This week I am talking to Alex Jahangir, MD, (@alexjahangir) Vice president for business development, vice-chair of orthopedic surgery, and director of the division of orthopedic trauma at Vanderbilt University Medical Center, (@VanderbiltUP) as well as the executive medical director of the Vanderbilt Trauma, Burn, and Emergency Surgery Patient Care Center. He is the author of Hot Spot: A Doctor’s Diary from the Pandemic.
A Doctor’s Diary from the Pandemic
Alex’s background helped guide him to the point he found himself in Nashville at the height of the Pandemic as the chair of the Metro Nashville Board of Health and head of the city’s COVID-19 task force. Not something you might expect for an Orthopedic Trauma surgeon but actually something that as he describes he was well prepared for thanks to working in a Level 1 Trauma center.
We discuss Alex’s journey through the pandemic, the strain this put on him and his colleagues and family, and the uncertainty, alienation, criticism, and public pressure that he withstood on a daily basis. Thanks to his work as the leader of the Board of Health he was appointed by the mayor of Nashville to lead the city’s Metro Coronavirus Task Force.
Listen in to hear what he learned, what we all should learn, and importantly the lack of available insight from our scientific bodies and institutions that found him reaching out for more local help to steer the city through the worst of the pandemic
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Today, I’m delighted to be joined by Dr. Alex, your hanger. He is an orthopedic trauma surgeon Alex, thanks for joining me today.
Alex Jahangir
So great to be with you today. Thank you.
Nick van Terheyden
So, as I do with all of my guests, we’re gonna get into the details. This particular story takes an unusual turn, given your backdrop, but I think it’s important to set the context. Tell us a little bit about how you arrived at this point in your career?
Alex Jahangir
Well, you know, I’m a orthopedic trauma surgeon, right, so I’ve for nearly 20 years have focused on fixing broken bones. When the COVID pandemic happened, I ended up being the chair of the Board of Health for Nashville, Tennessee, and let’s be honest, who the heck would have knew the National Health Board of Health much just who the chair was. But on March 7 2020, when Nashville’s first COVID case presented, I was that person. At that same moment, we also didn’t have a director of health. And so I ended up becoming asked by the mayor to kind of help lead the city’s response to the pandemic. So a little bit by happenstance, but that’s innovators kind of how a lot of interesting opportunities present.
Nick van Terheyden
So you were there as the board chair, how did you arrive at that point? Was that something that had just happened because of the work that you were doing in orthopedic trauma?
Alex Jahangir
You know, I So my story is, you know, I grew up, I was born in Iran. And my family when I was six years old, moved from Teheran to Nashville, Tennessee. At that point, you know, the community of Nashville really took my brother and me and my family and we got our, our dental care at the health department got vaccines, learned English, all that. So when I had the opportunity to return back, after all my training, for medicine, back to Nashville in 2009, I really want to get involved in the community. So I started doing work in the community, my trauma background really gave me an insight really to look at issues such as gun violence. Through some work around that, I think the mayor of Nashville, got to know who I was. And when there was an opening on the Board of Health, she appointed me to it again, very atypical because the person I replaced was a well known public health expert. And so my draw job for the next many years to at least to myself was just to learn about the world of public health, especially in the city. happenstance headed to the chair position opened up a couple of years later. And and at that point, the number one job for the chair was to hire a new director of health. And I, through my day job, had a lot of experience hiring executives. And that’s how I got put as chair and that’s how I ended up being there.
Nick van Terheyden
You know, it’s really interesting, but we often find, you know, doors open in front of us, not everybody walks through, in this case, you walk through through a little bit of context and history that found you in this part of the country, wanting to return service, you know, I’ll state for everybody listening. I think almost every physician I know, is there trying to deliver the best possible care to their patients in a variety of ways, depending on the specialty, but we all come at this with, you know, very similar intent. You found yourself in this unusual position, obviously, still practicing orthopedic surgery, although I imagine that practice sort of disappeared a little bit.
