On behalf of the association of surgeons of India, nothing gives me more pleasure than to warmly welcome you, Sadhguru, to the primetime program that is being held during the 80th annual conference of our association on a virtual platform. Sadhguru, our association, the association of surgeons of India is Asia Pacific's largest and the world's second largest surgical association after the American College of Surgeons. And the association represents practicing surgeons and surgical trainees from across the country and also specialists like the oncosurgeons, breast surgeons, surgical gastroenterologists, colorectal surgeons, genitourinary surgeons, rural surgeons, endocrine surgeons and we also have surgeons from the armed forces, all of them come under this umbrella organization. And traditionally every year during the conference, the president of the association is invited to deliver the presidential oration. So for a change to break the monotony, I thought I must break this monotony and have a luminary, have an engaging conversation with a luminary and it is such a great privilege to have you, Sadhguru. You escaped your responsibility and putting it on me, I'm an uneducated guy, what will I do with you surgeon, sir? It has been a great blessing, you know, and is a high point in my life to have you in a conversation at this conference congress. Thank you. So we start off with a few questions, Sadhguru, and thank you very much for your time. So as surgeons, we try to do our very best and we use all our knowledge and skills to ensure the best possible outcome for our patients. But despite our best efforts and doing all that is required, occasionally things don't go as we expect, things to go. And what happens sometimes is that patients whom we expect that they would recover, in front of our eyes, they rapidly deteriorate and there is nothing much we can do to save them. Sadhguru, how does a surgeon deal with this difficult predicament both as a healthcare professional and as a fellow human being? Well, when somebody puts their life into our hands, it's a tremendous privilege, responsibility and an honorous responsibility. Sometimes with terrible consequences, because after all, as a surgeon, you're using a knife. Normally in social terms, if someone says, I was knifed, it means somebody tried to kill me. Because putting a knife into somebody, not to take life, but to fix life, is a tremendous thing. It's a very courageous thing to do. Well, the complexity of what human mechanism is, this is the most complex system on the planet. Of all the many things that we have, the most complex system on the planet is human mechanism, which is a consequence of millions of years of evolution. Now surgically fixing something within that means you're mechanically intervening in a machine, a sophisticated machine, which is still running. It's not an autopsy. The machine is still running and it must run better after the surgery. If you allow me to tell you a joke, because I feel surgeons should be a joyful lot, because with this responsibility of opening up somebody's belly or somebody's head or somebody's something which is dangerous to open and not have nerves about it, needs a joyful, balanced human being. So this happened in United States. A cardiac surgeon was having little trouble with his Mustang, car, Ford Mustang, and he went to the local mechanic. So the mechanic said, you leave it here, I'll have it ready for you for tomorrow morning. So next day morning the surgeon took a taxi and went to the mechanic shop. The car was untouched and not ready. So the mechanic said, no, no, on your way back you come, I'll fix it. So the surgeon on the way back from the hospital in the evening, again he came back, still it was untouched and not ready. Then the mechanic said, come tomorrow, definitely I'll have it ready. Again the next day morning he came and still it was not ready. Then the surgeon asked, say what's the problem? Three times have come and still the car is not ready, you've not even opened it and seen what is the issue. Then the mechanic swaggered around a little bit and he said, hey doc, see, you fix engines, I fix engines. How come you have paid twenty-five times more than me? So the doctor looked at him and said, okay, try to fix a running engine, let me see. So switching off the engine and fixing it is one matter. When it comes to a human being, surgery is fixing the engine when it's running and it must continue to run. If it stops with the surgery, that is not a successful surgery. But the risk of putting your hands inside a running engine is always there because it's such a complex system and just about it is not necessarily… mistakes can happen of course, but it's not necessarily due to your mistake. You may do everything right and still the patient can die, as you said. Because it is such a complex mechanism, it is not just based on the mechanical aspect of what it is. There is a karmic substance, there are other dimensions of life which are not even within the purview of the surgery. The purview of the surgery is purely mechanical aspect of the body. That itself is too complex for anybody to understand. I'm saying you may study for a lifetime of medicine, still a really good doctor knows that he knows just enough to do a few things, but nobody really knows the entire system in its entirety. That is why the knowledge keeps growing endlessly. Believe me, after another thousand years of medical sciences, it will only get more complex. It will not get more simple. This we are realizing, isn't it? Now for each… each part of the body, there is a doctor. There was a time hundred years ago, there was only one doctor for your entire family. But now for your children separate doctor, for your wife separate doctor, for you separate doctor, for your parent separate doctor, that is not the only thing. For your eye separate doctor, nose separate doctor, heart separate doctor, the way we are going into specialties, expertise clearly demonstrates the complexity of what we are looking at. And another thousand years, if you look at it with the same intensity as 20th and 21st century has, believe me, you will still have surprises, you will still have things that you do not know, still many things will not be in your purview. Even if you… so if you go like this to do a surgery upon a person or to treat a person, you will need a hundred different doctors for different parts of the body. We are getting there because of specialization, specialization, which will create so much complexity in the knowledge that we have that to analyze and get to a solution will become difficult already it is becoming like that. So I am not saying this with any negative context to medical science, all I am saying is you are dealing with something that complex and you are trying to fix it with whatever knowledge we have today, all right? People have been doing surgery from the time of Sushruta but at that time they did surgery from whatever they knew best at that time. Today we are doing surgery from whatever we know best at this time. Hundred years later our surgeries may be very, very different. Our surgery capability what it was 25 years ago, what it is today is unimaginable but still it is very limited because that is the nature of creation. It is so absolutely complex and sophisticated. It is not for nothing that human being is a peak of evolution on this planet. It is the most sophisticated machine. So inevitably not all of it is under your purview and many of those dimensions are not, many of those dimensions are not even physical. So you can't see it, your instrument can't measure it. Nothing in medical science can tell you about those things. You are fixing one part of it but still not all of it. Very true Sadguru, human body is very complex and as you said the most complex body that is there but the corollary to what I just asked you, surgeons on a daily basis we operate on seriously ill patients some of whom have significant comorbidities and in these patients we don't expect very good outcomes but there is always a guarded prognosis in these patients but from time to time we see miracles happening and in those patients that we don't expect to recover quickly in those patients we expect that they stay for a prolonged period in ICU because of the various comorbidities and because of the illness itself but they bounce back, they recover remarkably soon and they lead a normal life and how does one explain these miraculous happenings? See for a patient or for his relatives and loved ones that he was, they thought he's going to die but they came, the patient came for a surgery post surgery he recovers in a month's time is back to normal that is a miraculous experience for them and it's great that they see it that way but a surgeon should never think his surgery is a miracle he must always be in awe of the miracle of the human body you're doing a mechanical job, you know what you're doing but if you think you're performing a miracle then there will be a disaster patient thinks it's a miracle, that's good for him to see it that way but you should never think that you're performing a miracle because that will lead to a disastrous process there will be no medical science left, something else will happen so the miracle is the way creation is how it is capable of doing things we are making a small intervention it's our privilege that life has allowed us it's your privilege that somebody allows you to open their body they won't allow their loved ones to do it I'm saying hello if somebody says I want to open your heart and see will anybody allow? no but they allow you to do that it's a tremendous privilege we must always bow down to that trust that somebody is offering to you that they're willing to knife them they're willing to allow you to knife them, you know? that is a tremendous trust how many people can earn that trust in their lifetime from anybody around them so they're offering that you may be out of helplessness but you don't look at their side from your side you look at it that they are privileging you with something that they do not honor their parents or their spouse or their children with but they're giving it to you they will not allow their wife or husband to open their heart and see what is inside but they'll allow you it's a tremendous thing so let not the doctor ever think he's performing a miracle he is doing a little bit of re-engineering for a fantastic engineering which is already there a little bit of re-engineering so what is a miracle in one person's experience he's actually engineering in another person's experience or knowledge so as far as you are concerned you are doing a mechanic's job for a very sophisticated machine see right now if somebody is driving a bus we call him a driver but if somebody is driving an airplane we call him a pilot similarly if somebody is fixing a bicycle we say he's a mechanic if somebody is fixing a spacecraft we say he's a scientist similarly you are a surgeon but actually the job is mechanical there's nothing wrong with that I keep describing myself as a mechanic people ask Sadhguru but you are not doing any miracles you are not blessing as no gold chain is coming I can add one medal to you if you want actually I think you misunderstood my comment that I don't think that we are doing a miracle no no I did not no I got the question but I am just saying not just for you a doctor the one who performs he should never think it's a miracle he should look at it as mechanics another person experiences a miracle that's fantastic you know that is the privilege you have I am saying though you are only exercising what you have studied and understood somebody else thinks it's a miracle the same with me everybody thinks I am causing miracles all I clearly know I am only exercising the knowledge and knowing that I have what I perceive is what I am doing similarly what you perceive about the human body is what you are doing you are not doing a miracle but how fantastic it is somebody thinks you are conducting a miracle isn't it fantastic such a privilege I am saying never ever complain about that privilege it's a tremendous privilege but at the same time it comes with the responsibility that sometimes the miracle that they expect does not happen you may know mechanically that this is not going to work but you may give it a try hoping something will happen but when the miracle doesn't happen to their end they are very deeply disappointed