I think we have an emergency
Ask Dr. Ro Gonsalvez
Quite a few resources exist for people looking for queer doctors. Hell, Tegan and Sara started the LGBTQ Healthcare Directory pretty recently, where you can filter doctors by sexuality and gender identity. I used these resources when I was looking for doctors to interview, but I was hitting a wall.
Enter Twitter dot com.
I posted a call for queer doctors and Dr. Ro Gonsalvez was the first to email me.
Dr. Ro Gonsalvez is an emergency medicine doctor in Chicago. They identify as queer and trans-non-binary. Being my first interview, I was a little nervous about asking dumb questions or not having enough material, but Dr. Gonsalvez was gracious, informed, and kind, we talked for over 40 minutes and they gave me plenty to work with.
In this interview, we talk about emergency medicine, their music, art, and what people ask them the most when they find out they are talking to a doctor. This first interview will be available to read and listen to via podcast.
Dani Janae:
So this is kind of a big question and I know that, but I just wanted to ask.
Dani Janae:
When did you first realize you wanted to get into medicine?
Ro Gonsalves:
Oh, this is always really fun to talk about because it is I think different from a lot of people in medicine. And I'm remembering this because, so I have a friend who's in art, he teaches art, and I've known him for a very long time, since way before I ever thought about going to med school. And I came to one of his classes on Friday and he was like... He's like, "And tell us about when you decided to start doing medicine," because he has some pre-med students in his class and they would, you know. So I was like, "Oh. So I graduated with a degree in music and then a few years later I got interested in bodies."
So really my answer is my entry point into medicine was I was really interested in bodies. I had been doing some caregiving work for adults and kids with profound disabilities, so a lot of in-home caregiver work. And then I really didn't know what I wanted to do with my life and I was like, "What is the thing I'm interested in?" I was like, "I'm really interested in bodies." And so then I started taking science classes. I went back to school and I was like, it might be medicine, it might be nursing, it might be physical therapy. And then I just kind of started down the pre-med track because it was the one that had the most things. And I was like, "Well, I could peel off at any time," and I just kind of stuck with it.
And it was the health sciences that just were a really good fit and I really liked it. And then I just applied, and suddenly found myself in medical school and I had no idea what I wanted to do. I thought I wanted to work in a clinic. I didn't even know emergency medicine was really a thing. Sometimes I wonder if... I definitely know that within medicine I picked the right field, but I was like, "Would I have been happier as a nurse?" Maybe, but here I am. And that's probably just because most of the nurses I know are more radical than the doctors I know.
Ro Gonsalves:
And it's definitely can be a queerer space.
Dani Janae:
Totally.
Ro Gonsalves:
Then medicine, capital M medicine. But I just kept going down a path and it kept feeling right. And then I just got here. And then, yeah, it's kind of weird. I think it's not the typical I wanted to be a doctor since I was nine kind of thing.
Dani Janae:
Yeah, totally. Yeah. So you said you were studying music at first?
Ro Gonsalves:
Yeah, I studied music in undergrad. And I wasn't that great of a musician and I was not a great teacher, which is what I was thinking of doing, was teaching music. And so music is still an important part of my life. And in general, creative expression in a lot of different ways is. I make some comics. But I went to my friend's class and actually sat in on his drawing class and was like, "Oh, okay, I'm going to take a drawing class now."
So I am always trying to still figure out what that looks like, especially right now with two little kids. That's actually the hardest part about trying to make art is more than being in medicine now that I'm out and I have way more autonomy over my life now than I did in medical school or residency. So I have space and my space is filled mostly with my children. Which is just a very particular chapter, and it's great. But I'm still trying to figure out how to make things... It's actually I think more about the time, it's the mental space and energy for doing creative work.
Dani Janae:
Yeah, totally.
Ro Gonsalves:
Yeah. Which is I think something a lot of people probably resonate with and experience.
Dani Janae:
Yeah, definitely.
Ro Gonsalves:
Yeah.
Dani Janae:
When you were transitioning from taking these music classes and everything to taking science classes, was there a learning curve? Did you already have I guess a natural bent toward science? Or was there some difficulty transitioning into that space?
