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306- Breaking Bad News

2018-05-08 | 🔗

When a doctor reveals a terminal diagnosis to a patient -- that process is as delicate a procedure as any surgery, with potentially serious consequences if things go wrong. If the patient doesn’t understand their prognosis, for example, they could end up making uninformed decisions about their treatment.

That's why many medical schools now offer training for students on how to break bad news, bringing in actors to help them learn how to navigate this critically important and very high-stakes moment. And that’s not the only connection between acting and this particular facet of medicine.

It turns out that one of the first doctors to recognize the challenges of this particular kind of doctor-patient communication wasn’t just a physician -- he was also a comedian. And he drew on that experience to transform the way that doctors break bad news.

Breaking Bad News

This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This is ninety nine percent, invisible, I'm roman Mars You imagine you're in a hospital room waiting to hear the results of a test you had the doktor comes in watch, Youtube videos, ask this House You might sense on some level was about to happen. Results and has offered to save lives the muscles in your shoulders? Tens up Your hands suddenly feel clammy ass. As I have said Lastly, does cells that are seen as positive
and then you get some very bad news, What that means, the cancer is basically untreatable theirs. Those rights Then, after about ten minutes, a timer goes off. Encounter is over
Ok, I won't take a deep breath that was not actually somebody being told they had terminal cancer it part of an exam ferment students at rush medical College in Chicago. I do remember that student and that he did a really really nice job, but what Para he played the patient. He went The whole day being told by medical students that he was dying and then reacting as if that was actually happening. It's yet certificate. It's a long day too long day too little. Demented theme park, job but as difficult as it is mark, is playing an important role for met students like already Missouri S, never like a shilling to break them. Patients by. I understand that, no matter We feel that go into your which specialty- and this is something that we all have to endure at some point in medicine, bad. This is defined as any information that drastically and negatively alters a patient's outlook for the future.
This year is a radio reporter and part time medical school videographer he actually said, cameras to film that encounter between Mark an already so that our, It can be evaluated on his communication skills, and I was really surprised by how com and compassionate already was many doctors struggle with breaking bad news. I've heard stories about a doctor leaving a voice mail to tell a patient. She had cancer, and I heard another story about a doctor who used to sports analogy to deliver difficult information as in its bottom of the ninth and there's one out left Breaking bad news is as delicate a procedure as any surgery, and there can be serious consequences if things go wrong. If a patient does understand their diagnosis or what the next steps are they get in making uninformed decisions about their treatment, with Is why many medical schools now offer training they bring in actors to help
students learn how to navigate this critically important and very high stakes moments meant that most of us will experience one way or another, but that's not the Only connection between acting in this particular facet of medicine ever lost. Twenty or thirty years I've been endless anecdotes. Just you describe the doktor came and so you'll be dead Friday, goodbye and left. It turns out one of the first doctors to recognise this problem. He wasn't just a physician, he was also a comedian and he actually drew on that experience too. Its form the way that doctors break bad news. There are ways of doing this. There are ways of breaking bad news. His name was robbed buck men and his very unusual life prepared him perfectly to tackle what might be the hardest part of a very hard job in nineteen. Sixty eight rub, Buckman Onstage in London's West end do restrictive.