because somebody is dead or somebody does not recover or whatever happens as a consequence so this is a transaction where two different parties are looking at it differently one is expecting a miracle another is trying to exercise his knowledge so it's a very tender kind of relationship the very big responsibility as a surgeon so one of the major limitations Sadhguru in a surgeon's life is to lead a balanced life a surgeon cannot work from 9 to 5 many times the operating goes on very late and we start very early as well and it's all the time work work work leave early in the morning and sometimes many of us come back very late and this creates a lot of tension at home the family is not happy and the kind of environment a happy environment which should be at home once you come back sometimes is missing so how does one strike a balance and yet lead a peaceful content and happy life so essentially you are saying too many surgeries but not enough surgeons in the world so one thing is we must definitely strive to increase the number of surgeons because a stressed surgeon is a dangerous man okay you don't want to go under go under his knife when he is in a certain level of stress or distress about his own condition or his family or whatever other situations that he goes through in his life should not get transmitted through his knife because it's possible because a sports person goes out there after a lifetime of practice but if he is little stressed about some situation he becomes a total failure let's say a cricketer goes out there to bat but he has some personal stress today you will see he will just do something which doesn't work because in a way he is trying to use it by bat like a scalpel alright for his profession so but there it is just out here somebody else gets out which is not a good thing so it's extremely important I would say definitely the number of surgeons should go up but more than that the number of surgeries that we are doing in the world must go down this will only go down if we create a culture of health we are not focusing on creating culture of health we are only talking about health care as if somebody else can deliver health to us somebody else delivering health to us is not a good idea health must happen from within us beyond that certain things will come to us for that a doctor is needed beyond that a doctor cannot fix it then a surgeon should come in right now I feel too much surgery is happening I am sorry I know people are not going to like this but I am saying I feel there is too much mechanical intervention with human body which could be large which could be significantly brought down if not largely it could be brought down to a certain level where only beyond a certain level surgery is needed but first of all why does a human being get to that level he lives violently he doesn't know what to eat what not to eat how to sleep how to get up nothing he knows nobody has taught him what he should after millions of years of living on this planet still we don't know what to eat every other creature has figured out what to eat what not to eat for their well being human beings the most intelligent are still debating what is the best food to eat they have not figured it out so if we settle certain things if a society is largely healthful because of their own innate efforts every human being individual human beings are committed to their health and they stay healthy the number of surgeries will come down and surgeons can go home on time and everything will be wonderful okay maybe it is not commercially a good idea but I am saying we need to invest in other ways right now what I am seeing is in Hyderabad city I see advertisements come and have your surgery done here never before I have seen an advertisement for surgery how is this surgery is something you go through when everything else has failed that is how I understand medicine I hope I am right you will be very pleased to know that I come home at five o'clock in the evening and even if I leave early I make sure that I have seen my children I have seen my parents and you know I make sure that I lead a balanced life thanks to Isha foundation and thanks to Inner Engineering Sadguru six years ago our honorable prime minister launched the make in India campaign which is a major national movement to foster innovation enhance skill sets and also build best in class infrastructure and in terms of medical healthcare I would use the word healthcare although you just brought out that point we have the most brilliant minds as far as doctors are concerned whether it is their knowledge their abilities or their skills wherever they are in the world they are really the best we see many doctors who are really made a name for themselves in different parts of the world similarly in terms of medical infrastructure we have very good hospitals and we have very good medical institutions as well medical colleges but Sadguru having worked in the UK for 10 years and having worked in some of the best centres of excellence how do we make a Harvard or an Oxford or a Yale or a Cambridge in India and how do we develop leaders in medical education and in healthcare infrastructure and have a world rating that we have the best infrastructure not only doctors but we also have the best infrastructure relating to delivering medical care see see that's a very vital question for the country's development in this area because we have 1.4 billion people if we have a healthy and focused 1.4 billion people that this very nation will become a miracle but if we have unhealthy unfocused uneducated 1 billion people we will be the greatest disaster right now we are at that time at the juncture in many ways we are at that cusp either we are going to cross this chasm or we are not going to in various forums in many ways I have conveyed this to the government and to everybody concerned that what is needed is investment into education if investment has to happen you must open it up I have been asking them to do this why don't you allow businesses to invest in medical schools in engineering schools whatever highest level of education why I am saying this is on one level how many Indian students are going out to study hundreds of them are in Russia now many of them are in China many in Germany of course United States they are not allowing so everybody is in Caribbean to study and somehow enter the United States why is this happening at quite the same level but if you go to these universities the premier universities in the world whether medical schools or business schools if you go most of the deans are Indian origin people why is it we are exporting talent we should export talent that is fine we have plenty you always export something when it is excess but you are exporting the best and you don't have that here simply because there is no investment in the arena that should happen only if we open up our minds that somebody will invest only if there is profit otherwise nobody will invest and why will they invest why will I invest and work hard if there is no profit to it right now in this country still profit making is a evil word right now you see things are going on in the country for everything they will say something your suit is a big problem okay for them they will put you under the suit boot category I'm saying this we have not dropped our socialist mindset is the government capable of really taking it to heights I don't believe that well some of the Ames institutions have functioned at the height but they cannot scale up they cannot scale up and create multiple universities like this or multiple hospitals like this they cannot do it and government should not do it because it will be an unnecessary burden on the government government should make the policies which will make these things happen exuberantly so right now I'm saying for example if I say I want to start a medical university I have you and let's say another hundred experts from across the world I can put them together if I put them together will you give me thousand acres allow me to raise investments start a medical school maybe I will charge very high but if students are willing to pay parents are willing to pay because they are getting a certain quality that they don't have to travel to Howard medical school or some other you know royal medical school in UK they will get something as good or better here it will happen right now nearly thirty billion dollars worth of education is going out of the country simply because we are not willing to invest because we are afraid somebody will make money say making money is not the issue creating quality education system is the real thing isn't it if you want if you are interested in this but right now we are in a socialist mindset we don't even want to recognize there are different levels of economic strata in the country at least five basic levels of economic strata the poorest who just want to come out of that level well maybe for them you have opened up IITs I am sorry not IITs what do you call them ITIs you know small diploma courses this that because you want to provide livelihood there is another middle class which is everybody in that middle class is aspiring to be a doctor or an engineer there is an higher middle class which is thinking of business and stuff like that there are rich people who are thinking of something else in the form of education so the many layers of India you have to recognize that you cannot say all of us go to ITI and become a diploma in mechanical engineering it's not going to work they will go to some other country and study naturally so I am saying this can be only done if you relax the policy for private players to look at the needs of a given society and do that I have gone to the extent of telling the authorities why are you trying to manage education even school I am saying why are you prescribing a certain curriculum and stuff why why are the bureaucrats doing this just leave it to me I will run a school I will charge ten times what anybody else is charging I will teach whatever nonsense I want to teach children are happy parents are happy what is your problem I am asking what is your problem when did it occur to you that a bureaucrat cares more about my child than myself how did this idea come into your head so no no no they will exploit what will they exploit you think parents are not able to figure out if their children are being exploited if they if I teach nothing will they just pay money and send their children to me will they do that only if some productivity is there they are happy with what is happening with their children then only they will pay isn't it so just because see market force is always the best force to regulate things yes there will be a period of time and an outburst of things will happen but it will naturally settle down what will make it settle down is quality right now quality is not the criteria for settling down something else government funding this one that one I am saying you leave this if I say I want to start a medical university don't ask me if I am a doctor or not I am not that's not the point I want to start one I am willing to get the investment will you just open up all the permissions no you will ask thousand questions those thousand questions will take a lifetime to answer so I won't start one don't do this this is the time this is the time nations education has to burst forth suppose I take people who have gotten the lowest marks in their 12th standard because I see some competence there what is your problem why are you saying they must get 95 or 98 or whatever is the standard for medical entry I am telling you this may be very upsetting for lot of people I am telling you lot of people who get 35 40 in their examinations are far more brilliant than those people who get 9500 it's a fact but you will reject them you will reject them because you don't want efficient doctors you want somebody who's got zeros in his mark sheet this is a ridiculous way of selection no no we got neat exam what is neat exam it's again like general knowledge kind of exam it is not really testing anybody's competence if I set up a medical university I will set up a completely different level of aptitude test whether you can be a surgeon or not just because you got 98 this doesn't mean your hands are good hello isn't it you got 98 does it mean to say that you have the studious hands and the sharpest focus in your life definitely not you are just a memory machine