Introducing an ICU and Pulmonary Physician

John Dehlin [00:00:00] Hey, everyone. Thanks for joining us. Okay, so one of the types of professionals that I really wanted to interview was someone who is actually serving in pulmonary care in the ICUs, in the intensive care units, someone who is literally treating the most severe COVID patients, vaccinated or unvaccinated, just to get a sense for what they're experiencing, why people are being admitted to the ICUs, who's being admitted to the ICUs, what. What the treatments are there and what they're seeing in terms of vaccinated versus unvaccinated vaccine injury, that sort of thing. And so what I'd now like to do is bring onto the show Dr. Robert Mildenhall, a pulmonary critical care physician in Nashville, Tennessee. Robert reached out to me. He is a listener to Mormon Stories podcast, and I just want to say I didn't cherry pick him. It's not like there was a mountain of pulmonary care physicians who listen to Mormon stories who reached out to me. Robert did reach out to me. I didn't cherry pick him. I didn't ask his points of view before I decided to bring him on. I just wanted to find out, you know, what Robert saw in the ICUs in the last wave of COVID and then what he's seeing now in the current wave of COVID I am not biasing or trying to pressure Robert to say anything other than what his actual experience has been. So. Robert Mildenhall, Dr. Robert Mildenhall, thank you so much for joining us today on Mormon stories.

Rob Mildenhall [00:01:25] Thank you, Dr. John de Lind. Appreciate it. And to your point, my main goal here is just to provide information, accurate information, just because I've been a little overwhelmed and surprised at the misinformation out there. But what that's done for me is make sure I'm making my voice heard in the sense of providing accurate information. Because, I mean, the bottom line is we just want people to be safe, and we definitely want this. I think everyone wants this pandemic to come to an end at some point.

John Dehlin [00:01:57] Excellent. Okay, so let's begin. Can you tell us just kind of what your specialty is, what specialty you trained in, and just a tiny bit about your training?

Rob Mildenhall [00:02:06] Yeah. So initially, I started off internal medicine and residency, and from there, you have a myriad of specialties you can choose from. And my first year in residency, the intensive care unit, definitely scared me quite a bit, but also drew a lot of interest and passion. And from there, I knew that was something I wanted to specialize in. So I did an internal medicine residency followed by a critical care as well, as a pulmonary fellowship, and so I specialized in those two areas of medicine.

John Dehlin [00:02:47] Okay, great. So tell us kind of where you're working right now and what type of unit you're currently working in.

Treating Critically Ill COVID-19 Patients

Rob Mildenhall [00:02:54] So, currently I work in Nashville, Tennessee, a bit far east from Utah, but we are still having a high predominance of critically ill patients related to the pandemic. I share time with some of my other partners in my group in the intensive care unit. We rotate through. So I do a combination of icu. I do inpatient pulmonary patients that are less acute but still sick. And then I also have a pulmonary clinic that I operate on the weeks that I'm not in the hospital.

John Dehlin [00:03:37] And is it pretty safe to say that when people get seriously sick and or die from COVID it's usually related to the lungs or to the respiratory system? Is that pretty safe to say?

Rob Mildenhall [00:03:47] Yeah. I mean, predominantly what we have in the intensive care unit related to the COVID 19 infections are respiratory related just because of the severe damage it does to the respiratory system and because of the severe damage and lung injury that we see, we usually see them either on a lot of oxygen support or they're placed on a ventilator, which assists in the breathing because they're not able to oxygenate and breathe on their own. And then from there, we see a lot of different organ failure issues. So kidneys, we see stroke and blood clots. A myriad of problems that are related from that initial infection, but it pretty

John Dehlin [00:04:36] much always starts with the lungs. Is that right?

Rob Mildenhall [00:04:38] Predominantly, yes. A high percentage of our Covid ICU patients have respiratory illness.

John Dehlin [00:04:44] Okay, so what did you see in the last spike, in the first spike, just to kind of get a sense for what you've already been through before the current resurgence?

Rob Mildenhall [00:04:52] Yeah. So I'd probably say here regionally, and of course, it just depends where you are geographically. But around the fall, we started to see an uptick in number of COVID cases. So we initially felt the large surge of patients come in around the fall and winter. And this is obviously before the vaccination was available. So our patient population were predominantly older patients, elderly patients, patients with multiple medical issues, including diabetes, coronary artery disease, asthma, autoimmune disorders, and history of stroke. A lot of medical problems coming into it. But diabetes, obesity were probably the higher risk factors related to patients that came in really sick in addition to age. So predominantly older patients. But we did see a few patients in their 20s and 30s that were

John Dehlin [00:05:54] very ill. And how in the. In the previous surge, how serious did it get in terms of how full the unit were that you were working in and kind of how overworked and stressed everybody?