I think the essence of it is that it was a strip routine that you might have. Bet a female burlesque down to come out and do with Robert in this extraordinarily physically unlikely guys going through all sorts of gesture Getting his head stuck in is full. I haven't heard what you don't have raised. No, nobody knows this is p kin and Russell Davies to have robs best friends. They were all students together. Cambridge University, and they were all members of the footlights, a theatrical club, was a big deal to be in the footlights then, and it still is today. The group has turned out tons of famous committee like half the com True Monty python and more recently, people like John Oliver, the foot its put on reviews each year, that featured comedy and music and I can the late sixties rob strippers
was a highly he did take it absolutely seriously, he came out and did it as if people were meant to be aroused. This routine. You may go play with removing his watch as if this were especially erotic, although the absolute nothing except taking off you walked like we're, There was no real punchline too. It was there except, except that he had a flower painted on his stomach, elaborate rather nervously. Robert GonNa Cambridge, with the intention of becoming a doctor by day, He studied medicine and two classes. In biochemistry by night he wrote in perform sketches in the footlights clubroom. Housed in the second story of a local fish shop, he slept only three or four hours the night. After Cambridge Rob went to a teaching hospital and it turns out
but he entered medicine, just as a big shift in medical culture was happening, one that changed the way doctors thought about their patients. Around the same time rob was on stage in London's West end doing a strip routine. A psychiatrist named Doktor Elisabeth Cooper Ross was working on a pretty radical project. She was meantime with dying patients in a hospital in Chicago listening to their stories. I just didn't: listen to dang patience and tried to be this books. If you can only sit and listen and hear what they say, they teach not only bad, but about living in nineteen. Sixty nine Kubler Ross published a book based on her research called on death and dying. You know the five stages of grief. That's where that comes from the book became international best seller and brought conversations about dying into the home Google,
Let us also encourage doctors to speak more frankly with their patients about that. She said they needed to stop tiptoeing around the subject, which is what doctors had done for most of the history of modern medicine, the original code of ethics established by the American Medical Association in eighteen. Forty seven said it wasn't the role of doctors to make quote gloomy prognostications unquote. Instead, they should be minutes. There of hope and comfort. Doctors were afraid that disclosing a bad diagnosis would actually be damaging and could even dry patients to suicide. This attitude remained unchanged through much of the twentieth century. In the fifties, the word cancer wasn't used. Doktor Walter Bale is a psychiatrist Anna Professor, at the empty Anderson cancer Santer. It's part of University of Texas in Houston. There was a lot of deception that went on around how sick people really were. You couldn't talk about
patient. I so you can imagine nobody really It was able to say good, bye in nine fifty one. The journal of the American Medical Association actually published methods for deceiving cancer patients and their families. They recommended giving evasive answers or using confusing euphemisms like calling answer and also or an infection, the same art recommended that cancer patients who learned the truth at their diagnosis and reacted badly to it, be given the bottom ease, and this attitude was pervasive in nineteen sixty one, a survey showed that ninety percent of doctors preferred not to disclose cancer diagnoses to patient. Despite another study showing that the vast majority of patients wanted to know the truth. Things started to change in the nineties. These doctors about effective treatments for cancer. The two big advancements were chemotherapy and radiation therapy. The research just exploded, patient
have a lot more to hope for than they did in the fifties and around the same time, palliative care emerged as a concept in medicine, We began to realize that control pain and other symptoms could give people a peaceful death, Modern palliative care movement together with hospice, has really made death less fearful for people these developments alone, with the work of Elizabeth Cooper, ROS all started to change the way our culture talked about death and dine, and it was in this context that Rob buckling became a doctor. A doctor who is totally irreverent take on medicine would ultimately help him transform the fields George, you robs work. Cambridge footlights got him noticed by the BBC, while still
as a doctor, he wrote in performed on radio and tv. In nineteen, seventy eight he and his writing partner or given their own comedy programme. It was called the pink medicine. There's a vibrant. Dr think. That is why I think medicine show was. Like personnel or mad tv, but all medical sketches. There is actually a lot. Out of comedy about medicine. At this time, especially in Britain, doctors were seen as these stodgy and distant authority figures, so they made a good target for satire. One of robs recurring characters on the show was Emma lingerer Guy pretending to be sick, who keeps showing up the hospital with different ridiculous excuses. What is it it's that night about the mass on a regular basis,
every morning on the dot of eight o clock coming this marvellous. What are you worried about? I don't wake up to nine rob success caught the attention of another footlights alone. Rob success caught the attention of another footlights alone. Mostly, we launched a lot because she was funny We was one of the half dozen people that I spent most of my time laughing with that's John police. You know mighty python. Faulty towers of fish called wander the James Bond movies. I think he's one of the hairy potter's anyway, when I reached him, he was getting ready to go on Safari well tomorrow, for three and a half months Simon, the usual state of wondering what I've forgotten to pack in nineteen. Seventy nine John Cleese was producing the secret policeman's ball. Accompany show that that it is the international and he asked Rob pure and sketch within and Michael Pailin, the old money python better known as the chief?
scotch jeez if how about a little less than yes, so very city python sketch in which a man goes into a cheese shark device, and she isn't it slowly becomes obvious that they don't actually Any any changes in the shop as the man puts it He was to be a shop entirely uncontaminated by cheese. Today, the whole time this ridiculous exchange is taking place. A greek bazooka band is playing in the background of the shop and there are two guys doing a weird dance with their arms around each other shoulders.
