DR. NICOLAS BREMER
Salma Jutt (00:01): Hi, I'm Salma Jutt, Divisional Vice President of US and Global Marketing for Abbott's neuromodulation business. At Abbott, we are working across our company to support communities with resources and technologies to fight the evolving impact of COVID-19. Getting new molecular antigen and antibody tests and rapid tests into the hands of frontline workers so people can receive the critical results they need. As the COVID-19 global pandemic unfolded in the United States, New York city was the hotspot and by April hospitalizations were into the thousands each day. As hospitals in the city, were reaching capacity. The call went out for volunteer physicians to contribute to the care of patients. One of these doctors who stepped up to the challenge is Dr. Nicholas Bremer. Dr. Bremer is a pain medicine specialist and anesthesiologist who recently practiced at the Spine and Nerve C enters of the Virginias in Charleston, West Virginia. He left his young family to head up to New York city. Dr. Bremer is no stranger to global disasters as a commander in the US Navy, he was a Naval flight surgeon that participated in the humanitarian effort in the wake of 2011, earthquake and tsunami in Japan. When the call went out in New York, he knew his experience would benefit the thousands of sick patients being admitted to New York city hospitals. Keith Boettiger, president of Abbott's neuromodulation business, sat down with Dr. Bremer to discuss his experience.
Keith Boettiger (01:38): I've just been impressed with some of you guys who kind of gave up your private practice and made the decision to go, go to New York city and work kind of in the middle of this whole thing. And I think that just takes a lot of courage and a lot of guts, and it takes a lot of risks. You have a, you have a wife and a super young child at home right now. Right? So you kind of gave up a lot to go, go help a lot of people. So I thought we, I have, you know, four or five questions. I just thought, I thought we'd go through, but I really want to do this because I'm impressed with you guys. I always, I'm always impressed when people take risks or kind of do do things that are kind of outside the norm. So, you know, I just thought I'd start with, you know, what really, what drew you to go to New York city to kind of jump in the middle of the pandemic and kind of like the hotspot for the whole globe.
Keith Boettiger (02:24): I mean, I know you got a super successful practice in West Virginia, and I know you guys, weren't seeing a lot of patients and doing a lot of procedures, but still it's a big deal to leave your family to go to New York city and work with really sick people.
Nicholas Bremer (02:37): You know, so that's a good question. I mean, you know, I'm, I'm kind of the type of person that's always run, sort of ran toward toward the action toward the fight. And, um, I saw things happening and, uh, you know, the other side of it is I, I had a great deal of experience with intensive care, um, or, you know, with critical care in residency. So I, I, you know, I felt extremely comfortable in the intensive caring and that sort of combined with, you know, my sort of a willingness to put myself in sort of, you know, more uncomfortable situations. And then with my Navy background, with this thing called operational risk management, we're always taking risks and everything we do and trying to mitigate those risks over time. I don't know. I, you know, it was at the time anyway, it was literally a city in crisis. And I would talk to people here and kind of hear your stories and, um, you know, the skillset that I possessed partially due to my training and pain, actually, you know, with, you know, using ultrasound and being able to put lines pretty much anywhere. And, you know, just in general anesthesiology training was extremely and, uh, you know, high demand. So it just, um, you know, I talked to my wife about it and, you know, we sort of went back and forth and then, uh, she eventually said, you, you just gotta go, you know, so that's, that's how it kind of came about really.
Keith Boettiger (04:03): How has it all evolved since the day you got there? Cause I mean, you got there kind of in the middle of it, right? And it's gotten to kind of hit the top of the curve.
