The Life and Career of Maine Health Pulmonologist Dr. Jen Palminteri

Hello, I'm Dr. Lisa Beil. And this is radio Maine today. I have in the studio with me, Dr. Jen Palm and Terry, who is a fellow physician and also, um, a fellow art lover. I would say New art lover. I feel like I'm just sort of coming into it after making some new friends that know a lot about art, which has made it much easier. Well, to be honest with you, that is how I became an art lover. Myself is through friends. So, um, so welcome to the crowd, I guess. Thank you. Thank you for having me. So That's a good thing. Um, you're also a fellow main woman. Yes. I'm. I was born in Alfred, so I lived there and left for training and then came back and, uh, I've been in Maine sort of for my adult life. So it's been nice. I feel like I'm like firmly in the community and I see patients that I know and families that I know and their kids sometimes. And so it's nice. So that's interesting if you're from Alfred and where do you practice In Portland in Portland, but you still draw people from the Southern part of the state. Yeah, we, I do pulmonary disease and critical care medicine. So, um, for kind of complex disease, they tend to travel a little northward for that. Um, so, and I, I don't know, they sort of know my parents and they're like, Jenny's a pulmonologist, we'll go see her. So it's been nice to see my parents' friends and all that, Uh, do you ever find it to be a mixed blessing? Sometimes? I guess if there's sad news, it's a little hard. Oh yeah. Um, but that happens rarely. So most of the time it is pretty good. Yeah. Well, I only ask this cuz of course, you know, my father, I do. And yes, I did rotations with him at, um, in his practice on, um, India street. Yes. It's a long time ago at This point, but yeah, I was gonna say a little while ago, a Little bit, a long Time. Okay. I might have even, I was a medical student at that point, so okay. I was like an early two thousands. Okay. And where did you go to medical school? Vermont, right? Yeah. So same. Yeah. Yes. I also did rotations on BSP. also did my residency there. I felt the same bad, but yeah, exactly. And the reason I ask about the, um, the mixed blessing thing is I, I find that, you know, everybody in at least one part of the state and it was my dad as a family doctor of he Is a Fixture almost 50 years. He is a fixture. And then on top of that, I have, uh, two sisters who are in medicine. A brother-in-law that's like, you gotta be well behaved. You know, you can't not be well behaved if you practice in the state where you grew up and your parents still live, Especially if your last name is parliamentary. Yeah. Yeah. You need to sort of, you stick out around here. There's not many of us, If it was like brown or Taylor or something like that, you'd be better off yeah. Away Yes. Parliamentary. Yeah. So how, uh, how did your parents come to live in the Alfred region? They're both from sort of the New York city region. And, um, they started at St. Francis college, which is now U E uh, my dad was a year older than my mom and they met there. Oh yeah. Fascinating. Yeah. Came to Maine and my dad, I don't know. He's not much of a city boy to be honest. So he sort of likes space and acreage between him and his neighbors and that kind of stuff. So, um, yeah, they we've been here ever since. So what, what do your parents do? Um, my mom was a nurse actually. She was a critical care nurse and, um, my dad worked in television for a long time. And then has we actually, we owned a Pat's pizza for a while. Um, and now they're kind of retired watching grandchildren. Oh, Well that's not a bad Pass down, you know? They're yeah, they're good at it. Yeah. How did you end up going into medicine? I mean, aside from the fact that your mother was a nurse. Yeah, my, um, I have an uncle who's an OB GYN, so there was like one other physician in the family, but it was actually this strange thing. I was, I remember like being in physics class as a senior and people were like going around the table and like talking about what they were gonna be. And I remember the words, I think I might be a doctor come out of my mouth, but I quite literally don't remember thinking about it before then, which feels really strange. Like why did I just decide on it? And then as you know, you sort of move through and before, you know, it you're a resident. You're like, how did I get here? But, um, I don't know. I, I love science and it felt kind of natural. And I dunno, I just really, I got into it sort of, I wasn't, pre-med when I went into college, I was a history major and then I kind of added it on second year. So it was great. I don't know. I feel I'm, I'm thankful that it sort of happened to me I guess, because I think it is the right job for me. Why, I don't know. I sort of feel like my persona is that of a person who like wants to be a doctor. I'm like one of those people who likes to kind of give out medical advice and stuff, which you probably shouldn't do to be honest. But, um, I, I don't know. I just, I like the