Alex Jahangir
Believe it or not, no, I stayed in this call scheduled throughout the entire pandemic response.
Nick van Terheyden
No, I didn’t mean that. I didn’t mean that you didn’t stop contributing. But I imagined that the patient numbers fell off a little bit or not. No,
Alex Jahangir
not really, really. Yeah, by the nature of what I did trauma happens. And you know, while my partners did help me a fair amount, I stayed as much as I could. And and the number stayed about the same. Wow, my, my family took the big, big brunt of it if you want the truth,
Nick van Terheyden
right. Yeah. Because you had to divide even less time up. And I think we all find that with our families, they tend to be the ones that have to give up more than others. So the pandemic hits, I think, you know, there was I want to call it a slow rollout of just sensed this is a problem too. And then suddenly, there was a line drawn in the sand around the country, and things shut down. You’re now assigned to the COVID task force in your specific area. Tell us a little bit about that decision and what happened through that experience.
Alex Jahangir
Yeah, so you know, it’s, I think you’ve said this so well, I think for months, many people all over the world and I know in our Our area here we would kept watching this COVID infection kind of go around, and then all of a sudden, and we and each little hospital system here in Nashville had a plan and there’s public health department a little plan. But really, it wasn’t until the very first patient when all of a sudden everyone’s like, Oh my God, this thing is gonna be so much bigger than a isolated silo response. And so I quickly began because of my role as Board of Health chair, but also because I, the new director, who was starting two days after the first case was from New York didn’t know the city, I quickly use my connections to bring a lot of people together, hospital CEOs, state leaders, city leaders, and through that, we started developing a coordinated city response. But again, by the end of the week, the mayor of Nashville realized that he needed to all in government responses somebody to lead it and, and he asked me to take that role. fun, interesting fact is in the city, at that time, the only person in the state of Tennessee at that time, the only person who declared a public health emergency was the chair of the Board of Health. So not the mayor, not any other entity, not the director of health. And so on that Sunday, when it became a week after the first case, when it became a reality that Nashville was was still booming. And there’s a lot of people going out into tourism and nationalist. So well. We decided, we decided that we need something needed to be done in other cities, they’re already started doing capacity restrictions and so forth. And so the first time that the public health emergency was declared in the city happened that week, and my signature is the one on it. And I think that for me, again, if my objective is what do I do to help my community, which is the whole reason I moved back to the city after I finished my training, this became the most obvious thing to do at that moment. And so that led to almost two years solid years of leading the city’s Task Force, which involves everything from setting up testing sites that tested hundreds of 1000s of people and vaccinated about 50,000 people to the capacity restrictions and other mask mandates and working with businesses and hospital systems and actually setting up a transfer center that kept 700 Nashvillians. Local during the Omicron storm, instead of having to ship them to other hospitals around the country. It all started at the end of the day, like he said, by by picking up a phone and saying yes to a random opportunity. I never saw coming.
Nick van Terheyden
So I don’t think I need you to answer this. I’m going to answer it for you. I imagine you had no hesitation when you were asked. I mean, there’s obviously some personal impact this had on the family. But you know, you you saw it as that opportunity. But in hindsight, looking back now, what I mean, if I’m wrong, please tell me, but what would you wish you’d known at that point in time going forward? I mean, I don’t imagine it would change your decision. But I’m sure there are things that you’ve learned along the way that you go. Hmm, I wish I’d had that.
Alex Jahangir
Yeah, you know, I think there’s so much right, as you know, part of it is I, I’d never been in public service. I’ve never been in public life i. Now subsequently, I’ve done hundreds of media appearances and press conferences and so forth. I tell you that for this reason. There are a lot of great people in this community, that that that stepped up people will never recognize who did a lot of good in the city. I also saw some who wouldn’t. And well, I guess what I wish I had known is that that I guess in every situation, there’s people who are like that. And sometimes one has to be a little bit more deliberative, and who you interact with who you bring into the fold, and really look at people’s motivations. But man, there are so amazing people who I worked with. I also wish I knew then that and we figured this out pretty quickly that that really every community’s response was every community’s response in isolation. There was no unified message. And I kept waiting and waiting and waiting for somebody smarter to me to give give a plan of how we can get through this. And if we had known that. At the time, I think we would have message that a little bit more clearly that, look, there’s not going to be clear answers. There’s going to be some confusion. But here’s what the science, the experts, and tell us and here’s my commitment to be transparent with you, which is what I tried to do throughout the entire pandemic with the public.
