Dr. Jonathan Reisman
Appearances
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
That's a great question. So I often say, you know, the bodily fluids are kind of the medium of a doctor's craft. Most of the time, what I'm doing as a doctor is... getting a patient's bodily fluid, whether it's urine or stool or blood, and sending it to the lab or testing it myself in some bedside manner, where you're kind of, in a way, reading messages from these bodily fluids.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
You know, urine is... urine is a language and blood is a language and it's talking to your provider your healthcare provider your doctor telling you what's wrong and so as a doctor you know learning about disease meant learning about those bodily fluids and what the messages mean so when urine turns red for instance depending on the clinical context
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
know if i see red urine coming out of the patient or in the cup that they then deliver to me from the bathroom i could think they have a kidney stone i could think they have a bladder cancer or a kidney cancer or uh some other injury you know maybe they were just got punched in the kidney by someone um so it's kind of uh depends on the context of course but those colors are telling me something and i have to interpret them
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
and figure out what's going on with the patient. And every bodily fluid has its own kind of messages, you know, whether it's color, consistency, smell, you know, and then obviously beyond that, things you can measure under the microscope, see under the microscope or measure, you know, electrolytes or blood cell amounts and other things. There's sort of a million messages contained in these fluids.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And so reading them is a really important part of figuring out what's wrong with the patient, which is sort of the first step to alleviating it.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
In most cases, I do think that is correct. Not all cases, you know, for instance, high blood pressure is sort of considered the silent killer. But you're right. You're right. There's been a lot of appropriate questioning of the annual physical. You know, a lot of the times, to be honest, the doctor puts a stethoscope on a patient's chest to hear the heart or the lungs.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Honestly, most of the time, it's unnecessary, to be honest. Not talking about an ER where someone's coming in with chest pain, but you know, in the general doctor's office. Like you're very unlikely to find something new.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And then there's also the question of, you know, if someone goes to their doctor and they don't listen with a stethoscope, they might feel like, well, what kind of doctor is this? Are you supposed to listen to my heart? Are you ignoring my internal organs? You know, I didn't get my money's worth.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
That is a huge problem, and I've had that experience myself. I've been the patient actually when I was in medical school, which is funny because I was sort of supposed to be learning how to be a doctor, how to be a good doctor. And the doctor I saw for a kind of a general checkup, I don't think he looked me in the eye once.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
He was a very slow typer, which I sympathize with, though I'm a fast typer. But, you know, there is so much the burden of documentation on doctors, especially primary care doctors, kind of grows every year.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So I understand the need to look at their computer and type while they're talking to the patient, especially as the number of minutes you have with each patient gets lower and lower as reimbursements are cut back. Needing to kind of finish your notes before you go home and have dinner with your family is a bigger and bigger burden. But still, I think it definitely, I mean, it's dehumanizing.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
It makes you sort of wonder, do they know I'm here? Do they care that I'm here? Is the opinion on the diagnosis and treatment actually going to be worth anything given how little they're sort of looking at me? And it also sort of points to the fact of how important eye contact is and just sort of basic human to human interaction.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
A huge part of medicine is just kind of being a human and having a sort of a normal social interaction between the doctor and the patient where you're hearing their story, they are feeling heard, you're making eye contact and sort of not touching them too much, not touching them too little. It's kind of this fine balancing act where you're in this sort of very
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
bizarre social interaction where you just met each other and yet I'm asking you about the color of your stool, how often you have sex, the color of your snot, I mean everything. It's sort of the most intimate conversation you could imagine with someone you just met.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Yeah, well, I guess that, you know, I think a lot of time is spent in ER sort of wondering why, why did the patient come? Why didn't they just stay home? You know, you know, and I don't blame the public for this. I feel like sort of the basic medical education for the public is not great.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And I wonder if there should be sort of basic courses in high school, you know, instructing people how to deal with their sort of basic, you know, colds and other things like that. People just don't know.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So, for instance, we see a ton of children, let's say, coming into the ER with a fever, and the overwhelming majority of those fevers are a viral illness that will most likely get better on its own, doesn't need any antibiotics or any even x-rays or blood work, just needs some Tylenol or ibuprofen. and just make sure the kid's hydrated and that's it.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