Rob Mildenhall [00:06:06] Yeah, as you can see, I lost a good bit of hair from the first time. There wasn't much there before. But in all seriousness, it did cause a significant amount of emotional and physical stress, not just to me, but to all the healthcare workers. We were having to create makeshift Covid units to keep separation from patients that were not infected with COVID We were maximized on the number of ventilators. We had patients who had to stay down in ER rooms because there weren't any beds available. And Nashville, it's not New York City, it's not la, but it's a large city. And all the hospitals that were in the area were having the same kind of stress. We were having to call in extra nurses to assist and relieve some of the local nurses because they were exhausted. They were taking on a high number of patient loads that they were not used to. And then the acuity of these patients was really high as well. So there was a lot of physical and emotional strain on all healthcare workers. And it's something that we were really not hoping to have to live through again and have to see again, but we are trending that direction.

John Dehlin [00:07:29] Did you see in the previous spike many people pass away from COVID and even. Do you even have a sense for kind of what percentages of people that come into the ICU with COVID remain versus don't make it out?

Rob Mildenhall [00:07:43] Yeah, there's some variable data. At the time, we looked at studies of patients who required mechanical ventilation and their ranges that were about 65 up to the lower 80 percentile. As far as if you were put on a ventilator related to Covid, you had that hybrid percentage of passing away. I saw a lot of death. And when it was at its peak around the winter, the mortality for Covid was number one in the US as far as number one cause of mortality. So it was seen systemically, nationally, and I also saw here, where I work, so most of the time when a patient comes into the icu, they're very ill. And the same goes with people who are infected with COVID And to that point, it's been a different experience, not just treating Covid, but also seeing the systemic effects and the length of time that it causes a patient to be acutely ill.

John Dehlin [00:08:48] So what are you seeing now with the recent surge?

Rob Mildenhall [00:08:53] Right now we're seeing obviously a higher number of patients coming in at a pretty accelerated rate. And as far as Patient population, there is a little bit of variability in the sense that we're seeing younger patients, patients who have not had prior health issues, maybe just a little overweight.

John Dehlin [00:09:13] And when you say younger, like, what types of ages is it bottoming out at?

Rob Mildenhall [00:09:18] Yeah, I would probably say that the averages before felt more like 60 to 80 years old. Now it's more like 40 to 60 years old.

John Dehlin [00:09:28] Okay. That's the average.

Rob Mildenhall [00:09:30] The average age, I'm gonna. Yeah, I'm gonna say it's in the late 40s, early 50s.

John Dehlin [00:09:34] Yeah. So younger people.

Rob Mildenhall [00:09:36] Younger people. And nationally, statistically, there's been a lot.

John Dehlin [00:09:40] Which means that if there's a bell curve, people in their 20s and 30s are being. Some are being admitted even as young as their 20s and 30s.

Rob Mildenhall [00:09:48] Absolutely. And these are 20 and 30 year olds without any prior medical issues, maybe overweight. And we're seeing them more acutely ill. We're seeing them requiring higher levels of oxygen than we saw before. Absolutely.

John Dehlin [00:10:03] So sicker than the last spike and requiring more levels of oxygen. And younger.

Rob Mildenhall [00:10:08] And younger. And these are patients that are coming into intensive care unit where I work at. Yes.

John Dehlin [00:10:14] Okay. What are you seeing in terms of those who have been. Percentages, breakdowns of those who have been vaccinated, who, who are being admitted to the ICU versus those that have not been vaccinated.

Rob Mildenhall [00:10:25] And what I've seen locally does fit with, sort of with the national picture. I would say right now, with the current data that we have, ICU admissions are making up 85 to 90 plus percent unvaccinated patients. So a small proportion of those patients are vaccinated. And those patients typically are older in age and have multiple medical problems and complications that come in with the vaccine. And that's seen nationally, that ICUs are being filled up with a similar number, up to 90% that are unvaccinated.

John Dehlin [00:11:03] So you're seeing significantly more admissions of the unvaccinated than vaccinated, Maybe nine times greater.

Rob Mildenhall [00:11:11] Yes, it's making up the bulk of our patient census. And again, the acuity of illness is significantly higher.