absolutely so totally agree with you Sadhguru actually investment in education has not happened the way it should have happened I am just moving on to you know traditional medicine and modern medicine can coexist because I deal with treating breast cancer patients on a daily basis and I get patients who have already commenced alternative treatment before coming to me and they are very fearful to even express that they are on those kind of treatments and I'm not against them using alternative treatment I sit them down I counsel them I explain what they have and I say that as long as you are able to take the allopathic treatment based on the multi-disciplinary protocols I have absolutely no issues in your continuing the alternative treatment but there is a view that alternative treatment should not be taken in those who have cancer which I totally disagree I feel that as long as they are able to take allopathic medicine in the way that they should parallely use alternative medicine I have no issues so do you think traditional medicine and modern medicine can coexist see essentially what you are asking is whatever knowledge and insights we have gleaned out of thousands of years of experience of life upon this planet should we keep it simply because a new force has come into play should we throw out all that and just go by the new things we have discovered in the last 150 years no this is not the way to approach life why do we think it is an alternate it is not alternate it is part of it tell me if I am wrong the yogic understanding of cancer is like this that cancer is not really a disease but a certain malfunction of our own system that it throws up what is already there in our body concentrates itself I would describe it like this in a city if there are ten pickpockets you know in every city there are there is a little bit of crime somebody is picking somebody's pocket something burglary is happening whatever we deal with it in a certain way we keep going but suppose these ten people got very organized and they built a team of 1000 people and became an organized crime and everybody's pocket is being picked tomorrow morning then we will say we need to act in a serious way this is how we understand cancer there are cancerous cells in our body there are cells which have gone rogue in our system they are always there but we don't care because they really affect us we just manage them managing them there are many many systems in the traditional system of medicine where you can manage them below a certain level for some reason either because of external stimuli or genetic stimuli or whatever else somehow it gets triggered and they become organized crime when they become organized crime you will say this is a cancer has established in the body and say cancerous cells were not in the body probably even a just born infant has I don't know you must tell me even a just born infant may have cancerous cells will it get organized or not to keep them disorganized there are many systems in yoga and Ayurveda that if you do certain things they will keep them disorganized but now they have already gotten organized see when it was disorganized to handle a pick pocket it is understandable who is little alert is good enough if five of them get organized then a sub inspector will handle it but suppose thousand of them got organized then you need national security alright so this is how I look at cancer if it is gotten so organized that something is rotting in your system already now it needs a different level of intervention which is what allopathic medical intervention is but at the same time even if that is happening should still the constable on the street be alert I think he should be yes absolutely sadguru thank you sadguru I am moving on to something that you know you have written a book on death and basically there is always this constant that is post surgery hahaha there is always a fear amongst many people about the risk of dying in fact death as you have described is an eternal truth and is an existential you know phenomenon so what are your views and how do we face death let me tell you a story there was a jewish surgeon he is an acclaimed surgeon doing very well but his father got some you know some serious surgeries needed for him for his own father so he felt very nervous operating upon his own father and he asked one of his colleagues who is also good to do the surgery upon his father when his father came to know he insisted no no no you must do the surgery so he tried to tell him father I can do the surgery but I am little nervous doing surgery upon you father insisted no you must do it he said why my friend is good he will do it that is not the point I want you to know in case the surgery fails and I die your mother will come and live with you and your wife you better know that so you you do the surgery for me so I am saying about death all of us will die but most people don't realize this through their life they think somebody happened some time ago last year a very well known sage in Karnataka he is a hugely respected man he lived an absolutely dedicated and devoted life he created many educational institutions he has transformed thousands of lives hugely respected man he died at the age of 111 111 all right and all the newspapers and politicians and others who say condolences we are shocked at his demise I said at 111 what do you shocked what's your problem hello why are you shocked at 111 you must know from the day you are born you are on a short fuse if you understand this if you are conscious of this then you will organize and plan your life in a way it's most fruitful if you do not know this that after 100 years you are still shocked that you may die well then you will live a wasteful life because you don't understand it's a limited amount of time if you understand something is very limited you will plan and organize it well if you think it's unlimited then you will live wentonly isn't it this is very very relevant for time because time is one thing that you cannot stop it is running away so actually in Tamil I will say it in Telugu maybe in Telugu also but in Tamil it said very well when somebody dies they will say kalamaitanga that means that time got over you know it's a perfect description of death time got over that's all well we can kick the can a little bit there is nobody here who can avoid death there is no such thing some fools have tried some fools in ancient past you see a lot of people sitting and doing tapas asking can I become immortal you've seen those idiotic affairs in the stories you know in our history we have heard people doing that in recent history people have been seeking immortality in so many ways once again this foolishness is manifesting itself as people become wealthy they want to become immortal no these are foolish efforts yes we can we can make the life little longer we can kick the can it's not that anybody wants to die but we are willing to die only then you can live if you say I'm not willing to die all that will happen is you will end up not living I don't want to die will not lead to an endless life it will lead to a life where you don't live so the problem is not that you will die the problem is that you did not live that is the biggest problem you may be physically alive according to medical parameters but you did not live life experience life in it's full profoundness this experience of life will not happen because of what you do or do not do in the world it happens because you deepened your ability to experience your ability to experience life whatever it is the food that you eat you experience within you the air that you breathe you experience within you pleasure and pain you experience within you joy and misery you experience within you just any experience happens only within you so it is in profoundness of experience that there is life if you understand time is limited then you will make sure your experience of life is super profound this must happen to every human being so everybody must be reminded I know as a surgeon you should not do it if you tell the patient you will die anyway then he will get very scared it's not your business it's my business to tell them you're anyway going to die yes sometimes have to counsel patients sometimes seriously ill patients that mortality and death is a possibility in the counseling in the consent form but it's a very inconvenient thing for a surgeon to say that particularly to the relatives who need to know what might happen to a seriously ill patient how do you have enlightened us on so many issues we have today delegates from across the country as I mentioned to you they're all practicing surgeons we have budding surgeons surgical trainees we also have distinguished surgeons from across the world six of them are being conferred honorary fellowship of the association of surgeons of India what would be your message Sadhguru to this audience as I said earlier once again repeat that with a little different context you're a surgeon means somebody they may not know who you are but they trust you to a point that they will allow you to knife them this is not a simple trust never misunderstand this this is a tremendous privilege that somebody offers you this level of trust lies down there willing to become unconscious willingly so that you can cut them up if you're aware of this that what is the level of trust involved in a person lying down there and allowing you to cut him up that privilege never never take that lightly but another aspect is of course you have to educate yourself you have to enhance your expertise and knowledge that is a medical part of the thing I will leave that to you but the other dimension of it is whatever you may know your intelligence, your skills, your knowledge all these things will work for you only if you have a balance within you above all balance if you're not balanced your intelligence will work against you your knowledge will work against you your very capabilities will work against you so this is important that you are balanced especially being a surgeon where other people are putting their lives into your hands all right? they even don't trust God this much I want you to know they're okay doing a deal in the temple from a distance they're not willing to put their lives into his hands hello? this is a fact they're putting their life into your hands please treat it as the highest level of privilege that a human being can enjoy in many ways and so you must equip yourself not just with medical knowledge and skills but with an inner balance for all the surgeons if you wish we will offer this in engineering online you can see how to reach them and then we can also initiate them into the process which will bring a certain level of steadiness and balance within you for which there's no substitute in life either to live your personal life well or to execute your professional life well for both for both these things you need an absolute sense of balance within you Namaskaram and thank you very much Namaskaram Sadhguru in fact I'd like to highlight the point about inner engineering that you said it has been a godsend opportunity and an incredible privilege to have attended, participated and benefited from the inner engineering program which has really profoundly changed my life the way I look at life the way I look at work and the way I look at the world around me and prior to doing this program I would be very stressed out even for small things and I would get tired very easily and I would not have my focus for too long so after attending this program first of all I become very joyous I become more relaxed I become more focused I get less tired and I don't take life seriously at all now and I feel that I have had so many benefits my family has seen that happening and if I can benefit I'm sure many of my colleagues can certainly benefit from this and I would strongly and happily encourage them to take this inner engineering program and thanks to you and to Isha Foundation I think since the beginning of the pandemic this has been offered free of cost to the healthcare professionals so once again Sadhguru I have no words to express my heartfelt thanks to you for sparing your valuable time to be with us today virtually and to me personally this has been a high point for me to be able to converse with you in a conversation for 45 minutes and most grateful to you Sadhguru for your grace and blessings. Namaskaram. Namaskaram. Thank you.


