A Change of Heart-Interview with Dr Alin Gragossian

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Episode Transcript

(00:00):
Historically, our demographic,African American population is

(00:04):
the demographic that requires ora candidate to say more so for
organ donations historically.
So that's the highest number.
So that's commonly livertransplants, most commonly
kidney transplants as a lot ofour population unfortunately

https (00:16):
otter.
ai Historically, on top of that,too, there's been a lot of
legislation that's been passedin other states, talking about
how folks register and how folksare able to come off those lists
to get those organ donations,specifically kidney donations as
well.
In the past, there's been somedisparities in terms of the

(00:39):
demographics, that needs itactually getting those organs,
but we made a lot of progress inrecent years to make sure the
folks that need it get it thesame rate that everyone else is
every other ethnicity, walk oflife, socioeconomic demographic,
thank you, Dr.
Ford.
That was amazing information.
And shout out to the doctor.
Yes.
Yes.
Yes.

(00:59):
Yes.
We got it.
Look.
Black people we gotta stop.
Yes, not wanting to do this.
Yeah, I think thank you forbringing a different perspective
because like I said There's somany different myths.
Yes floating around especiallyin our community And I loved how
he actually added to thecandidates on those lists

(01:20):
exactly Yeah, it's us.
Yeah, that's something to thinkabout.
All right, y'all.
Get your driver's license out.
I hear they just put a stickeron there now when you go
through.
They just put a sticker onthere.
Put it in your wheel.

Chris (01:34):
Welcome to pulse check, Wisconsin.

(02:15):
Good morning, good evening, goodafternoon.
This is Dr.
Ford, Pulse Check, Wisconsin.
And I wanted to thank you forjoining us here again.
We have a really good episodehere for you.
As you heard in that intro, weare going to be covering the
topic of transplantationmedicine and transplants in
general.
I got a couple of fan questionsand fan requests to do an

(02:35):
episode on this topic.
And I wanted to start out theepisode with a recent radio
interview that I did with one on1.
7, the truth here in Wisconsinabout the topic of transplant
medicine and what demographicstransplantations affect and who,
what Most commonly seestransplants and that will be us

(02:57):
in the minority community So Iwanted to bring on someone who I
wanted to interview for a whileDr.
Alin Gragossian who is acritical care and ER doctor out
west and I wanted to share herstory because it's an amazing
journey and I wanted to Sharewith you all some of her
insights into not onlytransplantation medicine But

(03:18):
also just being a patient and toshare some of the things that
she has experienced and some ofher insights along the way So
that being said we'll go aheadand get started

(03:48):
All right.
Well, again, thank you so muchfor being with us here today.
I'm very excited to get intowhat we're going to discuss I am
a big fan of yours Ben.
You know, we've been connectedon LinkedIn for a while now, but
I finally have the opportunityto speak with you.
And I gave you an intro rightbeforehand, but for our
listeners, could you please justgive them an update of who you
are and what you currently do?

Alin (04:09):
Sure.
My name is Dr.
Alin Gragossian I am currently,I, I trained in emergency
medicine and critical caremedicine.
I now do, I, I'm an intensivistthrough a tele ICU company.
I guess that's one thing that Ido, I do a few things, and I'm
also the medical director ofNorthern California's Organ
Procurement Organization.

(04:30):
I'm one of three directorsthere.
As far as the, the, you know,clinical management of organ
donors.
And then on top of that, whatI'm probably most known for is
the fact that I had to get aheart transplant during my
residency training, and sobecause of that, I do a lot of
work with advocacy, patientadvocacy and, and organ donation

(04:50):
and transplantation in general.

Chris (04:53):
Yeah, and I think, you know, kind of the latter part
is, is where I came to know you,you know, just through your
story, I believe, like a friendof a friend shared one of your
posts over on LinkedIn and justkind of went through everything,
you know, I, I can probably echothe thoughts of a lot of other
folks, I, I barely made it outof residency with the hours and
everything else, right, but Icouldn't imagine adding in
becoming a transplant patient ontop of that and just all the

(05:16):
things that you, that you wentthrough and, you know, how you
you.
Gotten to the place where youare right now is more so of a
testimony of, you know, who youare and kind of your
perseverance through that,through that process.

Alin (05:25):
Yeah, thank you so much.
I know.
People tell me that.
They're like, oh my god, like,it's so inspiring.
And I was like, it's funnybecause we, we go through
medicine, like, like, I thinkmed school was very difficult,
right?
College, med school, residency,those were like very difficult
years.
You put so much time and effortinto it, I mean, research, like,
on top of the actual stuff thatgoes into just medicine, and you

(05:46):
have research, extracurriculars,like, doctors are probably the
most, like, resilient peoplethat I know, in general, when it
comes to, like, facing so manydifferent academic and career
adversities, having to do this,moving across the country, like,
you know, not every career hasto do a match process, So I feel
like it's funny that I've beenthrough all that, but like, what
I'm most known for is somethingthat I had absolutely no control

(06:09):
over.
Like, I mean, literally, I cameclose to death, and, and, I, you
know, did it fairly okay.
And, and, you know, it wasn'tanything that I had prepared
for, like a test.
It wasn't anything that I, thatI, that I thought would happen
to me.
But, I always say that it's justinteresting that that is what
you're inspiring for after allthese, not that I'm, not that I

(06:31):
want to take away from it, butit's just my two cents.

Chris (06:35):
Yeah, absolutely.
You never know kind of, youknow, what, what your pathway is
going to be in order to shareyour gifts and share your
experiences with other folks.
And to be honest with you, that,that, that's another portion of
why I wanted to bring you in.
And I'm so fortunate that youare able to, to, to make this
work.
We're able to kind of jockey ourcalendars together to make it
work because I think it's sovaluable for our listeners.
At the beginning of thisepisode, one of the things that

(06:56):
I shared was a radio interviewthat I did recently, and they
were talking about the idea oftransplantation and, you know,
what demographics are mostaffected by it, and some folks
Are really apprehensive aboutit.
You know, there there are a lotof conspiracy theories behind it
yada yada yada And so I thoughtyou know, not only to break that
understanding and thatmisconception of it I thought

(07:17):
you sharing your story about howyou first found out that you
needed a heart transplant andJust kind of walk us through you
know your journey in thatrespect.