Nick van Terheyden
So I think I as I interpret that, you know, for me, it reminds me a lot of you know, when you’ve seen one EMR you’ve seen one EMR. And that was true with the pandemic albeit it was the same virus or mutating lots of times, but I think we’re all taken on little bit by surprise, expecting much more. And it became a sort of a labor for each of these individual groups, you’re thrown into this. Let’s be honest, you’re an orthopedic surgeon. How did that come across? Because it’s not you turn around you go, Alright, got to be a public health. But no, we’ve got an orthopedic surgeon doing this. How did that play out?
Alex Jahangir
So, you know, yeah, so I think here’s, here’s my message. So I am an orthopedic surgeon, I’m specifically an orthopedic trauma surgeon at a level one trauma center, I lead to lead the orthopedic trauma division, I actually lead the entire trauma service line. I think, actually, if you meant I’d say that people that I my success and leading this pandemic, and I do think our city had a successful response compared to a lot of people, a lot of places happened, because as a trauma surgeon, I’m comfortable making decisions with the unknown. I’m comfortable, like an emergency room physician, of sometimes knowing you made the wrong decision and correcting course fast, or knowing that your decision even though you don’t have it all the information can lead to serious implications. And also, knowing how to make decisions quickly and taking charge. And feeling comfortable just like emergency room physician of when you don’t know something to quickly bring in experts to help you right. And if I’m operating on the pelvis and the bladder is ruptured, I’m calling the urologist right away. I think people trained in public health and not everyone only generalizing generally. But a lot of people are trained in public health and epidemiology. It’s definitely more thoughtful approach to pandemic to every situation, right, you think about the implications, you bring in groups to think through things. I believe as a trauma surgeon and my ability to manage it to manage a crisis. That is the skill set we needed at that moment. And that’s why I believe I had the success that we did. And yeah, so I think you know, and would I be the first to tell you, I’m a public public health, or epidemiologists or infectious disease expert, no, could I tell you I sure as heck had access to a lot of good ones who I could think quickly with. Absolutely.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick, the interim gonna list and today I’m talking to Dr. Alex, Joe Hanga. He is a orthopedic trauma surgeon, we were just talking about the response. And you know, I think importantly, the preparation, that working in a level one trauma center, that takes literally, you are the as I talked about the buck stops here, that’s where those serious cases end up. They end up with, you know, as you describe less little information typically coming in, we add to that we change course change direction. And I think, as I’m listening to you, one of the key assets that you brought to bear on this was, number one, a network of people that you had developed over the course of time. And that’s also within the hospital, imagine that, you know, contributed that allowed you to draw upon the resources that helped guide you. So, in many respects, would it be fair to describe you as the conductor versus the driver of the engine?
Alex Jahangir
Oh, absolutely. I think the conductor is a great description, because the people who drove it, you know, when I took this role, the mayor was very clear that he wants experts and science to lead it and with transparency, and I think the conductor is the one that that helps bring the right players into a room. So when we were talking about how to create a drive thru testing centers, I brought process engineers and hospital operations people to help me design that when we were talking about businesses reopening capacity, we brought business leaders and hospitality industry leaders and we were talking about how do we make sure our hospitals stay open and we brought hospitals leader and the one constant all of that, frankly, was was me in a small team of people that I worked with. And we’re again, we’re in a community that has an amazing nationals, a health care, you know, city, there’s a lot of great health care companies and experts from HCA. I mean, health, Shay’s corporate headquarters are here, so very kind that that people they would allow us to tap into Vanderbilt, where I work and ascension, not to mention all the things we had a lot of experts and again, I think conductors a great describer of what we did.
