Too Much Propofol

This week: famed author's son dies after anesthesia, the "war on protein", and Arghavan's views on protests in Iran.

Join Arghavan and Alyssa as they into the 'war on protein' narrative propagated by RFK Jr, the tragic story of Chimamanda Ngozi Adichie's toddler son’s death following an anesthetic in Nigeria, and the ongoing protests in Iran.

They discuss:

New Dietary Guidelines, AKA the end of non-existent " War on Protein"

• Kevin Klatt, PhD, RD (Univ. of Toronto) analyzes the new dietary guidelines in plain language

The death of Chimamanda Ngozi Adichie’s 21 month old son on Wednesday, January 6. His family attributes his death to anesthesia care at EURACARE Multispecialist Hospital in Victoria Island, Lagos.

• Read about the reported conditions around his death in the Nigerian paper The Guardian. The hospital has denied improper care.
• Adichie is best known for her breakout novel, Americanah, and her 2011 TED Talk “Why We Should All Be Feminists”
• You can review the World Federation of Societies of Anaesthesiologists’ Workforce Map

Current events in Iran

• Massive protests have been ongoing in Iran for the past few weeks
• 12,000 protesters killed in Iran
• Videos of the Kahrizak forensic center show bodies in body bags
• Iranian regime charges families for the bodies of their loved ones

💊Take Two and Call Me in the Morning💊

• JB Star learns how to do the Dougie (here’s a tutorial for anyone inspired to learn!)
• Noah Wyle’s PSA lambasting RFK Jr on Jimmy Kimmel Live.
• SNL’s Marcello Hernández in American Boy

Thanks for listening to The Present Illness with Drs. Arghavan Salles and Alyssa Burgart!

Follow us on TikTok and Instagram @ThePresentIllness

Credits

• Production by Arghavan Salles and Alyssa Burgart
• Editing by Alyssa Burgart
• Theme Music by Joseph Uphoff
• Social Media by Arghavan Salles

Chapters

• 0:56 The War on Protein?
• 4:27 Content Awareness
• 5:11 Tragic Case: Chimamanda Ngozi Adichie's Son
• 10:34 Insights from Pediatric Anesthesia
• 30:22 Protests in Iran: Arghavan's Perspective
• 37:24 The Regime's Brutal Tactics
• 44:53 The Complexity of Support for Iran
• 49:40 Debunking Myths About the Protests
• 1:06:07 Take Two and Call Me in the Morning
• 1:10:44 End Credits

Transcript

Arghavan (00:00)
people seem really confused about like good and bad here. And I know that the world is a lot of gray. But this is not a case where that is true. The Islamic Republic of Iran is the closest thing to cartoon villain.

Hey there, fellow nerds. Welcome to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that's increasingly febrile. Like I feel like we're on the verge of seizure here and definitely under diagnosed. I'm Arghavan Salles, a surgeon, scientist, and your friendly neighborhood doom scroller in residence.

Alyssa Burgart (00:32)
And I'm Alyssa Burgart an anesthesiologist and bioethicist who scans news and health law like they're EKGs full of spikes and surprises. The present illness is where we dig into public health, politics, culture, ethics with a scalpel in one hand and a meme in the other.

Arghavan (00:37)
Yeah!

Huge shout out to everyone who's listening, especially anyone who has subscribed or followed on any of our various platforms. And a warm welcome to anyone who just stumbled in from the war on

protein.

Alyssa Burgart (00:57)
What's the war on protein?

Arghavan (00:59)
I it's the war that never existed, but, because you can get protein literally everywhere, and on average, Americans' intake of protein is about 20 % higher than the recommended daily value, but anyway, that did not stop RFK Jr. and the White House from posting last weekend that they're ending the war on protein. Isn't that great?

Alyssa Burgart (01:19)
I I feel like you cannot be... I mean, if you are on the internet, even the teeniest, teeniest little bit, I feel like protein is just being constantly, constantly pushed. I swear we're gonna push everybody into a little extra renal failure with all this protein.

Arghavan (01:29)
Mm-hmm.