mystery of like why somebody's sick and trying to figure out how to make them better and not hurt them at the same time. And, um, yeah, I don't know. I just, and I'm very grateful that I found pulmonary critical care because I think that like fits my personality really well. Pulmonology is, I don't know, lung disease is very interesting and it's like, it interacts with like a lot of different specialties, like cardiology and infectious disease and rheumatology. And so, I don't know, I get to like talk to all different specialists all the times and all the time and patients who are short of breath are like, it's very unpleasant to be short of breath. And so when you can help them, it like really makes a big difference. You know, it's like a, it's a disease that they definitely feel, right? Because there are a lot of diseases in medicine that you don't, you know, if you have high blood pressure and your doctor tells you, and then you have to go on blood pressure medicine, you're like, I didn't even know I had high blood pressure. It doesn't bother me at all. And now I want a new medicine and I'm not happy about it. But like usually when I add medicines, I make them feel better. So that's nice. Well, especially the critical care piece. Yeah. I mean, people really feel bad by the time they see you as a critical care specialist. Yeah. That's, that's very sad. Especially like during COVID was awful. I mean, early on, we didn't have that many COVID cases here, but it was, I mean, it was a time when, like we were dealing with a new disease. We didn't know exactly what was going on and you know, there's in critical care there, you know, you're always trying to balance the thing that you're doing to the patient, um, with the intention to help them versus Perth them. Right? So even just a ventilator, you know, the process of breathing that you and I are doing right now, where we pull air in and push air out, as we breathe on our own is very different from a ventilator pushing air into you. And if you don't need a breathing machine, you shouldn't be on one obviously. But like, you know, early on in COVID we were intubating people when they were on a couple of liters of oxygen. And, um, I don't know, we were probably hurting people early on cuz they probably didn't need them. Um, but we're pretty good at it now we know how to take care of people with COVID, which is nice. Um, and the cases in the ICU are pretty low. Even the people that are listed as being the ICU, aren't sick, usually with COVID as much as they're sick with some other disease and they happen to have COVID right. So sometimes those, uh, statistics can be misleading. I think a little, Yeah. I know in our hospital system we have a fair number of people who come in with something else, we test them, they have COVID, but that is not why they came into the hospital in the first place. Right. You broke your hip. Exactly. And you happened to have COVID also, Right. Yeah. Right. Which is nice. Cuz actually a fair number of people have also been vaccinated. Sadly. They still have COVID but they, the symptoms are not nearly as bad if, if any at all, really. Right. I mean, at this point it's pretty hard to find somebody who's never had COVID I feel like everybody's had It. I know that's true. Yeah. Yeah. But um, for those people who had some protection on board, they pretty much do pretty well. So thankfully, And I know that there is a different way not to get too technical, but I'm kind of fascinated. So I'm just gonna ask your selfish reasons. But um, I know that we actually have done different things for patients who have COVID with regard to their lungs. We aren't prescribing exactly the same things that we would for other lung diseases. We aren't doing steroids as quickly, for example, Right. If you come into the hospital with COVID, um, we've got drugs, like Remes Avir, which sort of act as antivirals, you know, like, um, Tama flu for the flu. Um, and then we tend to give steroids to those people early on, if we're worried about significant lung disease and then for people who unfortunately don't make antibodies or have never been vaccinated, we can potentially give them antibodies if it's appropriate. Um, and then there's drugs like PS livid, which it's kind of amazing old, you know, aids, drugs being renewed. Um, that's really been like, um, a good agent for people to get and sort of minimize symptoms. So, uh, yeah, it's it, the way that we have sort of figured out what drugs work and what drugs don't work so quickly has been like a, has been amazing because it, it was needed. I mean, we were at risk of hurting people with drugs that weren't helpful. So thank God they did the research quickly. Yeah. And are, are they still doing the thing where they rotate the patients? Yeah. I mean, that's also fascinating, right? It is. It's crazy. That is. Um, so they've done studies for years, looking at taking patients who have a disease called a R D S, which is basically like a dense kind of pneumonia picture in your chest. And those, the pneumonia is always