John Dehlin [00:11:20] Okay. Some people, you know, there are all sorts of. Well, let me come back to that. So what are the symptoms? You know, what, how severe? You know, sometimes there are rumors that, like, oh, it's just normal cold and flu season. And, you know, what doctors are doing is they're just, you know, over prescribing a treatment to people that really don't have a level of severity that requires this. So, you know, basically just saying they're putting basic people with, with just regular colds and flus in the icu. What, what state does someone need to be in to be admitted to an ICU there?

Rob Mildenhall [00:11:58] It's a great question. So what I'd say is to that point is there's a, obviously not everyone who gets the virus is going to have a severe acute illness. If that were the case, you couldn't find a hospital ER with anyone that'd be able to see you. Although a smaller percentage of patients become acutely ill, those who do become acutely ill are severely sick. And they're presenting in a way that we had never seen prior to the pandemic as far as the degree acuity and how sick they are, the amount of time that they're sick and the downstream effects that are related to the patients that are critically ill in the icu, related to Covid. So patients that come into the icu, like I said, a large portion of them come in with respiratory issues. These patients are breathing 40 to 50 times a minute. They're on maximum oxygen support. So not just the small nasal cannula, they have higher oxygen support needs. Face mask, high flow nasal cannula, BiPAP. And these patients are breathing a lot faster than we typically see someone with respiratory failure. They're sweaty a lot of the times, they're confused, their heart rates are really high. And that's in response to the systemic inflammatory effects of the infection and the lung injury that occurs. Again, we see patients that get lung injury from other diseases, but to this degree we haven't seen. And two, the amount of time it takes for these patients who get on a ventilator to come off is something we haven't seen. Excuse me, Specifically this volume of patients they'll get on a ventilator and they can stay on for weeks before they can either one, come off a ventilator, two, get a tracheostomy, which is getting a long term tube in your neck, that they can stay on the ventilator longer or three, pass away. So we do everything that we can to avoid these patients being put on a ventilator because we know the course is long and it's not so much the ventilator causing the damage or the, or the issues, it's because the disease has caused such injury to the body, to the organs, specifically the lung. It takes such a long time to recover and the amount of support they need just to keep their oxygen levels at a safe concentration, it takes a lot of effort. And again, I just haven't seen it on this scale or Magnitude before.

John Dehlin [00:14:51] So if I'm hearing you right, in, in addition to the severity of the cases you're seeing, you're not seeing a lot of basic cold and flus in the icu. It's COVID patients, correct?

Rob Mildenhall [00:15:02] Yeah, these are. These are. So when we admit anyone to the hospital, we've been doing this since we've had the rapid test. They could come in for an elective surgery, they could come in with stomach or stomach pain, nausea, vomiting, or testing them. So we have to make sure we keep patients who do not have the infection, say, from acquiring infection from staff as well as other patients in the hospital. So they're tested, and they are tested in the ER before they're even sent up to the icu.

Vaccines, Long-Term Effects, and Addressing Common Concerns

John Dehlin [00:15:38] There is so much overwhelming fear in some circles about the vaccine itself and what people are calling vaccine injury. In other words, a perception that the harm, the risk of harm due to the vaccine is as significant or even more significant than the risk of, or the severity of actually contracting Covid. How common is it, if at all, for you to see a patient in the ICU from a vaccine injury? Are vaccine injured people showing up in the ICUs?

Rob Mildenhall [00:16:17] I personally have not seen any patients in the intensive care unit, Never that were admitted for a vaccine related injury.

John Dehlin [00:16:27] Okay, so almost all Covid so far never seen one admission from a vaccine injury, correct?

Rob Mildenhall [00:16:37] That is correct.

John Dehlin [00:16:38] Okay, all right. That's super important because I think that's one of the biggest rumors out there.

Rob Mildenhall [00:16:44] Absolutely.

John Dehlin [00:16:45] Okay, so I think you've already talked about how severe the treatment is. Do you, do you want to add anything else about the long term consequences of actually contracting Covid and ending up in the icu? Obviously, death is a very severe. But there are also patients that either aren't admitted to the ICU or successfully leave the ICU, but still have long term consequences. Is that right?