Ro Gonsalves:
So it's funny, there were a couple of years off of in between when I taught English and I was interning at a non-profit. I did a bunch of other stuff trying to figure out what do I want to do. And in retrospect, actually, the music classes and more liberal arts training was actually more of a challenge for me. And when I got into science, I was like, "Oh, this is actually my flow in terms of academics." So it was definitely hard and I was like, "Oh shit, I haven't taken physics since 11th grade and now I'm in my late twenties." So it was a shit ton of work, but it came much easier to me actually. So yeah.
Dani Janae:
Cool. That's awesome.
Ro Gonsalves:
Yeah. Yeah.
Ro Gonsalves:
I didn't expect that. I just didn't know what it was going to be like. I was like, I might even not pass. And it was like, "Oh actually, this is great."
Dani Janae:
You might have touched on this, but I don't remember, was emergency medicine your first choice or was it a journey to get there?
Ro Gonsalves:
When I started medical school, I didn't even know really that emergency medicine was a thing. I was like, "Oh, I want to work in a clinic, with underserved patients." In the period of time before I was applying to medical school, I also was coming into my own in a queer space and finding community for the first time. And so I was like, I want to work with queer people. And then when I got into medical school I was just doing the thing, I was sort of feeling around for what felt like a good fit. And I think I was lucky because I went to medical school somewhere where there was a strong emergency medicine residency.
So it was a strong part of the school because that's like... So I got exposed to a cool thing in its best light. And it felt like a fit probably because I liked the work. And also I liked the people that I met in it. Which can be kind of a gamble because you never know if the specifics of who's doing that could be just hyper-local culture or if that's representative of something overall. But it turned out to be a really good fit. So I didn't know going in, but then when I started feeling around for what felt good, that's where I landed. And then I just pursued that and got to do what I wanted to do, which was exciting.
Dani Janae:
Yeah, totally.
Ro Gonsalves:
Yeah.
Dani Janae:
So I think that a lot of people also sort of don't know that emergency medicine is a thing. When you think of doctors, you think of neurologists, cardiologists, all that stuff. And there are a lot of fields that get really overlooked in the medical field. So for someone that isn't familiar with emergency medicine, can you tell me a little bit about what an average day looks like for you?
Ro Gonsalves:
Sure. And maybe I can also just explain from my perspective what emergency medicine is.
Dani Janae:
Yeah, totally.
Ro Gonsalves:
Yeah. So I mean, emergency medicine doctors can work in a variety of settings, but for the most part, from generalizing, we work in emergency departments in hospitals. And so, we don't choose who comes to our clinic and pick patients because they have a specific problem. There’s no “I already know you have a heart problem, so come to me, I'll be your heart doctor.” We treat all comers. So everyone comes into the emergency department with whatever it is that's going on with them. And sometimes it's life-threatening and sometimes it's a stubbed toe and sometimes it's I need a warm place to be. And sometimes it's suffering with addiction and sometimes it's like I'm having a heart attack. It is a gambit. And our job is to do our best to understand what's going on with that person and kind of what they need.
And so sometimes that's a thing I can provide myself. And sometimes it's about connecting them with what they need. Either at this moment you need a cardiac cath, so you're having a heart attack, you need to come in and get your heart vessel opened up and you need to be admitted to the hospital. You know, you have appendicitis. We need to talk to a surgeon and bring you into the hospital. You broke your arm. I need to splint it and send you to see a specialist. So at the heart of what I do is figuring out who's really sick and needs something right this minute. And getting that person, either they're dead and I'm trying to bring them back to life in the most extreme case when someone’s heart stops and they died and we're like CPR and all that. Or their life is threatened, finding that life-threatening thing and getting them the care they need.
Sometimes it's something I can do myself and sometimes it requires phoning a friend. But then, the majority of people who come into the emergency department don't have a life-threatening thing. And that doesn't mean that it's not affecting them in a profound way. And so, what feels secondary to me, although does not feel secondary to the person who's suffering from it, is addressing those other things as well. So sometimes it means treating people's pain, and sometimes it means getting people connected to the care they need. Sometimes it's reassuring someone about what's going on.
I think one thing that's really challenging is a lot of people come to the emergency department with maybe something that's been going on for a long time or is very complex and maybe long-standing, and are sometimes hoping for answers or solutions that we may not have in the emergency department. And that is always really challenging because I can't always provide people with the thing that they're hoping for from an ER visit in those kinds of circumstances. But sometimes I can. And that's always really gratifying.
