Transcript - Ep 1: Meet All Things Cardiopulm

Rachele Burriesci: [00:00:00] Welcome to Talking All Things Cardiopulm. I am your host, Dr. Rachel Bari, physical therapist and board certified Cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions, and patient experiences.

The goal is to learn, inspire, and bring cardio palm to the forefront of conversation. Thanks for joining me today, and let's get after it.

Hello, hello and welcome to the first episode of Talking All thanks Cardiopulm. I am your host, Dr. Rachel Bari, and today I really just wanted to introduce myself a bit. I think it's super important for you to know who is talking to you. Um, and I just wanna tell you a little bit about my background, where I've, where I came from, and how I ended [00:01:00] up in the world of cardio.

So as I said, my name is Rachel Risi. Rachel does have an E at the end and this typically throws people cuz it's a unique spelling. Um, of course there's a story behind it and I was told I couldn't just skip over that. So, um, It's a family name, but I actually spelled my name r-a-c-h-e-l until I was in the sixth grade.

When I was in the sixth grade, I had a basketball tournament and I had to bring my birth certificate. And of course I have this in my hand now and I'm like, ma, where did this E come from? And she's like, oh yeah, that's how you spell your name. Uh, you named after your aunt. Which of course I knew, but I also thought I had my own.

So she's like, you know, that's the Italian way to spell. It's pronounced, and I hated that. So I never called you that. I called you Rachel, and I was like, yeah, I get the whole concept, but I still have this random E. [00:02:00] So in the sixth grade, I had to decide, do I keep the E or um, I guess do I change my name legally?

So I decided to keep the E and kind of embrace it. It was a pretty spelling. It has some culture behind it. But really not a decision. You should leave up to a sixth grader, and it's caused a little bit of difficulty just because most people assume a different pronunciation. So that's the story behind that.

I didn't know how to spell my name correctly until I was in the sixth grade. Um, but I'm born and raised in Queens, New York. I lived in New York until I was about 28. Um, and I'll kind of get into what pulled me out of New York. Um, I played sports my whole life. I was always an athlete. I played softball and basketball primarily.

And then, Ended up choosing basketball as my primary sport. Um, played through high school, played D two college ball, I kind of coached as well [00:03:00] throughout. Um, and that's just kind of, I think, a really big part of me that I wanted to bring up because, Being an athlete, um, playing sports, being a coach, that stuff, the things that you learn is just instilled within you.

I was a five, six power forward and if you know anything about. , the position power forward is not meant for someone who is five foot six. So I really wasn't meant to be a power forward. I was a guard, a shooting guard, a point guard, and I always ended up on a team that just was smaller in size and I kind of ended up playing power forward through high school and even into college.

So if that tells you anything about me, if you know the game of basketball, . Um, I am a hard worker. I am super scrappy and I will do whatever it takes to get the job done. Um, the average person that I was playing against was six two to six six and that never stopped me. I actually had a coach, [00:04:00] um, say that he would take one Rachel playing power forward over three six foot girls.

And that was a really big, um, compliment. and it was really all related to my work ethic. I was never the ba, the best player on the court. Um, I was never the most talented, but I sure as hell was the hardest working. I averaged six to eight rebounds a game, five to six charges. I did whatever it had to do to get the job.

And no one would ever outwork me. And that has really stuck with me pretty much my whole life. My career has moved through like my different passions, um, scrappy and a hard worker. And I will do what it takes to get it done. Um, but basketball was my first love. It was my first true passion and it taught me a ton of life lessons.

It taught me grit, [00:05:00] communication, focus, and truly the lack of quit playing sports, coaching, all of that, being able to prioritize your day. I was playing into college, uh, out in Long Island, and I would wake up at five, get to school by six, work for about two hours in my car before going to class.

Prioritize prioritizing your day and making sure you get all the things you need to get done. is of utmost importance. And that prioritization has really helped me through my whole life. Um, it taught me how to work hard for an outcome. It taught me that when you put in the work, you're gonna get what you put into it.

Um, it even taught me professionalism, dealing with coaches, dealing with athletes, dealing with parents, and it taught you how to win and lose with grace. Taught you about heartbreak. It was not easy to leave the [00:06:00] game. I actually almost decided not to play in college and focus more on my career. It was around high school, probably my junior year that I decided to go into physical therapy and I, um, chose a three plus three program at N Y I I.

I really wanted to, um, kind of expedite into my career. I was always making logical, realistic decisions. Uh, that's kind of my mo realistic. Rachel is something that I still hear on a daily basis, but it has served me well and it was a great program. And I chose to go to N Y I T for the PT program, not because of basketball.

I ended up playing basketball at N Y I T for about two years, um, before I decided I had to stop playing. Um, cuz my third year of undergrad was gonna be primarily science. I think it's something like 21 credits and I couldn't. Risk [00:07:00] missing labs for games. And so I had to make those decisions and that was a really hard decision to make.