in the back and if you can rotate the patient and put them on their belly, um, you can help to improve their oxygen levels and it actually improved survival. And so we used to do this with patients that were on ventilators and we'd flip them over and put them on their bellies, but it got to the point in the hospital where even people who were just sick with COVID, but not in, you know, on a breathing machine, we had them sleep on their bellies intentionally and we would see people get better. It was pretty amazing. And that it's probably just the physiology of kind of the way that we breathe and where gravity sends the blood and the lungs and things like that. So What you're describing is interesting though, because I think this, this idea that we, we kind of had to go back to some very basic physiology, some basic microbiology to understand something floating around that was new to us. Um, and think about things in a really different way. I mean, I think that that was a little, at least I I'm on the outpatient side as a physician, but I found it kind of difficult, strange, it felt very risky. I felt like I was doing my own version of medical doom scrolling, like just like, Hey, who knows stuff? Who knows stuff? I need to figure this out. I think that was, that was the thing that was so unsettling in the very beginning of COVID because there would be groups of physicians or, um, you know, different areas of the country where there was a lot of COVID. And so there's something to be said for experience, right. And if those physicians were doing things and having good outcomes before we had real data, we started to sort of take their considerations like intubating people early or, um, you know, uh, medications like, uh, hydroxychloroquine were initially started for people. And, um, don't give anybody steroids that was early on the recommendation. So it was kind of, it was crazy how things like were changing so quickly depending on what people's individual experiences were. Um, so How much, um, telemedicine do you do? I do a little bit, I have some patients for whom leaving. They, they have such significant lung disease that leaving the house to come to the visit, like puts them down for two days. And so I tend to do telehealth visits for those people. And, um, cause I can make a lot of like good decisions based on kind of what the patient looks like on camera, even without listening to their lungs, like I can ki and you know, their symptoms and everything. So I could, I can do that for some people I think for other diseases it's harder. Um, but it really saves those patients from like feeling miserable for a couple, cuz it's just, it's so much work. They either, you know, they're pretty sedentary or they get terribly short of breath. And so the process of walking from the parking lot, even to the office is a lot. So especially in the wintertime, in Maine of which there is a lot of winter. So I think I'm, I'm still doing telehealth for those people. I mean, personally I found that there were situations that I thought would be great for telehealth that turned out maybe not to be so great, but other situations I hadn't even really thought about. And then I was like, wow, this is great. I hope we never go back because it is so good for the patients and their families. It is. Yeah. And you can get the whole family on the zoom call. Yeah. It worked for some people that worked out really well. Yeah. I mean it caused me to think a lot about access. You know, we, we talk about social determinants of health. Of course, you know, just, you don't have enough food to eat. You don't have, um, transportation, but we're talking about, I mean, I think you, and I probably have some overlap of patients that you, they need to get in a wheelchair, which means they need a wheelchair van or they have to have their own wheelchair van. And then it's, you've got ice on the sidewalk and sometimes the sidewalks don't have cuts. And, and I think that I always knew that that was out there, but I think when COVID came along, it really caused me to think like why, why do we make people not all of whom really need to come into the office, come in and see us when we can do so much of it remotely. We can. And even just talking to people about their disease, like maybe you spend less of the visit on the exam and more about the talking and the history and what they're feeling and their families can chime in and you can even potentially see kind of where they live and that I think that's helpful. Um, I think that has been like pretty helpful. I was definitely doing more telehealth, like during the middle of the pandemic there. I mean, my patients were very nervous about coming to the office and we were also nervous. I think it was hard if somebody had like an upper respiratory infection. I mean, back when you couldn't even get a test, we were like, well, you can't come into the office. We're gonna have to do this over the phone. Um, so, and people are on immunosuppressants and they have cancer and you just don't want them getting