidate and was just blown away. And then, I've been invited back; we have an international faculty. And I go back probably two or three times a year as faculty. I fly in out of Chicago; get in on Thursday. We set up Thursday night. The course is an intense twelve hours a day. The course itself is mainly 20% didactic, probably 20% hands-on workshops, and then the rest is high-fidelity simulation. We're talking about a training center, where we have collapsed buildings, and we have trains that have been wrecked, and we have houses and automobiles. And the key thing with a simulation is having live actors who know what they're doing in very realistic moulage. So, that would be the ATACC course. And then, the ATACC faculty will put on demonstrations and workshops in various other trauma conferences. So, two years ago, we went to a trauma conference in Sundsvall, Sweden, which was fabulous. Again, a large international faculty; we had probably about a hundred people from around the world. So, that's the big part of it, when I go over. But I've been invited over, you know... just a routine conference; just to do a lecture in person. And there's something to be said... We've been shut down for the pandemic. It's one thing to associate and talk with these people, and learn over the internet. But it's a whole different animal to meet someone face-to-face. There are certain things, whether it's law enforcement, military, and also pre-hospital, that you can't do online. There has to be a hands-on group effort.

Emily Silverman
What about the work itself? So, you're in a helicopter... Where are you going? Is it like disaster medicine? Or is it more routine? Like, somebody has a cardiac arrest in the field? Or, I'm imagining the simulation center of collapsed building, and things like that. Like, what sorts of events are you responding to in your helicopter? And, bring us into the helicopter.

Mike Abernethy
Well, it's interesting. And, people imagine it as all this dramatic roadside: car accidents, all sorts of disaster things. But, nationwide, probably 80% of the business is taking patients from smaller outlying hospitals to larger tertiary care centers. So, we may get called: someone's had an MI, and they're unstable at a small rural Wisconsin hospital. They may have an Emergency Physician there; they may have just any old Family Doc who's covering the ER. They may have a Nurse Practitioner or PA, and depending on skill levels and comfort with these very ill patients, and they're in the middle of nowhere. I've worked in rural emergency departments. Sometimes the academics in the ivory tower thumb their nose at the non-academics, but I tell you: It is working without a net. You don't have every specialty at your beck and call. You may be the only physician within 30-40 miles. So when that bad trauma comes in, or that child in near respiratory arrest... It's up to you, and your nurse and your techs. So we will get called into the small hospitals, whether it's a trauma... Stroke's another big one. We arrive; we stabilize the patient, switch them over to our equipment. And, the thing is, we can provide... If anything goes wrong, en route, we minimize the out-of-hospital time, by virtue of we're a helicopter, but yet we have a higher level of care too. We have an Emergency Physician there to take care of the patient, if something does go wrong during that period. That's 80% of our business. And then the other 20% is the sort of cool stuff, the fun stuff. There's car crashes. We see agricultural accidents, other things that we respond to. You know, I don't wish it on anybody. But, just like the firemen, they dream of the big fire; policemen dream of the chase. I like taking care of really sick patients in bizarre, sometimes very austere, environments. And we... Just the other night, we had a guy... (It was a very rural area.) He went off the road, collided with a guardrail. Guardrail came through; he was pinned in the car. And so, we were called. Now, we don't do the extrication. The fire department on scene, they'll do that. We will assist them, and help stabilize the patient. But, it took close to an hour to get this guy out of the car. But while he's in the car, we're administering analgesics, we're transfusing him with blood and plasma. We're giving him TXA. If need be... In this case, we didn't have to do anything with the airway. So that's an example of sort of the fun stuff. Agricultural accidents. There's no other industry where you have 80-year-old operators running 80 and 90-year-old machinery. They work long hours. I live primarily in an agricultural area, and I'm just amazed. But, it is an inherently dangerous profession. And we see a lot of agricultural accidents, especially in the Spring and in the Fall. They either get tangled up with equipment, or things fall, or animal-related incidents. So, yeah. We see some of those. And then in our area...Wisconsin is a big recreation state. People like to come up here; we've got great outdoors. So we see boat accidents, ATV accidents, rock-climbing falls. In the winter, snowmobiles. And alcohol's involved in a lot of these recreational accidents. So we take care of those too.