I know, know and constipation. But

you know, the thing is, it's related to the new dietary guidelines, right, that came out where they put beef, beef and dairy fats. So basically elevating saturated fats, because it is true that one of his advisors said they are ending the war on fats as well. And ⁓ it's also worth pointing out that Arfka Jr. has also said we're ending the war.

Alyssa Burgart (01:44)
which are so dumb.

Arghavan (01:59)
on vitamins, even though it's a 70 billion with a B dollar industry vitamins and supplements are, but we're gonna end that war. So, hooray for public health.

Alyssa Burgart (02:12)
I can't. I actually read, I just can't. just, I.

It pains me so much. know, one of the things, it was really interesting when they were talking about, I don't know, several months ago about, we're gonna fix the pyramid. And I'm like, we got rid of the pyramid a long time ago. you know, I really did prefer, the most recent guidelines had my plate, which ⁓ was like to show you the shape of a plate. And you would know like, half my plate should be vegetables and a quarter of my plate could be protein. ⁓ So I found it very interesting that they chose to go

Arghavan (02:39)
Mm-hmm.

Mm-hmm.

Alyssa Burgart (02:47)
back to a pyramid, but they were like, it's upside down. ⁓ as with, and I've talked about this before, I'm fascinated by the way that this administration is using, they must have really strong graphic designers who are trying to make everything look a certain way. And so the image of this triangle full of food is very pretty, but it's very.

Arghavan (02:50)
Yes, that's an inverted pyramid. ⁓

Hmm.

Alyssa Burgart (03:12)
not telling me any message. Like it's not telling me actually how much of anything to eat and it's way less clear than the old pyramid, Anyway, I did also read a really good sub stack. There's ⁓ a nutritionist, I believe he's a nutritionist. He might be a dietician either way, a PhD in nutrition sciences ⁓ at the University of Toronto who did a really ⁓

Arghavan (03:14)
No. ⁓

Alyssa Burgart (03:35)
detailed, like in-depth look at the new guidelines and how it is that they differ or are the same from the most recent guidelines. So I'll pop that in the show notes for if anyone's interested in the non-military occupation of your diet.

Arghavan (03:41)
Mm-hmm.

The other thing that would be I think that would be great for people to see and I would be interested in it as well And since you mentioned the aesthetic I should note that the photo that went along with this post about ending the war on protein is this extraordinarily shadowy image of RFK jr Like imagine the most poorly lit photo you've ever seen and then make it more poorly lit and it's like a villain, you know from a Marvel comic book or something and

It's just a very weird look. Like why would you have that as like ending the war on- none of it makes sense because I think they just don't know how to meme, you know?

Alyssa Burgart (04:27)
So just as a quick content warning to our listeners, today we will talk about issues related to the death of a child ⁓ and about the war in Iran. So if that's something that's going to be hard for you, feel free to skip this one out.

Arghavan (04:39)
But anyway, on to other things. What shall we talk about today?

Alyssa Burgart (04:44)
I have a little bit of a ⁓ sad story to talk about, but it's related to anesthesia, so I think it might be interesting for our listeners. ⁓ There's a very famous Nigerian author who I'm sure you're familiar with, Chimamanda Ngozi Adichie. ⁓ She wrote Americanah back in the, I guess, I think 2013. She ⁓ had a cute little chat book and a TED Talk that were called, you know, Why We Should All Be Feminists.

and has had a number of other books to critical acclaim. ⁓ Unfortunately, her 21-month-old son, Nakanu Nnamadi, and I apologize if I pronounced it incorrectly. I tried to look up how to pronounce his name, so I'm doing my best. ⁓ Really, really sad. The family was in Nigeria visiting family over the holidays, and they noticed that their son, they have twin sons and they have an older daughter. ⁓

Their son, noticed, was ill, they thought, with some sort of a significant cold. And apparently when they took him to a hospital in Lagos, he was found to be critically ill with, we don't exactly know what kind of infection. And unfortunately, he died during complications of anesthesia for procedures that were being done to prepare for his treatment. The family lives in Baltimore and they were planning to take him to the Johns Hopkins.