One of those guys was robbed at a certain point. My carriage got so irritating by the lack of cheese that I turned and snapped at the great does, then stop to slumber. Robs appearance with Monty Python Mart one of the high points of his comedy career. But if you look those that you might notice his face looked pale. A little puffy
as after finishing his medical training and establishing himself the comedy world Rob got really really sick. Soon, Rob would learn first hand what it was like to be a dying patient, and this role reversal from doktor to sick person would transform how he thought about his work. As a physician and the process of breaking bad news in April nineteen, seventy eight I contracted a very interesting and very rare disease, interesting, not just because it affected me in turn me from a doctor into a patient, but also because it's one of a group of diseases in which the bodies defences,
tat, the body itself and in which you become literally your own worst enemy. That's rob from a tv documentary he made about his illness as he was becoming. Sicker is called your own worst enemy. It began very simply and very mildly, with pain in my right wrist and when I moved my wrist it creaked that point Rob had Germano. My site is a very rare: Otto Mean Disease. The disease causes your body to malfunction and attack its own muscle tissue, so Rob wasted away and he developed these rashes Oliver, his body at one point I couldn't actually put my hands behind my head, because so much of the skin was inflamed. It was like wearing a leather jacket that have been shrunken onto a sort of encased in it. Rob was married at this point.
And had two daughters, got one of the more poignant moments of the film captures Rob trying and failing to pick out one of his girls. He talks about how weak and vulnerable he feels what happens is very, very simply the color drains out of everything. It's the same thing. It's the same families, the same house, but all the the color. The things you enjoy have simply that home of the illness about them for a while robs condition was so bad that his doctors thought he might not make it and they expect it's a being that close to death was profound. Years later, he'd recall an especially important encounter with one of his physicians, and I was sitting there and I was very ostrich like and I had all kinds of problems of the skin and bone. I was in deep trouble and I Feeling lousy. He said you ve got this. You got that you got the other
about the scheme, you got the muscles, it must be awful for you. I am sorry it must be awful for you, I'm sorry very nearly burst into tears and hugged it because gave me permission to feel ill, doktor was telling rob that it was ok to have feelings about being sick, that the negative motions were a valid part of the experience. The doktor was Pay attention not just to robs fiscal state, but also is emotional state, and while this might seem obvious, it wasn't especially common for doctors to do this back then this moment with simple but important. It would go on to become the cornerstone of robs approach to doctor patient communication
and then little by little rob started getting better. He was having blood plasma replacement therapy and a new drug he was taking started to work. The last four weeks have been like a gift I can drive my car, I can straight my elbows I can dress myself. I can put any kind of socks army than woody sobs by me of nineteen. Eighty robs conditions had turned around and I could go for a walk in the park with the kids not feel too bad about it, and I can stay awake all day and watch television in the evening or whenever I go to bed at midnight and live a normal life which is really is fabulous. Four rob normal life met, going back to his incredibly intense work schedule. He was more successful than ever training as a spur list, an analogy which is the branch of medicine, the deals with cancer while simultaneously co hosting a popular Besides show called where there is life where there is life return,
as doctors, Miriam starboard and Rob Bergmann explores such topics as cosmetic surgery, unwed mothers and the nursing profession, but that intention He wasn't good for his marriage. He and his wife ended up getting a divorce. And in nineteen eighty five rob moved to Toronto to take a job at a hospital in Canada. Rom had to restart his life completely, but there, he would end up making his most lasting contributions to the field of medicine. He started study in the way that doctors communicated with people they were treating specifically, he was interested in how doctors interacted with dying patients, because he himself had recently been a dying patient. This is from an interview he gave in ninety ninety nine, the grave saying about being. From my point of view was that I found out that I could tolerate mean. I did tolerate affair. Paying them handicap and saw. But I didn't collapse, I didn't I wasn't euro by any means, but I wasn't a different person
His big realisation- was that doctors didn't need to hide information from their patients and tiptoe through tough subjects. Sick people could, with They a lot so when I recovered, I was thin able to say: ok, I've been under fire. I stayed the same now I can be brave when talking to the patient. He walked in my room like a breath of not fresh air, was sort of like wind. This huge energy sort of exploding into the room never actually met anyone They quite like him before I think most people haven't doktor. Patricia Shaw was a cancer researcher at the same hospital where Rob worked in turn. Until she goes by pat pattern Raw met. In the most doctor, we meet cute scenario imaginable. He was told that I had the best microscope, either newest microscope, and so he came in to see me and that so we really matter
First conversation, one thing went to another and they got married in nineteen. Eighty eight. It was wrong. This time that robs started writing more. He had Large piece of solid mahogany that had brought with them from England and his favorite spot was to sit at this desk at his computer So, even though, is really busy at the hospital, he spent a huge amount of time after those hours working in his study, Rob wrote a book called. I dont know what to say how to help and support someone who is dying, it's kind of like what to expect when you are expecting. If what your expecting is that somebody close to you is gonna die soon, it's a very frank but easy to read a book that covers everything from basic listening skills to the sexual needs of the dying to survivors guilt and then in nineteen. Ninety to rob published the most important.