Hey there, welcome to this presentation on the new SiteSource R package. My name is Trevor Riley and in this presentation I'm going to provide an overview of SiteSource's general functionality and the primary use cases for SiteSource. So the package got its start at last year's hackathon. It's really fantastic to be able to share SiteSource for the first time here at Esmarconf. I'd like to thank Neil Hadaway and the Esmarth planning committee for your support was critical in bringing this team together and getting the project off the ground. I also want to make a note that SiteSource is in its final stages of development and testing. We're looking forward to launching version 1.0 here soon, which will include a fully functional Shiny app as well. Before I jump into the package, I also want to take a moment to highlight the members of the SiteSource development team whose hard work and dedication made this possible. Along with myself, we had Katelyn Hare, Lucas Walbrook, Matthew Granger, Sarah Young, Chris Prichard, and Neil Hadaway. Okay, so at its core SiteSource has two unique functions. First, the package allows for users to add customizable metadata in three fields. We've named them SiteSource, SiteString, and SiteLabel. And in this presentation I'll refer to this process as tagging. Tagging citations is the first step users take after uploading citations. By tagging a citation record, users can maintain information on a number of variables, which could include the resource which the record was found, the method used to find it, an iteration or variation of a strategy such as a search string or the progression of a search string, a research phase, and even certain groups of citations such as benchmarking articles. The second ability relates to how SiteSource deduplicates records. Instead of working like a traditional process where a user selects a single record to be retained, SiteSource actually merges records to create a single primary record. This primary record maintains the tags provided by the user in the three fields. And it's with these two functions that we can start to produce some really great visualizations and analyze our citation data. If you watched any of the Esmar sessions from previous years or even this year, you might recognize the ASIS package developed by Caitlin Hare. Currently a modified version of ASIS is the backbone of the record merging process. Alright, so let's take a look at the first example, analyzing resources and methodologies. We'll start by taking a look at the vignette on comparing topic coverage. In this example, we're using SiteSource to review overlap between databases for literature on the harmful effects of gambling addiction. To do this, we've ran a search for the term gambling harm in the title and abstract fields in Lens, Scopus, Criminal Justice, Abstracts, Psychinfo, and Medline. After loading the package, we can tag our citation files with the source names. And once we've run through the deduplication process, we can start to create some plots of our data. This heat map shows the number of records retrieved from each database, as well as the count of overlapping records found between databases. In this example, we can see the Scopus' highest number of records on gambling harm and Criminal Justice Abstracts, the least. We can also see out of the 176 articles found in PubMed, 171 of them were found at Scopus. This next heat map uses the same data, but provides a breakdown of overlap percents between two sources. As you can see, 97% of PubMed's 176 articles were also found at Scopus. The next plot is the upset plot. The upset plot is one of my personal favorites. And it's just another way of looking at that overlap, but in a bit more detail. So you can see here we have our five databases. You can see Scopus here at the bottom with the most number of citations, followed by PubMed. And then you can take a look at how these databases overlapped and in what combination. You can see here that Scopus had the highest number of unique citations, followed by Lens and PsychInfo. You can also see that there are only six articles that were found in every single database. All right, for this next example, let's say you want to understand not only how each database performed and look at the unique records each source contributed, but you'd also like to know how that searching of traditional databases and platform performed versus two other literature gathering methods. Let's say citation chasing forward on your benchmarking articles, and then using a new co-citation machine learning AI, you fill in the blank discovery tool. Right, so taking those two different methods. For this case, we can take a look at the source analysis across screening phases vignette. And instead of just using one of the customizable fields, we're going to use two this time. We use site source and site label. All right, so you are first going to install and load the package. You are going to point to the direction of where that data is that you want to evaluate. And then you are going to start tagging. So you can see these are the file names and then aligns with the source name. And then the label here, we have a search because those were search results. You get down to this next one. This is final. So it does not have an actual source and it is labeled as final because these were the final included studies. You can see that TIAB is the title and abstract. Those were the ones that made it past title and abstract screening. And above those, you can actually see that we have our two methods. Those are also labeled as search. So we're going to go through the deduplication process. And then we're going to start taking a look at some of these plots. So again, we have that first map plot, which does overlap between the databases. We have the same one as a percent. And then we have that upset plot. I want to get down to this next one, which is, again, one of my favorites. So this is where we actually start to see that site label come into play. At the bottom here, it might be a little difficult to see, but this is broken up into three plots, bar plots, as you can see. And we have actually searched, screened, and final. So not only are we looking at the databases across the top, your agris cab, the green file, and then Web of Science here at the end, and these two methods, we're seeing how many unique records that method or source brought in and how many duplicate records have found in at least one other resource or method there. And you can see then how that progresses through title and abstract screening and for the final included papers. Just below that plot, we do have the citation summary table. We're still working on this. This is one of the things we want to just make sure is polished. And I think this is going to be a really fantastic addition to the package. It's something I'm really looking forward to seeing. And thank you to Allison Patel for the inspiration on this and also for helping us in this regard. All right, one last quick example. This is actually a use case that I hadn't even considered at the beginning, but made complete sense when I was working on another project. So I'd like to show this one off benchmark testing. So we had a number of different searches and we wanted to be able to take a look at how well we were finding our benchmarking articles. And using site source, we were able to actually do multiple iterations of our search string so much faster. So in this case here, you can actually see that search string four and search string six. I know these are hard to see, but they are not contributing to finding any of the benchmarking articles themselves. Unlike you can see search string number five has found three. Search string two has done three just by themselves, right? But search string four and six while they are finding benchmarking articles, we also have other strings that are finding those same benchmarking articles. So again, a really interesting way to use site source in helping to develop your search strings and strategy. This was also just a whole lot of fun. I think we went through four or five different iterations of this and this is just one of them. I think this may be our second or third. And then also just heading down here and taking a look at this record level table. It's just fantastic. Lucas put this together and it still just blows my mind. I love it. It's very helpful in the benchmark testing. You can play around with it. You can also download it as a CSV. So if you're interested, come jump in this vignette and take a look. A couple more things before I wrap up. I just want to point out that site source is available via download on GitHub. We will be working to get it up on Cran soon. And we've also put together some discussion boards. We're really hoping that folks engage with us here. We've got the different use cases outlined and vignettes. And then finally, if you're interested in working with us to further develop site source, if you have some interesting use cases in mind, please drop us a line. Please reach out to us on this discussion board. We're really looking forward to working with you. And that's all for now. Thank you so much and happy site sourcing.