University Medical Center after they returned from Lagos and ⁓ Terrible story the child apparently was supposed to have ⁓ an MRI To do some to get some imaging presumably and a lumbar puncture So they must have been concerned about perhaps an infection of the cerebral spinal fluid or maybe they were worried about cancer It's really hard for us to know exactly what the plan was But

Arghavan (06:28)
Mm-hmm.

Alyssa Burgart (06:36)
during that procedure. ⁓ What the reports are that we're hearing so far is that he received, and I'm putting this in quotes, too much propofol and that apparently he then went into cardiac arrest, was resuscitated. And it sounds like maybe they then proceeded with these ⁓ procedures and at some point had a seizure and was intubated, he must have been. And then at some point at the end of the procedure,

The breathing tube was removed and he was brought out to the recovery room, apparently was carried on the shoulder of the anesthesiologist and was found to be unresponsive, I suppose, in the recovery area. some of these details are, you know, they haven't been verified. There was some messaging ⁓ from Chimamanda Ngozi Adichie, a message that she had sent to her family, which had been leaked to the press. The family is now ⁓

has filed a formal grievance against the hospital in Lagos. And in particular, the family has highlighted what they say is poor care from the anesthesiologist who took care of their son. So it's an incredibly tragic story and it's truly every parent's worst nightmare. Further compounding, you know, what I can only imagine is extra difficult for this family is the child's father as well as his aunt are also physicians in Baltimore.

And so I can also only imagine like as a physician, as a parent, you kind of, know, so much about all the things we do to try to keep people safe and to find out that their child was apparently not appropriately monitored during or after his anesthesia is, just truly, truly alarming and so sad. and so I thought this might be an opportunity for me to share with our listeners, just

Arghavan (08:05)
Mm-hmm.

Alyssa Burgart (08:25)
as a pediatric anesthesiologist, what are some of the things that I think about when I'm taking care of a toddler? I don't know, what do you think?

Arghavan (08:32)
Yeah, no, I think that would be great. I, you know, I came across a story ⁓ might have been over the weekend and ⁓ it is, it's really confusing, you know, as physicians were used to obviously medical information. And so as you're reading these stories, you're thinking through your head about like what, what is being signaled by the words that are on the page? Because often even though you mentioned there are doctors in the story, I don't think this, the writing that I saw was written by a physician. And so

you it's medical adjacent terms and you're trying to figure out read between the lines. Yeah. If tried to figure out what actually happened from the medical perspective, right? Like what? Yeah, where where did things go wrong? And it's as you said, such a tragedy. Obviously, you have a previously healthy 21 month old child who doesn't sound like necessarily had a deadly illness, but because of

Alyssa Burgart (09:05)
Yeah, what do those mean?

Mm-hmm.

Arghavan (09:31)
whatever happened when they provided anesthesia for these procedures. And you might have said this, but I just want to clarify in case people didn't catch it, that the reason that the child was put under anesthesia was specifically to get this MRI and this lumbar puncture because that was what the team in the United States had requested prior to the transfer over. And for children, mean, even I as an adult have a hard time with an MRI. So for children, that's a normal thing, right? To anesthetize a child for an MRI.

So that part like so far, up to there, it made sense, but then what happened in the process of administering the anesthesia and doing the MRI? There's nothing inherently dangerous about MRIs. Every procedure has a risk, but you wouldn't expect from a lung puncture that a child would die. So it's related as you're saying to the anesthesia. So yeah, I'd be curious to hear how you put it as an anesthesiologist based on the limited information you have.

where you think things went wrong here.

Alyssa Burgart (10:34)
Yeah, so one, don't have any experience. I've never been to Nigeria. I do not know what in detail the practice is like in Lagos, although my understanding is many of the hospitals in Lagos have physician anesthesiologists as well as ⁓ highly trained, whether it's, I don't know if they're called anesthesia assistants there or what roles they play.

⁓ But I can speak to my experience as a pediatric anesthesiologist routinely taking care of kids and routinely doing anesthesia for kids having MRIs and lumbar punctures in particular. ⁓ This is actually a big part of a pediatric anesthesiology practice. We call it out of OR anesthesia. It's its own branch of ⁓ practice that has some unique risks and we really want to make sure that children are safe when they're having exposure to this.

anesthesia in a place that's not an operating room, which is our most routine place for us to spend time and where we get the most training. So an MRI is ⁓ magnetic resonance imaging. And as you mentioned, as an adult, it can be really hard to tolerate an MRI and ⁓ very few, especially very young children. It's very difficult for a young child to not move around. It's very difficult for them to tolerate being in that very narrow tube. Although ⁓

Arghavan (11:27)
Okay.