And so a lot of my job is also kind of setting expectations of what I'm capable of, what we have the capacity for in a particular encounter in a particular institution where it's not just about me, it's about the resources available. What hospital you came to, what specialties do we even have here? And then other things that are just really terrible to have to consider, but what insurance do you have? Where are you from? All those things play in and navigating all those with people is extremely disheartening and kind of soul-sucking and all of it is important cause it's what people are there for.
Dani Janae:
Totally. Yeah.
Ro Gonsalves:
Does that make sense?
Dani Janae:
Yeah, that totally makes sense.
Dani Janae:
Yeah. Okay. So what are some misconceptions or myths about your field that you would like to dispel? If you could come up with maybe one or two.
Ro Gonsalves:
Oh. That's a good question. I guess I'm not sure if I'm going to be able to articulate this very well. And I touched on it a tiny bit, but I think there's a mismatch between how people who work in emergency departments think about emergency departments and what their mission and goal is, and patients who come to the emergency department, what they think about the emergency department's mission and goal. Not in every encounter. And this I think goes for the physicians, also, APCs, which includes physician assistants and nurse practitioners and also nurses and techs. We all kind of know that our goal within the emergency department is to find out find who's sick and dying, stabilize those people, and treat reversible things. And that is the core of what we're set up to do and oriented to do. Right? Address emergencies.
It's not always clear from the outset what an emergency is going to be. For patients, a patient doesn't always know whether the thing they're coming in with is an emergency or not. As an example of chest pain. Your chest pain might be caused by heartburn, or your chest pain might be caused by a virus. Your chest pain might be caused by your heart literally failing. Or many other things. And so, how can you know? You can't always, but our goal is to... Some things are very obvious and clear up front, but otherwise, dig through that haystack and find what are the life-threatening things. Like whose chest pain is caused by something life-threatening, just as an example.
And this is one of the things where there's a lot coming up right now about the way that health insurance companies are denying care for people. And one example is chest pain. If your chest pain turns out not to be caused by a heart attack, there are these instances where insurance companies are saying, "Oh, we're not going to cover this because it wasn't actually an emergency," but literally, how is someone supposed to know what's causing their chest pain? That's why people go to the emergency department. I think I'm a little bit on a tangent.
I was talking about the mismatch between what patients expect and what people who work in the emergency department, not just limited to the doctors, are expecting out of the encounter. So when I have an encounter with someone who's my patient, who has what I've identified at the end of the visit as being a non-emergency thing, sometimes the best thing I can provide is reassurance and a follow-up plan. But I think a lot of times to people it feels like that means we've done nothing. Because I'll see people after my visit with them have frustration, or I'll see them a few days after they saw another doctor or an APC in an ER and say, "They didn't do anything for me." And sometimes I think it's partly a failure on our part in our communication because the onus is on us to explain what we're doing and our thought process and why.
But my ideal scenario is coming to the end of an encounter with a patient and saying, "I didn't find any emergency here. I didn't find any emergency cause of your," just using chest pain as an example. "Here are some things that may help you feel better and here's like a plan for what the next steps are. But I can reassure you it's not your heart failing. It's not your lungs failing. It's not another severe and serious thing." Sometimes I think for patients it feels like nothing has been done. And for me, an incredible amount of thought and care to risk stratify and review every little detail and make sure I don't see something that's serious and life-threatening. So for me it feels like a ton of heavy lifting and for patients sometimes I think it feels like you're telling me it's nothing.
That's I think the biggest one that kind of comes up. It's not really exactly a myth, but it's a misunderstanding. Or ineffective communication between, maybe it is mostly ineffective communication between providers and patients about what's going on in the ER. And a mismatch of expectations that is not just driven by patients not knowing what an ER is for. Often people don't have another option for healthcare. And I recognize that, and that is a huge driver of why people come to ER, including sometimes for completely so-called non-emergency things.
Dani Janae:
Totally.
Ro Gonsalves:
And it's easy in emergency medicine to get frustrated by that because we really feel the burden of all the other ways that the healthcare system has failed people. And in many ways help carry that. Sometimes people's primary care doctors have been waiting weeks to try to get prior authorization for a CT or something, some basic stuff that a patient needs. And on the one hand, it's very frustrating to me that a patient ends up in the ER asking for that CT.
Dani Janae:
Yeah.