From theCUBE Studios in Palo Alto in Boston, bringing you data-driven insights from theCUBE and ETR. This is Breaking Analysis with Dave Vellante. Much of the discussion around Intel's current challenges is focused on manufacturing issues and its ongoing market share skirmish with AMD. Of course, that's very understandable. But the core issue Intel faces is that it has lost the volume game forever. And in Silicon, volume is king. As such, incoming CEO, Pat Gelsinger, faces some difficult decisions. But on the one hand, he could take some logical steps to shore up the company's execution, maybe outsource a portion of its manufacturing, make some incremental changes that would unquestionably please Wall Street and probably drive shareholder value when combined with the usual stock buybacks and dividends. On the other hand, Gelsinger could make much more dramatic moves. Shedding its vertically integrated heritage in transforming Intel into a leading designer of chips for the emerging multi-trillion dollar markets that are highly fragmented and generally referred to as the edge. We believe Intel has no choice. It must create a deep partnership in our view with a semiconductor manufacturer with aspirations to manufacture on US soil and focus Intel's resources on design. Hello, everyone and welcome to this week's Wikibon Cube Insights powered by ETR. In this breaking analysis, we'll put forth our prognosis for what Intel's future looks like and lay out what we think the company needs to do, not only to maintain its relevance, but to regain the position it once held as perhaps the most revered company in tech. Let's start by looking at some of the fundamental factors that we've been tracking and that have shaped and are shaping Intel and are thinking around Intel today. First, it's really important to point out that new CEO, Gelsinger, he's walking into a really difficult situation. Intel's ascendancy and its dominance it was created by PC volumes and its development of an ecosystem that the company created around the x86 instruction set. In semiconductors, volume is everything. The player with the highest volumes has the lowest manufacturing costs. And the math around learning curves is very clear and it's compelling. It's based on Wright's law named after Theodore Wright, TP Wright. He was an aeronautical engineer and he discovered that for every cumulative doubling of units manufactured, costs are going to fall by a constant percentage. Now in semiconductor wafer manufacturing that cost is roughly around 22% declines. And when you consider the economics of manufacturing and next generation technology, for example, going from 10 nanometers to seven nanometers, this becomes huge because the cost of making seven nanometer tech, for example, is much higher relative to 10 nanometer. But if you can fit more circuits on a chip, your wafer costs can drop by 30% or even more. Now this learning curve benefit is why volume is so important. If the time it takes to double volume is elongated then the learning curve benefit, they get elongated as well and you become less competitive from a cost standpoint and that's exactly what is happening to Intel. You see x86 PC volumes they peaked in 2011 and that marked the beginning of the end of Intel's dominance from manufacturing and cost standpoint. Now ironically, HDD hard disk drive volumes peaked around the same time and you're seeing a similar fundamental shift in that market relative to flash. Now because Intel has a vertically integrated model, its designers are limited by the constraints in the manufacturing process. What used to be Intel's ace in the hole is process manufacturing has become a hindrance, frustrating Intel's chip designers and really seeding advantage to a number of competitors including AMD, ARM and NVIDIA. Now during this time, we've seen high profile innovators adapting alternative processors, companies like Apple, which chose its own design based on ARM for the M1. Tesla is a fascinating case study where Intel was really not in the running. AWS probably Intel's largest customer is developing its own chips. You know, through Intel a little bone at the recent reinvent and announced its use of Intel Sabana chips. And practically the same sentence had talked about how it was developing a similar chip that would provide even better price performance. And just last month, it was reported that Microsoft, Microsoft Intel's monopoly partner in the PC era was developing its own ARM based chips for the surface PCs and for its servers. Intel's Zenith was marked by those peak PC volumes that we talked about. Now to stress this point, this chart shows x86 PC volumes over time. That red highlighted area shows the peak years. Now volumes actually grew in 2020 in part due to COVID, which is not really reflected in this chart, but the volume game was lost for Intel when, and has, it's been widely reported that in 2005, Steve Jobs approached Intel as it was replacing IBM microprocessors with Intel processors for the Mac and asked Intel to develop the chip for the iPhone, Intel passed and the die was cast. Now to the earlier point, PC markets are actually quite good if you're Dell. Here's some ETR data that shows Dell's laptop net score. Net score is a measure of spending momentum for 2020 and into 2021. Dell's client business has been very good and profitable. And frankly, it's been a pleasant surprise. You know, PCs, they're doing well. And as you can see in this chart, Dell has momentum. There's approximately 275 million, maybe as high as 300 million PC units shipped worldwide in 2020, you know, up double digits by some estimates. However, arm chip units shipped exceeded 20 billion units last year worldwide. And that's not apples to apples. You know, we're comparing x86 based PCs to arm chips. So this excludes x86 servers, but the wafer volume for arm dwarfs that of x86, probably by a factor of 10 times. Now back to Wright's law, how long is it going to take Intel to double wafer volumes? It's not going to happen. And trust me, Pat Gelsinger understands this dynamic probably better than anyone in the world. It's certainly better than I do. And as you look out to the future, the story for Intel and its vertically integrated approach, it's even tougher. This chart shows Wikibon's 2020 forecast for arm based compared to x86 based PCs. It also includes some other devices, but as you can see, what happens by the end of the decade is arm really starts to eat in to x86. As we've seen with the M1 at Apple, arm is competing in PCs and much better position for these emerging devices that support things like video and virtual reality systems. And we think even we'll start to eat into the enterprise. So again, the volume game is over for Intel, period. They're never going to win it back. Well, you might ask, what about revenue? Intel still dominates in the data center, right? Well, yes, and that is much higher revenue per unit. But we still believe that revenue from arm based systems are going to surpass that of x86 by the end of the decade. Arm compute revenue is shown in the orange area in this chart with x86 in the blue. This means to us that Intel's last moat is going to be its position in the data center. It has to protect that at all costs. Now, the market knows this, that knows something's wrong with Intel and you can see that it's reflected in the valuations of semiconductor companies. This chart compares the trailing 12 month revenue in the market valuations for Intel, NVIDIA, AMD and Qualcomm. And you can see at a trailing 12 month multiple revenue of 3x compared to about 22x for NVIDIA, about 10x for AMD and Qualcomm, Intel is lagging behind in the street's view. And Intel, as you can see here, it's now considered a cheap stock by many. Here's a graph that shows the performance over the past 12 months compared to the NASDAQ, which you can see that major divergence. NASDAQ being powered in part by COVID and all the new tech and the work from home. Stock reacted very well to the appointment of Gelsinger. That's no surprise. The question people are asking is, what's an X for Intel? How will Pat turn the company's fortunes around? How long is it going to take? What moves can he and should he make? How will they be received by the market and internally, very importantly within Intel's culture? These are big chewy questions and people are split on what should be done. I've heard everything from patches, clean up the execution issues. This is very, very workable and not make any major strategic moves. All the way to Intel should do a hybrid outsourced model to Intel should aggressively move out of manufacturing. Let me read some things from Barons and some other media. Intel has fallen behind rivals and the rest of tech. Why is Intel is replacing Bob Swan? Investors are cheering the move. Intel will likely turn to Taiwan semiconductor for chips. Here's who benefits most. So let's take a look at some of the opinions that are inside these articles. So first one I'm going to pull out. Intel has indicated a willingness to try new things and investors expect the company to announce a hybrid manufacturing approach in January. Now, if you take a look at that and you quote CEO Swan, he says, what has changed is that we have much more flexibility in our designs. And with that type of design, we have the ability to move things in and move things out. And that gives us a little more flexibility about what we will make and what we might take from the outside. So let's unpack that a little bit. I mean, Intel, we know is a highly vertically integrated workflow from design to manufacturing production. But to me, the designers are the artists and the flexibility you would think would come from outsourcing manufacturing to give designers more flexibility to take advantage of say seven nanometer or five nanometer process technologies versus having to wait for Intel to catch up. It used to be that Intel's process was the industry's best and it could supercharge a designer to master certain design challenges so that Intel could maintain its edge, but that's no longer the case. Here's a sentiment from an analyst, Daniel Denali. Denali is at city. It says, he's confident, Denali is confident that Intel's decision to outsource more of its production won't result in the company divesting its entire manufacturing segment. And he cited three reasons. One, it would take roughly three years to bring a chip to market. Two, Intel would have to share IP. And three, it would hurt Intel's profit margins. He said it would negatively impact gross margins by 10 points and would cause a 25% decline in EPS. Now, I don't know about this. To that, I would say one, Intel needs to reduce its current cycle time to go from design to production from let's say three to four years where it is today. It's got to get it under at least the two years, maybe even less. Second, I would say was what good is intellectual property if it's not helping you win in the market? And three, I think profitability is nuanced. So here's another take from a UBS analyst. His name is Timothy Arcuri. And he says, quote, we see but no option, but for Intel to aggressively pursue an outsourcing strategy. He wrote that Intel could be 80% outsourced by 2026. And just by going to 50% outsourcing, he said would save the company $4 billion annually in CapEx and 25% it would drop to free cash flow. So look, maybe Gelsinger has to sacrifice some gross margin in EPS for the time being, reduce the cost of goods sold by outsourcing manufacturing, lower his CapEx and fund innovation in design with free cash flow. Here's our take. Pat Gelsinger needs to look in the mirror and ask, what would Andy Grove do? You know, Grove's quote at only the paranoid survive it's famous, less well-known are the words that preceded that quote. Success breeds complacency and complacency breeds failure. Intel in our view is headed on a path to a long drawn out failure if it doesn't act aggressively. It simply can't compete on cost as an integrated manufacturer because it doesn't have the volume. So what will Pat Gelsinger do? You know, we've probably done 30 cube interviews with Pat and I just don't think he's taking the job to make some incremental changes to Intel to get the stock price back up. Why would that excite Pat Gelsinger? Trends, markets, people, society, he's a dot connector and he loves Intel deeply and he's a legend at the company. Here's what we strongly believe. We think Intel has to do a deal with TSM or maybe Samsung, perhaps some kind of joint venture or other innovative structure that both protects its IP and secures its future. You know, both of these manufacturers would love to have a stronger US presence in markets where Intel has many manufacturing facilities. They may even be willing to take a loss to get this started and deeply partner with Intel for some period of time. This would allow Intel to better compete on a cost basis with AMD. AMD would protect its core data center revenue and allow it to fight the fight in PCs with better cost structures. Maybe even gain some share that could account for another $10 billion to the top line. Intel should focus on reducing its cycle times and unleashing its designers to create new solutions. Let a manufacturing partner who has the learning curve advantages enable Intel designers to innovate and extend ecosystems into new markets. Autonomous vehicles, factory floor use cases, military security, distributed cloud, the coming telco explosion with 5G, AI inferencing at the edge, bite the bullet, give up on yesterday's playbook and reinvent Intel for the next 50 years. That's what we'd like to see. And that's what we think Gelsinger will conclude when he channels his mentor. What do you think? Please comment on my LinkedIn post. You can DM me at dvalante or email me at david.valante at siliconangle.com. I publish weekly on wikibon.com and siliconangle.com. These episodes, remember, are also available as podcasts for your listening pleasure. Just search, Breaking Analysis Podcast. Many thanks to my friend and colleague David Floyer who contributed to this episode and has done great work in the last, better part of the last decade and has really thought through some of the cost factors that we talked about today. Also, don't forget to check out ETR.plus for all the survey action. Thanks for watching this episode of Cube Insights powered by ETR. Be well and we'll see you next time.