Nick van Terheyden
So let’s move forward. So you’ve you’ve let’s call it settled in although I can’t imagine you ever settled quite into this role. You’re dealing with multiple elements that are probably resisting many of the things that you described, certainly based on the experience that I had you sort of you, you, to me seem a little bit like a lightning rod in all of this that would attract an awful lot of negative response was a lot of that going on and how did you whether that what were your sort of your coping mechanisms?
Alex Jahangir
You know, short answer is yeah, there was a lot of that going on. And it’s really an unfortunate reality of what happened. In fact, funny enough, even as early as this morning, there was some hatred on social media and then working out for out we are it’s kind of blows my mind still. Here’s the thing. I think what I found was the three reasons for this lightning rod. One was the people who I described as, you know, people were hurt, I had one person come up to me, and, you know, their, their, their photographer, he was a photographer, his wife’s a catering business. I mean, their business was devastated. I mean, and they devastated I feel so terrible for them, right. And they, those people, I think what, you know, I understood their pain. And they saw me as their as the reason for it. And while I wasn’t I understood, then there were those people who I call fanatics, I had a person come up to me sneak into where we did our press conferences, and hand me a package and said he was a messenger from the Lord. And, and those people are the ones that really scared me, right, because they believed into this, the crazy stuff that’s being spun out there. And it shows how power of persuasion and when the vacuum of leadership, how fanatical people can get, and those people I worry a lot about. And then third are the people who are entitled, who frankly, didn’t care about the community. And those people were out there too. And, and all of those that hatred was, again, I was the face of it, right? I, for better or for worse, I became the face of this pandemic here in this region. The way I dealt with it was first of all, I told myself, I didn’t care, right, but but I think if we’re being honest yourself, that’s not true. Everybody cares. You know, I was a kid. As a kid, I was bullied a lot in middle school in elementary school, I was the kid from a funny country with a funny name. But you know, I, I lead, I felt that my gut, my North Star was always transparency, expert leadership, or experts guiding and science driving. And I felt if every decision was made with that in mind, I was comfortable with the decision. The thing that was really interesting to me, and it was sad is the people that really didn’t care, though, were my, my family, my parents, my wife. And that is I think we just as a society to really focus more on civility. And, and again, I felt that for the greater part, I know we were doing the right thing for our city with what we knew at that time. And so I, you know, Leadership isn’t easy, and I’m comfortable with that. But but it’s just really kind of sad where society is devolving quit pretty quickly.
Nick van Terheyden
Yeah, I I’ve said this a number of times on my show, I think we shone a spotlight on things that already existed, this wasn’t new, it just became far more apparent. I think it was a surprise to many certainly was to me, I don’t think I had quite established the level that this could rise to obviously huge impact. I’m sorry to hear that. And I think, you know, like so many people trying to do the best with the available knowledge, you know, guiding things in the best possible way. Do you think we’ve learned from this experience? And were this to happen again? or something similar? Do you believe that we’ve got a better chance? Would you step into the fold again? I mean, would that be an option?
Alex Jahangir
So it’s a great question, right? Do I believe we’ve learned how to deal with a pandemic? You know, there was a pandemic playbook written in Oh, four, I believe, by the Bush White House, they did an amazing job from what I understand about it. We didn’t learn then. You know, I think we, I think I think we have as a as a society learned a lot about how the responsive handling also how things that may be problematic. What I worry about for for our region is there are tools that we had at our disposal, public health emergency orders lead that was signed by the Chair of Public Board of Health, able to do maths mandates, capacity restrictions, that politics have now stripped us of here in our state. You know, I wrote a book called hotspot doctors diary of the pandemic. Mainly one of the reasons I wrote it is so as soon as that history remains because I hope we don’t any of us have to deal with this in our lifetime but let’s say two generations from now, we have something similar to what we just went through. What I hope that hasn’t happened is some of the factual information on what we did. Doesn’t get spun and goes out away. I’m very I one thing that gives me hope is I think we’ve just read it there’s like a huge increase 1,000% of people The increase in people entering public health education and classes now, I think there’s the infrastructure and financial infrastructure has been put in to build public health systems, if it maintains will help us as a society. And I hope that the federal government and states really continue to build that data and expertise and community locations. I’m just not as hopeful that that actually will happen. So yes, we’ve learned some stuff. Yes, there’s some reasons for hope. But there’s also some anxiety I have, that we haven’t learned lessons. And if this happens again, and another generation or two, we may be somewhat back to where we are now.