Book of his career. It was title of how to break bad news, the first medical textbook on the subject. When Rob Bachman right, the bark and how to get bad news. It was from his. Experience as an non having to give it. Sir four times a week, that's doc Walter bail again, he was also studying doctor patient communication. When robs book came out, he understood that bad news, was a series of steps that can be broken down into a series of steps. Walter and Rob would eventually right a set of guidelines based on robs book. They called their strategy. The spikes protocol. Spikes was an acronym but stood for sending perception. Invitation knowledge emotions strategy. In summary, it's a mnemonic device that doctors can use as they prepare to give bad news
and then during the actual conversation with the patient, so that it doesn't fly off the rails. You didn't worry that it sounded to additives. Spiky net we did, we didn't even think about. It because it was so I would get. Everybody remembers that sir Walter and Rob were giving presentations on spikes and hospitals all over the world. They made videos for medical schools which demonstrated how spikes could help doctors navigate. These difficult conversations in some of the videos rob performs improvise scenes with actors plank patients are family members. Just like you heard already doing with mark at the beginning of this episode. Not real, but really intense. Here is the six step protocol, which has the robber inelegant and threatening acronym spikes. The lessons stand phone s set, getting the physical is right, sit down cry to have relax, make eye contact and assessing
patient is either angry or cry important to have clear right, have percent assessing the patient's perception of his or her medical situate. When you got that chest pain when you found a lump in your breast, what did you think was going on then comes the pivot of a whole interview when you ask the patient what he or she would like to know, and I for invalid. Do you want to know the exact resolves the bone, scan and know what is going on? Is that the kind of way you'd like need to handle the information place, K for knowledge, giving the medical facts to Wilson took a little bit of that growth from the law. I'm looking it under the microscope, I'll go. Tell you what it give the information in small chunks and always check that the patient understands What you are saying after each small chunk, it showed that the truth was malignant cancer,
in other words of the night. I have answer my long and the all important for emotions, knowledge and navy emotion, but the patient is expressing the fish. Is obviously a great shock to this is difficult to believe this must make you feel all this is overwhelming your ability to empathize with patients, emotion, is the single most important characteristic of good and supportive news breaking. Without it, you can appear insensitive and of little support and then ass strategy. And summary so, whoever due from Here- but we do from here is very important what every day,
So it's going to happen next, make it clear, as you can hear from those scenes, Rob was masterful at breaking bad news. He was calm present, compassionate and clear. Andy was good at it, not just because you ve been a patient but because he bent a comedian. It's the ability to put yourself in your audience, is shoes and understand what makes them tick right so a comedian. You want to know what you can do to make. People laugh right if you're a doctor, you need to put yourself in those shoes and and what they need in order to make sense add of the process of giving bad news. Even though Rob had recovered from his illness. It had taken its whole on his body and he had health problems for the rest of his life. A case of shingle
left him paralyzed on one side, he had difficulty dressing himself and walking and he couldn't drive a car that was pretty devastating again robs wife, Pat this insult leaving him with this permanent deficit. I think was really really damaging and he had a hard time coping with that Bert. Typical Rob way. He kept work on his many projects, in twenty eleven. He flew to London to film a series of health videos with Terry Jones, another four of Monty Python. So much flights got delayed on to bed and Reilly, wasn't answering his text messages. Wasn't too unusual. He traveled so much flights got delayed. I went to bed and about midnight There is a knock on the door and there was a policeman at the door doctor these are the only ones who have to break bad news, a tiny bit of nonsense.