Nicholas Bremer (04:12): So, uh, I guess when I first got here, it was, um, what I would call controlled chaos at Bellevue. Um, you know, Bellevue hospital center is essentially the flagship hospital of the New York city, HHC health and hospital corporation, uh, public hospital system, which, which incorporates us into 11 hospitals around the city, I believe. Um, and each hospital has an academic affiliation with some university in New York city seemingly. So, um, you know, so HHC was, was in really a tough spot. And I think Bellevue did an amazing job in terms of preparedness. Um, you know, whether it be physical plant, you know, infrastructure, making ICU beds available literally out of thin air inventing ICU beds, new units, just expanding. So I got here and it was a, you know, kind of controlled chaos. Other hospitals, um, were, you know, maybe not doing quite as well, but , Bellevue was a, it was a controlled chaos. And, uh, you know, as I sort of sort of integrated into the intensive care unit, so the anesthesiologists were placed in all, all types of units. Most, most anesthesiologists were placed with, um, the anesthesiology department. I was placed in the intensive care unit with the COVID NICU so, so actually integrated into the, uh, the teams, you know, sort of over the course of a week, really, you know, it became something called an uptrend attending where I would be kind of in the role of an intensivist. Um, and that has sort of grown over the, over the past, you know, six weeks where, you know, I sort of run my own teams and, you know, things like that. So if people were placed in different roles and so as, um, time went on, you know, you, you know, the disease was really unknown. Like we didn't really know what to expect. Was it, was it going to be like a traditional ARDS type picture or not? And then we, we, we just learned the entire time. I mean, people would come in with a, you know, otherwise, you know, standard medical problems. And we would ultimately find that they would be COVID, people who come in with, you know, heart failure. And we would find that that would be COVID myocarditis. People would come in with, with renal failure. And we would find that that would ultimately end up being due to COVID. People come with all types of problems and end up in the intensive care unit. And so many people would end up there, their presentations were due to COVID and, um, it was really interesting. And, um, you know, sort of beyond the, the front lines of trying to figure out, like, what is this disease and what is it doing and what does it mean? And we were really making it up as we went along, um, and so and so to be in that, in the center of that really, you know, uh, you know, sort of infrastructure was, was really one of the highlights of my career. Really. I consider it to be a high privilege to be really, you know, trusted with the care of these patients, um, with the disease that was essentially unknown in the epicenter of the, of the, of the COVID crisis in the world. So really that just a huge learning curve. And then as things progressed, um, you know, we, we of, we sort of understood the disease a little bit more. We understood we could, we sort of needed to be done in terms of anticoagulation in terms of treatment in terms of outcomes. Um, so I think we have a, a little bit of a better sort of handle on it now. Um, I think the rest of the world, um, probably would, you know, do well to, to really, you know, pick up on the New York city experience. Cause it's just, it's just been so instructive here. We have so many papers, you know, pending that we want to publish and, uh, you know, and, you know, we're still learning as we go, but, um, yeah, just to be on the front lines of literally, uh, probably the most important emerging disease or special pathogen in the world has been, uh, just a tremendous privilege.
Salma Jutt (08:27): As time has passed since the earliest days of the pandemic and hospitalizations have begun to ease, Dr. Bre mer reflects on some of the things he learned from his days on the front lines and what he can take forward with him in his practice, from those experiences.
Keith Boettiger (08:42): What have you learned kind of, what would you, what have you taken away? What would you apply back to practice when you went back and you just seem like you've kind of, you know, even though it's a difficult experience, seem like you've enjoyed it and it's humbled you and, and, uh, it's been an overall you great experience for you, right?
Nicholas Bremer (08:57): So in terms of, uh, you know, what I've learned, I mean, you know, like other than like the basic critical care type of, you know, skills and learning kind of, you know, I've learned how to really, you know, interrogate an emerging special pathogen, uh, you know, the, I mean, that's been just amazing. So I've learned systems based practice in disaster medicine that in real life, that's something that you wouldn't even imagine, you know, the, the complexities in terms of just, I mean, from everything from scheduling to manning, to, uh, you know, making changes on the fly to making teams, putting teams together, it's really just been a unbelievable experience in that way. I've taken away. It's just really, you know, I guess a couple of things, one is how fragile life is, and, but also how, you know, resilient and people can be after being essentially decimated by this disease, you know, families and patients, you know, you know, everyone still has hope, you know, the healthcare workers still have hope. We still have hope that we can help people. Um, the family still have hope that we can help people, you know, they have so much faith in us and we literally have no, you know, or very minimal understanding of what, of what we're doing even sometimes. So it's, it's just a very humbling, um, as well as just in New York city, you, you know, I can't walk down the street with, without someone saying they're essential worker, thank you so much. I, you know, thanks so much for what you're doing or, you know, so hooting and hollering, you know, sharing, and, uh, it makes you feel good about what you're doing. So, um, just, you know, the, you know, the grace, you know, really just the grace of people for, you know, kind of understanding that we don't know what we're doing, but we're trying our best and you know, that they know that they are, and they know that, that we are type of thing. Um, in terms of what you can apply to practice. Um, I mean, really the teamwork elements of this are just not to be understated. I mean, if, if we were able to, you know, kind of create a system that we can accommodate so many patients with the most infectious probably virus in history, I mean, sky's the limit, what we can do on our private practices back home in terms of just, you know, teamwork in terms of making, making our systems better. Um, and, you know, as in terms of returning to practice, I mean, COVID is not going to last forever. We hope I'm always going to be ready and willing to help with any, you know, one who wants any advice on kind of how to deal with it. But I mean, ultimately I'm, you know, so I'm an anesthesiologist I'm trained in interventional pain specifically, um, love that love helping people in that, in that situation as well. Um, but, um, you know, also would love helping people that suffer from COVID-19. So, you know, my plans are to return to the practice of painful time, and hopefully we don't have, you know, second waves and you're coming in and, you know, we don't have mass, you know, shutdowns again. And, you know, because of this and people are going to, they're going to practice there, you know, uh, you know, going to wear their PPE, they're going to, they're going to do physical distance and do all the things that, that we need to do. Um, but if it does come back, we need to be ready, you know, and we need to have people that are willing to kind of raise their hand and step up. And, and I think we do, I think we have a good amount of people that are gonna be willing to do that.
