Our extraordinary lungs’ power and fragility [PODCAST]

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“With the obvious accounted for, we turned to the obscure, the area of medicine where judgment and experience come into play. Fortunately, we received sound advice and guidance from the infectious disease physicians. Stick to the basics, they stressed, only do them better. We continued our patient on the first-line anti-TB drugs he had been on, this time at a slightly higher dose, and added one dose intravenously since he had inflammation in his abdomen and likely wasn’t absorbing a lot of the medicine he had been taking. We supported his immune system with appropriate calories through a feeding tube and kept the pressure in his lungs low on the ventilator. In this case, there could have been an urge to change the plan radically, to alter the anti-TB drugs or give steroids or other immune modulators. The art of medicine is knowing when to give up and start anew versus when to stay with the basic plan, executed better. In this case, we stuck with the basic plan.

Gradually, the inflammation in the chest and abdomen calmed down. We were able to give the patient physical therapy, and he got off the ventilator and went to the general medical floor. We stuck to the basics of antibiotics and nutrition, and he did well. When in doubt in medicine, stick to the basics are indeed words to live by.”

Michael J. Stephen is a pulmonary physician and author of Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs.

He shares his story and discusses his KevinMD article, “The lungs and the common good.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Michael Stephen. He’s a pulmonary physician, and he wrote the book Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs. And he contributed an excerpt from that book on KevinMD, “The lungs and the common good.” Michael, welcome to the show.

Michael J. Stephen: Thank you so much, Dr. Pho. It’s really a pleasure being here.

Kevin Pho: So we’ll get to your book and article in a little bit, but first off, can you share your story and journey to where you are today?

Michael J. Stephen: So I got interested in pulmonary and critical care medicine back when I was an intern in Boston and saw these super sick patients, and they were really falling off the cliff. I saw these very skilled clinicians, nurses, and respiratory therapists just really working together, in this concerted, amazing effort, trying to pull these patients back from the edge. And it was such an inspiring experience. I said, “I want to learn this. I don’t know anything now. I don’t know what’s going on here, but I really like these clinicians and how they’re working in a sort of multidisciplinary fashion. This is what I want to do with my life: study the lungs, study ICU medicine.” And that’s what I’ve done.

Kevin Pho: So, of course, pulmonary physicians have been in the forefront during the last year of the pandemic. Tell me something that you’ve learned about yourself over the past year. I understand that you’re a specialist in cystic fibrosis, and during the pandemic, you got pulled back into the ICU. So what did you learn about yourself over the past year?

Michael J. Stephen: Well, it’s been an extraordinary year, and it’s been an extraordinary year for everybody, you know, not just us lung doctors. And we’ve both shared stories, and there are amazing stories out there. You know, mine started almost exactly a year ago. I got pulled back into the ICU doing nights, kind of revisiting where I was as a clinician 10 years ago, taking care of very sick ICU patients, and it was an amazing time, not in a good way. You know, we had no medicines to treat these patients, and we didn’t know the natural history of the disease, so it was a very scary time for everybody. Everybody pitched in. I never saw a schedule go unfulfilled.

Two months after, I came down with very serious COVID myself. I ended up in the hospital with blood clots and pneumonia. And so I learned how great our system was from the inside, being on the other side of the stethoscope. So that was very humbling in a good way, and it kind of just reinforced all those lessons that we learned: the power of the human touch, of patience, of listening to your patient’s story. And for me to experience that and get better and get the best care in the world here at Jefferson University was an amazing experience. So I just learned a lot about myself, and about having patience with your body as well as the health system, and fortunately, I recovered to 100 percent and got back on the COVID front lines.

Kevin Pho: Let’s talk about your book and KevinMD article. The excerpt’s titled “The lungs and the common good.” The book is Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs. Now, for those who didn’t get a chance to read that excerpt, can you just walk my audience through it and share the story of why you decided to share it?

Michael J. Stephen: So, you know, COVID’s an acute crisis with the lungs. We all know this. There have been other acute crises that everybody’s been in tune to: the wildfires; toxic air in this country has gone up over the past three, four years; the vaping crisis. So, you know, it’s just the tip of the iceberg that we haven’t been taking threats to our breath seriously enough. And we see in this country it’s built up in these acute diseases that I described, as well as chronic illnesses. So COPD, asthma, interstitial lung disease have all just seen these amazing, amazing, not in a good way again, increases in the past 50, 60 years.

