Too Important to Die with Dhruv Kazi, MD
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What is the main topic discussed in this episode?
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Part of being a doctor is springing into action when you're off the job. When someone feels faint in the grocery store, for example, or when they slump over in the theater. Or when a stranger's heart stops on a moving train. In North Korea. That's exactly what happened to our next guest. I'm Emily Silverman and this is The Nocturnists stories about what it's like to work in medicine. In this episode, we'll talk to cardiologist Drew Vazi. He'll walk us through that heart-stopping tale, and afterward, we'll talk about his experience as an exchange student in North Korea and why some patients are treated as VIPs and some aren't. Have a listen to his story.
Kazi. I think someone's having a heart attack. Well, as a cardiology fellow at that time, I'd heard those words on numerous occasions. But this time was different. I was on the Pyongyang Express, returning from North Korea to Beijing, China. We were a group of twelve students, mostly studying humanities. I was the one medical person on the team who had spent a week in North Korea as part of an exchange program. We had studied North Korean history, had played a friendly soccer match at the local university, and um of course visited the gargantuan communist monuments that dotted the capital. That included a maternity hospital where every piece of equipment and a red tag that said generous gift from the president.
There was also the mandatory visit to this colossal mausoleum of Kimil Sung, the founding president of North Korea, who was still the eternal president more than a decade after his death. Every night we returned to a high rise hotel and had good laughs over bad beer. But in private moments we reflected on the horrors of the day. The sunken cheeks of the people who were crammed into the trams on their way to work, even as the chubby smiles of their eternal leaders grinned from the lapel pins that they were all required to wear. All this talk of fertile apple plantations, even as we knew that in the nineteen nineties there had been this destructive famine that had killed so many North Koreans that that was the only way the country got out of the famine.
They had food for those who survived. It was surreal, absurd, exhausting. The train ride back involved crossing a border that was a river between North Korea and China. On one side were abandoned fields and a ferris wheel. On the other, these tall skyscrapers that mark China's rise into the global economy. Parallel to the train tracks was this pedestrian bridge that had been bombed in the Korean War, so that only half of the bridge now stood. The Chinese could walk halfway across the river and stand on this viewing platform and gawk at North Korea. The other half of the bridge was missing, so the North Koreans had nowhere to go. As a train crossed the border. We did this little celebratory dance of freedom.
Even though we'd actually just crossed into China. We'd had dinner, we're settling in for the night when a grad student said, Cosie, I think someone's having a heart attack. I rushed in the general direction, the toilet door was ajar, and outside lay a an obese man flat on the floor, half naked, his pants bundled around his waist, no shirt on, and his scrawny travel companion was frantically trying to wake him up. I do what any self respecting cardiologist would do in that situation. Without saying a word, I reach for the carotid pulse. There is none, so I start chest compressions and call for help in English. Two of the students I'm travelling with are trained in CPR, so we decide to take turns for chest compressions.
One of them speaks Mandarin, so he translates for the train conductor to go get the first aid kit. I'm hoping for a defibrillator. The other speaks Korean, so we asked the travel companion, What's going on? Does the patient have a medical history?
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Chapters
7 chapters
1
What is the main topic discussed in this episode?
0:00–5:59
2
What is the emergency medical incident that sparked the episode’s story?
5:59–6:39
3
How did Dr. Kazi end up on the Pyongyang Express train?
6:39–8:19
4
What was the exchange program in North Korea and what did the participants experience?
8:19–16:54
5
How did the political status of the patient affect the emergency response on the train?
16:54–18:43
6
What steps did the team take to perform CPR and manage the patient’s collapse?
18:43–27:40
7
What reflections did Dr. Kazi share about the aftermath and the concept of ‘too important to die’?
27:40–36:17