Emily Silverman
I'm thinking about COVID, and how there were many, many failures when COVID arrived in the United States. But one of them was this urban-rural divide, and just the dramatic inequity in resources. And I've spoken to some people who went out to rural areas to volunteer, and were just stunned by the doctor-patient ratios and the nurse-patient ratios, and also issues around moving patients around. Like, this hospital would fill up, and there was really no organized system for how to redistribute patients among different hospitals, depending on where the virus was surging at the time. So I'm wondering, did you watch all of that unfold? And did you have any thoughts about, like, Oh, God... The United States needs to have some kind of centralized redistribution system, so that in the event of a mass illness event, or something of the sort, we can get people from hospital A to B; we can redistribute people and, kind of, get people to resources instead of having all these people dying in one tiny hospital and no way to get them out?

Mike Abernethy
Yeah. I saw it from all three ends. I saw it from working in a rural hospital, working in a large academic center, and then the guy who shuttles them in-between. Yeah, the bed availability: Ahh, I mean, we were doing flights that we've never done before, both in length and location. Taking patients... They'd have a bed available somewhere up in Minnesota, or down in Illinois. We'd be taking patients. But the sad thing was, again, working in community and rural hospitals, we'd have these non-COVID patients. You know, all of the beds were taken up by very sick COVID patients, both in the community hospital, and also at the tertiary centers. So there was no place to take your regular patient... your sick DKA's, head bleeds, septic patients, that absolutely needed a Critical Care Unit. And here I am; I'm the only physician. I'm caring for these patients, in the Emergency Department, along with everything that comes in the door. And, they talk about patients who died by COVID, but I wonder how many of these patients died because they could not get critical care. Now granted, the people were doing the best they could. But there was just a level... I remember we had a situation where we had a drowning: a young kid who was a great candidate for VV ECMO. We got him back, and his lungs were just bad, and great candidate... a young kid. There were no ECMO beds available; everything was taken up by COVID. Now, as far as the question of a central access center: Where are the beds? I think there's a couple people... I know for sure, one of the friends of mine, Tony Macasaet, (who is a rural Emergency Physician in Viroqua, Wisconsin), was very passionate about starting up a regional app addressing just that. Because when you'd have a patient in your community ED, you would spend hours, depending on if you had staff who could call. But, you just start calling an ever-widening circle. I've sent patients as far as 200-250 miles away. Why the government couldn't do it? Not saying it's any better in the other countries. But again, when you have a national health service, it's one entity, and they tend to share information a lot more readily.

Emily Silverman
You said something earlier, that I think was so interesting, which was the firemen dreams of the fire, the policeman dreams of the chase, and maybe the Emergency Doctor dreams of the emergency. And I'm wondering about that. Do you feel like you were, kind of, born this way? You're just attracted to these extreme situations? Feeling called to help; called to serve? How do you deal with the adrenaline of those situations? I assume you must feed off of that in some way. But, yeah, tell us what it's like to be somebody who gravitates toward this work, because, as you might imagine, it's not for everybody.

Mike Abernethy
Absolutely. When you talk about people who are in fire, or law enforcement, or EMS, there's part of the job that is learned. But then part of it is innate. You have to be able to handle that. You can take the greatest physician in the world, even Emergency Physician ,and put them in the pre-hospital environment, and he may very well become overwhelmed. I've been doing this from a very young age, and I think there's part of that "being exposed to it during that pluripotent stem cell period of your life". But, I think a lot of it has to do with proper training. I've trained pretty hard and long my whole life, to be able to handle these situations. I see our Critical Care colleagues in the ICU, handling these ECMO patients in these emergencies. My god, I could never do that. One of the great things about pre-hospital medicine is, typically you're taking care of one sick patient at a time. So, to answer the question, well... But yeah, part of it is due to training. But there's no doubt, part of it is inherent. It's something, I guess, in your DNA. We run into fires, while other people are running out of them.