But I think people, you know, understandably don't know that. They, you know, most viruses, thankfully, are kind of can be ignored. 90% of what I do for children in the ER is giving them over-the-counter medications like Tylenol, Ibuprofen, and sometimes Benadryl for hives and other rashes.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
I think that you're right. That is a big part of every doctor's job, but it's especially the case with pediatricians, partly because usually nothing is wrong with the children. Not always, obviously, you know, sometimes things are wrong, but for the large part, for the most part, when children, let's say, come to the ER with a fever,
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
The large, large, large majority are just viral illnesses that will go away on their own, need no workup, need no testing and need no specific treatment. And, you know, I get a lot of I'm an internist and a pediatrician. So I see both adults and children and work in the ER. A lot of internists who only treat adults will often say to me, you know, I don't know how you do pediatrics.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
The parents just must be so difficult to deal with. And I don't find that at all. I find parents, for the most part, you know, yes, some worry too much. I mean, I'm a parent too. I've worried too much about things that ended up being nothing myself, even though I'm a pediatrician, it happens. But I find parents are very reasonable and understand your reasoning. And the reassurance really works.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
That was almost one of the most shocking things was,
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
uh when i became a doctor and i could tell tell people oh it's you know for reasons x y and z this is not a serious illness and you don't need antibiotics and and just keep an eye on them and they'll get better they really responded to that like it was sort of this message coming from the mountaintop um of the like sort of universal truth and i sort of was surprised that they trusted me or believed me um but they do and they're just looking for someone who has experience evaluating children with fever which i've done thousands of times
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
you know, to tell them, you know, I've seen tons of deadly infections. I've seen tons of mild infections. This one's mild. And they're reassured and they go about their life.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
You know, I could say one thing I particularly enjoyed learning in medical school was about urine as a bodily fluid. I can mention that it is my favorite bodily fluid of all. And while most people never thought of having a favorite bodily fluid, you know, as a doctor, I mentioned bodily fluids are kind of the medium of our craft.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
It's what we spend a lot of time analyzing and interpreting to make a diagnosis. But urine in particular, I find really fascinating, not only because As a doctor, it tells me so many messages about the body.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
It tells me about the urinary tract through which it flows from the kidneys to the bladder, tells me about diseases in those organs, but also tells me about body parts that are distant from the kidneys and seemingly completely unrelated to the urinary tract. But one thing that I really love about urine is how the
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
The salt levels in the bloodstream, the sodium and chloride are high, the potassium is low, and the kidneys are responsible for keeping those salts, those electrolytes in just the right balance. And that balance happens to match the concentration of salts in the ocean. And I sort of love that because our ancestors sort of evolved first in the ocean.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And so the only reason that we were able to sort of crawl out onto the land and live as, you know, air breathing animals with lungs. The main reason is because the kidneys, by making urine, carry around the ocean inside of each of us.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So in a way, we're each sort of still have that ocean inside of us and our cells, which are fed blood and fed the nutrients and electrolytes in blood almost don't know we ever left the ocean at all, because as far as they know, it's everything still just as salty with the same proportion of electrolytes. So that makes me love urine even more.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
The fact that as it flows, it's sort of keeping everything in balance and keeping this little bit of ocean inside of each of us.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Thanks, Doctor. Awesome. It's been an honor to chat with you, Mike. I really, really enjoyed it.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
thing i like to focus on in the throat is is how uh kind of unnervingly close the food tube the esophagus is to the air tube the trachea you know in our throats the job of our throats is kind of to deal with everything that we inhale that we swallow that uh everything that comes in our nose and mouth sort of coalesces in the throat and then our throat's job is to keep
