Mississippi Today Editor-At-Large Marshall Ramsey sits down with Dr. Jennifer Bryan. Dr. Bryan was the first female elected as chair of the Mississippi State Medical Associations Board of Trustees. She educates lawmakers on global issues that affect medicine and emphasizes the importance of patient communication. She is a family physician in Flowood, Mississippi. Marshall and Dr. Bryan talk about how Mississippi will fare until the coming COVID vaccines are widely available in 2021. She also talks about how the medical community is holding up in the face of long hours and stressful conditions.
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Below is a full transcription of the interview:
Marshall Ramsey: Hey welcome to Marshall’s Mississippi Zoom tour, I’m Marshall Ramsey, editor-at-large at Mississippi Today. Really glad to have our guest on today, somebody that I have actually gotten to know through the power of Facebook. And I know… You’re probably looking at me right now going “Marshall, I don’t know, there’s a lot of people on Facebook I don’t really want to know, or I know and I don’t want to know them.”
But Dr. Jennifer Bryan is a very good communicator on all things COVID and all things that are going on medical in Mississippi. I wanted to have her on today and we’re going to have her tell us a little about her and have her try to walk us through the next six months or so as the vaccine starts coming in to play, as you know, we’re having some of the challenges that we’re having right now with COVID and so I wanted to get her on. And she of course is the first female elected as chair of the Mississippi State Medical Association’s Board of Trustees which has been around for 150 years. That’s pretty darn impressive. She moves medicine, I like that term, by educating lawmakers on global issues that affect medicine and emphasizing the importance of patient communication. She’s also a mom and a family physician in Flowood, Mississippi. If I can say physician then we might just get through this interview. But anyway, Jennifer thanks for taking the time and talking to us today. I know you’re incredibly busy and I don’t want you keeping your patients in the lobby reading too many old magazines. That would be bad on my part. Thanks for taking the time today.
Jennifer Bryan: Thanks for having me, I really appreciate that. Like you I have enjoyed getting to know you over the past year or so with our public personas. You and I actually met one time over in, I think it was actually a chamber of commerce thing in Rankin County and I was so impressed. You were there with some of your media colleagues and we got to chat and so I’ve really enjoyed developing this relationship with you and have appreciated your leadership. Your talent through expressing feelings and current events through art has certainly helped keep Mississippians afloat, in touch, and also many times it’s been just the positive boost that we needed in some pretty dark times. So thanks again.
Ramsey: Oh you’re welcome. That’s one of the things I like about you is not only are you a physician but you also really believe in patient communication. That I think in 2020 is something we need not only on an individual level but also on a global scale. We’re fighting so much misinformation with what’s been going on with the pandemic and like I said, I’ve really gotten to know you a little bit through your Facebook persona but you are very good. There’s a couple of doctors, Justin Gentry up in Louisville, he’s fantastic. He’s really been calming for his community too. But I just wanted to get you on today and talk a little about A) about you and your career and what got you interested in medicine, how you’re holding up through the pandemic and then we’ll kind of walk through the next six months. As the vaccine comes online, obviously we’re looking at maybe next summer when things can get back to normal. We’ve got a lot of things we need to do between now and then, so let’s just go ahead and get started.
Bryan: Yeah sure, where do you want to start?
Ramsey: How’d you get into medicine?
Bryan: When I was young, my uncle, Dr. Tom Joiner, he practiced in Jackson for many years, just kind of gave me a job in his office and I came along in the summers, I would work there in a private practice. I really enjoyed what I saw. It was an era where there was a lot less regulation than there is now. I enjoyed it, I enjoyed what it was to be the town doctor and the community physician. He also was really involved in health policy and was past president of the state medical association and gave me the best piece of advice, which was to just keep showing up and things would come to you. And so I did. And also to keep doing the next right thing. My dad is an attorney, he’s retired but he was the federal public defender for Mississippi and did that for 17 years. Those two are brothers and so I kind of had a good foundation coming along understanding the law and our governance but also the compassion involved with being a physician.
Other than wanting to be a rockstar when I was about five, I really didn’t have many other ideas besides being a doctor. I set that course early on. I graduated from Brandon High School, went on to Mississippi State and majored in microbiology and actually was organizing some things and ran across some of those classes on an old transcript this week. It was really fascinating. Some pathogenic microbiology and virology and immunology. I just learned a lot there about some of the things that we are facing. And then (I) came back to UMMC and did medical school here and just really fell in love with family medicine. I tried to have an open mind but went back to my roots which is what I had always know. Alongside that developed a love of health policy did an elective my last year of residency at UMMC which was designated to spend some time in Washington and just gaining experience. And then went back to my hometown of Brandon and started practicing. Eventually I drifted over towards Flowood which is where we’re raising our kids over on this side of Rankin County now. The love of medicine, I’ve always enjoyed communicating, I’ve always enjoyed people, and it’s just something about being the doctor that can break things down in real speed to someone and explain a really serious condition and walk them through it and be that person that has always fed my soul a little.