And so we really have to think about what is going on with our atmosphere. What are we breathing in? We don’t see it. We don’t take it seriously enough, but we know it’s a place of illness at times, and we have to have more respect for it. And hopefully that’s one lesson that we can learn from COVID. And I want to spread the word. It’s my life’s journey and my life’s work to talk about the atmosphere, to talk about lung medicine, and a healthy breath is something universal and that everybody is entitled to as a human right.

Kevin Pho: Now, what’s something that we in primary care can do to really emphasize the importance of our lungs? Because I often see that sometimes it gets overlooked. If I’m counseling about smoking, sometimes they just brush it off. They don’t take the threat of cigarette smoking seriously enough. Now, what are some things that we can do to kind of really help enforce the importance of the lungs to our patients?

Michael J. Stephen: Well, first of all, you know, primary care doctors have an incredibly hard job. I have such tremendous respect for all of them. And these things take time, and you’re not given enough time to do your job right. But, you know, studies have shown that you do hold a lot of power, that discussing tobacco cessation with patients can have a tremendous effect, just two minutes from a primary care doctor. There’s still a tremendous amount of respect for doctors in this country, as there should be. So I think, you know, introducing the subject, talking about, you know, illnesses to the lungs, talking about the atmosphere, is very important.

You know, patients have to be ready to quit, though, you know? So if you push them too hard before they’re ready to quit, they’re just going to get frustrated and smoke more. So talking about them, and those ready to quit, give them a plan. Tell them, you know, “This isn’t going to happen in a day. This is a long-term thing, quitting smoking. It’s not like a surgery where you just cut it out and it’s gone.” It’s going to be a battle the rest of their lives.

Good, invested primary care doctors are our frontline health care workers. We need to invest more in them and give them more time. But absolutely, they can talk about threats to our breath, and very effectively. That’s been shown.

Kevin Pho: Now, in your world in pulmonary medicine, are you seeing patients take their lungs more seriously, especially after seeing what the pandemic has done to so many millions of people around the world?

Michael J. Stephen: Absolutely. And that’s, you know, another possible positive thing. Everybody’s got a pulse oximeter at home now. Everybody’s talking about, “How can I make sure the air at home is clean, the air at work is clean? When do I need to wear a mask?” So we need to keep talking about these things. You know, they talk about these things in the East, right? So if you go out in China and it’s a high-pollution day, people will have masks on. But we don’t do that here in this country.

But I’m very hopeful now that we’ll start talking about this. You can track pollution on your smartphone. You can be more involved in terms of monitoring your own lung health. And I’ve seen a tremendous increase in interest in lung health, and we just have to keep the ball rolling, and I have a lot of hope.

Kevin Pho: So other than in the exam room, a physician counseling patients, from a policy standpoint, what are some initiatives on a policy standpoint for clean air and how we can improve lung health?

Michael J. Stephen: Yeah, so a lot of this happens at the federal level. So we need to have our, you know, politicians talking about this. You know, the most effective thing I think we can do is tell our stories, you know, tell them to each other. These are extremely powerful stories: COVID taking the breath away, you know, taking your breath away from asthma.

You know, things that we’re going to need to do is, you know, a lot of this is going to be a climate crisis thing. So thinking about how we can improve the warming that’s happening around us, how we can improve pollution, what we can do locally in terms of, you know, forests and planting things. People can do a tremendous amount just in their own backyard in terms of, you know, a sustainable ecosystem.

And then, you know, nicotine is obviously a big threat. You know, there are still 34 million smokers and over a billion worldwide. So there is still so much work to do. And, you know, like I said, primary care doctors are on the front line. So talking to people about their habits, where they live, how they can live cleaner, both at home and at work, with their breath, is very important.

Kevin Pho: We’re talking to Michael Stephen. He is a pulmonary physician, and he wrote the book Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs. He wrote an excerpt on KevinMD titled “The lungs and the common good.” Michael, tell us more about your book.