exposed. Yeah. And you raise a great point about really seeing where people live. I mean, when you see when there's a camera and sometimes it's just somebody holding up their cell phone or, you know, they're holding up the iPad for their grandmother or whatever. Yeah. And you see that the, when you talk about social determinants of health, these are real issues. These are huge problems. You know, people, I was, people kind of shoved into their, you know, mobile home with like two bedrooms, but 12 people living there kind of thing. And you know, you could see like black mold and like just horrible things that I think are so theoretical and they can tell you, this is what's going on. But when you actually see that, or in my case, sadly enough, when you actually see a patient who is smoking on the camera with me, I was like, oh, well I don't need to ask whether he is quit because he hasn't, but I'm not gonna, I'll say, can I help you with any resources, something like that. But I think for me, it just, it really hit me like this is, it's not that it was fake before, but it more like this is real, this is real stuff that real people are really dealing with. And somehow we need to figure this out a little bit better. Right. And I think that the, you know, sort of improving your health sometimes comes along with improving your life, which, um, is not possible for everybody. There's like a lot of poverty in Maine and some people don't even have wifi and they can't might have to do phone calls instead. And um, you know, trying to help them manage, you know, nicotine addiction when there are all these other stressors, you sometimes have to modify your advice to match what the patient is even like kind of capable of doing. Yeah. That's, I mean, that's such an interesting thing because I, I think you're right, it's nicotine addiction. It's not like you are a smoker wagging my finger at you. It is an addiction and it is related to stress and it's, you know, what are you going to have to navigate without the help of this, this product, this way, that you're medicating your life when we take it away from you. So I think being able to see it in a much more compassionate way while simultaneously recognizing like, okay, this is lung disease and we really can't have you smoking. It's like having to figure out how to communicate that with the patients. Yeah. And to make it sort of shame free. I think, because for people who have been smoking for 50 years, I mean, they are terribly addicted. They, I mean, the people that can't get down to less than a pack a day without having like terrible withdrawal symptoms, I mean, trying to quit smoking under those circumstances, cold Turkey, certainly, which is, is very hard. Um, I mean their brains are like so addicted. They feel, they feel physically terrible when they try and quit and their brain is also starved of dopamine and all sorts of other reward chemicals and they feel terrible about themselves. I mean, it's just, it's awful. So, um, if you can, I don't know, try and help them with like nicotine replacement and working on cutting back and just kind of, you know, work on doing your best. And I feel like that's sometimes the best way to help people to just cuz it, and if they feel bad enough about it already right. And don't need, make them feel worse. Yeah. I mean, we used to think, oh, it's all about education. If people just, if they know that smoking's bad for them, they will stop. I don't know whoever thought that was just not gonna work the answer. Cause when you keep hitting people over the head with the same message yeah. In a really judgemental way, it doesn't, It Doesn't work. It doesn't really work. They don't really soften, you know, it's like, yeah, I got that. I'm not stupid. I know that smoking is bad. They know. Right. Yeah. It's been 20, 30 years of that message. And I mean, going back to the sixties when that message really started. So, um, clearly there's another driver for why they're continuing to smoke and that's like a chemical dependency just like people get chemically dependent to other things. And it's sad, You know, as I'm, I'm talking to you, I'm thinking about when I started in medicine a little bit longer ago than you did. Um, but I'll just say not that long ago, let's just say that it's not true, but cuz you could cuz I have a daughter who, um, was born my last year of medical school and she's 26. So that tells you something so, uh, but I do remember back in the day that we, I think as a profession, we did tend to be more judgemental and a little bit less compassionate mm-hmm and I think that, you know, in family medicine, we tried to be kind of the interface, but now I'm seeing more and more people who go into specialty medicine that they're not leaving it to the family medicine doctors to be the interface they wanna be there with the patients present, they wanna be communicating the message themselves. And I really appreciated that. I really appreciated that. We're all on the same team. We all speak the same kind of language of wellness. And