Rob Mildenhall [00:17:11] Yeah. Lingering Covid or long term Covid is a real thing. And what we have found that the higher degree of injury your body sustains, your lungs sustains, the higher risk you have of long term Covid symptoms. So for instance, if you are able, if you're that small percentage that survives an ICU admission related to Covid, you're on a ventilator, you miraculously come off the ventilator. It's not that you walk out and you feel 100% and you're ready to go run a 5K or do whatever it is you were doing beforehand. You're typically sent to rehab facilities because you're musculoskeletal strength is significantly decreased. I mean, you have to imagine the amount of muscular atrophy or your muscle wasting that occurs not just from the weakness that occurs related to the infection, but also laying in a bed for weeks. There's a lot of effects that just laying in a bed several weeks can cause, can put you at risk not just for weakness, but you're at risk for blood clots. And we give higher doses of medications to help prevent these clots. But Covid in itself is a risk factor for clotting in the hospital and shortly thereafter even. And I've had patients in the hospital that get strokes, that get blood clots to the brain, that get blood clots in veins. And you know, these patients can have this occur when they leave the hospital. And so there's just a lot of follow up that takes place. And specifically for the lung injury patients, I have some that come to my clinic that are still needing oxygen months out. And there have been some therapies that have early studies that support some possible recovery. But all in all, there's just not enough information that there is a foolproof treatment for when these patients get out that sustain lung injury long term or how long they maintain this lung injury and how much they will recover. In fact, I've had to make some referrals for lung transplants because these patients who survived are not recovering enough to sustain any sort of meaningful recovery from a sense of getting around and just doing day to day routine things like going to the kitchen, going to the car, they're severely short of breath. So this is a real thing. And typically we see a higher predominance in the patients that survive these ICU admissions.

John Dehlin [00:20:05] Okay, so some have very severe long term consequences, including lung transplants and never fully recovering and prolonged oxygen use, et cetera.

Rob Mildenhall [00:20:17] New York, actually, because they had a high predominance of the initial surgery cases, had one of their highest lung transplant referrals. Now, to that point, I'm not saying everyone who comes out of the ICU is gonna need a lung transplant, but I see severity of lingering respiratory symptoms that range from patients who get better and in weeks to months, or those who sustain shortness of breath and some who sustain needs for oxygen thereafter. There's patients who have what is called a Covid fog in their brain and they stay confused for weeks and months on end. So it can involve multiple organs and it can drag out a long period of time. And what it's going to do five years from now, we're not sure. But I can say that these symptoms and organ injury related from COVID 19 infections, they're going to be lasting longer than we expect in some patients.

John Dehlin [00:21:20] Okay, let me try and, and just ask you a few of kind of the, the rumors that are out there that are kind of keeping people from getting the vaccine. And I'm just going to share a couple with you here that are kind of directly related to, you know, working, working at a hospital in an icu. There are a lot of really skeptical people that just don't trust institutions or professionals. And some would say that either you as a doctor or hospitals as a money making corporation or nonprofit are like literally just kind of finding a way to milk this situation. In other words, you're either diagnosing people that aren't really sick and sort of like forcing them into the ICUs so that you can like charge them more and make more money and maybe even forcing trachs or intubation because there's more money involved. And then maybe you're even doing that to people just with general colds and flus and not people that have really severe illness. Yeah. And so that it's really just about doctors or hospitals just cashing in and making as much money and forcing not so sick people into very severe consequences. How would you respond to that type of fear or suspicion?

Rob Mildenhall [00:22:37] Well, first off, those who go into medicine, we take a note that's do no harm. And this goes into a variety of things and how we treat patients, this goes into the vaccine. And the fact that we're promoting the vaccine would be a little counterintuitive if the vaccine reduces hospitalizations and deaths, and we would not be promoting it if that was our end goal. Also, the pandemic has led to elective surgeries having to shut down. And if you look at a way hospital runs from a fiscal standpoint, those elective surgeries bring in a lot more money. And so when you're having a hospital having to shut down elective procedures that typically bring a high yield of income to a hospital, that also goes against that argument as well. I was fearful after seeing statistics and trends in the US and Louisiana, Missouri, Texas and Florida, that I'd have to relive the nightmare I had to live through in the fall and winter. I, I haven't met a physician of any specialty, including er, critical care, general medicine, that wants to relive what we had to relive. Watching the number of deaths, watching patients unable to see their family, calling them on the phone or on an iPad, saying their goodbyes because they don't know if they're going to come off the ventilator again. Calling families who had to see their loved ones the last time as they approached death because they were not allowed to come in due to the infection risk, except in specific cases where they were letting go of all life support and putting them on a comfort care pathway. None of us want to see that, none of us want to relive that. And the other thing it does, the downstream effect that more COVID patients does is it causes what we see more predominantly pre pandemic, the heart attack patients, septic patients, patients with other organ injuries, patients who need treatments for surgical needs, patients with strokes. All other medical issues that we deal within a hospital can be put to the on the back burner because of the amount of resources and energy that are needed to take care of these patients and just the sheer volume. So I can promise you, if you ran into any physician, nurse, administrator, that they would do everything and anything that they can to prevent what reliving another pandemic surge like we had and are transitioning towards. So I have strong emotions, I guess to that point, because that's the reason why I'm on here, is to make sure I can educate and inform individuals the importance of getting vaccinated.