Emily Silverman
Right. And we have to have people like that on Earth. And how do you cope with that? In the story, your wife talks about how you've never really been a great sleeper, and she says, "You don't sleep. You wait." So, I imagine that this does take its toll, especially over decades. How has that part of the journey been for you?

Mike Abernethy
Oh, I agree. It definitely does. And if you look amongst fire, law enforcement, and EMS, there's a horrible suicide rate, rates of anxiety, depression and other mental illness. And I guess, it's a combination of the person, a combination of, again, genetics, their social situation. I've been lucky. The one thing though... They talk about circadian rhythms in medicine, and sleep. I have no circadian rhythms. They went away. I work, on average, about seven 24s a month. And my schedule is bizarre. There's never any sense to it, as far as night-days, days-nights, so I have horrible sleep hygiene. That's my biggest complaint. Sometimes, if I have a stretch off, I can actually sleep. But here I am in my 60s, and this has been going on for a while. But, again, Thank God, due to genetics, I have no major health issues. I am blessed from that standpoint, but I can't speak for everybody. And the other thing is: "How do you cope?" I guess it's good support systems. It's... Again, when you get to be my age and have been doing this long enough, you're... There's not a lot of second guessing. A young EMT is constantly, "Well, if I would have done this, or I would have done more CPR, or I would have given this drug, what would have the outcome have been?" And, you know, I've seen quite a bit, I have an n of well over 100,000 Emergency Department patients, and probably I have flown close to 5000 people over the last 33 years. So, I have the benefit of that experience. To be able to look back and say, "You know what? Yeah, I did the best I could on that one; there's nothing else could have been done." And there's always room to improve and do better. And that's when you look at those cases, and you learn. But I think that's a big benefit, making it as far as I have.

Emily Silverman
One thing I noticed about myself in residency is: Sometimes I would get to the end of a rotation, and somebody would say, "What did you see on this rotation?" Or even they would say, "Oh, you're a senior resident now. Tell me about your intern year. Like, what did you see?" And, of course, there are those cases that you never forget, and that stand out. But, I found myself having some degree of, almost, amnesia. Was like... I closed my eyes and tried to remember the patients, and I would just draw a blank. And, I was reminded of this when I was re-listening to your story today, because there's that moment where you're approached in the grocery store by the patient, and the patient says, "Are you Dr. Abernathy?" And you say, "Yes, I am." And the patient says, "Do you remember me?" And you look at him, and you say, "Nope, I got nothing." And so, I was thinking about that amnesia component of things. Like, is there a way in which maybe our bodies do that to protect us? Or is it just a matter of numbers? Like, you just can't remember every single n of the 100,000? Or, how do you think about that amnesia? Does it ever bother you? Or is that just part of the territory?

Mike Abernethy
I think it's a combination of both. I mean, literally, I've seen so many patients in my career. One might argue, it's as you get older, your memory mercifully gets a little bit worse. But the idea of selective amnesia, and purposely... Would you want to call it sublimating?... bad things and horrible things. Because they will come up after years, much like this case. And then all of a sudden, it's all there. But it was just put in a nice box.

Emily Silverman
That was one of the things that I noticed about the story, which was you didn't remember, but then as soon as he starts to give the details, it's like your memory opens up. Like an accordion or something, and it's all right there. And so I wonder, like, if you had never bumped into him again, maybe those memories would never have been retrieved? And, how do you think about that? That physical experience of it all flooding back, all the memories coming back? Is that a pleasant experience? Is it strange? Do you wish it happened more often? Or, how are you thinking about that?

Mike Abernethy
Well, in this situation, they can be landmines. Here, all of these came back, but it was in the context of this kid is in front of me. It's not that I'm driving past an intersection, and all of a sudden, I remember something. Or walking through a cemetery, or a relative, you know. So, it's sort of a different situation. But, I agree. There are things packed in boxes. And it's not just a gradual name coming back, and then you think about it for a while. No, it just springs open. And I've had that happen to me on several occasions. And yeah, not necessarily a pleasant experience all the time.