But it was the right one. Ended up coaching and I'm so glad I did. You know, everything that you do in life just adds to the learning experience, the overall outcomes that you experience. And it was, um, it was an awesome, it was an awesome experience to coach. Actually in the, the history of the Mary Lewis Academy, we won two state championships, one that I played in and one that I coached in.

And it's just, just an awesome ex, just an awesome feeling to be a part of that again. And from a different perspective. I loved coaching. I still love coaching. I think, um, coaching, teaching, all of those aspects just hold such, um, Similarities and parallels similar to sports and [00:08:00] life. And I think being a good coach has made me a good teacher.

And just understanding that not everyone learns the same way and not everyone responds the same way, and not everyone is motivated in the same way. And just to learn how to communicate different to different people is such a skill, and I've had the pleasure of learning how to do that. . So I'll kind of fast forward a little bit.

Um, I went to PT school at N Y I T. I was in a three plus three year program. Um, I graduated May, 2009 and right out of graduation I started working with a temp license. I thought for a fact I was gonna be in the world of orthopedics. I loved the orthopedic outpatient setting. I loved manual therapy. I was good at it.

Um, and I had a mentor from my previous job, um, one of my first jobs [00:09:00] in PT school. Um, just one of my first jobs really was in a PT clinic, so I helped run the front office and I learned so much from working there at billing, the insurance aspect, um, the ins and outs of running a clinic. I saw the transition from an orthopedic clinic to a pelvic floor clinic.

Um, so I was really. In a great position to learn and I absolutely appreciated everything about that. I learned so much about PT with that job and I had a great mentor and she actually told me that I should go into the acute care setting now. Um, cuz if I went into the outpatient, I would never go back and I would.

Gain lots of valuable skills of being in the acute care setting, especially as we were just starting to push for direct ac, direct access, and you know, she was like, get the experience, be in the hospital setting, be able to identify those red flags. It'll [00:10:00] help you be a better clinician. So I listened. out of, out of PT school.

I was working on a temp license in an outpatient clinic. I really enjoyed it. Of course, there were things I was, um, studying for my mpte. I was working probably four hours in the evening in the clinic and then I was staying until, I don't know, 10:00 PM writing notes and I was. See some trends in that world.

Um, and my hands were just really not holding up. I was left parat at night and so I really embraced trying acute care. I really didn't know what to expect. I didn't have an acute care affiliation while I was in school, and, um, I, I truly didn't know. How it was gonna go. And I fell in love with it. I loved the fast pace, I loved the quick turnaround.

I loved how quickly you could see profound change in the patient. [00:11:00] Um, and I think that was like the big. The big piece for me, that quick change, it wasn't taking weeks and months to see the change. It was happening in two or three visits. Uh, it was very hands on. I liked the medical aspect of it. I liked being able to learn different pieces.

Um, and as I started progressing through acute care, I started diving into those pieces a bit deeper. Uh, so needless to say, I never went back to the outpatient. Um, which was really a surprise. I even looked back at, um, we had a PT yearbook, and in my PT yearbook it said, you know, where do you expect to be in five years?

And it was outpatient, orthopedic manual. Um, boy, why I was wrong. So this is why I always tell students, keep an open mind. Try different things. Um, see what you like, see what drives you. And then when you find that that thing that like you're hooked, go for it. [00:12:00] So I was in a acute care, um, orthopedic hospital, so primarily total joints, total knee, spine surgery.

Um, and I really liked it, uh, everything about it. As I got kind of better acquainted with being in acute care, I started diving into different aspects. Um, had an opportunity to work in the PACU in a pilot program that was just starting. They called it rapid Rehab, and it was a post-op day zero initiative.

For total knees, it was only total knees at that time it was at a pilot, pilot stage. So very select patients were being pulled into it. But the, the main goal was to decrease length of stay and to see if we can start rehab sooner and faster. And would that have any impact on length of stay? So of course we have this cherry picked population who was doing wonderful in N pacu and they were decreasing length of.

[00:13:00] And so little by little we started adding different patient populations. And so being a part of that allowed me to advocate for the patient, advocate for the PTs, and to start paying attention to the trends. Um, I was starting to see trends in different anesthesias, and I started to dive in a little bit deeper.

With that, I started to see trends with different estimated blood loss, and I started diving a. Deeper with that. Um, but it was really in the PACU that I had this pivotal moment of wanting more and wanting to understand more. And, and just to dive deeper, I was seeing these patients just outta surgery. I was helping to develop protocols.

I was, um, creating like quick and dirty techniques for the nurses to help expedite the patients that were actually ready for PT versus the patients. We're definitely not ready. And in the pacu I really started to realize that [00:14:00] even though I had the instincts and I had, my gut was always, or mostly always correct, I knew if it was gonna go well, if it wasn't gonna go well.

