Maggie McKay (Host): Having a stroke is disconcerting to say the least, but what about the whole process, the treatment and recovery? Where do you go from there? And how do you recover? Today, we're going to get a firsthand account from the CEO of Beebe Healthcare, Dr. David Tam, and his doctor, Dr. Reid Gooch.

Welcome to the Beebe Healthcare Podcast. I'm your host, Maggie McKay. Thank you both for being here.

David Tam, MD: Thank you. Good to be here.

Michael Reid Gooch, MD: Thank you for having us.

Host: Would you please introduce yourselves? We'll start with you, Dr. Tam.

David Tam, MD: Hi. Hello. My name is Dr. David Tam. I'm the President and CEO of Beebe Healthcare.

Michael Reid Gooch, MD: And my name is Reid Gooch. I'm a neurosurgeon, a cerebrovascular neurosurgeon, and Associate Professor at Thomas Jefferson University in Philadelphia.

Host: Thank you. So, Dr. Tam, can you give us a brief background of what happened when you had your stroke and what the care was like at Beebe Healthcare?

David Tam, MD: Sure. You know, I am the CEO here. And I woke up on a Friday morning, felt a little tired, but was able to just do all the things that I do every morning. Got up, got dressed, went to the office. And at the office, I just felt a little unsteady. There was a little bit about my tongue feeling a little funny, but not a classic dysarthria or some other kind of speech problems. I could type just fine. But for some reason, I couldn't sign my name. My hand wouldn't respond to signing my name, which, as you know, as a CEO, I do a lot of. I kept saying, "Well, I'm just tired or maybe I just ate something funny or I slept on my hand wrong," and realized that I needed to probably go to a meeting. And when I stepped out, my assistant said, "You better go to the ER. You don't look so good." She threatened to call my wife. I said, "Okay, I'll go to the ER." And at the ER, I said, I think I'm having a stroke, and started from there in terms of the treatment.

Host: Tell us what it was like going to the ER. I mean, you're right in the building already, right?

David Tam, MD: Yeah. Well, number one, I don't know if you know this, but I'm a neurologist myself. I'm a pediatric neurologist, but it was still one of those things where I wasn't sure that I was having a stroke. Maybe it's denial, and maybe it's just fear about by saying that you have a stroke, maybe it'll happen, and then all the potential consequences.

But I went in, and you know, I know we'll talk more about this, but we have a protocol in place here at Beebe Healthcare. We're a local, non-profit, independent community health system. And we have worked with Jefferson to create the protocol to ensure that everybody has a standardized approach to stroke management, evaluation, diagnosis, and treatment. So, I actually went to the front desk. I didn't go in the back like a CEO. I didn't call the chief physician. I said, "Hey, I think I'm having a stroke." And when the front desk realized that I wasn't like testing them or something, they got me in the back and they went through the entire protocol of the evaluation process as established to determine what was going on with me.

Host: Wow. Were you scared? I mean, dumb question.

David Tam, MD: Yeah, I think so. I think there's always an apprehension, and I think that's something that I wanted to talk about a lot with people as I talked about my experience. There's a lot of denial that maybe it's something else, maybe if I wait long enough. But as a result, I got a CT scan right away, CT with angio as Dr. Gooch will tell you. And then, I was in the exam room right away, got evaluated right away, and within literally minutes, had the Jefferson neurologist on our tele-neuroscience network talking to me about what the symptoms were, and making a decision about what the treatment course was. To be perfectly frank, I was a little bit-- I don't think I was scared yet. I was still trying to figure out what the heck was going on.

Host: Right. And Dr. Gooch, tell us what you do and about the Jefferson robot.

Michael Reid Gooch, MD: Basically, what Dr. Tam's referring to is if there's any suspicion for a stroke, and I mean any suspicion, they have a very low threshold for bringing the neurologist in on a robot, which is basically an iPad on wheels. They can do a FaceTime evaluation, which it's all HIPAA compliant and this first thing, but there's a neurologist that's on call who will get a phone call that there's a patient at Beebe Health, for instance, that there's concern for a stroke, meanwhile the ER physician that's with the patient in the emergency room will wheel this robot into the room.