so it's not getting kind of funneled down the road back to primary care. So thank you for that. Oh, I can't even imagine how busy primary care doctor's offices are with all of the requirements for all of the, you know, sort of various metrics. One has to meet I to then be like, oh I'll turf your C O P D back to your primary care doctor also feels a little bad. Um, I think I could probably help out with that. That probably would be in my purview. So, um, I dunno, I like to sort of take ownership of those things and do them myself. You know, I tell my patients, if you are having an asthma attack or your C P D is acting up call here, you know, you don't have to call your primary care doctor. You can call here. We have somebody on call all the time. We can take care of you, you know? And then I can keep track of when you were sick so that I know whether or not I should change your medicines or do something else or get some imaging. Um, so I don't know. I like to, I dunno, maybe I'm a little bit of a control freak. I like to know what's going on Well, and I appreciate that and I know that there are some primary care doctors who are like, no, I wanna manage everything I, I am not, I am not that way. And in part, because you're right, it's very complex and we know so much more about so many more things than we once did that. I'm like, Hey, listen, I am happy to be on your team with you, Mr. Or Mrs. Or Ms. Patient. And also I'm gonna have this other person on the team with me as well. And so if we can all just be clear about who's doing what and just kind of be open to the communication mm-hmm , I think it's really Helpful. I think it is too. And the patients are very motivated for their primary doctors to know that is pretty universal as they get older, like patients who are in their like sixties and seventies and eighties are, are very concerned that maybe, you know, like I just wanna make sure that, you know, my physician, my primary care doctor is getting my records and will they get a copy of that cat scan? And they get this, I just want them to know what's going on. So I think they still view them very much as like being the center of the, of the wheel. Um, which I think is really important because I mean, you're prescribing the majority of the medicines and medications interact and um, yeah. So that's pretty important. I'm glad to know you're on our team. I am, I am. Yeah. And, and I, I have been here for a while, so I feel like I know a lot of the primary care doctors in town, so it's very easy to just contact them. And it's, I don't know, there's something about the efficiency of like one doctor just calling another doctor and fixing the problem in five minutes is amazing. And instead of like passing notes back and forth or, uh, communicating through your nurses or your medical assistants, it's like, I don't know that I think that like important professional relationship and like that communication is still, it's incredibly valuable. So I like to do it and I like it when I get called so see, And that's, that's also great to hear because I, that is the way it used to be. Yeah. I mean, I, I know we have a range of providers now that are practitioners that are not doctors, but when we used to have, we'll just call the doctor's lounge, cuz that is what it used to be called. And that is how people interacted. You know, you talk to the person who was in the hospital, taking care of your patient and you talk to the primary care doctor who was then a family doctor or a general, a GP GP, you know, and then we had all these wonderful electronic health records that I'm gonna call them wonderful because they do have their benefit. They do. But I think that created this weird digital barrier and then it took away all the human and now you have got like, all I have on the other side is like a name I can send a task to or an electronic health message to. And I really appreciate it when I can do the same thing and be like, okay, I know Jen so those texts, okay, could you gimme a call? I have this patient, I just have a question, give a call that way. I don't have to send a patient in for a consult. It's gonna take three months, you know, like, so how do we make that happen more? That's my question to you? How do we actually get that to be more the case? I actually think that it's, um, it sounds terrible, but it's like social events again, you know what I mean? Like medical staff meetings and like places where, you know, providers like get together again and like get introduced face to face to people and those kinds of things, because there's less of that people are very busy and then it's kind of perceived as like an add on to work sometimes. Um, so I think that's really important because I don't know I was the house staff president at Maine medical center when I was a resident and my job was basically to plan parties. But it just may, I don't know if you're calling for a consult, you're essentially calling and asking somebody to do work for you. Right. That's just, if you like break it down to the bare