John Dehlin [00:25:59] Thank you for that. And it's kind of an insulting question to think that you, Dr. Mildenhall, would intubate somebody just to make more money when they really didn't need it. It's a really serious and offensive.

Rob Mildenhall [00:26:17] I mean when you're looking at lack of like you're looking around and there's not any available ventilators, which we came pretty close to. We were fortunate our healthcare system had purchased a significant amount, but there was a while where we were looking around and weren't any ventilators, but one or two. There's hospitals that run out of oxygen supply and we came pretty close to that too, so. And again, like I had said earlier, we do everything we can to avoid intubation, not just because of the resources or lack of ventilators, but we know that when they get that sick, their mortality rate increases because of the illness and the acuity of the illness is worsening and causing a systemic crash to the body.

John Dehlin [00:27:11] Yeah. In terms, first of all, does your hospital force your medical staff to get the vaccine?

Rob Mildenhall [00:27:22] No, not at this time they don't. Obviously education and this is with everything from taking care of patients, infection control. We are always trying to provide the best up to date services and treatment and prevention for our patients. But we currently, at this time, the hospital is not forcing us to, but education has been a big part of what we're dealing with.

John Dehlin [00:27:50] And so what percentage of the medical staff, as far as you know, have just voluntarily chosen to get the vaccine?

Rob Mildenhall [00:27:59] I'll, I'll go into at least a sort of hierarchy of who has been vaccinated. From a healthcare staff standpoint, physicians are in the 90th percentile, upper 9th percentile administration and then actually our environmental services fall after that. And unfortunately our nursing vaccination rate is lower, at least where I work. I've heard in different areas of the country there's some similar trends as well. And I think it's more sort of geographic region. But there's been some hesitancy with nurses.

John Dehlin [00:28:37] But the doctors overwhelmingly are just voluntarily choosing to get the vaccine, correct?

Rob Mildenhall [00:28:43] Yeah. And again, the vaccines, like anything else in medicine, we do our due diligence to keep up to date with the most accurate studies and information, make sure that we look at the benefit risk ratio. And this is with everything we do in medicine. What's going to provide the patients the best benefit and provide them the lowest risk and what's going to improve outcomes? What's going to improve them getting out of the hospital alive? What's going to improve, improve them getting in the hospital sooner. So we've been looking at this information for some time as far as keeping up to date on treatments, on everything Covid related. I'm reading daily because it's a moving target, especially with the variant recently. I want to make sure I'm providing my patients the most up to date care and treatment and educating them to make sure one, we can avoid getting infected. And if they do become ill enough, what can I do to help their chances to come out alive?

John Dehlin [00:29:49] And I'm just going to guess that since the percentage is, is well over 90% for doctors, that, that, that participation in the vaccine crosses all ideological lines. Okay, to kind of conclude, let me just ask you just very directly, what are you seeing in terms of the risk of vaccine injury, in other words, being harmed by receiving the vaccine versus the risk of actually getting Covid if you don't get the vaccine and or serious injury or death if you don't get the vaccine.