Um, I was still having a hard time articulating the why. Why wasn't it gonna go well, I could predict that it wasn't gonna go well, but could I articulate the why? And so I was working alongside residents and I was asking questions and I was starting to see differences again with ebl, with ekg, um, with comorbidities.

And I just really wanted more. So I started to look into different specialties. And at that, acute care specialty didn't exist. It technically still doesn't. Um, so I dove into the geriatrics certification cuz that was my primary population and I did it with self-study and um, . While I was studying for the geriatric certification, I realized I still wanted more [00:15:00] and I wanted, um, a mentorship.

I wanted someone to push me to challenge me, and I, there was still something missing for me, so I just wanted to dive in again. So, um, at this point I was a clinical specialist on my unit. I was running rapid rehab. Um, had a great rapport pretty much. Most of the hospital staff, including upper administration, and I decided to start looking into residencies and again, no acute care residency available.

So I started looking into what a cardiopulm residency would be because most of the issues that I were, that I was seeing in the PACU related to cardio palm. Impairments or issues or changes like hypo, hypovolemia, hypotension, changes in ecg, and I really just, I needed more. I wanted to be able to articulate it and.

I was ready. [00:16:00] So I applied for the two cardiopulm residencies that were in existence at that time. I was wait listed at one and I was accepted for an interview interview at the Ann Arbor VA residency. And so, you know, I went for it. It was about four years into my career and I decided this would be a great time to pursue this from both a personal and professional aspects and.

So I went, I went on this interview, um, in Michigan and of course there's like so many stories attached to this day, , but um, it was just a wild day. I had the early flight. I was up at 3:00 AM I was hoping to, um, check in to the hotel when I got there. And be able to like take a nap, iron my clothes, take a shower all before the interview and none of that happened.

I got there, they couldn't check me in early , and they were like, [00:17:00] well, there's a big boy next door. So if you don't know what a big boy is, it's a diner type restaurant. It's a chain restaurant. So, , I did just that. I went to the big boy and I was like 8:00 AM So I think my interview was at four. I was gonna be able to, or my interview was at three.

I was gonna be able to check in at four, and just timing wasn't on my side this day. So I basically hung out at. Hung hung out at the big boy for God knows how many hours. I pretty much ordered everything on the menu. And about halfway through my morning I was like, well, I guess I should try to get changed.

So as I was trying to get changed in the Big Boy bathroom, there's only two stalls. Um, the stall that was not the handicap stall. Tiny that if I would've tried to change my clothes, I probably would've end up with like pants in the toilet. So I ended up using. The handicap stall, and [00:18:00] I'm like, five minutes into getting changed and I hear a crying baby outside the stall and I'm like, oh no, the changing table was in that stall.

So I'm like panicking. I'm trying to get myself dressed. I'm sweating. My clothes aren't fitting right. Everything feels wrinkled, and I'm just like, oh man, this is, this is, this isn't going well. So I quickly got out of the stall to let. The mom and the baby use it. And I was just like, I had just gained some weight.

I'm like putting on my button down and like it's just not fitting right. And I'm just like, oh man, should I go shopping right now? And you know, I finally got over myself, . And so I go back into the big boy to probably grab another cup of coffee to just waste a little bit more time. And I start to see that the waitstaff is like in a panic.

So PS I've been at. Restaurant for like three, maybe four hours at this point. And they probably thought I [00:19:00] walked out on the bill. So, you know, I make eyes at my weight staff and I'm like, I'm still here. Just had to get changed. Had to get changed in the big boy bathroom and . Um, eventually I kind of made my way into town and, uh, eventually to the interview and.

You know, it was just one of those days, it didn't feel like anything was going my way. I kind of felt out of sorts. I felt a little chaotic and I'm pretty non, non-anxious, stable. Um, go with the flow for the most part. But I do like structure and there was nothing in the world of structure on this day. So I get to the interview and I'm sitting in the waiting.

and I like lose my phone and I'm like searching through my bag. And, um, again, like starting to feel anxious. Nothing is like, nothing is where it's supposed to be. and there's this woman in the waiting room and she's just smiling. And I, and I just notice her, right? She's sitting there, she's [00:20:00] smiling, and I'm like, wow.

She's just really smiling. And I'm like, in a full fledged panic. And moments later, another person walks into the weight room, um, that looks just like this woman who's smiling like same. Smile is coming at me. It takes me a bit of time to realize that these two people are related and the person who is coming into the waiting room now is the person I'm interviewing against.

I guess I don't know how you would say that, or is also on the interview for the residency. That's probably a better way to say it. So again, I'm like, oh my God. I wasn't prepared to meet someone who is essentially. Interviewing for the same position and I was just really trying not to panic. She was, um, dressed really nice.