Ro Gonsalves:
But there's a misplaced frustration if that frustration goes toward the patient or even the primary care doctor who sends that person in. There are incredible failures on a system level and every single person in that chain is a victim of that.
Dani Janae:
Totally.
Ro Gonsalves:
Including the other person who's waiting in the ER for an actual emergency. And the resources are congested because all these other things have been driven into the emergency department.
Dani Janae:
Yeah. Definitely. Okay. So also along those lines, I guess, what do people assume about you when they hear what you do?
Ro Gonsalves:
Oh, everyone wants to hear, everyone's like, "Oh, that's so intense," and wants to hear a gross story. But really people ask for your most intense story, but I think that they really want is to hear about something getting stuck in someone's butt. And when people ask what's the most intense thing that happened, there is so much secondary trauma in emergency medicine. We see and experience and walk alongside people through just some of the worst days of their lives. But I at some point have come to realize people just want to hear the story about the thing stuck in someone's butt. And so, that's what I go with.
Dani Janae:
Yeah. Okay. Okay. So does your queerness ever become relevant or intersect with what you do on a daily basis?
Ro Gonsalves:
Yeah, in a couple of ways. Some that make my work harder and some that make my work easier. Medicine itself is so structured around the gender binary. Every single history that we take, there are certain things that we're all kind of educated into or indoctrinated into. Including every single time, across every medical specialty, when you talk about a patient, you just say, "35-year-old male with the past medical history of blah, blah, blah, blah, blah. Here with this particular problem." Or if you read your clinic notes from your doctors, they'll say things like that. It'll be like, "67-year-old female, blah, blah, blah, blah."
And it's always age and sex and in some cases race, although some people don't do that, including myself, because it's problematic history as to why that's included upfront. But that’s a different story. Sex being included as the main primary thing that is outside of people's age identifies who the person is. I've seen this justified to me sometimes as like, "Well, I want you to tell me upfront who that person is and include these details so that I could look around a room and pick them out," but you can't really do that based on those details.
And there's very little room for thinking outside the binary. Medical education was so driven by the male/female binary, and even though more progressive parts of it were like sex is binary, gender is not, which is also not true. Even as we learned about different types of intersex people, people were still saying sex is binary. Which is so not based in reality or even the science that we literally were being taught.
Ro Gonsalves:
It's this way that I have been further educated into a binary that I reject for myself, and I reject in general. And so it's really hard for other people in healthcare to accommodate non-binary people. And this is just speaking about in my work environment, it's really challenging for people, they/them pronouns are just a real challenge. And in some cases, I've seen people accommodate a little easier when someone is trans and wants to present as trans and I'm a man trans and I'm a woman. Just she/her pronouns, just him/him pronouns, in a way that is... What's the word I'm looking for? It's kind of putting them in a space where they'll fit into the two gender norm options that preexist. You know what I mean?
Dani Janae:
Yes.
Ro Gonsalves:
So if you try to move in a space in between there somehow, it really is challenging for people, I think in many people in many walks of life. But in my workplace, it's been harder than anywhere else to have accommodation for that. And I mean, there's things I've done to try to address that. Like legally changing my name was really just about my workplace.
Dani Janae:
Yeah, totally.
Ro Gonsalves:
Ro was not the first name I was born with. It was really about my workplace because then my workplace wouldn't accommodate any alternate given name except for it's the official medical records. We have to use the name is on your documentation. Anyway. So I feel like I've gone to great lengths to try to present in a non-binary way at work. I have a big they/them pronoun pin on my badge and I introduce myself that way. And it still is very challenging. So still, one of the things that I think about, aside from what I will hopefully be making my workplace a little easier for trans and non-binary people who come after me working there, I also just think about the trans and non-binary patients that have no choice. They have to come to an ER sometimes. And so they're in that space hopefully for everyone I work with, having had an interaction with me, if this is totally outside their comfort zone and/or things that they accept as reasonable, hopefully having an encounter with me where I'm someone in a high-status position in this space, hopefully that makes it easier for the next patient who comes in.
And then that brings me to the second way in which this is important in my work is there is such a long and well-documented history of trans people being treated terribly in healthcare, but also specifically in emergency medicine. There's that one woman who was in D.C., who was a trauma victim. And I'm trying to remember what her name was, but she was like, care was delayed and denied due to preoccupation with what her body looked like. This was in the '90s or something. Don't quote me on those details.