Today, or tonight I should say, I'm gonna take you on a call shift which included a code STEMI, procedures that became way too dangerous to do, and more fun adventures as a cardiology fellow. Now as a first year fellow, I'm on call once a week. My calls are also in-house which means that I stay overnight in the hospital. During these call shifts my primary responsibility as on-call fellow is being the point of contact for any cardiology related questions for ICU patients and sick patients around the hospital. So let's go ahead and get started with our shift for today. Now every one of my call shifts starts around 4.30pm which means that I finish my day responsibilities today that meant a combination of reading stress tests in clinic and heading back to the hospital. And today I managed to get into the hospital right before 4pm. Now the first thing that I do in the evening is to review the list of patients in the ICU so I can be familiar with who the patients are, what they're there for, and who the sickest ones are out of the group. I then keep mental note of patients on the list who may have interesting findings on their echoes or imagings and then pull those up to read myself. This patient right here has really bad aortic stenosis aka a very tight valve. This patient on the other end here has a very weak heart which is barely squeezing when I look at their echo. After going through each patient's chart and images I then grab some quick caffeine and snack before the daytime fellow signs out the patients and any updates for the day. Once I have the sign out for all the patients I'll grab the list of my notes and walk the unit to make sure everyone is doing okay at the start of my shift. And just as luck would have it on my way walking over to the unit I hear the word Code Stemmy called overhead. Now Code Stemmy means somebody is suspected to have a heart attack based on both their symptoms and their EKG findings. Now obviously as the on-call cardiology fellow I'm responsible to go to all of these so as I'm walking over to the patients room I quickly pull up the EKG to know what I'm walking into. So I just got back from this Code Stemmy. They actually canceled it on my way up so a little bit of description. A Code Stemmy is basically where we're concerned somebody's having an active heart attack. My role overnight is usually laying eyes on them while all the interventionalists and their team is driving in to plan on taking a look and putting a stent in possibly. Since I'm on site it's to figure out are you having a heart attack or not. This patient however already had a catheterization somebody had already looked to see if their cornea arteries had some blockages and they actually do but they are being worked up for a possible bypass. And so the question was are they having something new and based off of the EKG that somebody called a possible heart attack on it didn't look much different than the last one and the patient's chest pain wasn't very different compared to what had been the past few days. So going back to do I need to have our interventionalist team come in and fix that and I think the discussion amongst everybody was that it wasn't. And so looking at the EKG we'll keep an eye on this patient overnight but not anything extra to do and then during the day team comes in or the day time we'll let them know and they can make any adjustments if they want to act quicker. Now after getting back to the office I spend whatever quiet time I get to finish some personal work. The first thing on my to-do list for the night is finishing some modules that I need to actually be able to do research as a fellow. Probably the most boring as modules I've ever done in my life but still gotta get done. Part of being a good fellow is always being on top of your learning and moving down the rabbit hole of learning new stuff in cardiology. There is so much in the field of cardiology that I didn't even know exist and so thus there is so much I need to learn. And when you have a decent evening like I've had so far it is a great time to learn. So here is what we're learning today. So I'm going to be starting ICU in just a few weeks which is going to be a little nerve wracking being a first year fellow and running the ICU. But one of the things that you have to really get comfortable with is what we call mechanical support. If somebody's heart is not pumping well then we can put devices into their hearts and essentially allow them to pump a little bit better or give the time for the heart to heal and allow these devices to kind of do the function of the heart for at least a short term. And so one thing that I feel or need to get more comfortable with is like knowing do I go up on the support? Do I go down? And what type of lab values, clinical signs do I use? Contextually, I think I know what to do but I want to make sure that I know all the nitty gritties in terms of what to look for on an echo or what to look for on their labs on a daily basis so I can better make decisions for these patients in just a few weeks. Because again it's going to be me especially if my tendings are making decisions on going down on things like an impella or a balloon pump or ECMO. I want to be able to know how fast do you do it or how often will you do it or what type of things are you looking at every time you're making some changes? So by no means does this have make sense to you guys but this is a great time so right now it is about 8.26 pm. I'm definitely getting tired and sleepy and I could be heading to bed right now but I think it's better use of my time to feel like my knowledge is getting a little bit better. And so what I'm going to do is I'm going to go ahead and actually pull this up and on the other monitor I will start to take some notes on RemNote so let me show you what that looks like. So this is RemNote, this is a tool that I am going to likely be making a video about in some point in the future but essentially what I have is an inbox for my cardiology learning all together. So whenever I have topics like I do today of things that I want to learn more about or make sure that I'm on top of I will add those in here and it's a growing pile so as you can see in cardiology we're really big on studies and so there is literally a collection of studies that I need to read and when I'm down on this list and I want to read a study I can just go there. In addition if I'm learning something and my attendings tell me something I'll just put it in this Pearl section and then every time I feel like I've mastered something so for example this right here this is a section that I actually learned about earlier today that may have already shown in the video but this is me learning about what to do with different types of blood thinners that we give for patients in the setting of heart attacks or ACS and I've already taken a lot of notes this probably took me 10-15 minutes but I want to make sure that I store this effectively so what I don't do is I then go ahead and just add some tags so let me do that so as you can see now I've added two tags to this and again I can make a video on Rome note if it's not already alive but these are two topics I'll pertain so if I ever want to learn anything about dual anti-platelet therapy or ACS I can just look up those tags and I will pull up all of these notes that I put into this section but now that this is done this is my system I just literally just throw it in the archive page and it is out of sight out of mind and there it is in addition to everything else that I've been doing with this although the lectures and studies will go in here so these are some of the studies that I've looked at with their notes but it's a quick easy way that I can search this if I wanted I could actually do flashcards from this entire page but this is my system and now I'm going to go ahead and do some notes on MCSD escalation using this this is how many pages is this okay it looks like a lot I don't know how many but we will get through this I will probably do a good amount of skimming and I usually always copy the link of the paper so that way I can refer to this in the future if I need to which I likely will have to do when I'm on my C rotation so with this free time I begin to spend the next 20 to 30 minutes of going through the article and taking down my notes so just managed to finish reading the article it is now 850 I think I've been reading for what 20ish minutes and this article is absolutely gold you guys can kind of see the quick notes I was able to write and not all of this is new to me but having it in one place kind of like a second brain so that way if I need to look up when to go down on somebody's support like their ECMO these are advanced things that you wouldn't be doing in residency typically but as a fellow I get to and so just making sure that I make the right moves by my patients have this article linked in case I ever want to refer to it and now if I just go back up to my home page this is the nice part of this entire system is I have all these notes I've already tagged it with what it needs to be so I can look it up later and I'm just put it in my archive and put it in my archive there you go so now it is in my archive and my inbox just looks like this in terms of what type of things I need to look up or are my lists next and that's pretty much how my studying goes now again it is 850 so I will look at the next thing on my to-do list and likely get ready for bed now before trying to get to bed I'll do a combination of things which includes having my dinner which today is chili that my wonderful wife prepared helping my clinic notes for the upcoming week and chart checking some of the sicker patients and ICU to just make sure that they're still stable while having my dinner I'll also catch up on some youtube currently I'm on a huge marathon video binge and once these last bits of tasks are done I'm going to go ahead and get ready to