Thank

Alyssa Burgart (11:52)
We're really fortunate at our facility that there's, ⁓ you can actually have kids watch a movie. So older kids oftentimes will actually be able to watch a movie. There's a special MRI safe ⁓ headset and headphones that they can use so they can watch ⁓ something and so they can tolerate these procedures without needing sedation. But for a lot of kids, that's not possible. ⁓

Arghavan (12:11)
Mm-hmm.

Alyssa Burgart (12:16)
a magnetic resonance imaging unit. a giant magnet that spins around and there's a lot of really awesome physics that happened to make sure that they were getting these photographs so we can see the insides of people's bodies and see where there's, ⁓ you know, there's all sorts of different ways you can see blood flow and you can look at certain types of parts of the body in detail. And this can be really helpful for diagnosing illnesses. ⁓

Arghavan (12:35)
Thank

Alyssa Burgart (12:42)
Because it's a giant magnet, there's a bunch of safety things that need to happen that are different. So we actually have special ⁓ anesthesia machines that are compatible with being near an MRI. We actually can't pull the machine too close to the MRI because it can interfere with the computers that are in the machine. But we also have, ⁓ the way that our group runs it is we actually have a small room outside of the ⁓ area with the magnet. So we actually induce anesthesia

Arghavan (12:57)
Hmm.

Alyssa Burgart (13:11)
without being very close to the magnet, get the patient safety monitors in place. We have all monitors that are MRI compatible. So the monitors we usually use in the operating room are actually not safe to use inside of an MRI because they contain metal. And if you, it's wild. If folks haven't seen it before, go watch some videos of metal getting sucked into an MRI machine. It's very powerful, very powerful magnets.

Arghavan (13:23)
the

Yeah, I mean

every year there are I think it's every year frequently there are people who are severely injured or die because they had metal on them when they entered the room and they got sucked in I think it happened last fall even there was a guy I think his wife was getting an MRI or someone he cared about was getting an MRI and was feeling anxious and so this person had ⁓ walked in trying to provide emotional support but was

had a heavy metal, I think it was like a lock box or something, hanging from their neck that yanked them to the machine. mean, there's anyway, the MRIs, you don't want to take metal into MRI.

Alyssa Burgart (14:16)
Yeah, very powerful.

We all go through actually special training in order to be allowed to enter that area. So there's like different ⁓ safety grading depending on how close you are to the magnet. The magnet is always on. The magnet doesn't get turned off for holidays. Like to turn off the magnet is actually a huge deal. ⁓ So we go through a bunch of safety. The nurses and ⁓ radiology technologists that work

the MRI technologists who work in that area, they all go through special safety training. We actually do a safety check every time to prevent exactly the kind of story you just mentioned, ⁓ to prevent ourselves from accidentally bringing any sort of metallic objects into the room with us. So there's inherently when you're doing an MRI, there's some very unique safety concerns that are important. And what I wonder, and I don't know the answer to this because again, I

Arghavan (14:57)
Mm-hmm.

Alyssa Burgart (15:13)
I don't know what it's like to practice in Lagos. ⁓ Those monitors are incredibly important and it's so valuable for us to be able to monitor the safety of a patient using our standard anesthesia monitors, a pulse oximeter that tells us how much oxygen is in a patient's body, EKG leads that can tell us every single beat of their heart, pardon me, ⁓ we have a way to give the patient oxygen, so.

Arghavan (15:22)
Hmm.

Alyssa Burgart (15:38)
whether it's by nasal cannula or using the ventilator if we have to place a breathing tube or a special mask inside of the airway. We're able to not only monitor how much oxygen we're giving the patient, but also how much carbon dioxide they're producing. And we check a blood pressure every few minutes. So these monitors are the standard monitors that anyone having anesthesia should always have. there's so many, like you said, there's all these kind of tidbits in the story that

Arghavan (15:58)
Mm.