Then ass. If I was Missus, Walkman an event. She got guy around saying that that Rob had passed away, Rob had died in his sleep on the plane from an undiagnosed heart condition. He was only sixty three. It took part a long time to get over the shock. There was so much about missing rob. There is how much about having to deal with the realities of what happens when somebody dies and even though Rob himself had talked openly about death and dying, even though he had spent years writing books and encourage people to be frank about these subjects, he wasn't actually ready for his on death in real terms. You know like finance and insurance and all that kind of stuff, so it was. It was hard even now. Six years later still makes me a bacteria thinking about it
beyond robs death spikes has endured. It And absorbed into the mainstream of american medicine, just recently the american society of clinical on CALL jeez started recommending that doctors use a protocol when giving bad news. They offer spikes as a good example and like this taught in many medical schools, in the: U S and Canada, as well as schools in Europe, Asia and South America. You remember already the medical. Soon from the top of the show he's spikes to navigate his income. Nor with marked the anger hogwash. If I hadn't have US bikes recalled training beforehand, I would have been completely lost. I would not have known, and I were to go next, Spikes isn't the only set of guidelines for breaking bad news and it may not apply to every bad new situation. In some scenarios like an emergency room, doctors might not have the time to be that delicate and tat.
I am is one of the main things working against doctors as they try to do their jobs thoroughly and compassionately. These days the average physician visit less about twenty one minutes more than half of visits. Last fifteen minutes or less it can be really stressful to try to convey necessary information in that amount of time, especially if somebody is freaking out, because you know the dying and throughout the course of their careers, many doctors will have to break bad news over and over and over again emotionally exhausting spikes. A doctors do more like we need to do in the limited time they have. It turns the awful task of breaking bad news into a clear and simple set of steps. What it really is is a protocol that can help doctors be more like rob, or at least the person. He tried to be open, honest and empathetic. Here's John Police again they give two examples see how
Can you talk to someone whether it's a group of people or a signal for us now? Can you talk to them? If you don't have an empathetic feeling of base, who they are. They know already and what they need to know robs. For Earl was held in Toronto. The same minutes Who married Robin Pat, led the service for rob died? He requested that this song be played as people exited what a day for a day a day a day dream I point zero service. I want to record a message which is played as the people Leaving Me- and you say, miss you so much for coming. Unlike the rest of you,. I don't have to get up in the morning.
It is now. That message wasn't actually play that robs funeral, even though he choked that he wanted to be. But you'll hear more from Rob and from Monti by funds John CASE right after this and ass, we often don't think of winter as a time of growth or creation. But if you think about it, it's the perfect time to greet your own website. Cooped up your thinking about being productive and now square space can help you do it with squares. Based can take your cool ideas, you ve creative content, your services, goods, and you can turn them into a beautiful website in just a few clicks. Does it because there is to use templates
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and to the new story itself. So there's a little extra bit for you, Monty Python fence. So. Roman, are you Monty Python fan, I would say, and went through Andy Python phase of phase a you know like a leg in June in junior High, where you find them, and you think I'm really special for liking this, when no one else like it, because it was just on pcbs, That was my phase where I watched all of them and love them, but I haven't get my phantom alive so, like I'm a huge amount, Python fan and when I started reporting the story, I had no idea. There was any connection between Robin Monty Python. So finding. That out was like a big deal and I also you know found. This rare stuff that hardly anybody has seen like stuff. I got from tapes that robs widow pulled out of storage, of cool like logwood
Gimme example. Well, so right around the time Rob was writing how to break bad news in the early nineties. John. Please got in touch with them and he had to say The first series called videos for patients. It always seems to me that it would be a very good idea to make videos for people who had just been told by their jp that they have Some sort of medical problem occurs when you told that you always get anxious, and that is absolutely the worst time to take. The information the idea was to make a bunch of videos describing various metal. What conditions in detail so that patients with those conditions could replay them whenever they needed a refresher and almost all of them. With this little sketch that kind of spooks breaking bad news and some very beautiful music
Ninety cd, rom music- or I don't know, what's my problem: well, you got leg else's leg else, so clean plays a patient enquiring about his condition and rob the doktor proceeds to lay some heavy medical jargon on him I see what exactly leg else. Well, quite simply a leg out through the consequences of tissue hypoxia following on ischemia due to Venus Stasis, evidenced by approximately very costs. It is, and incompetent perforated or costs due to our airlines, efficiency. There's food thickness.