And then, the actual software, I mean, it's 2024, it's incredible, but we just use it on our phone, or you can do it on a computer. But you can be out and about, have your phone, and then they can beam in immediately in a secure way to see the patient, talk with the family, talk with the physician, and they can view imaging. And usually, what will happen is they'll evaluate the patient and the ER physician will examine them. I mean, obviously, if you're awake and interactive, that's easy. But if the person has significantly altered mental status, the physician that's there can help with the exam.

And then, usually, what will happen is they will the robot outside of the room and then the ER physician and the neurologist will talk and they'll come up with a plan, figure out if there's any other imaging that needs to be done, which is always going to be a CT scan to look to see if there's a bleed. And then, also vessel imaging, so a CT angiogram where they give contrast through the vein and then light up the arteries in the head to try to look to see if there's a large vessel occlusion.

The first decision to make is whether or not there's going to be administration of thrombolytic, which is tenecteplase is what we generally give now. And that is an IV medication to help break up the clot. Obviously, you would not do that if you see that the person has a bleed on the CAT scan. But that decision is made immediately with the ER physician and the neurologist over the robot. So, that's the first decision to be made.

The next decision is, if there is a large vessel occlusion, which is literally, an artery that is blocked, that we can see on the CT angiogram. If that is the case, then the decision is made, all right, should this person be transferred to another center, which has the ability to do a procedure and emergently go in and open up that occlusion, which in Dr. Tam's case, it was a little bit more complex than that because he basically had a severe narrowing that there was a concern that this could go on to shut down. So in those cases, we again have a low threshold for overreacting, so to speak. So, we have a low threshold for initiating that transfer. It should be said that the majority of the time that the robot is used, we're able to keep the patient there. We're able to say, "Look, you know, you're at a hospital that is more than capable of treating you and you don't need to be transferred, which obviously is extremely helpful. But in the cases where the patient needs to be transferred, then that is done immediately. And then, that's how I got to meet Dr. Tam because I am part of the team that gets alerted when there's a patient coming in who potentially has a large vessel occlusion.

Host: And let's just talk a little bit about transportation. When a patient does need to be transferred, are they airlifted or an ambulance? How does that work?

Michael Reid Gooch, MD: So, it depends. But in the case of a stroke, if it's an acute stroke, the time is brain, so they say, so it's as soon as possible. So if the weather's good and they can fly the patient, then that is done. If not, then it would be in an ambulance. And for Dr. Tam, I think it was a sunny day, so he got a quick ride.

Host: Dr. Gooch, you've talked a little bit about this, but let's just talk more about the teamwork and the decision-making at Jefferson.

Michael Reid Gooch, MD: Yeah. So, I've been with Jefferson for seven years. And Dr. Rosenwasser has really built up this program long before I came, but we have a pretty robust and well established group of neurologists and neurosurgeons. The other thing is just the attitude for us is always, you know, auto accept, basically. Like we don't turn anyone away. We have relationships with other hospitals where we don't look for reasons to deny transfers coming in. So, the whole process as far as like, if a neurologist is concerned and wants the patient brought in, they get brought immediately. They don't even get brought to the hospital, to the ICU, they get brought to the room where we do the procedure so that the patient can be evaluated there. The whole team is called in. We call this an I&R alert. So, the neurologist on the robot initiates the I&R alert. The transfer center knows what that means. The transfer center coordinates the physical transfer of the patient. But meanwhile, there's a team of people. There's a nurses. There's technologists. And then, there's physicians that are ready and waiting for the patient when they get there. So once they get there, they're further evaluated by obviously a physical exam, but also more imaging can be done if needed. And then if we do make the decision to go ahead and do a procedure to try to open up the blood vessel, then the patient is simply just wheeled right into the room and that happens.

Host: The collaboration between Beebe and Jefferson sounds amazing. Like, you guys have it down for sure. Dr. Tam, how does it feel, especially as a CEO, to have this care available to you and to the community? You must be really proud.

