 I'll start by introducing myself. I'm David Feinberg. I'm a child psychiatrist and head Google Health, my friend Karen. Hi, I'm Karen DeSalvo. I'm a primary care physician and I'm the chief health officer in David's group at Google Health. I thought it'd be good for us to kind of talk about our old life and working as physicians and both of us have spouses that are physicians and we obviously have amazing colleagues that we've known over the years and kind of what do you think they're going through and how hard it is for them and how can we help them? Yeah, you know, Karen, I keep thinking about two things and one you just brought up. One of them is, I can't remember ever in my career where I was worried that I would bring something home. Like that's a new one. And then I don't ever remember in my career or in those that I know, other than in the military. Docs, how to make nurses, how to make decisions about who would actually get the care, kind of these rationing decisions. I just think that's got a way on them. Have you heard from anyone who's had to, in essence, say you're going to get the ventilator and you're not? To me, it's just like, we were in this country and in the developing world, we've been so blessed and we never have that question. And I think we have a lot of folks that are now having to answer that and I don't think we were prepared. I'm reflecting what you're saying all about Jay. And he's very meticulous when he comes home from work about shedding all of his clothes because he does think a lot about bringing home drug resistant bacteria and other organisms because he's living in that every day. So it's a part of his way of thinking, I think from an infection control standpoint. But for us in Louisiana, I mean, David, the Katrina experience is really raw for us still. I mean, it's only been 15 years. And a lot of our physician colleagues had to make choices about who was gonna get intubated and who was not. And there were a lot of choices that we continued to have to make in the months, literally, after Katrina where we were working on the streets without electricity or potable water, no access to laboratory or radiology services. And it wasn't nearly as dramatic as the early days of the hospital, but it was a time of rationing and resource allocation because we didn't have any open facilities. So things interesting for us to have had that prolonged experience in Louisiana. And maybe that's part of the reason why Jay and some other folks that are working down there feel like they're a little more equipped. The folks in New York, interestingly, some of my colleagues there are reflecting on some of the experiences that they had in Sandy. And so there are, I think there's some training that people have had in some pockets, but there's 15 or 10 years of new physicians who it's a new experience for. And it's absolutely stressful. I mean, that's not the way, we're so used to having resources in this context. It's a different way to have to practice medicine. You're exactly right. In some ways gives us ability to help other parts of the world practice medicine all the time. We've heard about countries with four million people that have four ventilators to start with. So in some ways it's pretty humbling and I think hopefully we come out of this with a better sense of equity kind of worldwide. I hope so. I think that the fact that people are paying attention to the equity issues and it starts always a very similar way. People look at differences in mortality or death rates based on the color of someone's skin or their zip code. You start to back that up and you realize it's differential for care. And then I think even now we're getting clarity on the data that it's different. If you have access to a test, there are disparities and equity issues there. In Louisiana, we're one of the first places to recognize that you couldn't just have drive up testing sites because people that were low income didn't have cars or other people don't have cars. So trying to build not only care models in general but remembering you gotta even do it in COVID to meet people where they are. So I'm much I believe in things like equity and eliminating disparities. I know you do too. It's not good that it's happened in COVID but it's on the front page and causing us to think about all the structural ways that we drive inequity. So maybe there'll be some good that comes out of it. Yeah, I keep thinking if we come out of this and telemedicine is working, that's great. If people understand mental health, that would be great. If people understand the public health, that would be great and the disparities. Like I mean, these could be the silver linings that we say, okay, now the world, hey, the world knows about curves and epidemiology. Went to be great if we had this now part of our discussion, part of our kind of political will. You know, we have doctors and other clinicians on our team at Google health that have gone back to work as frontline folks. Tell me about that. It's, I signed up to volunteer in California. They didn't call me but felt this kind of calling that if called. I wanted to answer the call. And some of our folks have. And I'm just wondering kind of what you think about that kind of sacrifice and how it helps us. Yeah, I was really so proud of you for volunteering. And I know you and I've had discussions about what it feels like to be a physician and not be, I'm an intern. So slinging a stethoscope, you know, like sort of in the middle of it. And watching our colleagues who were in a position for one reason or another to go back on the front lines has been really heartening. We had a lot of our folks in the UK who actually got called up as you all know. And so it was, there was volunteering, which a lot of the team did in the US context. But in the UK, they were so shorthanded that people had to work in field hospitals and other places. And though they're typically clinically active anyway, it was just sort of this added type of work in a different, I would say more military environment because it was these field hospitals. To a person, they are all proud to be able to do it. I think felt like it was meaningful and appropriately concerned. But at the same time, I think very similar to my husband's experience, like we have the skills and we want to apply them. Now, I think what's been really a struggle is people who are not, who have specialties like Durham or psych or pathology or radiology, we have folks like that on our team and they were a little worried they're called up to intubate somebody. But even in New York, that was happening to a lot of our colleagues that is pretty out of specialty, they were being asked to triage in the ER. So I think the physician community, I would just say it really stepped up. I'm super proud, not only of our people, but everybody. Yeah, the other thing that I think is always more moving than even the docs are the nurses. I mean, to me, nurses are