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Everything but air, you know, out of the airway, everything we swallow must go down the food tube, the esophagus to the stomach, and only air should go down the windpipe to the lungs. And the amazing thing is, you know, we swallow thousands of times a day, whether we're eating food or we are subconsciously swallowing.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And every time we swallow whatever that is, food, drink, saliva is coming within millimeters of the opening to the windpipe. And so one small slip up, if some of that goes in the windpipe, you could you know, pretty much choke and die.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Yeah, that's exactly what happened. Some of that water went down your windpipe or your trachea and ended up in the lungs. And the body has evolved many ways of dealing with that because it's sort of inevitable given how close the two entrances to the tubes are, you know, sort of inevitable something's going to go down the wrong tube.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And when you laugh or speak while trying to swallow, you're kind of opening up the airway. And if you try to swallow, you're opening up the food tube. And so if you do those two things at the same time, Both tubes are open, which is why things happen like things going down the wrong pipe.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And coughing, which probably resulted after those instances, is one of the ways that we kind of clear out the lungs. Coughing is a mechanism for kind of clearing out whatever goes down the wrong tube, and it's quite effective at getting rid of it.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So the liver is almost like 100 organs packed into one. The liver is one of our most complicated organs. It's the biggest internal organ. The skin, which is also an organ, is actually bigger. But as far as internal organs go, the liver is the largest. And which is appropriate because it has a ton of jobs. It really, in a way, oversees all of digestion and all of metabolism.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So whenever you eat or drink anything, it comes into your intestines and then is absorbed into the bloodstream. And the first place it goes from there is to the liver, where the liver sort of checks out, you know, what is this thing? What did we just take into our body? Is it nutrition? Is it poison? And what do we do with it? So the liver from there will sort of sort and package.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
It's almost like, you know, the Amazon sort of sorting and packaging center where it determines where everything is going to go. It packages up all the protein, all the fat, all the cholesterol, sends it to its appropriate organ somewhere else in the body. And it also obviously detoxifies, you know, famously detoxifies poisons, including our favorite poison, alcohol.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And so really the liver just does a tremendous amount every day to keep us alive. And, you know, the best illustration of how important it is, is when it fails in people with cirrhosis of the liver, really everything kind of goes wrong with the body in those cases.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
You're right. And that in many specific instances, I got that same feeling while learning about the body. You know, for instance, there's bacteria right all over us, even in us, in our throats, our noses, throughout our intestines.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Many of those bacteria could kill us if they got into our bloodstream and perhaps landed in the right organ, you know, landed, let's say, in our central nervous system causing meningitis. I mean, there's bacteria that could kill us if it got to the right part inside our body. And yet here it is sort of millimeters, you know, it's on us or even inside our gut, perhaps.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Yet it's sort of only millimeters away and kept at bay by, you know, various parts of the immune system, white blood cells, also just membranes that sort of prevent it from invading. And so sort of like I always think of the body as sort of the barbarians are right at the gate and any moment they can sort of slip in.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Not only can you aspirate, choke and die with any swallow, but, you know, if your guard is let down for a moment, these virulent bacteria can invade and kill you. And yet we go about our day sort of happily for decades at a time, perhaps suffering no ill consequences from these things.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
There's kind of the social aspect of skin where we, you know, skin is what we see in other people. When we look at someone's face that we recognize, you know, mostly what we're seeing is skin. And that's how you know people. But on a biological level, the skin is really amazing. It's almost, it doesn't get credit for being a very intelligent organ, almost predicting the future.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
You know, when sun rays bombard your skin, the skin is smart enough to want to become tan. And tanning involves producing a dark pigment and putting that pigment right in front of the nucleus of every cell in the skin, because the nucleus where the DNA is, and that's where the harmful sun rays, the UV radiation can disrupt the DNA and result in a skin cancer.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So it produces these little plugs of dark
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