And on a population health perspective, with the pandemic I think that’s what drew me in to social media even more was to want to explain what seems so nebulous if that makes sense.
Ramsey: I saw a great exchange today on my Facebook page, somebody was calling somebody a sheep and…basically this person they were calling a sheep about the virus actually is a researcher for the vaccine. That’s the problem is that right now there are people that are experts that do understand the virus, do understand the things that we need to do and they’re competing against the conspiracy of the day. How as a doctor…I’m telling you I’ve been on the other side of the doctor patient relationship when you get bad news and a lot of times you’re just sitting there and you hear Charlie Brown’s parents. You know, you hear womp womp womp womp cancer, as it was in my case. It’s hard to take hard news like that. We’re kind of in the situation right now where the hospitals are at record numbers from COVID patients, we’re going into a time when everybody is going to be indoors, the vaccine’s just now coming online and really won’t be online for the average person until the spring. How can we communicate to the population and actually get them to understand that if we don’t do something this could get very dire very quickly?
Bryan: You know, there’s so much psychology to 2020. We could spend all day talking about the stages of grief. We all have experienced grief in our life on an individual level where the shock initially hits you and you think this can’t be happening. There’s a denial — “This is not happening.” And we rage about it or sometimes we cry, we feel sadness, but eventually there comes acceptance. Politics aside, we all know that politics hijacked some of this narrative this year. It did. It’s an election year and conversations got really heated and polarized but we, I think, I hope, are coming around to some collective acceptance as everybody is individually touched. And sure as a physician, I wanted a proactive message out there. A prevention message, like exercise and eat healthy so you don’t deal with these other medical problems. Go on and wear a mask, social distance and handwash, live your life, let’s contact (trace), test, track and isolate and get through this. But we are more reactive as a society and as a government. That is what it is and I had to accept some of it along the way. Because it would eat me alive to take it so personally why people could not do the things that I thought were common sense or were tried and true public health measures. So you kind of meet people where they are, and psychologically people have processed a lot.
This is a collective trauma that we’re going through. It’s awful. It’s a crisis. A real full blown crisis, but we’re going to get through it. So right now we’re in the worst of it and it’s going to get worse. We know that unfortunately because as cases escalate, deaths follow. Now some of that’s been tempered by the fact that science has gotten better, we’ve gotten some tools, we’ve gotten better at managing people and keeping them out of the hospital and so on, but it’s going to get worse before it gets better. But I believe that people are beginning to understand…just how serious it is just because of the sheer numbers and how many of us have been personally affected.
What can we expect moving forward? Well we’ve got the vaccine rolling. In just a couple of weeks we’ve got healthcare workers who will be able to … get the vaccine, followed by … I posted something about today from the American Medical Association …
Ramsey: that was brilliant by the way, that was really helpful.
Bryan: I really appreciate them putting it out there, that timeline just breaking it down. So we don’t have enough for everybody, but if we get this estimated in the 187,000 doses to Mississippi sometime in December. That’s what I’ve heard thrown around. If we get that, we’re going to interrupt significant transmission there just by vaccinating the healthcare workers. If you picked a row of matches and the virus was burning along and then this match is vaccinated, it stops. We understand that’s going to blunt some. So I would imagine around the first of January or so we’re going to start to see some of these deaths kind of leveling off and the models are calling for that to start kind of coming back down. But it’s going to be a slow painful process. We’ll continue to see, we’ll come online with more and more vaccine in the first quarter of next year and I’ve seen where well into the late spring or early summer the majority of the population is expected to be vaccinated. And they’re working on nuances of what population gets the vaccine when.
But right now, I keep saying the world’s on fire right now. This is the time to batten down the hatches. The next few weeks are going to be critical.
Ramsey: And that’s hard because we’re coming in to Christmas, when everybody wants to be together inside with family singing carols, enjoying eggnog, that’s the tough thing. We’re going to pay for part what happened during Thanksgiving the next couple of weeks too. What I’m worried about, and I think this is, you’re really dialed in to what’s going on in the medical community in Mississippi. What I’m worried about is it’s great to have a ventilator but if you don’t have anybody that can actually run it then that comes to be a problem. I’ve talked to several nurses and a few doctors who are incredibly burned out and they’re frustrated because they see people on the news, they see people on their Facebook page where people are saying “Aw it’s just the flu,” or whatever. I can’t believe they’re still saying that. Everybody I’m noticing kind of sees it through their own prism. If it hasn’t touched their family or if they haven’t had it they still don’t understand the potential seriousness of it. But what are we gonna do…I understand medical workers will get the vaccine first, long term care residents will get it second. That’s the way it needs to be. But what can we do mentally to help our medical staff be able to survive the next six months? It’s like they’ve been in combat since March.