Dani Janae:
Okay.
Ro Gonsalves:
And then there was another trans woman in the East Bay. Which is actually, I moved from the Bay Area just about six months ago, so I used to work there. Who also a case of EMS and emergency medicine, so EMS paramedics, and people in the ER delaying and denying care due to just discrimination and curiosity about this person's body and who they were and all that. There are many other stories like that. And also it seems like everyone, if people don't have a story like that, that they hold themselves, there's still this collective history. And people know to be careful and it's a known problem. And so, trans and non-binary people come into the ER expecting to be asked inappropriate questions, expecting to be potentially subjected to inappropriate and invasive exams. And just straight up, just not acknowledged for who they are.
And so there is just sometimes this magical sense of relief and joy that comes over a patient's face when I walk in and I'm their doctor. Because, I don't know if it's just about how people are reading how I'm presenting myself. I'm sure it's partly about also my very obvious pronoun pin, I identify myself as trans and use they/them pronouns. There's just a sense of a wave of relief and a sense of, "Okay."
Dani Janae:
Yeah, exactly.
Ro Gonsalves:
And it is such a wonderful starting point. And so whenever I have trans or non-binary patients in the emergency department, it is just the icing on the cake for my day. It is an extra level of drive. I'm like, "I'm so glad you had to come in the ER. I'm so glad you're here and that you're my patient." And that is just a wonderful thing. And it seems to me that it makes a difference for other people. And being able to do that makes a huge difference for me. It's knowing that people come in with a certain set of expectations about the way they're going to be potentially mistreated. And not that just because I'm trans I'm not capable of also mistreating, misgendering, or having a bias against other people. So there's no free pass for me.
Dani Janae:
Yeah, exactly.
Ro Gonsalves:
There's also a lot of work that I have done and then work I continue to do. That's an active process for me that is ongoing and requires a lot of self-reflection because I am still a part of this system that just fucks a lot of people over. So if I can provide some safety to the extent that I'm able to, and do, within that, it is one of the things I love about my work.
Dani Janae:
Yeah. Totally.
Ro Gonsalves:
Yeah.
Dani Janae:
Awesome. I just want to do a quick time check. We're at 30 minutes. Do you still have time?
Ro Gonsalves:
Oh yeah. I'm good.
Dani Janae:
Okay, cool.
Ro Gonsalves:
Yeah. Thank you though. I appreciate it.
Dani Janae:
Yeah, no problem. So are there any other queer doctors in your field or in your hospital that you get to interact with?
Ro Gonsalves:
So in my current hospital, so I'm new here. I just started a couple of months ago. In my group, there are a couple of, to my knowledge... And I also only work nights, so I just interact with a select group of people in general. There's a couple of gay guys in my group. Before being here, I worked in the Bay Area, which is like queer central in general. And I trained in a residency where there were a lot of queer people. I think I was the first non-binary person to go through their residency, and actually kind of came out and went through some of my gender-affirming process in a public way in residency. So that was its own thing but yes, there aren't very many, but they're here. And I'm always really happy when I see them.
Dani Janae:
Yeah. Totally.
Ro Gonsalves:
It's just so nice to have them present. And also there are a lot of queer nurses who I end up working with at various moments, probably more so than queer doctors. And those folks are also people I just find incredible companionship with, and I'm so happy that they're in those spaces too.
Dani Janae:
Totally. All right, cool. Okay. So this is also kind of a big question, but I'm curious to know your answer.
Ro Gonsalves:
Sure.
Dani Janae:
If you could change one thing about how medicine is practiced, what would you change?
Ro Gonsalves:
Oh, that's so easy. I would abolish insurance. The insurance system is just a huge racket. There is a lot of work done and things published about... And people commenting about the ways that insurance companies, especially the big ones right now in the U.S., deny and delay care. But just as a few personal examples, it's one thing to have, I am a doctor. I am financially stable, and when my insurance company fucks up and denies my claim and I get a bill for a few thousand dollars. Or they tell me, "If you don't fill out this form, you're going to get a bill for a few thousand dollars," it is so stressful, and I am financially stable and it is so stressful. I have been in much less financially stable positions in the past, and it was incredibly stressful then. And I've had medical bills in the past that have drained my savings and taken everything. And so I know a little bit about what that feels like as a younger person. So just the amount of stress. And we know that stress is toxic.