head to bed and I feel like as soon as the universe knows that I'm going to bed I usually get a text recall which right now is a call for a request to put an essential line on a patient now a central line is essentially an IV that we place commonly in someone's internal jugular vein in their neck it allows for quick medication administration blood draws and allows a nurse to have three ports versus the standard one that comes with a normal IV it's a procedure that any medicine doctor is trained to do during residency and stand out bedside using both ultrasound and sterile technique now this particular patient was having some issues with the nurses having reliable IVs and ultimately needed some critical IV medications so the request was made for me to put one in so around 9 p.m. I grab all of the supplies and the ultrasound machine that I need for the procedure hoping that it'll be a quick one and then we can head to bed soon but unfortunately it did not go that way so just got back from that line which did not go as planned patient continue to move for any procedure you want your patient to be as safe as possible while you're having a needle especially at their neck so this is one of the scenarios where you try everything to calm the patient control their pain and their anxiety and if you can't then you just kind of abort and you come up with a plan B because it's just too risky to have a sharp object while patients are just moving their neck which happens sometimes and so you just have to be aware of it and be able to audible we tried for an hour unsuccessful so came up with a plan B on how to help with that patient main is just pain and anxiety control overnight and if they really need another line hopefully we can put it in successfully or do it from a different place sometimes we can do it the groin it's usually not recommended it's not as clean as you can imagine something you have to do if it's needed so for this patient we'll see if we can get them by oral medications when they don't have an IV and yeah if they need me they'll call me if not I will try to head to bed it's 10 30 right now I feel like we've done enough this evening in terms of studying and keeping up with everybody so let's see how much sleep we can get if any see you guys later now while we wait to see how this patient will do with the oral medications that I prescribe for better pain control and ideally better urine output I'm headed to the call room to get some sleep and about three hours into my nap I get another call seems like our friend with the failed line attempt is not doing so hot nurse is concerned about his breathing and he needs an IV quick our friends um back in the room after being called for that one patient who ultimately needed that line so we went with plan B this time the patient was much more comfortable much more compliant with my instructions and able to get that line in smoothly just got back to the room and they're doing well so that's always a nice thing to hear and usually in these nights when you get called by one nurse or one doctor usually everyone else's messages somehow just happen to come together which is fine people need your help you help them and so after putting that line in I got messages of persons hemoglobin or their blood counts being low somebody's blood pressure was kind of low another doctor wanted me to lay eyes on somebody they're admitting from the emergency room because their blood pressure was low and so kind of saw all these patients or at least looked at their chart and now I'm just going to quickly write some notes in terms of just updating everything that done documenting that procedure documenting my decision making for that patient plus other patients that I saw overnight and it is 440 so hopefully hopefully I can get maybe an extra hour plus of sleep though usually the way these nights work for me is that if I can get five to six hours I can usually make the rest of the day because tomorrow I get to go home around seven or nine depending on certain scenarios and that means I'll have the rest of the day off until I come back to work the following day so this is Tuesday of Tuesday morning so I'll have the rest of Tuesday and I'll come back to work on a Wednesday so if you do it right and you get enough sleep during your night which we've got three four hours so far if I get an extra hour plus a nap this afternoon I can enjoy time with my wife and my daughter and actually have a full day off so I'm gonna write these notes I'll catch you guys soon so I quickly pull up his chart on the computer in the call room just to know what I'm walking into again and go ahead to see this patient now while typing up these quick notes for the night I'm starting to get messages from the nurse before their shifts in there's another description of what I'll get called overnight is about almost five o'clock and usually in the mornings there will be new x-rays on certain patients in the ICU and sometimes the nurses are not sure if something is normal or not depending on what they see so this is a patient this is yesterday this is today this is a patient that has a device that we call an LVAD basically is like a pump sitting in the muscle of the left side of their heart which is normally supposed to be able to squeeze blood out to everywhere else but for this patient that muscle is weak and so this pump essentially is bypassing part of that function of that heart or that side of the heart and so not only do they have this device if you can kind of see if something coming in here that like loops around in cardiology this is like a big thing that we use a lot this is called a swan gans catheter or a pa catheter it's basically a fancy IV that goes in the neck and has a catheter with a balloon at the very end that you can put into their right side of their heart and then essentially take it up in the initial part of their lungs and you use it to measure pressures and this is something that you get 24-7 monitoring of the patient in terms of how much pressure especially when you have a weak heart you want to make sure there's not a backup of fluid and so if all the numbers go up that means volume is going up and this catheter can pick it up but every day you want to make sure that that catheter is in the right place you can see this nurse is concerned because it looks different here it kind of looks like this catheter stops like here and then here it looks like it's going much much further the reason i'm not too concerned is she sent me the waveform of what it looks like on the monitor and it looks like a normal waveform there's no changes in numbers and then two you can see the orientation of this patient is different here at the pump is facing this way and here i'm kind of faced in more and so i think it's more or less going to be the same positioning but just returning the patient more and so the line is moving that way again not everyone will feel comfortable calling that so sometimes you have to look at x-rays but cool finding and uh just keep an eye on it and then you go from there on to the next one now once i've finished all my notes and messages i try to get another one hour of sleep before my shift ends and as soon as i lay down as we've seen multiple times tonight the universe will conspire against my sleep and suddenly i hear the words code blue called overhead now code blue means that somebody has lost their pulse and is a need for resuscitation now as the icu fellow i go to all of them in case the reason for their arrest is ultimately cardiac so it's about 5 20 a.m and i'm headed to the code while quickly looking up the patient on my phone now in this case this was ultimately a false code as the staff quickly realized that the patient was dnr or do not resuscitate so the hospital staff respected their wishes and allowed them to pass peacefully without pushing on their chest or giving them drastic medications which can be a lot for the body especially for our elderly all right good morning guys it is and now it's 6 32 i managed to sleep about an hour after that code that was supposed to be a code i have somebody that hasn't been training the right way overnight in the icu so what i'm about to do is just brush my teeth so it's about to be then my shift go see them i'm on the way out and then prepare to just let the fellow for the day kind of know about all of our fun adventures um and then that's pretty much the day i feel like i've got enough sleep so i'm gonna try to enjoy the rest of the day with my wife and my daughter so good call shift um felt like there's a lot learning in there for you guys for me um hopefully you guys enjoyed following me on today's um episode if you did hit that like subscribe whatever i'm putting down below hit your comments um with questions you guys have and then i'll catch you guys the next one take care peace