Keith Boettiger (12:43): So when are you gonna, when are you going back home? Do you know?
Nicholas Bremer (12:46): Not sure. Um, we're sort of, uh, constantly reassessing every week kind of, uh, the needs of just the, you know, the different units and systems and, and all of that. So, um, that's kind of up in the air I would like to return this month. Um, that would be great, you know.
Keith Boettiger (13:06): All right. I thought that's all I got. I mean, look, I'm super impressed with, I'm super impressed with you going up there and doing that thing. I mean, it just seems like you're, you're engaged, you've done. You've kind of, you've enjoyed your experience. You've learned a lot. And I just, I just, again, I just I'm impressed by what you've done and kind of how you think about it and kind of how it seems to have impacted you. So I'm glad I'm, I just, I'm thankful you've taken the time to talk to me, and then I'm thankful you went up there to help a lot of people. I don't know if there's anything else you'd like to say?
Nicholas Bremer (13:37): So I will, I will just, you know, say something that I think is important. You know, certain companies, um, stepped up and certain companies didn't. And I think the fact that Abbott, which I was surprised to hear the name Abbott, you know, uh, came up with a point of care test that what that would help with the ability to, to identify patients suffering from COVID-19 in the, in the setting of a pandemic, literally within, I don't know how long it took weeks or days, or it was, seemed to be like right away. Um, it really just shows the, uh, you know, dedication and I'm just proud to be affiliated in some way with company that is going to, uh, you know, sort of take on that role, that kind of responsibility, um, you know, kind of raise their hand and kind of make up a test that can help us. Um, and I know that it did cause I heard that test being used in.
Keith Boettiger (14:31): That was the, that was the rapid diagnostics group, but they, yeah, they spent, I don't know how many days they worked, but they worked 24 seven, you know, for a week or two to get that thing, to get that thing done. So, I mean, there, there was a lot of, a lot of work to get that done and now just scaling, just scaling it from a manufacturing standpoint, to be able to provide number of tests they need to provide. I mean, I think we've hired or their process of hiring 5,000 people and opening two manufacturing sites. So they can, instead of manufacturing, 50, 50,000 tests a day, they can do millions and millions of tests. So they can, we can test many people need to be tested. So yeah, it was an impressive feat. It really impressive feat by the, by the corporation. So, Hey, I, one last question. So what do you miss the most about not being home?
Nicholas Bremer (15:17): Well, you know, I miss the family. I miss, uh, you know, baby girl, wife and dog. Um, you miss it all. I miss my house, miss my bed, miss my shower. I would jacuzzi over there. Don't have that here. Um, you know, I miss the patients, you know, I miss the staff I work with at all my different locations, uh, you know, St. Francis CMC, uh, you know, Logan, Logan actually sent me a card, which was, you know, very sweet, um, you know, checks on me from time to time. Um, I don't know, I just sort of miss it all, you know, it's sort of hard to be away, but I sort of view it as a military deployment where we're going to do, we're going to do what we need to do regardless, and we're going to get through it. And at the end of it, we're going to be able to, uh, you know, really sit back and kick back and reminisce about, about, you know, the good work we've done. So anyway, that's the hope.
Keith Boettiger (16:08): I'm sure you'll validate. Hey, look, if there's anything you need, feel free to reach out. I mean, they will do anything we can to help you.
Nicholas Bremer (16:16): Thank you, sir. Appreciate it.
Keith Boettiger (16:17): Alright, well, dude, have a good night and thanks. Thanks for doing that.
Salma Jutt (16:21): Since that last interview, after spending three months at Bellevue hospital in Manhattan, Dr. Bremer continued practicing critical care in COVID-19 intensive care units across the country, most recently in Atlanta, Georgia. He was the senior author on a publication studying an investigational agent with potential activity against COVID-19, which resulted in an FDA investigational new drug approval and a follow on large multicenter randomized control trial. He plans to continue his COVID-19 research and clinical critical care practice as future surges may require. But currently he's looking forward to the possibility of returning to the practice of interventional pain medicine in November. Thank you for listening.