David Tam, MD: I would never have guessed that I would be the personal recipient of this. Because when I got here four years ago from a large health system on the West Coast, where neurologists were available 24/7, 365, right? Academic medical center. And here we are in a place like Lewes, Delaware, which is a lovely place to live, but we have a medical physician shortage, not enough neurologists to cover that kind of service, and recognizing that time is brain, as Dr. Gooch said. We felt it was absolutely necessary to reach out to Jefferson and, of course, Dr. Rosenwasser to make sure we could have that kind of access.

It wasn't just the access, if I may, it's great to have Dr. Gooch and all the professionals on the device. But it really also involved, and I'm sure Dr. Gooch can speak to it, having nurses trained at Jefferson as well as at Beebe. So, the idea was our nurses at Beebe Healthcare knew what to do. They knew what the protocol was, and not just in the ER, but now in the ICU and in the ward. Because prior to this happening, prior to Jefferson coming aboard, we had to send everybody who had a stroke to Philadelphia. All the right things to do for all the right medical reasons. But now, with Jefferson's partnership, we've now kept those patients here close to home so their loved ones can be here and they can visit and get the care they need to then do the recovery.

Who would have thought that all this time later, I would be the guy that would show up and we just follow the protocol and next thing you know, as Dr. Gooch will tell you, I had waited too long to get that TNK. As he will explain, there's a certain timeframe in which you can get that medication. And if it goes too long, it doesn't really make a difference and it could potentially hurt you. In this case, though, the collaboration between the Beebe ER and Dr. Gooch, Dr. Rosenwasser's team helped prepare and create another kind of medication regimen to make the clot to resolve as best as possible so that I could get the best recovery. And I think those are the things besides the technology, the collaboration that makes this program so great for our patients and our community.

Host: And Dr. Gooch, what does it mean to you to be able to provide care to other areas outside of Philadelphia?

Michael Reid Gooch, MD: I mean, it's fantastic. And it's meaningful because, I mean, you know, especially when we're deep into the healthcare career, for instance, is you really see that a lot of it is luck as far as like where you are when you get sick, right? And especially for something like stroke, where it's just time is the most important thing and you want to be cared for as quickly as possible. The ability to kind of extend the arm, so to speak, of the health system so that we can efficiently get the patients in that need to be treated is meaningful. And there's still a lot more to be done. I mean, we're fortunate that Philadelphia, I mean, there's a lot of surrounding communities that we kind of take care of. But if you look at a map of the United States, I mean, there's still plenty of areas in the country that are still hours away from this sort of care. But it's extremely meaningful.

And one other thing on the side note, like, for instance, it's not uncommon where we will do these interventions for people. And I never see them again in person because it's too far for them. So, we'll do followups, telemedicine, they're doing fine. They don't need to drive the three hours or two and a half hours to come, but that just kind of speaks to how extensive the reach of the program is.

Host: That is amazing. Some people are frustrated with technology, but when you hear it in this context, it's amazing. Thank goodness for technology. Dr. Tam, has this experience had any influence on your leadership?

David Tam, MD: Absolutely. You know, I served in the Navy for a long time. And telemedicine, in some respects, was something that we did a lot of when you're deployed in Afghanistan and you got a patient. There's a lot of work that's being done in other ways, I won't say primitive, but compared to today's technology.

So coming here today, we really are now working with Jefferson in partnership, not just on Neurology, but on other kinds of healthcare issues where there is a shortage of people with certain kinds of subspecialty cancer care or cardiovascular services. You know, we do not have academic medicine. We may have a doctor who knows how to do it, but you got to have the intensive care unit. You got to have the Neurosciences ICU and the nurses or the Cardiothoracic or those specialties. And so, being able to use technology in multiple ways is an opportunity to extend the clinical continuum. And from our perspective, it helps us with managing physician shortages or not being able to get care. Like we can go right now and reach out to Sidney Kimmel where you have a National Cancer Institute physician who is designated to be able to provide clinical trial medication and then we can provide that care here in Lower Delaware without having that patient go two or three times a week to Philadelphia. That's good for the patient. That's good for the independent community health system. And I think it's good for Jefferson as well.