Hi everyone, Joe for jaspyscasebreaks.com coming at you with 2020 Panini contenders baseball four box pick your team number three Which sold out before number two for for some odd reason. So first to fill first to break I still think there's like six or seven teams left in and pick your team two Which we could get into tonight if you want to so here's pick your team three right there And if you bought at least two teams Then you got a shot at some break credit and no vet comments right here Big thanks to oh, it's a big thanks all these folks. It's a pick your team that I printed out I did big things these folks for getting into the action pick your team three appreciate it Thanks for spending a bit of your Friday with us too. All right now. Let's figure out which four boxes. We're gonna do We'll go one two three For the left side four five six for the right side and it's one so we're gonna do the left side right there So this We will now say for pick your team number two. There you go pick your team number two which we can do tonight If you want And at the end of break we'll do all the randomizing for the for the break credit. All right. Good luck everyone Looks like beyond Sanders his son who is a quarterback commits a Jackson State He was recruited by His dad beyond Sanders Who's the coach of Jackson State? All right, good luck everybody I think I should have the 2020 MLB draft class. I should have that list for guys like this 23 out of 99 Carson Tucker He is the 23rd overall pick from point or from mountain point high school, Arizona He's a shortstop Are we guessing what? Oh, no, I don't I mean it could be a guess who if you want to did you know where Carson Tucker went? Yeah This is this is contenders baseball for giving away a million dollars $500 in this I've not memorized the 2020 draft class No, not Carson fuller. I know where he goes Carson Tucker he goes Chicago White Sox What about Austin Martin from Vanderbilt? He's a top five pick. Let's see if Nick knows 39 out of 75 top five pick out of Vanderbilt Shortstop went to a blue team blue Jays PS I think yeah, I think you need 50 count slider boxes. I feel like we're out of those Yeah, we're out of those. Yeah for stuff like that. I've got one right here Is it worth Freddie Freeman? Yes, I mean might be MVP. I Mean, I'd rather I mean I I'm a betting man. I pick Freddie Freeman my heart picks mookie bets There's a you don't think Freddie Freeman's gonna win Well, I'd be fantastic. Maybe I'm just doing reverse psychology Arturo with the Phillies gets the Nick Matton Or Matten don't know then we got Matt Tice for the Angels on card autograph 39 out of 99 That goes to Jeff Goldberg and the halos Right Austin Martin also a fancy car You think Austin Martin like with his first like maybe maybe not as minor league pay I don't know you might have gotten a decent signing bonus is this He's gonna be Driving an Aston Martin. Wow. He could he signed on July 8th and received a seven million dollar signing bonus You could put you could put a little bit of that into, you know, I mean Definitely a maybe I maybe some real estate. Maybe a house Maybe treat yourself to a nice car. I gotta get a good show car right there DJ St. DJ San DJ LaMahieu to 149 With the Yankees and Kevin Ginkle rookie roundup autograph for the snakes Robert Primrose with that Matt Medlin will get that Yankee. By the way, these are all purple parallels. They will ship in case you're wondering So those are not considered common. They're uncommon and we got Dray Jameson Jameson Prim with the snakes Although maybe you don't want to drive around an Aston Martin maybe that'd be too flashy for some of the I Was a blue J right with I don't know where their single or double a teams are maybe maybe save that Aston Martin until Until the big leagues as like motivation I'll get that I make my big league debut. Just focus on baseball now. Really? Wow TJ saying Back when Yadir Alvarez was in Tulsa. He was driving around in a McLaren So I guess I Guess for him. He's like, yeah, I could I could I could flash Be flashing my McLaren And the streets are tall so 74 out of 99 for the White Sox Matt Lieber getting the Norhay Vera I'm gonna go with that 74 out of 99 I don't know how to spell them. I don't know if there's an A maybe an A at the end of that R8n R. I am not sure I guess since I'm a very long way from being able to forward one of those I don't even bother looking it up Eugenio Suarez Five out of 18 on that one for the red legs That'll be for Anthony and we got this bad at for TJ and the Nats the rookie catcher rookie backstop Nick saying let's get the last one of these contenders locked in. Yeah, why not? We got Logan Allen for the tribe 15 out of 15 nice Nice platter like Argyle pattern in the background Arturo with the Cleveland Indians and the next autograph is Sheldon Newsy rookie ticket on card autograph for the Oakland A's the athletics TJ with the A's both teams hitting for Tige You need some break right? You nice little trifecta and we got a cracked ice Randy Johnson 9 out of 23 We pulled one of those in the last four boxes That would be going to Prim There is Adrihan Morrojon in that red foil right there 37 out of 75 on card autograph For the live armed youngster Anthony there's Eddie Diaz for Colorado Rocks that's gonna go to Jeff Jeff Goldberg. All right two boxes to go Yeah, traditionally contenders does have a lot of autos football is the same way. I think football is like five or six autos a box And maybe contenders basketball doesn't have as many It's just fewer fewer people in the basketball pool, but obviously baseball has a ton of professionals in the in that they can select from in football too Yeah, absolutely TJ's right. It's a good product to stash away for a few years and then You know see see when and then check in on them in a few years see if they end up being big names. I Think the hobby leans Leans hitters there's Josh Donaldson to 149 but It's off some pitchers could solve some value too. I think They're definitely it will be a little bit of a an ace pitcher sort of vacuum once the likes of That goes to Anthony by the once the kershaw He's getting older. Scherzer is getting older for a lander is getting older, you know, so that generation Which is kind of crazy to think about but that that sort of generation of pitcher will be gone now And who will fill that vacuum will it be the guys like Walker Bueller? Maybe even Casey Meyes There's Nica Horner for the Cubs Ryan Harold Ryan H with the Cubbies and we got Patrick Sandoval rookie ticket autograph for the halos That's gonna go to Jeff Jeff G. We got Ronald Acuna, Jr. to 99 Feels like a redemption. Yeah There's a redemption any guesses on that redemption Actually, don't know who the redemptions are There are a few players that don't like to sign Could it be that one player that we're thinking about maybe? Notorious non-signer there's Mauricio Dubon rookie autograph For the Giants Anthony. Yeah, that's what I was thinking to TJ and Nick He is a notorious non-signer. There's Jake Rogers of the Tigers Jake Jake Jake Jake Jake That goes to Ryan Harold.   It's one of his last spot mojo teams And you get a free toddler. All right final box. Good luck That blue jays team could be pretty scary really quick Guys like boba shit Kevin Biggio Vlad Guerrero, Jr. Tungent Rue on top of that rotation Nate Pearson throw pretty hard We were pulling some of his Bowman draft cards just a few years back a couple players here and there and They could be ahead of schedule. You're right. Yeah Vlad did lose about 30 pounds. I saw that Hopefully we'll see the same news for Zion maybe There's Brian Anderson to 99 although I don't know to Zion 30 pounds is kind of a lot Whoa, what was what? What kind of weight was Vlad carrying? Probably more weight than Zion All right, there's Willie Castro Detroit That goes to Ryan Harold think Zion maybe like 10 or 15 pounds on this Trim up a little bit. Maybe Vlad here and you did have to lose a lot of weight. I don't know It's I think that's his height weight right six to 250 So if he's six two to twenty, it's pretty lean There's Josh flying for the Tampa Bay Rays that goes to Ryan Harold Although it I guess it just depends on the person sometimes You could lose a significant amount of weight and then You you play differently. I don't know it just feels differently if you can play with carrying a certain kind of weight You get used to You know being with at that McCann I know baseball is different than some of the other sports Angels Jeff Goldberg like you know Tony Gwynn carried some extra LBS's and he did just fine He was just fine EA. What's going on? Yes? Check out our Twitter feed Out of 23 cracked ice Taylor Tremel potential cracked ice and another redemption any guesses for bragging rights Maybe maybe some of you will double down on your guesses from the previous redemption. There's Mauricio Dubon rookie autograph for the Higantes Anthony Right and then Ryan Harold pointing out the polar bear. He just stays strong just doing squats and drinking chocolate milk The old-fashioned way. There's Jake Rogers Rookie ticket autograph for the Tigers another one for Ryan H. Pick the right teams in this one Ryan nice Got a shot at that break credit to All right, Redemption Redemption Redemption is gonna be Focus boba shed again Two for you Matt Lieber it happens. There you go ladies and gentlemen. All right now You know what's great about this break a lot of great hits and A chance to win some break credit. So if you bought at least two teams You'll get the entries, you know how this works by now two teams one entry four teams two entries so on and so forth the top five We'll get a hundred dollars of break credit. So let's get those entries squared away. Let's sort by column a So Anthony you've got four teams right here. That's two entries Are doodle with four teams. That's two entries Daniel with two teams. That's one entry Six teams for Jeff. That's three entries Matt with four teams. That's two entries Matt Medlin with two teams. That's an entry prim with two teams. That's an entry Ryan H four teams two entries And TJ with two teams. That's an entry. Let's grab everyone's names here Let's roll it. Let's randomize it One and a five six times top five after six We'll get money Good luck one two three four five and Sixth and final time after six Top five right here. There you go. Congrats To let's get everyone's names in here This group right here You are winners Jeff Goldberg hundred dollars of break credit Matt Lieber hundred bucks of break credit TJ hundred bucks of break credit Jeff another hundred bucks of break credit and Ryan Harrell hundred bucks of break credit That'll be sent to you in an automated email It'll it'll say gift card I think but you're gonna use that for break credit check your spam folders If you don't see it and you don't have to spend it all in one place you can spread it out or spend all in place It's yours. It's up to you. Jasper's case breaks calm. I'm Joe. I'll see you next time for the next break. Bye. Bye