Alin (07:25):
Sure.
Basically I always I like totell this story by reminding
people of, like, think of a timewhere, like, everything was
going well in your life.
For me, it happened to be Thefall of 2018, I was 30 years old
at the time, probably had beento a doctor a few times, but

(07:46):
never had any medical issues.
I was in residency.
I was applying, because as youknow, for emergency medicine,
for most specialties in general,you apply to fellowship the end
of your second year, and thenthrough your beginning of your
third year is when you're kindof interviewing, and you usually
know where you've matched forfellowship.
By like November or December,depending on which match you're

(08:08):
going into.
Not every residency, but ingeneral, that's how it works.
And so I had just finished mysecond year.
I was applying to, to do acritical care fellowship, which
is always what I really wantedto do.
Even as an intern, I remember Iwanted to do emergency medicine
followed by critical care.
I had all these amazinginterviews.
I was on the interview trail.
There's pictures of me, like.
You know, at all these differentplaces, like UPMC, Geisinger,

(08:31):
Mount Sinai, New York City, allthese places that I really
wanted to go that had such bigimportance to me as someone who
was going into this field,especially because at that time,
emergency medicine was fairlynewer to critical care medicine.
It's a, it was a difficultprocess, but I, I got through
the interviews and then I hadactually just met, like, I
really wanted to live in NewYork City my whole life.

(08:52):
So.
My the best part is like, Iremember when they sent me an
email, because at that time, Idon't know if they were going
through the match, or like,you're like trying to figure out
exactly, like, what, Where youwant to end up.
With the process.
Absolutely.
With the process, exactly.
And so I, I found out thatbasically they had accepted me
at, at Mount Sinai in New YorkCity, which had been my number
one program.

(09:13):
And so it was academically doingwell, socially doing well,
getting ready to move to NewYork City, which is where I've
always wanted to live since Iwas like five years old.
And nothing had been weird in mylife.
Like I think, I think I was atthe peak of being 30 years old
and, but the only thing that Iremember is right around Like, I

(09:34):
want to say Halloween because Iremember things based on, like,
events.
Like, around Halloween, I waskind of sick.
Like, cold.
Like, I had I was congested.
Had a cough.
It wasn't going away.
And it was nothing that's weirdto us in residency.
I mean, all of us usually workthrough shifts when we're sick.
And,

Chris (09:50):
you know,

Alin (09:51):
you get through it.
Exactly.
And I remember specifically, ithad been a bad flu season.
And one of my co residents hadthe flu.
One of them had, like,pneumonia.
And So it was something that afew people had had, and so I
just assumed that I hadsomething.
And it was not anything that waskeeping me from living my life.
Like, I was still going out withfriends, I was still working my
shifts, I just, like, was notfeeling that well.

(10:13):
Like, a little more tired thanusual, which I feel like that's
all of us, right?
Like we're just a little bitmore tired than usual going
through residency.

Chris (10:21):
Exactly.

Alin (10:22):
So I had, I want to say like that happened in October,
December, October, November, Imatched into this program.
Still kind of had this weirdlingering like cough that wasn't
going away.
And then fast forward to aboutfour or five, six weeks into
having these like, you know,generalized symptoms.

(10:43):
Um, this one particular night, Iwas in the ICU, because in the
ER, as ER residents, we wouldcover ICU as well, like we had
our ICU month rotation.
And so I was a senior residentin the ICU and we did 24 hour
shifts and I remember thatparticular day was a Wednesday
and I went into my shift andsomething was like off.

(11:03):
My attending, who was anemergency medicine critical care
doctor who was one of the firstpeople who noticed, she was
like, something is wrong.
Like you keep like stopping inbetween sentences to take a
breath.
Like when I was trying topresent patients to her, I was
like.
Short of breath.

Chris (11:17):
Wow.
And

Alin (11:18):
she was the, she was somebody who was like, you
should definitely get a chest xray or something.
Like I've never seen you likethis.
And I remember thinking like,okay, of course in medicine, I'm
like, well, let me just at leastfinish my shift and then I'll
see what I can do about ittomorrow.
So that was like a Wednesday,the following day when I got off
shift.
Oh, I should also point out theone big red flag that particular

(11:39):
night.
Was that usually we wouldrespond to codes in the hospital
and I would take the stairsbecause it was like my way of
getting exercise in during these24 hour shifts and like I just
couldn't like I remember I hadto take the elevator for just
like one floor up and I waslike, that's kind of weird,
whatever.
I mean, even if it maybe it's apneumonia, right?
Like, like, I didn't think itwould be anything crazy.

(12:00):
So the following day I got offshift and when I tell people
like I felt a hundred timesworse Which is interesting
because in emergency medicine,we're told like young people
usually like they compensate sowell to the last minute so I
think that's what happened to melike I Felt fine fine fine fine
fine, and then suddenly thefollowing day like I couldn't

(12:20):
even walk a few yards withoutstopping, which was super weird.
So I went back to the emerg soafter I had done my shift, I
actually went back to theemergency room because something
was definitely off.
And my colleagues who had justseen me throughout the week were
like, pale, I had like, bluelips, I was tachycardic.
Nobody knew exactly what waswrong, but, but I, like, True

(12:43):
emergency medicine fashion, butone of my attendings was like,
like, I know you have to beadmitted.
Like, like something is off.

Chris (12:49):
We know the disposition.
We don't know what's wrong yet.
Exactly.
As soon as he saw me,

Alin (12:53):
yeah, he knew.
And, and this is when people askme like, okay, but like, why
didn't they do an echo?
I don't know.
Like, in the, in the moment inemergency medicine, we order a
bunch of tests.
We could get the work up going,but like, He, he knew I had to
be admitted.
I, I got up to the floor andthey had done a chest x ray and

(13:14):
the basic stuff, and I thinksome of the stuff was still
pending, and the chest x rayshowed bilateral infiltrates,
which in someone who's otherwiseathletic, young, healthy 30 year
old, you're thinking atypicalpneumonia.
Like, you're not immediatelythinking something, I mean, not
that that's not serious, butThings could be worse than an
atypical pneumonia.

Chris (13:32):
Exactly.

Alin (13:33):
So I got admitted, um, you know, I was getting antibiotics
and I remember they were evenlike, we're not really sure if
it's that, but we'll get a fullworkup going, but that night I
got a hundred times worse andthey had to call like a rapid
response at one point.
I remember, I remember they gaveme magnesium and I remember
thinking like this might've beenbecause of the magnesium, but it

(13:53):
obviously wasn't.
I, I felt really sick, nauseous,and I started sweating a lot,
and I looked up at my monitorand my heart rate, which had
been in like the 120s, 130s, wassuddenly down to like 30, 20,
like I almost felt my own heartrate.
P.
E.
A.
arrest happening in theImpending.
It was, it was insane, and wecan laugh about it now, but at

(14:15):
that time it was scary and I wasdating an orthopedic surgeon,
and the running joke, again, wecan laugh about it now, and I'm
still friends with him, but We,he said something like, like, I
looked so sick that even anorthopedic surgeon knew that
something had been wrong.