pigment right in front of the dna almost like uh putting sunglasses over you know your eyes in the same way it's building this wall in front of all of its dna knowing that more sun might be coming in the future and it will want to protect its dna from that harmful radiation and the same same kind of amazing ability when the skin creates a callus so if you get a repetitive friction on your skin the skin thickens and hardens into a callus almost to anticipate future uh
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
For instance... The salt levels in the bloodstream, the sodium and chloride are high, the potassium is low, and that balance happens to match the concentration of salts in the ocean. And I sort of love that because the kidneys, by making urine, carry around the ocean inside of each of us.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
future friction in a way, you know, and sort of will be better protected against that future friction. So, and not to mention when people get cuts or lacerations, when they come to the ER, you know, I usually will repair them with sutures or stitches, but skin really has an amazing ability to repair itself.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
any wound almost, as long as the person's healthy and well-nourished, the skin cells will invade from all sides of the wound and fill that defect and just kind of fix the hole in the body that shouldn't be there. So skin is really amazing for all those reasons. Talk about the eyes. The eyes are a really peculiar organ. I mean, their function is incredible, obviously.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
Everybody knows that, the fact that they can allow us to see the world around us. Another aspect of the eye that I really enjoyed while learning to become a doctor was how I use it a lot in emergency medicine. It's often the most important thing I look at. In certain cases.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So if someone comes in, let's say comes into my ER completely comatose, unresponsive, even when I push hard with my knuckles and rub their breastbone called a sternal rub, if they don't respond to that, you know, something's really something terrible is going on. Like, why are why are they comatose? And actually, the first thing I'll do in those cases is look in their eyes.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
So I won't grab my stethoscope. I won't grab anything else. I'll grab a light off the wall behind their bed and I'll peel open their eyelids and shine it into their eye. And in a way, I'm sorry, the eyes are telling me what's going on in the brain. So, you know, there's this old saying,
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
eyes are the window to the soul in in the practice of medicine the eyes are actually a very useful window to the brain and can tell me what's going on so if i peel back their eyelids and for instance see that one of their pupils not both but just one is really large wide open and when i shine a light into it it does not shrink as it should in response to the light we call that a blown pupil and that can tell you that there's high pressure inside the skull and
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
If on the other hand, as often happens, a patient comes in, I peel open their eyelids and I see that each of their pupils are very, very tiny black dots, almost like a little black poppy seed on both pupils. That actually suggests that they've had an opioid overdose like heroin or fentanyl.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
its main function obviously is uh to push blood you know in one way the heart is sort of a simple mechanical pump which uh you know maybe is much simpler than let's say the the liver which has sort of all these millions of metabolic biochemical reactions going on all the time
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
the heart is sort of in a way simpler in that it just squeezes and pushes literally blood up into the aorta and then into the rest of the branching vascular tree of blood vessels. And what the heart and the blood do together really is just deliver nutrition and oxygen in the blood to the kind of the doorstep of every cell in our body. You know, we have something like a trillion or more cells
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And so each one, every moment must be receiving oxygen primarily, but also nutrition of various kinds. And also the blood has to then take away the waste from those cells. So in a way, when our ancestors in the distant past started as single cell organisms, that was sort of easy. The fluid of life was sort of surrounding them all at all times.
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
And so they were surrounded by it and it didn't need to get delivered to them. But once you start getting multicellular organisms, especially at trillion cells like us,
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
know getting that nutrition that fluid containing all the things you need to live getting it to every every cell requires this kind of infinitely branched cardiovascular tree pushing blood to each to each cell and then bringing away the waste and so that's kind of the job that the heart and blood do every moment in a way when we you know in cardiac arrest for instance when the heart stops beating and stops pushing any blood forward
Something You Should Know
How the Human Body Works & Stories Your Doctor Won’t Tell You
The whole body is sort of dead at that moment. We often note the time of death when the heart stops in particular. People, your liver can fail, you might have weeks to live. Your kidneys might fail, you might have days to live. But when the heart stops, you're dead.