Emily Silverman
There's a funny part of your story where you say, "I'm too old for this shit." And the audience laughs. But you're still doing it. So, are you too old for this shit?

Mike Abernethy
No, no. I, you know, they laughed. They said, "When are you going to retire?" And it's sad. I see a lot of young physicians in Emergency Medicine. And they're talking about, "How can I retire before 50?" And all this. I like going to work. And as I get older... And that's the beauty of Emergency Medicine and pre-hospital care: it's shift work. So, I can drop back. I don't have to work the insane schedule that I've worked for many years. I don't like to work nights in the Emergency Department anymore. I work a lot of them on the helicopter, which is its own animal. But yeah, I've got a couple of years left. But boy, Emergency Medicine, we are the safety net for the entire healthcare system. And anything that goes wrong in a hospital, whether it's procedural, political, anything; it all trickles down and bites the Emergency Department in the ass. So, people are getting burned out, and people are getting worn out. Not just physicians. Nurses, Advanced Providers, techs, custodians. It's changed radically, I can see, in the last 30 years. So, in a way, I can't blame them for wanting to get out of it. So maybe we need to teach them better how to stay into it.

Emily Silverman
And what has changed over the last 30 years? How do you see the arc of healthcare evolving into the future? Most people I speak to are pretty pessimistic about it. And I'm wondering if you are too? Or maybe you have some more hopeful feelings about it?

Mike Abernethy
I'm somewhat pessimistic. Seeing how it runs in other countries, I don't think socialized medicine is the answer. A pure socialized system versus a pure capitalistic system: It's going to have to be something in the middle. They're having their problems with overcrowding, I know, in the UK: overcrowding, over-saturation. So there's all sorts of inherent problems in the systems overseas. Our system... Boy, someone can go bankrupt for a simple appendectomy, or a natural childbirth. There's something very wrong there. It's just out of control. In the air ambulance industry, Emergency Medicine, healthcare in general: It's owned and operated by private equity firms. There's so much that is run and, I'm sorry, a private equity firm, their job is to make money for their investors. That is their number one priority, and they may say otherwise. But, when push comes to shove, it's profit. And I think that is just inherently in conflict with what we think of as healthcare.

Emily Silverman
You said you think you have another couple years in you of this work? What do you envision for your retirement? How do you go from the snowmobile accident, the crumbling building, the helicopter, to retirement? That's such a dramatic shift. Are there any people who have, like, extreme retirements? Where they're doing other types of extreme activities to help feed that?

Mike Abernethy
Yeah. I know some people doing... cruise doctors, expedition doctors, they go on these different trips. That would be fun to do. I would like to continue to be an educator. And again, I don't want to be that old guy. I remember in medical school, they had one of the Surgery emeritus faculty lecturing to the freshmen medical school. And this guy was lecturing... Again, this was in the 1980s. He was lecturing out of the 1950s: technology, techniques and all that. And you say, "Who is this old guy?" I don't want to be that guy. I mean, I want to be the guy that's still up and current on a lot of things, which I still think I am. As I say, I'm a PGY 35, and still learning. To stay up on all this, and then that, combined with my experience, you know, that I can serve as a valuable asset for pre-hospital education. So, I can still see myself traveling, doing some educational-type stuff.

Emily Silverman
So, as I mentioned earlier, our audience is mostly healthcare workers. We have doctors, nurses, students, trainees. Is there any message that you'd like to leave them with? What would you like to communicate to The Nocturnists audience?

Mike Abernethy
I guess you can get pessimistic; you can get somewhat downtrodden about what we do, the hours. But... So, I was talking to one guy... I think it was one of my mechanics for my car... And we were talking about what I do, what he does. And I'm in awe: this guy can fix anything, make anything. And I go, "That's incredible." And he sort of looks at me. He goes, "Yeah, but on your very worst day, you're still a doctor." And I thought that was pretty neat, because, again, I look at it as a profound privilege to be doing what I'm doing.

Emily Silverman
I have been speaking with Dr. Mike Abernethy. Mike, thank you so much for speaking with me today.

Mike Abernethy
Thank you.