Chris (14:31):
God bless our orthopedic uh, brethren.
Like,

Alin (14:34):
I remember he, you know, he, he was just like worried.
And so that night, they ended upintubating me taking me to the
ICU.
I was on support, and, uh, Overthe next couple days, they did
all these tests, and by the timeI woke up, they told me my
ejection fraction was 5%, whichis the lowest I had personally
ever seen, and And they werelike, yeah, you have, like,
really bad heart failure.

(14:54):
Now, the cause of Remember whenyou're in the hospital with
these acute issues, like peopleare like, Oh, why didn't they
figure out that?
Okay.
It takes a while to figure outthe cause.
Later on, we found out it was agenetic issue caused by like a
desmoplacan gene mutation that Ijust never knew I had.
And so the running theory wasthat I probably had like a virus
that like Turn the seaprecipitated.

(15:16):
Mm-Hmm.
Exactly.
Exactly.
Yep.
And so then I got, I was so sickthat they eventually transferred
me to Penn.
Um, and I remember at that timethey were like, you need some
advanced heart failuretherapies.
And even being an ER resident, Ididn't even know what that
meant.
Like, I was like, wait, solasik, like, what is advanced
heart failure?
By the time I got to Penn, mycardiac index wasn't improving.
Everything was just gettingworse.

(15:38):
And so they listed me for anurgent heart transplant and less
than two weeks later, receivedmy heart transplant and then
discharged after that.
So like all my, from mydiagnosis to basically death,
to, to everything just happenedin less than a month.
And then I got discharged likeall in less than one month.

(15:58):
So I went from like normal 30year old without any medical
problems to like, here you go,here's your transplant.
Have fun.
And that, that was almost, well,as of this, so my, my sixth year
will be January, so about sixyears ago.
This all happened to me, andlike, this is the part of the
story where I'm like, well,that's what happened, and now

(16:19):
I'm here, so, there's a lot ofstuff that happened in between,
but, but, yeah, that's basicallyhow I ended up requiring, like,
needing a heart transplant, I,I, I had biventricular failure,
and so it was nothing that Couldhave been fixed with like an
impella or a balloon pump, or soit just needed a heart
transplant, got it.
And here we are now.

Chris (16:39):
And that's it.
And, and, you know, I feel thatyour story in general kind of
highlights some of the thingsthat we.
We talk about with patients,especially how much of a niche,
you know transplantation surgeryis.
And even as someone, you know,at the highest level of
education in the field, right?
Like these are things that evengo over our heads.

(17:00):
So we expect the public and ourpatients to just understand it
and grasp it.
You know, there's a lot that isstill yet to be ascertained by
someone who is a medicalprofessional yourself.

Alin (17:11):
Absolutely, and that's what I, even, because now that
I'm part of like a patientadvocacy committee, like, not,
well, a committee, yes, but alsoin general, the community of
patients that I deal with and,and do a lot of social media
collaborations with and thingslike that, like, they're always
like, I wish, like, the ER knewmore about LVADs or about heart
transplant, but I'm like, yougot to understand, like, in the
three years that I didresidency, and we were at a

(17:32):
place that had transplants,like, I saw one heart
transplant,

Chris (17:36):
like, it's

Alin (17:37):
not that, it's not that I don't think people should be
more aware, but it's such atiny, tiny part of medicine.
That, it, and I don't want tosay like, like, you know, people
could just like not care about,it's not what I'm saying either,
but in general, yes, like, like,it's, there's so much that goes
into it that when you're in,when you're in it, you don't

(17:57):
realize how, how small of afield it really is.

Chris (18:01):
Exactly.
Exactly.
Being both a patient and aphysician, that creates its own
unique strains, right?
And so, what were some of yourmost challenging aspects of
being both a patient and adoctor?
Did you have to kind of removeyourself from the treatment team
aspect?
How was that along in yourjourney?

Alin (18:18):
It was interesting.
I think people say, so, ingeneral, and I've been
hospitalized enough times toknow this, I think they
anticipate me being, like, very,like, type A, and But in
reality, I'm like, I actuallydon't want to know a lot of
things.
Like, in fact, what's reallyfunny is when I get my ECHOs, I
get ECHOs like every few monthsfor surveillance.

(18:40):
I like, don't, I don't look atit.
Like, they're like, it's sointeresting.
Cause most patients want to knowwhat is that?
Why is that like that way?
That so, so I don't know ifthat's just my personality.
I don't know if other doctorswould be the same.
So I think they anticipated mebeing a little bit more like
wanting to know everything andwanting to make my own
decisions, which, you know, IIt's so funny because I'm, I'm

(19:00):
not.
And so in the beginning, Iremember they'd come in every
day giving my, my CBC and I'd belike, I don't, like, it's fine.
Like if, unless there's a bigchange, you don't need to tell
me what my like white count isthis morning.
And, and, and then I think theother part of it was just what
you said.
Like I think even the, yougotta, you gotta remember that
like places like Penn or eventhe, the transplant center that

(19:20):
I'm at right now, like there areliterally cardiologists for
every ventricle at this point.
Exactly.
That's how

Chris (19:26):
hyper

Alin (19:26):
focused

Chris (19:27):
it is now.

Alin (19:29):
Like, like there was a pre heart transplant doctor, there
is a, like, so, so, for them tothink that I knew, like, half of
what they were talking about,like, maybe now I know a little
bit more because I did acritical care training and
focused on cardiac, but evenwith that training, there's so
much I don't know.
And so a lot of times they'd askme questions like, hey, like,

(19:50):
you know, I'll never forgetthat.
They came in and they're like,you're, you're SVR today is
like, What did they say, likeit's 6, 000 and I remember in my
head I was like, like

Chris (19:59):
it's like,

Alin (20:01):
isn't that good?

Chris (20:03):
Well, yeah, with that, well, it sounds good.
It's better than five, I guess.
I think

Alin (20:08):
I remember they were like, you know, they'd give me these
numbers and like these like, andthey're like, And I understood
the basics, well, nitro toreduce your afterload, like
things like that.
But overall, like these tinylittle things, like, I'd be
like, Oh, sounds good.
I guess we want it to be lower.
Yeah, lower.
Okay.
Okay.
That's right.
Exactly.

(20:28):
So, so I think they, theythought that I'd probably be,
Okay.
I don't want to say smarter, butI feel like they, they
definitely, when you're adoctor, people assume that, you
know, everything and evendoctors assume that even though
you're a third year ER resident,you know, but that's not the
case, so it was, it was weird insome ways, but I think once you

(20:48):
get, they get to know you, theysee like what your personality
is like, I hate making decisionsfor myself, so I'd be like,
whatever you guys think would bebest.
It's fine.