Host: Absolutely. Dr. Gooch, in a nutshell, what can people expect who have had a stroke? What can they expect when they receive this care as far as recovery? I know you said a lot of times they can just check in with you telemedically, I guess you'd say, but what's the recovery like?

Michael Reid Gooch, MD: So, part of the hospitalization is kind of getting through the acute phase of figuring out if a person needs to go to rehab or something like that, but also the workup, trying to establish why does this happened and what medications need to be taken to prevent it from happening in the future.

The follow up is almost always there's follow up with not just your primary care physician, but also a neurologist, oftentimes a cardiologist. And then, from the neurosurgical standpoint, we continue to follow the patients. But main thing is in preventative, trying to prevent a person from having another event. And then, it depends on, you know, the level of disability from a stroke, if there's going to be more rehab or speech therapy or something like that.

The other thing I will say is there's more and more devices and technologies that are coming out to help patients who are even years out from a stroke. So, there's going to be much more on the horizon. So, people generally continue to improve over time. Again, it depends what your starting point so to speak is, but it takes months and months and months to years.

Host: Any thoughts in closing that you'd like to share, Dr. Gooch?

Michael Reid Gooch, MD: I would just say that Dr. Tam is a perfect example. Like, here you have a neurologist who is reluctant to go to the ER, we see that all the time, where people are just like, "Well, I felt weird for, you know, a long time or a few hours, but I just, you know, kind of waited for it to pass." And we see that with family members too, where it's like, you know, someone was slurring their speech and the family member just said, "Oh, that was weird," and then, just kind of like let it go until the morning or something like that.

So, I think the big thing in this sort of podcast is helpful to kind of just get the word out. So, if you suspect something, really just try to drill down on your loved one or even yourself, like look in the mirror, see if you have any facial weakness, you know. And if there is concern for a stroke, then the answer is you got to call 911. I mean, obviously if you work at a hospital, go down to the emergency room. But this is not like, you know, get in line at the ER and just go to the waiting room. If you do not want to wait on line in the ER, you call 911, you say you're concerned, you're having a stroke, they will suck you up and it turns into a very organized circus, which is a good thing, because we want to just try to figure out what's going on as soon as possible.

Host: Right. Dr. Tam, any thoughts in closing?

David Tam, MD: To follow up with what Dr. Gooch says, I was a neurologist for a long time. And the fact of the matter is there was a point where getting a diagnosis of a stroke was pretty devastating, right? Because there was no treatment and you had to go through this terrible process of paralysis and deficit, being bedridden. And I think everything works. Everything works really well. I've had a complete recovery. And I think that it's so important for people to know that times have changed, and it is so important to get evaluated, diagnosed and then treated appropriately just as fast as possible. And I think that's one of the reasons why for us, we really are excited about having this teleneurology network to make sure that we get that treatment right away and not have to wait for someone to come in from some other part of town or something else like that.

Host: Right. It is amazing. Well, thank goodness you had such a great outcome. Congratulations on that. And thank you so much, both of you, for sharing your experience and expertise. We appreciate it.

David Tam, MD: Can I just say one last thing, Maggie?

Host: Of course.

David Tam, MD: I just want to say thanks to Dr. Gooch. I remember being there. I remember in the basement of the Farber Building, having that level of expertise and I'm a physician too, but having that level of a specialist being there, knowing already what's going on and saying, "It's going to be okay." You know, my wife was not there because it was helicopter. I was all by myself. I have to tell you that it's a great program, and I'm very grateful for everybody from Rob down to everybody else for the work that they do in Philadelphia. So, thanks a lot, Dr. Gooch.

Michael Reid Gooch, MD: You're welcome. Our pleasure. You look great.

Host: You do. it's just amazing. Thank you both again. That is again Dr. David Tam and Dr. Reid Gooch. To learn more, please visit beebehealthcare.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to the Beebe Healthcare Podcast.