And so the way the fear of having to pay exorbitant amounts of money to access healthcare, and it's a real founded fear, the way that adds to the stress that everyone is already experiencing, is just an unnecessary burden. And the ways that insurance companies delay and deny care by requiring prior authorizations of having specific formularies that take people off medications that have worked for them for forever, and now you need to figure something else out. The way that creates extra layers of work for those people's healthcare providers, like their primary care doctors, the way that disrupts the lives of people who are maybe stable on medication and now have to go through new changes or different things. The way delays and denials of imaging and other care that requires prior authorizations, the way that sucks up hours out of primary care doctor's days, and the way that delays care for patients, that system is a leech on the healthcare system overall, which is already bloated.
I don't have a specific policy solution suggestion because I think there are a lot of ways to thread the needle. And I'm in favor of all of them, any of them. Just whatever it takes. We just need to do something else. Because even just in emergency medicine, if I'm going to do what's right for patients, the times that the emergency room is used for care that isn't an emergency because health insurance companies are stalling or dragging their feet. The way hospital admissions are sometimes used for things that don't need hospital admissions because everyone involved in the patient's care knows there's no other way for the patient to get that thing, it's a huge, huge drain on resources.
Dani Janae:
Totally.
Ro Gonsalves:
Every time those things are required it's using a bed that someone else actually needed, and this person just needed not to have prohibitive barriers to getting something outside of the hospital setting. There are stories, there are... yeah. Without violating a lot of HIPAA, I can just say-
Dani Janae:
Yeah.
Ro Gonsalves:
Yeah. There are just so many examples of this. And if you sat down with anyone working in an ER, like a nurse and an APP. When I say APC and APP, that's like a nurse practitioner or a physician assistant or a doctor. And you ask them for examples of this, they could probably just list and list and list them.
Dani Janae:
Yeah, totally.
Ro Gonsalves:
Yeah. So that is the one thing I would change and I would cry no tears for insurance companies. I'd just be like, "Give us our money back. Go away."
Dani Janae:
Okay. So I have one more question and it's one that someone asked me to ask you, and I don't know if you'll be able to answer it, but we'll see. So what this person wants to know is, how is PrEP doing and where is it headed?
Ro Gonsalves:
Oh, that's not an area of specialty for me.
Dani Janae:
Yeah.
Ro Gonsalves:
But actually if you want to have somebody on to talk about PrEP, I can connect you with some good people.
Dani Janae:
Oh yeah, totally.
Ro Gonsalves:
Yeah. One who is not queer, but who is an incredible ally and is the person I go to for all my PrEP information.
Dani Janae:
Okay.
Ro Gonsalves:
So actually in residency, I gave a workshop on prescribing hormones and PrEP from the emergency department. Because one of the ways that I... And I don't have very many trans patients in this current hospital where I work, but there were more when I was in the Bay Area just at the specific hospitals I was at. But one of the ways to fulfill my mission of being a good member of the trans community is if a patient comes in and needs... And I've had many patients come in, and part of what they needed was hormone refills. And under certain circumstances where it's safe, which is almost every circumstance, I help make that happen for them. Because my goal is to not be a further barrier to care.
Dani Janae:
Yeah.
Ro Gonsalves:
So I gave this workshop on prescribing PrEP along with hormones from the emergency department. So what I can speak to is that it's easy to prescribe. There are a few things you need to do to get things lined up. There are many emergency doctors who do not necessarily prescribe PrEP from the ER, but we'll refer you somewhere else where you can get it. Which, is a second best, requiring someone to take another step is just... We know there's a large proportion of prescriptions that are sent to pharmacies that are never picked up. And it's because it's another step. People have full and challenging lives in all sorts of ways that we never understand. And so for me, anything I can do to get you what you need right here, as long as it's within reason and I have the capacity and it's safe for me to do so, it's like within my scope of practice, I'm happy to do it.
So I can't speak to what's happening with PrEP overall, but I can just say... I don't know, because a lot of emergency docs won't prescribe PrEP for people. I do, but it's one of the ways that we could do better in emergency medicine. Yeah. It's one of the ways that we could build out the emergency department to be that social safety net that doesn't exist in other places, which is kind of a backwards sort of workaround, but we work with what we have. That was one of the things that I would love to see all emergency docs doing.