Chris (20:57):
Yeah.
And, you know, just the processin itself too, you know, how did
that work for you in terms offinding out that you had a donor
heart available, how long didthat process take for you,
because I feel like a lot offolks don't understand how much
that goes into it besides theactual surgery itself.
You know, there, there'saftercare, there's precare,
there's all these things that gointo it.

(21:18):
And, you know, you were kind ofon the end of the spectrum of
needing an emerging cardiactransplantation, but for like,
you know, renal transplantation,liver transplantation, there's a
whole host of considerationsjust to harken back to, you
know, there, there are a lot ofconsiderations that even go over
our heads as medicalprofessionals.

Alin (21:34):
Absolutely.
In fact, one thing that I tellpeople is my case and having now
having worked in a cardiac ICUand doing all those things, my
case was actually really rare.
Like most people have chronicissues for years.
Kidney patients are on dialysisfor years and needing an
emergent transplant basicallyhappens in liver and heart.

(21:58):
Like it's still pretty rare.
So, so there's, so for me, itwas very different than what it
is for.
I don't, I don't know the exactpercent, but for, for the
majority of people, there's awhole listing process.
You have to go see multiplespecialists.
You got to get.
You know, CAT scans, MRIs, youhave to get titers done, you got
to get certain vaccines.

(22:18):
They go through a committee.
For me, it was more of anemergent process.
And so I can give you what itwas like for me.
But just with the caveat beingthat for most people, it is not
like this.
So for me, you know, they toldme that one of the only things
that I, that could really helpme at that point was a heart
transplant.
We found out later on that itwas genetic and my dad had
actually had heart failureBasically since he was my age We

(22:42):
just like never connected itbecause it all makes sense now
and I wrote an article aboutthis But his dad died of sudden
cardiac arrest at age 40, whichis a big red flag But he didn't
he wasn't close with his dad.
So he like he didn't reallyInvestigate that then my dad was
diagnosed He didn't know hisfamily history and so they
basically put him on medication.

(23:04):
They said maybe it's amyocarditis that he had had and
he, for him, he was just onmeds.
He still is on meds.
He gets echoes every year.
It's still, it's a little bitbetter than what it used to be.
But it's never been, like,cardiogenic shock, at least not
yet.
And then for me, I mean, now itmakes sense that it was like a
genetic issue, but mine wasbasically so bad that I

(23:26):
presented as cardiogenic shock.
And so the, there are multiplethings that could happen when
you have something.
That happens to you similar towhat happened to me, one of them
being like an LVAD.
You can get some sort of implantto impella for a few weeks.
But for me, it had been, you canonly get a transplant.
So when they told me, I rememberthat they came in with like the

(23:48):
paper, like the coordinatorscame in and like, well, we're so
sorry.
You know, there's really nothingthat can happen, that we can do
other than we have to list youand like, there are meetings,
there are meetings for everyone, like Monday or Wednesday.
So yeah, they have to presentyour case and because mine was
emergent, it was kind of like.
Okay, well, this is what we haveon her, overall healthy, if you

(24:08):
think about it, like, I wasoverall healthy, no other organ
systems were affected, young, soI had been technically, like, a
good candidate to begin with,and so, when they told me that
One of the only things that wecould do is transplant.
They were like, starting to goover all the paperwork.
They were like, okay, well thisis what's going to happen.
You're going to need to takemeds.
And like, you know, it took likea good 30 minute conversation

(24:29):
that they went through, wentover everything.
And then they're like, anyquestions?
And I was like, nope, let's doit.
And they were like, you were oneof the first patients.
They were like, you were one ofthe first people that we've ever
seen who had like, No question,like you, and they're like, it
was such an ER doctor of likeway of doing things because the
only thing you said was like,let's get it so I can go home.
Like you're only thinking like,well, it's what I got to do.

(24:53):
Exactly.
Exactly.
People are always like, well,how did you make that decision
when, when it's between that anddeath?

Chris (24:59):
And that, and that's the thing too, for, for our
listeners, for context, as Alinesaid, her ejection fraction or
kind of that squeeze of theheart was about 5 percent or
less.
Right.
Right.
When we start talking about aninjection fraction of 20 percent
is when we start to put in thoseimplantable devices that will
shock the heart in the eventthat it goes into these rhythms
that can be dangerous or eventhreaten your heart to go into

(25:19):
VTAC or even asystole orsomething.
And so at the point that she wasat, you know, like she said, it
was either that or nothing,right?

Alin (25:26):
Yeah, exactly.
And so, without a question, forme, it was, well, I'll figure
out the rest later.
Like, let me just say yes togetting listed.
And so once you get listed, Ithink, you know, there were some
things that they had to do, likethey had to get, you know, a
full, like, body scan to makesure there was no infections or
cancers, and they had to, Imean, there were some things
that I did after the fact, sofor example, you need to get

(25:46):
your Pneumovax vaccine andthings like that which I hadn't
gotten because I was only 30,and so some of the things we
waited till afterwards, but theyknew that I had, you know, all
my other vaccines I think they,they do like a psychosocial
assessment, and one of thethings that's really important
for for getting listed is makingsure that you have support not
only financially, but also just,like, people, and, and my

(26:09):
parents, I, I, I'm originallyfrom Los Angeles, so I lived
alone in Philadelphia, which iswhere all this happened, and so
they had to make sure that,like, my parents, my mom, ended
up living with me for about sixmonths, My brother and my dad
would come too, so just to makesure that I had someone there in
case I needed anything.
And so there were theseconsiderations like that, which
doesn't necessarily mean youcan't get a transplant if you

(26:30):
don't have those, but they haveto make sure that there's some
sort of assistance available foryou, whether it's financially or
through support.
So once they checked off all theboxes, I got listed.
They have to go through acommittee that basically, like,
talks about you and whether ornot you'd be somebody who'd be,
Adherent with medications, likeif you have a history of non
adhering, which I understand ifyou're not going to take your

(26:52):
meds, like something that peoplelike a hundred, over a hundred
thousand people need organsevery single day.
So like they want to make sureit's given to the people who are
going to most likely take themedications for.
So they do all these things andthey go through these like risk
assessments and then eventuallythey said, you know, for me,
again, they went through thecommittee and then they came

(27:13):
back and they were like, allright, you're listed.
Those two weeks were the hardesttwo weeks of my life because I
remember, I, There were certainthings happening.
So whenever you get a, you'relisted for a transplant, they
try not to give you transfusionsbecause of antibodies.
Luckily, like, up until then inmy life, like, I had never
required a transfusion.