Alyssa Burgart (16:06)
implicate that indicate that this child may not have been appropriately monitored ⁓ during this anesthetic and I'll be very curious if sure.

Arghavan (16:13)
Yeah, let me read.

Let me just read that part of the note because this is what she says, I think this was written by ⁓ Chimamanda. She says, the doctor came out and told her Nkhanu had been given too much propofol by the anesthesiologist, had become unresponsive and was quickly resuscitated. But suddenly Nkhanu was on a ventilator, he was intubated and placed in the ICU. The next thing I heard, she says, was that he had seizures, cardiac arrest.

All these had never happened before. Some hours later, Nkhanu was gone. It turns out that Nkhanu was never, this is what she says, was never monitored after being given too much propofol. The anesthesiologist had just casually carried Nkhanu on his shoulder to the theater, so nobody knows when exactly Nkhanu became unresponsive.

Alyssa Burgart (17:07)
Yeah, and this is something where, you know, there's going to be an inquest, there's going to be, I don't know if we will ever see what comes out of that investigation. The hospital is claiming that they did everything appropriately. ⁓ But we'll see. but because, you know, part of this, he also was supposed to have a central line placed, I was, I don't entirely also understand why all of these things needed to happen before they.

Arghavan (17:13)
Mm-hmm. ⁓

Mm-hmm.

Right.

Alyssa Burgart (17:38)
went home, but again, I don't think we have all of the details. but again, with this idea of like, he was given too much propofol and became unresponsive. I I give propofol inappropriate dopases to purposefully make someone unresponsive, but I want them to be sedated to the point, especially for something like an MRI in a child of this age, presuming that he didn't have ⁓ whatever this

Arghavan (17:39)
Mm.

Mm.

Yeah, right.

Alyssa Burgart (18:07)
illness was, we don't exactly know, presuming he was safe to not have a breathing tube placed to have this MRI done and to have the central line done and all of these things. You think about how much propofol do I give a child to achieve unresponsiveness so they're not wiggling around and moving during the procedure, but that they're also still breathing safely ⁓ and monitoring as a critical component of that. And you absolutely can give so much propofol.

Arghavan (18:20)
Mm-hmm. ⁓

Alyssa Burgart (18:33)
to somebody that they stop breathing. And that's actually the most common cause of cardiac arrest in children. It's not for adults who develop cardiac arrest. It's oftentimes that they have an underlying problem with their heart. They have blocked arteries. They have an arrhythmia, things like that. Children, the most common reason that they develop cardiac arrest is actually a respiratory arrest. So it's the lack of breathing and the subsequent lack of oxygen that leads the patient's heart to actually slow down and eventually stop.

Arghavan (18:55)
Amen.

Mm-hmm.

Alyssa Burgart (19:03)
And so I suspect that this child was not being monitored for appropriate respiratory activity. ⁓ And because of that, my guess is that he stopped breathing and then developed cardiac arrest due to that. That's my best guess reading through all this.

Arghavan (19:11)
Mm.

that's it.

Yeah, it's such a tragic series of events. What she said about the central line was later after the central line procedure, the anesthesiologist casually switched off and conduced oxygen and then again decided to carry him on his shoulder to the ICU. So I agree the timeline is also a little confusing, but that does make sense. mean, again, we don't know, but I think people trust.

Doctors, know, especially when you're talking about your child, right? This is the most important thing in the world to you and you when you have a sick child you're looking for help and As terrible as it is to have a bad outcome for oneself. It's even more devastating right to have a bad outcome for your child I'm wondering if there's anything we can advise folks if their kids are having procedures or

what your takeaways are from this for folks.

Alyssa Burgart (20:22)
Yeah, you know, one of the reasons why I really love that I work in a children's, I work in a children's specific hospital. So ⁓ I have worked in a hospital where we took care of both adults and children. I really love being in a kids only hospital because really everybody from the surgeons, the anesthesiologists, the nurses, the environmental services people, the folks who are cleaning the ORs, the operating room assistants.

Arghavan (20:23)
And.