Bryan: It’s awful. We’re going to have a workforce riddled with PTSD by the time we get through all of this. And in fact, we’re already seeing our professional health programs being utilized at levels it has not been historically. … What can the public do? One thing, pay attention to the doctor you’ve listened to your whole life that to tell you about that cancer diagnosis or or your heart disease diagnosis. They’re not gonna lead you astray. We by and large generally are all on the same page. You’re going to get a person here or there who hollers about masks or hollers about some latest greatest treatment, but really, physicians communicate in real time all day long. We talk constantly in our groups and things and there’s just not a lot of controversy. There’s a lot of frustration, we’ve got a lot of physicians sick at home. So to the extent that the public can support these guys, we got a lot of clapping at first. We got a lot of “Healthcare heroes work here” and man, that’s appreciated. But we also have a lot of burnt out doctors.
I’ve got a lot of doctors at home. Just this morning I heard from another one, she and her infant daughter are quarantined from COVID that they got from work and so that’s another strain. Because when a doctor goes down, there’s not another group of doctors over here ready to step up. And these guys have been operating with minimal PPE, they are still in crisis level PPE, I’d say modified crisis. It used to be you walked into a room with an N95 with one patient, you got through it and you threw it away. If you went back and saw them at three o’clock in the afternoon you put on a new one and you threw it away. Now some of that probably was excess and we’re learning about that, but in the meantime we know these are finite resources. And so every day people are reusing things that are there that were not originally designed (for reuse). They know that, they want to do it, but that’s a constant stress.
Seeing people die, they’re with people taking their last breath and trying to relay this to family members. And so I think I saw today actually, I saw someone call (out) Dr. (LouAnn) Woodward on Twitter, “panic much?” Kind of teasing her about it. I’ve certainly been called and ridiculed and laughed at. You get a large (amount of) appreciation but you get negativity. I think the more the public can support the people on the front lines just by listening, accepting what unfortunately is the reality of what we’re going through, and changing things ever so slightly.
We talked this week about Christmas. We don’t have to give up Christmas. We do need to figure out how to problem solve through it. And we need to figure out adaptability. I firmly believe adaptability is a human quality that the importance (of) cannot be underscored in the pandemic. You gotta figure out how you’re going to get through it and not go crazy. So the public needs to figure out how are we not going to spike again after Christmas? Or how are we going to blunt the Christmas impact? How are we not going to be Thanksgiving again? There’s going to be a bump. We know there’s going to be. Because you can’t get everybody on the same page. That’s not going to happen. So do you have a fire pit, a favorite fire pit outside? Can you figure out how to utilize zoom? Can you postpone to February like we’ve done with family out of state? How can you logistically plan to not be normal in abnormal times?
Ramsey: I’ve been working on trying to be normal for 50 years so I don’t know, I think I’m in trouble on that one. I listened to a very powerful interview with Dr. (Thomas) Dobbs he’s talking about the hospitalizations now are actually at record levels. We’ve gone back up after we had the mask mandate and everything dropped and then the governor removed it. OK, he did that and now we’re back up. What happens though — we’re full, ICU beds at 12 hospitals are full — where do we go from here? We haven’t even really had Thanksgiving hit yet, then Christmas is coming, are we talking about do we put facilities in the parking lot? I mean, where are we going in the next two or three months to be able to get through this next surge?
Bryan: That is an excellent question, one for which there is not an easy answer. Where do we go from here? You can build extra hospitals, you can build field hospitals, you can do it all day long. But the human resource is the most precious one, and we have a finite number of doctors and nurses and respiratory therapists and I don’t want to miss anybody, all of our wonderful healthcare professionals. But they are a finite resource. So you look at the things that have worked, as much as we hate to postpone elective procedures, it works and it frees up bed capacity quickly. So if Dr. Dobbs and Dr. (Paul) Byers called on physicians about six weeks ago to really start ramping up their performance of those type procedures in anticipation of a request to start self moderating. And they did. The doctors have been trying to pay attention to OK we’re not going to do as many elective procedures to keep bed space available.