(27:34):
I had no antibodies.
I'd never been pregnant.
So all these things were goingin my favor, favor, but my
hemoglobin had been under seven.
And so, like, We were reallyteeter tottering on, and, cause
heart failure could do that, wewere teeter tottering on like,
okay, we can't transfuse her,but we gotta make sure, you
know, there were little thingsthat every day I was like, well,
I might die today, I might dietoday.

Chris (27:55):
Oh, jeez.

Alin (27:56):
I know, and what's, what's interesting is like, there were
nights where I wouldn't go tosleep because I was afraid that
I wouldn't wake up the next day.
And like, even like, I getchill, like, I remember thinking
that, I remember writing,because I would write everything
down, and I remember thinking,like, I don't, like, if I, if I
don't sleep, then I, I can'tdie.

(28:18):
Like, that, that's how, whichis, which is not true, but
that's just the way it is.
But still, it's the

Chris (28:23):
psychology of it, absolutely.
It's,

Alin (28:25):
exactly, and so, like, you know, those two weeks were very
difficult, but I remember, Youknow, there were a few things in
my favor, such as, no antibodyproduction I happen to be, you
know, smaller, which is, usuallypeople who are bigger, taller,
it's a little bit difficult tofind them organs, because you
definitely need a bigger organ,for, for people, who are bigger,
so there were like little thingsthat were going in my favor, and

(28:47):
every day I'd be like, well,hopefully, tomorrow, hopefully
tomorrow, and then You know, oneday I'll never forget.
I don't know if you want, if youwant to ask me any questions
before I go to the day that Iactually got, okay,

Chris (29:01):
definitely go, definitely go.

Alin (29:03):
Cause that's actually a very interesting story.
So my parent, I had tons ofpeople, this was the year before
COVID.
And so like.
I mean, when I say there werealways residents, like, my
parents, I had my friends fly infrom all over the country to
visit me, like, my room in theICU always had 5, 10, 15 people,
which was great, but, this, at,at some point, like, it was

(29:25):
just, I just wanted to be alonesometimes, and I remember, like,
the nurses were awesome because,like, we had a code word of,
like, me saying something like,I think I need my dressings
changed, and so they'd be like,Okay, well everybody has to
leave the room, and So it got alittle overwhelming, but that
particular night, My mom hadbeen visiting me from L.
A., She came every day, shewould actually sleep overnight,

(29:46):
And That day my cousin wasvisiting me and I was like,
dude, I was like, you got totake my mom somewhere.
Like she's been here every, likeshe would come at 6am, stay till
night, and then would stay withme at night.
I would say five, six times aweek.
So like, just was with me thewhole time.
And so I told, I told him and hewas like, well, like me, does

(30:07):
she want to go to a casino, likeof all places?
My.

Chris (30:12):
It take you mad off of it.
It.

Alin (30:14):
It's exactly, and so, you know, my cousin was like, I'll
take her to the casino, and, youknow, my parents, like, my
parents, like, love playing onthose, like, slot machines, so,
I had been alone, and the nursecame in, and was like, hey,
looks like you have a phonecall, got the phone call, and it
was the coordinator saying,like, hey, there's a heart
condition.
It's been found, like, all Ineed is for you, like, you know,

(30:37):
OR time would be 2am we thinkit's a good fit for you it's,
blah blah blah blah blah, andthen, you know, we just need a
yes or no.
You have about an hour, I think,I forget the exact timing.
Wow.
To, to say yes or no.
And like, I was so, I got soanxious and nauseous, And I
almost feel like I, like,regressed, like, I was like I'm
not sure, let me talk to mymommy.

Chris (30:58):
Right, exactly.
It's a big decision, that'sfair.

Alin (31:02):
So like, I remember I was like, you know, it was just, I
didn't know what to do and soshe was like, eventually like I
called my mom, and of course shewasn't picking up her phone
because like she was in acasino, the reception wasn't
good, and finally she was like,she was like, are you jo I was
like, mom, like they found aheart, like, the OR's gonna be
in six hours.
She's like, are you joking?

(31:22):
No, I'm not.
Everybody rushed back, it wasamazing, and so You know, they
had to, there's all thesethings, like, you know, the
anesthesia has to come, come in,do all this, do all that, and at
the time, like, I don't think Irealized, because I had been
intubated already for thatresuscitation, and so I was
extubated, and then I had to getre intubated, and I remember
thinking, like, now that I'vebeen an ICU doctor, I didn't

(31:47):
even understand how risky this,like, to, to intubate somebody
with an ejection fraction of 5%,Like two times in two weeks and
like, I remember I was like,well, like, let's do it.
Like I had, when people asked meif I was nervous, I'm like, I
don't know, like I was obviouslynervous, but I don't think I
understood the gravity of thesituation, which was actually

(32:10):
kind of nice.
Like, it was nice to not.
Think like a doctor in

Chris (32:14):
those moments.
Exactly.
Not being in the driver's seat,not having, you know, the, the,
the clinical intuition aboutwhere to go next because you
have to give yourself that timeto be the patient, right?

Alin (32:22):
Exactly.

Chris (32:25):
Yeah.
How do you think, kind of goingalong those lines, how did your,
as an ICU provider now and as aER doctor now, how did your
experience as a transplantpatient, how does that now
affect your approach to patientcare?

Alin (32:38):
That's a really good question.
So, I get this, I get asked thisall the time.
I think that, and by the way,I'm going to caveat with, I
don't think every doctor needsto go through a cardiac arrest
to be a good doctor.
Like, I absolutely hate whenpeople are like, oh my god, I
want you to be my doctor,because you know what it's like,
because there are plenty of gooddoctors who have never had any
health issues who I would trustmy life with.

(32:59):
I think that in general thereare a few, like, I say, I call
them like pearls that I neverlearned in medical school, but
like, Little things really domatter, like communication with
our patients.
So I'm Armenian and so myparents speak Armenian.
They don't, my mom, especiallylike doesn't speak that much
English.
And so I was the, Interpreterfor my family and of course they

(33:20):
could have gotten like anofficial interpreter, but I
don't, you know, we tried ourbest and so I remember like
they're not in medicine.
They're like immigrants, right?
Like they're not in medicine.
They don't really speak thelanguage.
They definitely don't speakmedical English.
And so a lot of times like theywere confused as to what was
going on.
And if it wasn't for me, Ihappen to be a doctor.
I don't know what they wouldunderstand or what they

(33:42):
wouldn't.
So communication is always likea major thing for me to make
sure that, you know, patients,caregivers really understand
what's going on.
Even little things like when theICU doctor would come in in the
mornings for rounds, like Iremember I specifically one time
he's like, she's doing well,like she's doing great.
Like all good.
Next, next patient.
Okay.
Okay.
In the ICU, doctor's eyes.