Nick van Terheyden
Yeah, I have to say I read the the detailed pandemic book from the earlier flu pandemic, and was actually quite shocked at how much we had failed to learn from that experience. I imagine there’s going to be a lot of study of this experience and some of the learning opportunities, and hopefully, the application and we see this uptick, I hope, it’s not the short term memory and so forth. We’ve all been changed by this pandemic, what’s changed for you? What do you think? How are you different now?
Alex Jahangir
Yeah, you know, I think for me, first of all, I am hopeful in the good that this community has, will give us personally, I think I’m just more grateful of those opportunities I have, and I want to continue to push to lead our community and our society to help the lesser than us. Right, I think, probably, as you said, problems, we’ve had already seen health disparities being a big one for us. This just highlighted that lack of civility being one, it’s, again, highlight that I want to be somebody who continues to push on these issues to try to bring change to these issues locally, regionally, nationally, in my draft drafted as stronger because of this experience I had.
Nick van Terheyden
So as you think about all of the learning points that you had, throughout that experience, what are some of the small things that you think made the biggest difference in terms of positive impact and contribution, you know, putting to one side, that, you know, they might even have been wrong, because we didn’t know as much, you know, I think of airborne, you know, aerosolized is one of the areas but what what are the small things that you’ve learned along the way that you’ll continue to apply?
Alex Jahangir
So I think, for me, one thing that I think I always try to tell myself as a surgeon, and I tell myself, personally, when it comes to leadership is don’t believe that hype. Always keep your humility, you’re up and down to earth, and listen to everyone, you know, it’s the, it’s the whole Checklist Manifesto of how to avoid or errors, as you listen to everyone, empower everyone to speak up, I think we need to be very deliberative, and doing that when it comes to this. So that’s important, I think we need to pay attention to trends are happening outside of our borders of the United States on a bigger scale, seeing what happens in other countries and learning from them. Because again, we’re not, you know, there’s just given some great information learned if we paid a little bit more attention to what was happening. And we got some people in this cut in this country to do pay attention to Christ site. And then finally, I think, continuing to focus on people, when there isn’t a crisis, around the issues of disparities around issues of preparedness. Let’s not just look at the thing, when it’s shiny and sexy, let’s always pay attention to the foundational things we need to do to keep each other safe and healthy. And that’s critical for me.
Nick van Terheyden
Yeah, I think, you know, important sort of points around, you know, the, the learning opportunities that we can apply that, you know, the shiny object challenge is it’s not just a healthcare problem. I mean, it’s ironic that we’re sort of listening to all this innovation, but we still have all of these people that are sitting completely underserved. You know, failing to gain access, we’ve developed all of this. And I I’ve got to be honest, I worry about the persistence of some of the things we’ve realized, you know, I’ve talked telehealth for 20 plus years, and it was, you know, two years away for the last 10 years. Not from a technical standpoint, but from a you know, political will and reimbursement. It’s now here, but there’s even some talk about pulling back so I hope we can persist and learn and and benefit from, you know, the established details that you’ve been good enough to set out in a book that will, you know, continue to guide hopefully, and learn from those experiences and obviously the contribution, unfortunately as we do each and every week, we’ve run out of time. So it just remains for me to thank you for joining me on the show. Alex. Thanks for joining me.
Alex Jahangir
It’s really a pleasure. Thanks for having me.