minimum, that's what it is. But it's somebody, you know, asking for your help on a topic that they consider that you have some expertise in and that's like what you should do. And if you know that person already, because you were at a party with them three weeks earlier and you met them there, then it's a lot easier. You'd be like, oh, Hey Lisa. Yeah, sure. Oh, sure. I'll come down and see her sounds fine. You know, it just like changes the interaction. So I don't know. I think those things are important and we probably should do more of them. So I'm always a fan of parties, parties, but yeah. We're social be nicer to each other, you know? Not, yeah. I think that would help. Yeah. If we all like spent a little bit more time together outside of work, maybe it's easy when your friends are calling you, you're like, sure. Michelle come down, no problem. You know, friends in the ER. But if you like, don't know people, sometimes you're like, yeah, I'll be down. You know, it's just, it's sort of like the way that you talk to people. I think. Yeah, That's really true. So that's how we'll fix it. More parties for doctors and nurse practitioners Levels Everybody out there. We're gonna bring you to our Party. We're gonna Know each other once Again. Yeah. Maybe we know what somebody looks like by face and not just by name. Yeah. That Would be nice. And at some point when the masks come down, we actually will know what their full face, which Like my, that has been, I, I mean, I'm terrible with faces to begin with same. And then you put masks on everybody for two years and now I'm supposed to know what they look like. Again, it's been brutal, but Yeah, no, I, I, I, I feel that I, I took a new job and then COVID hit like within weeks and I was like, oh, okay. So someday when the mask come off, I'll be like, wait, do I know you? Yes. You and I have been talking for the last three years. That's crazy. This is what I look like. I Know. So it feels weird to not have a mask on sometimes I know, I know it's very true. Mm-hmm so we've been talking a lot about medicine and, and thank you for those of you who are listening or watching to us go on and on about one of our passions, which is medicine. Um, I appreciate that people who are listening or watching are interested in this, cuz I know I am selfishly, but the other thing that I'm interested in is your intersection with art. And, you know, you mentioned that it was really through knowing people who knew art and you're relatively new to the art game. So art was not woven through your kind of educational life as you were going through. No, I didn't. I mean, I didn't take a lot or I didn't take any what I remember as being like any sort of like artistic or art history courses in college or anything like that. I, I remember being in a music class once, but it was like as a requirement I think. Um, and I've always kind of struggled with like I was buying, you know, prints at target and I was, you know, and I just, there was nothing that I, I was anxious about finding art that I both liked and was gonna like fit a style that I wanted to match my home and this, for whatever reason, like caused me anxiety to the point where, when I like redid my condo, I wallpapered the entire like main space thinking that it would decrease the amount of art that I had to buy. I mean, this was on the list of the reasons why I was getting wallpaper. I do love wallpaper, but I was like, oh, well, if I get more wallpaper, I won't have to buy as my chart. And then, um, COVID happened and you're in your home a lot. And there is not much on the walls except for your wallpaper. And it felt unfinished all the time. Um, and I met Emma and I went to one of her gallery openings. And while I was there, I saw a piece by Dateland and I loved it and I showed Emma that I wanted to get it. And then I heard Dateland talking about kind of the techniques that she uses and the things she's trying to represent in her pictures. And one of them was that the lines kind of represent breath. And I was like, oh my God, this is perfect. I'm a lung doctor. This piece is about breath. I liked it. It's birthed. Um, and so I got it and put it in my home and I love it. And since then Emma's tried to, she's been helping me like find other pieces, but it feels nice. Like my home feels much more finished now. Like it's just, it felt sort of stark before and now it's like homey. I don't know. So it's, it's definitely been, you know, kind of a new hobby, I guess for me, which, as adults having hobbies is hard but I, I don't know. I like talking about art with Emma and um, having her show me pieces that she likes because she knows what my home looks like and what she thinks would work well in there. Um, so I don't know. It's been lovely and she's a lovely new friend, so Well, Emma Wilson is absolutely a lovely person and I've known her for a a while and she is that's, that's the excellent thing about Emma is that she's she gets to know you as a person. It's not just like, oh, this blue thing would look nice next to your pink thing. Yes,