(34:02):
I didn't die last night.
My, my vitals are stable.
Yeah, exactly.
Like I'm, I'm on two pressers.
But, but like, an ICU doctor'sgoal is to make sure overall,
like, everything is stable.
Whereas, like, the cardiologistwould come in and say like,
Okay, well, you know, herejection fraction's like, still
5%, like, we need to get over,get through this surgery, blah,

(34:25):
blah, blah.
And my dad, It was like, why isthe cardiologist so negative?
Like the ICU doctor is notnegative.
And

Chris (34:32):
why is that left ventricle cardiologist so
negative, man?
The right one is great.
Exactly.

Alin (34:39):
Exactly.
So it's so interesting becauseit was never something I.
Thought of as like, I was like,Oh, because they don't realize
that like all these doctors haveway different goals, but that's
something that's so intuitivefor us, like in the ER and ICU,
especially because we're workingwith specialists all the time.
So I make it a point to alsotell doctors and providers that.

(35:02):
Make sure your patient knows whoyou are and what your goal is.
Cause I don't think they know ifit's a neurologist or like an
ICU doctor coming into that roomhalf the time.
So things like that making surethat you, you stay like
empathetic and understand thatsometimes I remember like the,
the residents would be rightoutside my room.

(35:23):
Again, it's fine if it's mebecause I understand what's
going on.
But like, Even little things,like sometimes, like, nurses,
residents, doctors, I, and thishas happened in hospitalizations
even ever since then, but, like,they'll say things out loud that
I could hear, like, Oh, yeah, Ifeel so bad for her, you know?
And, like, Heh, like, hearingthat, like, I remember one of

(35:44):
the, a tech came in once andwas, like, checking my heart on
an echo, and she was like, Thisis so bad, and I was like, I
don't know, sometimes you shouldbe careful with, like, you
should be, it's, I'm a doctor soit's okay that you're, like, I
understand the re, but like,just, you know, to say
something, like, imagine tellinga patient, like, oh, I would
never be able to live with thisheart, like, what is, what kind

(36:05):
of thing is that to hear?
So, just be mindful of whatyou're saying to, to people,
and, and, by the way, like, Ifeel like because I was a doctor
before I was a patient, Thiswhole experience has, if
anything, made me empathize evenmore with doctors, right?
Like, like, sometimes patientswill be like, my doctor is like,

(36:26):
why is the ER doctor onlyspending five minutes with me?
Like, why is it?
And sometimes I'm like, dude, doyou, how many people they're
seeing in one hour?
And like, it's almost made merealize, and like, sometimes
doctors will, will, like, if Igo to clinic, they'll, they'll
come in like 15 minutes late.
I'm so sorry.
Oh my God, I'm so sorry.
I'm like, dude, don't say sorry.
Like, it just goes to show howmuch even.
Clinicians are, like, on edgenowadays because they're so

(36:49):
afraid of what their patientsare going to say.
So I see, I see it from bothends.

Chris (36:55):
Yeah, and that's that important context too, right,
until you've been on both sidesof the coin, it's hard to know,
you know, as a physician and asa patient, you know, what the
other side, what strains othersides of experiencing, and it's
really important to kind ofcarry that through, and I think
you said a couple of good thingsin there as well about You know,
the way that we, we front facepatients, right.
Especially as providers,especially as ER providers, ICU

(37:17):
providers, we are in very highstress situations all the time.
And, you know, it's not atypicalfor us to be talking as, you
know, colleagues and to blow offsteam and say things, but like
you said, the patients get overhere and the patients, you know,
definitely are going to be theones who feel.
A certain way, adversely aboutit, and especially when you're
trying to do your best to stay,you know, mentally and

(37:38):
physically, you know, in a bestdisposition, it's hard to, it's
hard to hear those things, andthey shouldn't hear those
things, so it's really importantto know.

Alin (37:47):
Absolutely, absolutely.

Chris (37:49):
One of the things that we talk about all the time too is
about not only the proceduralaspect, not only getting on
those lists and coming off thelist, but the aftercare of
transplant, which I feel like alot of folks don't understand as
much that goes into that,changing of diets, changing of
social activities, you know,medications that you have to
take.
Have there been any long lastingeffects from the transplant that

(38:11):
you still navigate today?

Alin (38:13):
Absolutely.
I think the easiest part isactually the surgery itself.
And what's interesting is a lotof people assume that like, oh
my god, a heart transplant issuch a big deal.
What actually gave me mostcomfort is when the
cardiothoracic resident came upto me because he said something
like, honestly, like hearttransplants are so easy because
it's just like putting fivevessels together.

(38:34):
Like it's actually the one thatlike nobody wants to, I mean not
nobody wants to scrub into, butit's like, Technically not a
difficult surgery.
There's like, you know, valverepairs and things like that
could be technically much moredifficult.
And so that gave me comfort.
I don't know if that givesanybody any other patient
comfort, but knowing that like,it's really not like a surgery

(38:54):
that is extremely, I mean, in myopinion, liver transplant
surgery, it has its owndifficulties and could probably
be more difficult.
I'm not a surgeon, so no surgeonshould come after me for that.
But, but, like, the surgeryitself, in my opinion, is one of
the easier parts, and so,afterwards, there's so much that
goes into it, I actually failedto understand how much was gonna

(39:17):
go into it, like, I remember, Iwas like, alright, well, good
now, gotta take a couple meds aday and I'm fine, but no, like,
in the beginning so, first ofall, there's the, the, the The
surveillance, especially, andright now I'm about six years
out, so things are way differentnow than they used to be, but
that first year, you are gettingcathed all the time, like,
that's one thing I didn'trealize was like, weekly right
heart caths, so imagine gettinglike a cortis every Monday for a

(39:41):
few weeks and then on top ofthat, you, you get echoes, you,
you have, I think I started withlike 37, 27, something like
that, meds a day and thenthey're constantly changing,
right, because they get your TAFlevels every week and they want
to make sure that you're on aspecific dose of tacrolimus.
And so the surveillance is justinsane.
I mean, I remember, like, therewere so many restrictions,

(40:03):
again, early on the restrictionsare a lot worse because you are
hyper immunosuppressed.
So things like, you know, when,be careful in public places,
always wear a mask, likeespecially in crowded public
places.

Chris (40:16):
Especially around the time that you had it, too,
around the pandemic, too, sothat's that added bonus, right?