Michael J. Stephen: Yeah, so, you know, I think I wanted to bring interest in lung medicine. I started this book back in 2016. And people, you know, ask me, “Oh, did you start writing this during COVID?” And the answer, sadly, is no. There were a lot of warning signs in terms of what’s happening in terms of our breath, and this has been around for decades. So being at a university, and being in tune to this at the university level, I saw these things happening. And I’ve seen a lot of people struggle with the breath, and I wanted to bring their stories. I tell their stories.

But I also tell sort of miraculous stories of rebirth and what happens when our breath is restored. So I talk about the first lung transplant, which was done in 1983. And, you know, the lungs are on the front line between us, our bodies, and the atmosphere, the only major organ that has this constant connection to the atmosphere. And we’ve known this power for centuries, you know, prana and chi and the Holy Spirit. Every society has talked about the breath and its importance. We forgot about that, and I want to bring this back.

And, you know, I had a patient with COVID recently tell me, “You know, with COVID, my breath got taken away, and it was like going to a place where nobody could help me.” And that’s lung disease. That’s lung medicine. But when it’s restored, that’s a glorious event. And I tell the story about [name removed by the editor], who had two lung transplants by the time she was 12, and how she fought her way through it with cystic fibrosis. And now she’s on the swim team and living in Florida and doing great things down there.

So there’s a tremendous amount of hope. You know, for the first time in like 2 billion years, there’s more oxygen on Mars. So we’re going there, and we’re bringing oxygen. We’re bringing the breath to Mars. And there are just some amazing things happening in lung medicine. And I talk a lot about these miracles, and I describe them as miracles because they leave you with an abiding sense of awe. And that’s the breath. So there’s a downside to losing your breath, but there’s tremendous upside. There’s a tremendous amount that’s amazing going on in lung medicine, and I talk a lot about it.

Kevin Pho: Now, what are some of the technologies and innovations that are in the pipeline when it comes to pulmonary medicine?

Michael J. Stephen: So one of the big things, and I talk about it in my book, is stem cells. So an amazing thing that they’ve done is they can take a skin cell, they can take a blood cell, and they can reprogram it back to a very early embryonic cell and then bring it forward, not to the skin or the blood again, but to a lung cell. And they’ve figured it out. There’s a physician, Dr. Darrell Kotton at Boston University, our alma mater, who is doing a lot of this work. And so he has successfully done this: gone back, brought it back to an embryo, and then brought it forward to a lung cell.

So patients with COPD, patients potentially who need, instead of getting a foreign lung transplant, to grow their own cells for a transplant. And so they’re sort of working on the framework of how to grow these lung cells, but they have them, and they have them in culture. So this is going to come in the next few decades. There’s no question about it.

And so that’s sort of one of the most amazing things that’s happening in medicine, in lung medicine today: the birth of this stem cell field. And you can use somebody’s own cells, and that sort of takes away any rejection issues, and you don’t need to use embryonic cells from somebody else to do this. So it’s an extraordinary breakthrough that, you know, has happened in the last 15 years. Nobody’s talked about it yet because it’s not prime time, but it is coming.

Kevin Pho: And what is something from the history of lung medicine that physicians today can learn from?

Michael J. Stephen: Yeah, so one thing I talk about is the discovery of our circulation. So for many years, it was thought, you know, the liver was the source of the blood, and it would go sort of through the veins and through the arteries. And it took, you know, 1,500 years to figure out, no, that doesn’t happen. Liver is produced in the bone marrow, and it doesn’t go out to two different places. It goes in this beautiful circle.

So nature often works, you know, in harmony with itself. We have to look for answers and ask questions along those veins. And, you know, William Harvey was the first one to describe the circulation, but there were many other people who built up to that work. And scientific discoveries happen not just out of the blue. They happen on the backs of others, and they happen with cooperation. And that’s one very important lesson that I think I learned, you know, researching this book.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Michael J. Stephen: You know, I think for all doctors out there, one thing I learned with my hospitalization with COVID, and I talk about this in my book, is that, you know, patients want people who are positive, upbeat, invested in their patients, and have tremendous energy. And that’s how you form a really good bond with your patients, and that’s how you really make things happen.

Kevin Pho: Michael, thank you so much for sharing your time and insight, and thanks again for being on the show.

Michael J. Stephen: Thanks so much. I really enjoyed this.

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