The hospitals have done a very good job of auto regulation up until this point. But if the damn starts to break, and I think that’s what we’re seeing, right? We’re seeing healthcare workers at home, we’re seeing full hospitals, we’re transferring out of state in some situations, then that’s why you have a state health officer. That’s why you have public health laws. Because if you sit around and rely on all of us to collectively figure out how we’re going to do this, this problem just exponentiates. So I would anticipate the governor and the state health officer working very closely, making some probably unique management decisions over the coming weeks. It’s gonna have to happen. Our leaders are going to have to lead us through this and I would ask the public to embrace some of that. These are not easy decisions. Our physician practices, many nearly folded during the shut down just like other small businesses. Our physicians continue to be under strain. The hospitals and so on.
So, these decisions are not made lightly but I will expect that there will be some further recommendations. Holiday breaks with school will help some. Because the virus really doesn’t care, I mean a crowd is a crowd. It’s gonna spread. So the more that we will do small groups, the more that we will listen, we can interrupt a lot of the transmission. We know it works. We know masks work. So I think you’ll see more encouragement from our elected officials. You’ll see more encouragement from the health department to do the things we know work. The recurring theme is they ask you, they ask you, they ask you, and then they do it. That’s what I’ve seen anyway.
Ramsey: Yeah, you’ve got a long history of working with them on different public health issues so you know what you’re talking about on this one. I know you’ve got a busy schedule, I don’t want to keep you too long. The press releases, I know they haven’t been peer reviewed yet, but the press releases on the information on the two vaccines and now I guess the one from England too have all been very, more than encouraging. They’ve been incredible. So what is your take on the vaccines? Do you feel like that is going to be a total game changer once that gets online?
Bryan: I absolutely do. Though the peer review process is ongoing, we’re all very connected in these scientific circles and our colleagues nationally that are on ASIPP (American Society of Interventional Pain Physicians) and AMA (American Medical Association) and all these physicians that we’re talking to, all have looked at the science and it’s really sound. All we’re getting is wonderful promising reports from independent reviewers. And Dr. Dobbs is very confident in the vaccine when he speaks about it. I am as well. So I can’t wait to get mine. I’ll be honest when all the politicking started, I didn’t know that I would be this confident at this point in the game. And if I wasn’t confident, I wouldn’t say that I was confident. I would sit here and tell you I’ve got a problem. And I don’t. I’ve talked to enough people that the science is there. You know, we’re not at the final process yet but we’re anticipating wonderful news and being able to get this vaccine to our healthcare workers later on this month and I’m confident in that process. So I think we’ve got good days ahead, but we’ve got some horrific ones to get through before we get there. So now’s the time to protect your family. If it’s not your livelihood, stay home when you can. If you do not have to get out, please do not get out. Please take this virus seriously and let’s make it to the other side of this as whole as we can possibly be.
Ramsey: I think probably a great way to sum up this is it was the best of times, it was the worst of times. If you think about that vaccine you’re talking about a scientific achievement on the level of the moon landing. Because you know, it usually takes four years to produce a vaccine and we’ve done it in a year. I mean thankfully, a lot of this research was built off of the first SARS virus that hit back, gosh, in the early 2000s. But still, to be able to get this out there… I agree with you, I would be the last person in the world to want to get a shot if it was built by the government on low bid.
Bryan: Right, absolutely.
Ramsey: I don’t want a tail or something like that to happen.
Bryan: It’s an incredible achievement.
Ramsey: Of course now we’ll have the special logistics of getting it out there, I know you’ll be wrapped up in that too and have your special freezers set up and ready to give shots.
Bryan: We’ve already been talking about it and planning, doctors have been meeting with the health department. They’ve been wonderful purveyors of information so we’re excited about getting that out to the people. I wanted to end with you on one plea for our psychological health. These are hard times. I mentioned adaptability and I’ll mention it again. Look for the joy right now. Not the reality we wish was happening, the reality that is happening. Clinging to normal, normal, normal, normal is going to lead to disappointment over the next few weeks. How we innovate and how we figure out how to be a little different and get through…smaller is OK right now. Invest in your family. Invest in the things that are important, it’s going to come back to you psychologically to help you get through a crisis, it’s going to come back to you by protecting your neighbor, protecting your family, it’s a time just to think differently. You know, we’ve made new traditions with trying to cook old family recipes or making Christmas ornaments or whatever it is that makes your family happy. Look for those things and it’s going to carry you through.
Ramsey: That’s a perfect way to end and thank you so much. I hope the holiday seasons are good to you and I appreciate you taking the time with me today.
Bryan: thank you for having me. I really appreciate you and all that you do for Mississippi as well, so thanks again.
Ramsey: Thank you so much. Dr. Jennifer Bryan, thank you.
Bryan: Take care.