Alin (40:21):
It was right before the pandemic, and so, for me, it was
so interesting because Likethose first few months I was
wearing a mask and then likesuddenly a pandemic hit and it
was almost a blessing becauselike everybody else started
masking too so it was actuallykind of nice but yeah so so
there's like precautions youhave to take like that and then

(40:42):
also the the biopsies, thecardiac care that you go to,
again, I'm talking more firstyear than anything.
And then there's all the otherthings too.
Cancer surveillance, right?
I had to get a I have to getscopes done to make sure there's
no colon cancer.
I have to do this.
I have to do that.
Making sure that skin checks atleast once a year.

(41:02):
So it's not just thecardiologist that I have to see,
but it's a multidisciplinarycare of seeing multiple
specialists every year.
Multiple times, usually, to makesure that everything is in
place.
One of the most, one of themore, actually, probably the
most difficult thing, that wasactually even more difficult
than my heart transplant, when Iwas on the high dose steroids, I
ended up having avascularnecrosis of both my hip joints.

(41:26):
And so, yeah, so I had, probablythe hardest thing I went through
was actually both hip, I gotbilateral hip replacements when
I was in fellowship.
And it's just something thathappens.
I mean, you know, as well as Iknow that being on any kind of
steroid puts you at risk forthings like this.
And and it was weird becauselike, I remember.

(41:48):
I was in so much pain, likewhen, so when AVN patients come
in now, I mean, when, when Itell you it was the worst pain
in the world, I mean, I wasdepressed because of how much
pain I was in, because not only,I was somebody who was very
active, so not only could I,like, not move, but I remember
because nobody could reallyfigure out what was going on,
and I, I put it on myself too, Icould have gotten, like, checked

(42:10):
out by multiple specialists, atfirst they thought maybe, like,
I'm having hip pain because ofstatins, maybe, because of, so
we tried different things, Andwe could never figure out the
exact cause.
And this went on for about twoor three months.
I was waking up at four in themorning to soak my legs.
Like, I would just sit in a bathfor an hour to like, prepare
myself for how much walking Iwas about to do as an ICU, as an

(42:33):
ICU fellow.
I was wearing all sorts ofbraces.
Like, I think I spent so muchmoney on Amazon on like, all
these like, gimmicks, like, Iwas like, what is it?
And, you know, looking back,like, especially as a ER doctor,
I'm like, what's the first thingyou should do if somebody, I was
having, Mostly knee pain, but itwas like radiating to the hip.
The first thing you think of isgetting a hip x ray.

(42:54):
Like if it's knee pain.
Yeah, exactly.
And so, like,

Chris (42:58):
But when it's you, right?
It's you, it's a whole differentsituation.

Alin (43:01):
And so, like, two or three months went by and I got, I went
to my PCP, my cardiologist.
I even went to the ER because atone point my leg was so swollen
that I had a DVT.
And so, afterwards, my, myfriend who had been one of the
ER residents who was taking careof me, I was like, Dude, let's
just get a hip x ray, too.
And, like, he'll, if he everhears this, he'll probably,

(43:22):
like, I remember he was like,why?
And I was like, I was like,cause I'm having knee pain, and
it's radiating to my hip, and,What if it's ABN and I've been
on pregnancy and he's like,yeah, but you know, we, we even
thought about it, but he had hisattending come in and we, we had
like an actual discussion.
I was like, let's just get it.
And lo and behold, ABN, bothhips this whole time.

Chris (43:42):
Wow.

Alin (43:43):
So I had to get, I got my left one hip replaced first
because it's really hard to getboth at the same time because
you, you need your other leg torehab.

Chris (43:54):
PT and, exactly.
Nice.

Alin (43:56):
But, I mean, the other one was like a little bit, like I
probably had a little bit moretime for the right one and then
of course because I had donesuch, so much PT, like
immediately the right onecollapsed like within a couple
months and so I got them donefairly close to each other in
time.
And then, yeah, and I honestlytell people like, Like, that's

(44:18):
why when people come into the ERwith joint pain, but like not
their high blood pressure, nottheir diabetes, I understand
that joint pain is tangible painthat is unlike any other.

Chris (44:29):
And like you said, you're waking up in the middle of the
night to prepare for the daybefore that.
That's not even including thepain that you're already waking
up with.
That's just in preparation.
And, you know, for ourlisteners, AVN, Avascular
Necrosis pain is felt by a hugedemographic of people, including
our sickle cell population too,right?
So a lot of times folks talkabout patients that I speak to

(44:51):
outside of the healthcare realmand community activities, things
of that nature, talk about howthey don't feel like they're
hurt.
And when they come to theemergency department with this
type of pain, again, like yousaid, that adds that
connotation, that adds thatlived experience to, to bring to
those patient interactions thatAline was talking about as well.

Alin (45:10):
Yeah, we had a large sickle cell population in
Philadelphia and I remember,like, I'd be like, how much can
it possibly hurt?
How much can your hip possiblyhurt?
Do I regret ever, ever saying,like, I remember thinking
specifically, I'm like, I amnever ever gonna question any,
again, and it's not that, like,you don't believe patients, but

(45:31):
it's just like, I rememberthinking, like, there's a lot
more stuff going on here.
Like, how much is this hipreally bothering you?

Chris (45:37):
Right.

Alin (45:37):
But yeah, it was insane.

Chris (45:40):
Well, you know, I appreciate you so much sharing
your story and your aftercare,and you talked a little bit at
the very beginning of thingsthat you're currently active in
as well, organizations and evenyour own personal endeavors that
you're undergoing right now.
How do you currently advocatefor transplant awareness and
organ donation in yourprofessional or your personal
life at this point?

Alin (45:59):
Sure I I do patient advocacy work through AST,
American Society ofTransplantation.
I was actually the chair oftheir transplant community
council last year.
It was, it was great.
And so through that, we did alot of public health awareness
about transplantation ingeneral, you know, transplant
recipients, education aboutcaregivers and how important
they are to people, like, Liketransplant patients, we did a

(46:23):
lot of stuff for livingdonation, but on top of that, I
feel like What's even moreneeded now is more awareness
about organ donation in general.
We have lots of people who areso against organ donation
because they think that allthese Terrible things are going
to happen once you sign up to bean organ donor.
And so, I do a lot of advocacyfor, in general, organ donation

(46:46):
too.
I actually became very closewith my organ donor's mom.
And her whole family, and Ifound out that Lucy, who was my
organ donor, had died of asudden, she had a brain cyst
rupture.

Chris (46:56):
It was

Alin (46:56):
just as sudden as something that happened to me,
which is insane when you thinkabout it.
And for her mom, it, she foundso much solace in knowing that
her daughter went on to savefour people's lives.
Me, two kidney recipients, and aliver recipient.
And it almost, you know, she's,her, her daughter's able to live
on through the gift that shehas.