the heroes of healthcare every day. And you've seen them step up in ways that just, well, they bring tears to my eyes all the time. So I'm on, I think it's nurses week now or nurses month or whatever it should be nurses year because they're so key to care. And proud that we've got nurses on our team and proud to have really close friends that are in nursing that have come home. I was trained by a lot of really great nurses at charity hospital. Yeah, no, but. They're telling me what to do. And I'm 100% with you. And I think also the whole suite of workers and we, I think we all have to remember that for people working front desk, back desk, cleaning the room, turning over the rooms all those folks have been putting their lives on the line. So it's pretty, it's remarkable to watch and be a part of. Certainly a team sport. I used to always say that we could learn so much from nursing from a mental health standpoint when a nurse has a patient that dies, that he or she has been caring for. The other nurses on the unit come over, hug that person, say, hey, why don't you go take a break and I'll cover your other patient or patients. You were starting to talk about this a little earlier and we can get back to it a little bit, which is you have such, I love your frame always of whole person and physical, mental and emotional health and the nursing profession, I'll just call them out or so much better at thinking holistically about a person is having all of those needs and care plans and they reflect that in the way they take care of each other. I think that comes to be a big part of it. Our training in medicine is much more typically focused just on physical health needs. And how have you stayed strong because you're new to Google? Thankfully, we got you. I don't think we could have designed in a test tube a better person for the role that we've thrown you into. How have you handled and stayed strong during what has been this world pandemic? You're in a new company, we have this big platform and we've really asked you to be front and central, not only for our own 100 plus thousand workforce but for all of the kind of things that Google's doing around coronavirus. Well, I'll start by just saying what will sound cliche but it's a great team. And the company, the people in the company are really science-based. They are about taking care of each other. So it's a really warm and welcoming place to work. It's been like that since new orientation really since before. So I'm thankful for that. I think I'll be honest, I've had some rough days. It's been a long few weeks. And there are days when, even especially days honestly when I start digging deeply into the science and thinking about the trajectory of developing good therapeutics or a vaccine and considering what's gonna happen not only clinically over the course of that time but the social and emotional and financial impact on people in the world. It's tough some days to think about that suffering. Frankly, that's happening because of the pandemic and I still sometimes can't really believe that I'm living through this and I bet you're having similar experience but most of the time I feel really grateful that I'm here now with you and others on the team get to do the work that we get to do. As a public health person, when you try to get out messaging through your platforms and even when I was in the federal government it's the reach is so small compared to what we do when we push out just some small information about washing your hands or taking care of yourself and literally billions of people get that information and in their language and in a way that they can ingest it just feels great to be able to give back to the world. So all things considered good but definitely like everybody's struggling with the reality of this and how we're gonna get through it. Yeah, I'm having those same feelings. There's definitely been bad days. I was having a very bad day yesterday and now I realized what was driving it. I thought yesterday was Tuesday. Yesterday was actually Wednesday. When I realized that this morning like my mood completely changed and my wife and our older daughter who's sheltering in place with us was noticing that I was cranky and irritable yesterday. And I'm like, I'm much better at it because I realized what day it is. So it's just so disorienting, you know? There's this, the world is sick and upside down and we all got a fever. We all have the same nightmare. It's, we're all, we all have these worries some way, way worse than what I have. So I am beyond blessed, but it gets to you. And I think it's okay. And I think, you know, breathing and exercising and sleeping and a break from the news and reaching out for help when you need it are all good pieces of advice. That being said, it's hard. And anyways, my day is way better today because I'm not, well, you know part of your vital signs are, are you oriented? Time three, I'm disoriented. It just, I'm with you. It kind of starts running together. You know, I think some of this is about as physicians, we, well, we want to fix things, right? That's our inclination. And this is something that we want to fix. We want to be able to say, there's a treatment, there's a vaccine, there's a prevention, whatever. This is the known science, but it's, well, one of our team members says this and so I'll use his quote, which is that never really before has, has science been so rapidly evolving and so consequential at the same time. And so it's, it's a lot to keep up with. It's exciting to see and it'll be great when, you know it's a mix of public health and medicine strategies. But yeah, it's like you feel like you're being helpful, but we don't have the tools that, that we sometimes expect to have in medicine to make people well. Yeah. Yeah. I was just going to add this thing about also the physician persona where, and you were talking about this after the code kind of situation. And we are taught at least in my generation of physicians to be more like independent cowboy-ish, like you're on, you know, be strong, do your own thing. And I think it's increasingly, and I'm glad, okay for people to say it's not a good day or, you know I need, you know, I need someone to talk to you because that's perfectly human and perfectly normal and exactly what we should all be doing even as caregivers. Yeah, I would just say as kind of to wrap as to our colleagues out there, those that we know and those that we don't know but we know how hard they're working that we so have incredible gratitude. We hope we're building tools and information that's helping you and don't be afraid to ask for help. And hopefully we make that easy to find. So, hey, this is a pleasure, Karen, to talk with you at this level because usually we're firing away trying to get stuff done. So, well, this is- It might have a loss, it's like high-trust, I'm super, I'm super lucky, it's great. Thank you, David. Thanks, have a great day. All right, you too.