We do so as robs talking the cameras slowly. The aims and on clean sue looks increasingly confused and upset. He leans in squint slicks ever his shoulder by the time the camera land in close up his face is slack and his eyes are wide with terror. Other any questions: low noise, your yep aim, then I'll see you. In six weeks, bye, bye, by then please gets up and walked off stage revealing to the audience that he's on a set. As it happens, I haven't gotten legos and of course doctors don't really told that, although sometimes it can feel a bit. But the time I get home, I always realise that I haven't understood everything that the doctor said:
Another always some questions that I should have asked, but for some reason didn't and that's exactly why we made this yet so than the rest of the video is just rob going over the condition, slowly and and painstaking detail leg. Alpha is what happens when the skin over a part of your leg, can't grown proper, They made almost fifty these videos on everything from breast cancer to something called glue ear with. Never heard of, but they ran in your problem. We hit a major problem, which none of us had anticipated, and I am not entirely sure one could have anticipated it and what was the problem? There the trouble selling them, as we should all sorts of schemes, but we just couldn't really shift them
he could never find a way of getting people to give us twelve or thirteen grid for a twenty five minute lecture people wouldn't pay said. That's why you never in them. But now you can see them on our website. Yes, you can, you can see one of those videos and can also see footage of robs strip routine from the footlights days and the stuff he did with Terry. That's right, so Rob Bergmann, also workers videos with another member of Monty Python, Terry Jones, can you tell me a little bit about those yeah? It was literally The last thing he ever did he died on the plane on the way back from working with Terry in London and these videos, can't see online already. There called the top ten tips for health. The goal was to provide practical tips first, healthy other really when you're watching it, it just feels like you're, watching two old men Guph here
Rob and Terry and drag Sue old, Ladys I'll kill? My dog maintains volley eating Wall Paper whom, do you hit its strategy on the wall, the European the spam lady voice around her too This reminds me of my favorite sketches from the shadow which is like hello, MRS Smoker, hello. This is non smoker been shopping, no pain shopping. What you by his thin engine, what you by that it was about again when I know by our That was good he's out there than in another sketch and video series. They actually directly make fun of breaking bad news. I'm afraid you ve got type two diabetes wireless that's nice- You have got type two diabetes, Mr Robinson. I think I saw it
the cinema the other day and what diabetes to new. Terry Jones is still alive, but unfortunately he suffering from dementia. So we were unable to interview him. He robber really close, though Terry actually wrote so bitter airy in the guardian after he died, I remember when you bring the story together when got the interview with John please, I was just shocked yesterday that he was involved, be that he talked to you have how hard was that demanded. A man so actually got that in our view, through robs daughter, Joe Joe Buckley as a screenwriter in LOS Angeles and she participated in the interview to I think it. It meant a lot to her. You know rob death was so sudden that I can't I've got the sense from his family that the wounds of never fully healed, so
for Joe the chance to here. John. Please talk about her dad and such glowing terms. I think it was really meaningful for her and in it at an end, it felt really good to be there in it to hear that summer months or noise. So whether the yeah robs family has been really great and supportive of this story about particularly Joe. She was really my partner and crime. You now helping me with the police interview, which is obviously Gatt and then also help me get some of the archival. You heard the story of Serbia will thanks to Joe Bergmann Pearl, yet Joe shadow to Joe very represented. Visible, was produced this week by John Vasil edited by Delaney Hall mix intact. Reduction by Sharif, Useth Muse, by shown Rio hurt costed, is the digital director or senior producer is Katy Mingle, the team is Emmett Fitzgerald, a reach often turn We are brought into another one point: seven k, L, W
the staff of rush medical College, Dr Mary Mulcahy and Dr Miriam Stoppard. I think one more, I'm too robs family Joe Bergman, Patricia Shaw, Jenny, Bergmann, not Bergman Joan vended Indy. We are, Roger ninety one point: seven k: L W in San Francisco and produced on radio row in beautiful, downtown Oakland California,. We are part of radio Tokyo from pure Ex collective, the best most innovative shows in all of pod gascony. We are supported by our listeners, just like you environmental crimes and of his bones, or discussions about the show on Facebook. Entreated me at Roman Mars and the show at ninety nine p org or an Instagram and read it to, but the only play, you can see videos for patients with Rob Bergmann and John. Please is none. P. I dot org.
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Transcript generated on 2020-02-14.