(47:17):
She was able to give in, in, inher passing.
And so I do a lot of work again,I work for an OPO on the
clinical end and we help withorgan donor management, but I
think even more than thatadvocacy regarding all these
myths, like, for example, Iheard that if I'm an organ
donor, doctors are going to killme for my organs, like, like,
first of all, like.
Like, I always tell people, evenif there was a rogue doctor who

(47:40):
was gonna do that, like, in theICU, we don't even know who's an
organ donor or who's not.
Like, that comes after the fact.
So so things like that do not,like, it's insane to me when
people say things like that.
Or even things like, I thinkanother, another common myth is
like, People don't realize howrare it is to actually die in a

(48:00):
way that lets for organdonation.
So, you're actually more likelyto need a transplant than ever
die in a way that makes itpossible for your organs to be
procured.
And that study was done in 2011in Canada, like, that is
absolutely something that peopledon't understand.
They think that immediately, ifthey're an organ donor, all
their organs are going to betaken.

(48:20):
It, it, it is such a longprocess to get from organ,
potential organ donor to actualprocurement to transplantation.
And so there's so much that goesinto it that people just don't
realize.
And there's all these myths andthings like that, that I'm just
like, it's so sad, especially tome because like I'm a recipient
and I'm in the healthcare fieldand it's just, so I try to

(48:42):
dispel those myths as often aspossible, as much as possible
regarding like, You know, notonly signing up to be an organ
donor, but also just making surethat people are aware that, you
know, transplant patients existand we are here and we're living
our lives.

Chris (48:58):
Absolutely.
Absolutely.
What message, if any, would youlike to share with our audience
and share with others who, youknow, may be in that same
situation as you were and have alittle bit more time than an
hour to make that decision, butmay be waiting on a transplant
or thinking about it or evencounseling a family member for
transplantation.
What would be your message tothem?

Alin (49:19):
I think one thing that I like to tell others who are
either, you know, waiting fortransplants or in the process or
potentially going to be listedis that it is a long process and
you have to take it day by day.
And, and another major thing totell people and their caregivers
is that every patient isdifferent.
Everybody's story is different.
And so while some things may betrue for some people, it's not

(49:40):
true for everybody.
And so comparing yourself toothers.
is not, doesn't usually help.
With that being said, findingothers in the community who are
going through something similardefinitely helps with supporting
you.
When I first got my transplant,there were so, and this goes not
just for transplant, but ingeneral, people who have chronic

(50:03):
illnesses.
I was getting so many messagesfrom people, um, I started a
blog and an Instagram for noother reason than I just, like,
I'm a millennial and we writeeverything, so I didn't think, I
didn't think it would get big oranything, but I got so many
emails from people saying like,I'm going through something so
similar, and like, it's so nicethat you're putting it out there
because I feel like it's nottalked about enough, and so just

(50:25):
to be able to voice yourself ina way to help, you know, connect
you with others, It doesn't meaneverybody has to do it, but it
was something that really helpedme.
Healthcare workers, especially,like, notoriously, we never talk
about our own health issues.

Chris (50:42):
I got

Alin (50:42):
emails from people saying things like, I don't remember,
it was like a nurse or aresident who said something
like, you know, I had, I wentthrough cancer without telling
any of my co residents.
I, I went through, like, Allthis stuff.
I've had a transplant for 25years and not any of my
colleagues know and like, it'sso liberating to know that
there's someone else in thisworld who's also a doctor who's

(51:02):
gone through something crazy andis able to tell their story.
Um, when I first got mytransplant, I started, I started
a few like little groups, groupchats.
Um, one of them had been womenand in their, uh, young women
with heart transplants.
And it meant a lot to me becausethe, the support group that I.
You know, had you got toremember, like most people with

(51:25):
heart failure, like old whitemen, like what is like, it was
not anybody I could relate with.
So it was so nice to have like agroup of women in their twenties
and thirties.
We were able to talk to eachother and then I even created a
group at that time.
It was just five of us, fivephysicians with organ
transplants.
And now that group has almost 70members from all across the
world, like, attending residentdoctors who have organ

(51:48):
transplants, and it's just beenso nice to be able to connect
with each other.
So don't necessarily compareyourself to others, but it's
totally okay to use thatcommunity for support.
And that's what helped me themost.

Chris (51:59):
Absolutely.
And like you said, havingsomeone there with you that has
walked a similar path, and alsoto help soundboard, because like
you said, we go through so muchas medical professionals It's
just a basal level, just abaseline.
But to have someone that you canbounce those ideas off of, or
even just talk to, it, it, itgoes a long way, especially when
our first reflex is just to hidewithin ourselves and to keep

(52:22):
those things away from folks.

Alin (52:23):
Exactly.
Exactly.

Chris (52:25):
So, Elaine, you know, how can our listeners follow you?
How can they support anything,any endeavors that you're doing?
Uh, cause I'm sure I'm gonna getmany, many, many questions about
that.
So,

Alin (52:34):
I'll send you, um, specific links, but if, if
anybody wants to check out myblog, which is Not as updated as
it used to be, but there's lotsof good resources on there.
It's a change of h e dot a r t,so it's a change of heart.
And then my Instagram isprobably the best way you could
reach me, and it'sachangeofheartblog with
underscores after each aftereach word.

(52:54):
And I'll send you both of thoseand I think another thing that
we do me and, there's acardiologist who has a heart
transplant, so we have a podcastcalled Both Sides of the
Stethoscope that we update onceevery couple months, so there's
always like other people withtheir transplant stories or
chronic illness stories, orother doctors, and so those are
probably the three easiest waysto get a hold of me.

Chris (53:15):
Awesome.
Awesome.
We'll definitely post that tothe website and we'll definitely
send that out as much as we can.
But I want to thank you so muchfor taking the time.
Again, so happy that we're ableto finally link up and looking
forward to speaking more.

Alin (53:27):
Thank you so much, Chris.
It was great being here.
I want to thank Dr.
Gragossian for coming out andspeaking with us here today.
I want to thank you all forlistening.
Feel free to click on any of thethe information that I have
listed on the website.
From this episode, I'll have alink to Dr Gragossian website.

(53:48):
Blog space, a change of heart aswell as her Instagram page and
her podcast as well, to learnmore about the amazing things
that she's doing, feel free toreach out there as always.
I want to thank you all forjoining us here today and join
us next time.
Again, this season, we have alot of good surprises and a lot
of pertinent medical informationthat's going to be coming up So

(54:09):
you definitely don't want tomiss that feel free to reach out
to us either on instagram or xWe have a page now up on blue
sky as well So feel free toreach out to us there with any
of your fan questions any ofyour show ideas again shows like
this came from some of the fanresponses So feel free to reach
out and we'll continue to tailorit to what you want to hear So

(54:32):
with that being said