Rob Mildenhall [00:30:33] So I would say prior to the delta variant, the vaccines that were available were very protective and not just keeping you out of the hospital and lowering your risk of death, but just even getting the infection. The delta variant, again, like I said, the virus is a moving target due to mutation. The virus now is Obviously able to penetrate patients who are vaccinated regarding becoming infected. Okay. But at least from a statistical standpoint, the rates of hospitalizations and deaths for those who are vaccinated versus unvaccinated we discussed before are significantly separated as far as percentages are concerned. Now you look at the risk of an adverse event or side effect from the vaccine. It is statistically there's a chasm between getting a side effect versus getting a benefit from the vaccine, whether it's getting the infection, how acutely ill do you get from the infection and do you survive the infection? And the other thing that we found as well is transmitting the infection to others. Because a lot of times people say I'm young, I'm healthy, if I get it, it's going to be like a cold. If I feel anything, I'm going to be fine. But what if you happen to transmit that infection to a parent, to a grandparent, to a loved one, to a stranger? And that's why we've been pushing the vaccine more so, not just to protect yourself, but to protect others. And there's a lot of misleading information about some of the side effects that the vaccine causes. And depending on the type of vaccine you have received, your risk factors can include inflamed muscle tissue, which is a still under 1% probability. You can also have effects of increased risk of blood clots as well as nerve related disease, again less than 1%. Way below that. The chasm between a side effect versus becoming infected or becoming infected and getting sick, it's a wide gap. Again, it goes down to the benefit risk ratio, the benefit of getting the vaccine versus a risk of an adverse event or side effect. If it were close or even kind of close, I can understand some of the hesitancy, but it's not even close.

John Dehlin [00:33:11] Okay, so let me just see if I can try and summarize. If you. So the risk of getting injured from the vaccine as far as you've seen is incredibly small. And the benefits are huge in that it's going to dramatically decrease the chance you're going to end up in the hospital and, or the ICU and or die. Is that part right?

Rob Mildenhall [00:33:35] Absolutely. As well as protecting loved ones, family,

John Dehlin [00:33:39] and will protect your grandparents, your loved ones, your neighbors, your friends, your kids, et cetera. And then on the flip side, people who don't get, who choose not to get the vaccine, pretty much almost all of the people going to the icu, being intubated and passing away are people who chose not to get the vaccine. Is that correct?

Rob Mildenhall [00:34:05] Yes, I mean, upwards of 90%. That's a hard statistic to argue with.

John Dehlin [00:34:09] And you've seen. I'm going to repeat this, you've seen no one in the ICU from a vaccine injury, is that correct?

Rob Mildenhall [00:34:14] 100%.

John Dehlin [00:34:16] Okay. All right. So your overall advice to people, based on the science, based on the evidence, and based on your feet on the ground in.

Rob Mildenhall [00:34:26] In the icu, is get vaccinated. Make sure that you're wearing masks, that you're following CDC guidelines, that you're getting sound information from valid resources, and if you have any hesitancy, talking to a physician, qualified physician who can give you the correct information. Because the amount of misinformation out there is beyond anything I could have comprehended. And I can guarantee you every physician wants every human being to not get the infection wanted if they do come out alive. And part of that is getting the vaccine. And we are not biased by money, political affiliation, geographically influenced, religious, it doesn't matter. Our only bias is to get people healthy, to keep them from getting infected. And if they do, give them the best chance to survive. Yeah.

John Dehlin [00:35:34] And if the prophet is going. If the hospital is going to experience higher profits, it's not going to do that through Covid. It's going to do that through the elective procedures that will come once the ICUs clear up and the hospitals are free to engage in the elective procedures. Correct.

Rob Mildenhall [00:35:53] Although ICUs may bring a large amount of income, it's predominantly the elective procedures that bring hospitals money. So you can trust me, when they shut down elective procedures, they're not. They're doing it because of the safety of patients, not for money. Not for money.

John Dehlin [00:36:13] All right, Dr. Mildenhall, maybe we can have you back to talk about your experiences with the church and the vaccine and Covid. But maybe we'll save that for next time. How does that sound?

Rob Mildenhall [00:36:24] I'll be happy to do it. And thanks again for having me on. And again, just like your journey is to provide truth and information so people can make decisions that affect their lives and do so with informed consent, I'm trying to do the same on this end with the pandemic and COVID 19. So thank you for having me on. Means a lot.

John Dehlin [00:36:43] Thanks, Dr. Mildenhall. And also thanks for staying up late with this. I know it's 10:30pm Your time.

Rob Mildenhall [00:36:49] We're used to odd hours in critical care, so there's a lot of. There's caffeine anywhere we can find it.

John Dehlin [00:36:55] All right, well, don't drink too much because you know that's a bad thing. No, I'm just kidding.

Rob Mildenhall [00:36:59] Especially green tea. Thank you.

John Dehlin [00:37:01] All right, Dr. Mildenhall, you take care and come back and see you soon?

Rob Mildenhall [00:37:04] Absolutely. Thank you.

John Dehlin [00:37:05] Thanks. Get some sleep.

Rob Mildenhall [00:37:07] Thanks.

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