She was in a full suit. Just looked very kind, had a very calm demeanor. and I'm like, panic, sweating [00:21:00] through my shirt. It doesn't even fit. I'm wrinkled and I'm like, oh man, this, this is not, this is not going in my favor. So, um, and then this person talks and she's got this really sweet Texas accent and I'm like, I'm done.

I'm out. No one's gonna hire. The, the New Yorker against this sweet person from Texas who's like, got her shit together. And, you know, I just created all this chaos in my own mind. Um, we ended up both getting the position for the residency and it was amazing because, um, this, my residency partner, we were complete opposites and it was like the perfect match.

No one could it really, no one could really expect how well we worked together or how well we just meshed. Um, we were complete opposites. Like I said, she was from Texas. I'm from New York. She grew up around [00:22:00] cows. I'm like in a huge city. Very different backgrounds and also just different demeanors. And we both brought something to the table.

Um, but she was amazing. She, uh, basically one of my best friends. Now. I'm sure I'll have her on the podcast at some point. Um, but the residency was a great experience. It was exactly what I needed. It was exactly what I wanted. I feel like I earned my gc. During that residency, I was at a va, so I really got to use my whole scope of license.

I was doing wound care and wound vacs and running patient education sessions and creating protocols in the icu, creating, um, or having PT join medical rounds in the icu. I was, Helping run outpatient, pulmonary and cardiac rehab. And basically in an entire day I can go from outpatient to ICU to clc, which was [00:23:00] like a skilled nursing facility.

So it was just an awesome experience. I ended up getting hired into the residency, um, and ended up being a mentor in that re. , and quite frankly, it was my dream job ev anything that you could do that was in your scope of practice, you could do. And there was good PT culture and there was just a lot of, um, advocation for PT to be in different settings.

Uh, like I said, I was running outpatient, um, cardiac and pulmonary rehab, but I also had the opportunity to start a telehealth cardiac rehab program. Um, it was originally created. The Iowa VA and we basically, they were trying to expand and so we were one of the VAs that basically took it on and ran it in our own setting.

So just so many different experiences. Like I said, you could be in the icu, run outpatient, cardiac rehab, then be in telehealth, then have a [00:24:00] skilled nursing facility patient, then be up on the floors doing acute care, treat. Literally, it was the best of all worlds, and being a mentor in the residency, I got to teach.

So just having all of that versatility in my day. Is something that I thrive on, um, and something that I hope to recreate now. So, just kind of as a recap, I'm born and raised in Queens, New York. I grew up playing sports, basketball and coaching have been a huge part of my life and have instilled a lot of, um, values.

I graduated from PT school in 2009, was in the acute care setting for about four years. Um, I then uprooted my life to Michigan to do a residency, and I was there for about four and a half years or so. Um, and then I decided at that point, um, we were kind of, we were in Michigan, so we were between New York and Kansas.

We were the, we were always [00:25:00] travel. To and from family, and we decided that when we got married, we would try to move closer to at least one family. So in 2017, we uprooted our life again and did all of the things that I highly recommend that you don't do in a small period of time. Um, we quit our jobs. We bought a house.

We got married, we went on a honeymoon while still looking for jobs and, you know, it was amazing. And also do not recommend, um, guilty position opened up with a need in cardio palm. And honestly, it just felt like the universe, the universe put itself. In its place and everything was lining up and I had already been thinking about teaching.

My mentor from the residency asked me if I was interested in teaching and I already had been teaching in the residency. Um, but just not at this, I don't even wanna say level, but not at the [00:26:00] consistency that a faculty position would require. Um, but it all just felt right. And as you know, I. . I ended up getting the position and I dove in head first, and I was in faculty for just about four years before I decided to leave academia and pursue all things cardiopulm full time.

So here we are now. We're in a fullfledge of building. Um, And I'm super excited, and as you know, I am diving in head first, so I'm super excited to get this podcast off the ground. Um, it's actually something that I, I didn't realize I wanted to do or needed to do until I started talking about it. And this podcast needs to exist.

It doesn't exist currently. Um, there's nothing out there like it. And. I really feel like cardio palm holds so [00:27:00] much weight in so many different settings and it just doesn't get the weight or respect that it deserves. And I've constantly heard, especially through the last nine years as I've moved further and further into my specialty, uh, like why cardio palm?

It's not sexy. No one likes that class. Like I don't even remember my cardio poem teacher and all, like all sorts of. , here's what I have to say. Cardio palm is super important, it's super necessary, and it's sexy. Watch me make it. All right guys. Thank you so much for listening. It's been a pleasure. I'm looking forward to chatting with you, learning with you, and bringing all things cardio palm to the forefront of conversation.

I hope you have a wonderful day whatever you have to do, get after it.[00:28:00]