Alyssa Burgart (20:49)
Like everybody is really focused on the safety of the child and everyone's really focused on and really recognizes the unique vulnerability of a child ⁓ who is having a procedure. And the same goes for my colleagues that I work with in MRI. You people take this job really seriously. And so, ⁓ but there are times when you need to have a procedure done and you're not at a hospital where they may not have a pediatric anesthesiologist.

Arghavan (20:59)
Mm-hmm.

Alyssa Burgart (21:17)
All anesthesiologists are trained to take care of children. ⁓ And so I think it's really important if you to ask about, you know, what sort of monitoring will be done? Is this the standard monitoring? ⁓ You know, I, this is a common.

thing for me to talk about with families because I know that it's an incredibly stressful day for them no matter how straightforward the procedure no matter how healthy the child no matter how basic the intervention like to hand your child over to someone like me who is basically a stranger and to trust that I will bring your most precious child back to you in good condition safe sound that you get to take your child home ⁓ again it's something that that is just such an important

Arghavan (21:37)
Okay.

Alyssa Burgart (22:06)
It's so important that we live up to the expectations that parents have for us to do a good job because it is truly a leap of faith anytime you let someone else take care of your child. And so I think people can ask about ⁓ monitoring. I it's important to ask about training. What happens if I, know, sometimes people don't feel comfortable asking about emergencies, but you can certainly ask if there was an unexpected emergency, like what happens? What do you guys do?

Arghavan (22:29)
here.

Alyssa Burgart (22:35)
⁓ I routinely will talk to families about, most people don't ask, but I routinely will say, I don't anticipate an emergency, but it's my job to be prepared. And so these are the things that I have available. These are the buttons I push if I need help. These are the people that I can reach out to. ⁓ And then sometimes folks have follow-up questions. ⁓ If there's somebody who has, you know, it's, think, very reasonable to ask.

Arghavan (22:46)
Yeah.

Mm-hmm.

Alyssa Burgart (23:03)
You know, how much experience do you have taking care of small children? It's a very fair question to ask somebody that is going to take care of your toddler or your elementary school aged kid.

Arghavan (23:06)
Mm-hmm.

Mm-hmm.

Yeah, and I think it's important to note, because I don't want to just freak people out and think this could happen anytime you take your child in to see a doctor, but, and this is, I have no way of verifying this, but this is what's in the note is that they had heard about two previous cases of the same anesthesiologist, and she uses the word overdosing children. So it's hard to know whether this was just,

You know, sometimes as we all know, anyone who works in medicine knows there's just a series of things that line up in an unfavorable manner that lead to a bad outcome. They call that the Swiss cheese model, right? Where a certain person was gone that day, a certain machine wasn't working, you know, like, and just everything lines up in the worst possible way and you end up with some kind of tragic outcome like this. ⁓ And you and I both know that there are some physicians who...

I think we both agree the vast majority physicians are showing up doing the best they can every day, doing all the right things to the best of their capacity. And then there are these outliers of physicians who maybe aren't doing that. And so I think that's the allegation that's being made here is that this person was not a safe physician. I'm not saying that, I'm just saying that's the allegation that was made here, which if it's true is a huge problem on the part of a hospital to not have done something about this earlier.

Alyssa Burgart (24:37)
Yeah, and like you said, we don't really know ⁓ exactly what happened. We do just have this one perspective and obviously this incredibly tragic outcome. I can't imagine that anyone who sees this outcome thinks everything went as expected. ⁓ And these medications we use are incredibly powerful. again, like I said, it's not totally clear what the child was sick with. sometimes,

Arghavan (24:43)
and

Okay.

Yeah.

Alyssa Burgart (25:05)
When you have a child who is critically ill, but they're like compensated, they're doing okay. Anesthesia can be the thing that really tips you over and really drops the blood pressure. And you see some complications sometimes that are more profound because you're taking care of somebody who is especially fragile or in especially a fragile state.

Arghavan (25:11)
Mm-hmm.

Hello.

Mm-hmm, I think I remember from I'm not it I don't take care of children as you know, ⁓ but I think I remember learning in medical school that children will Tend to be more resilient ⁓ in the early phases of an illness to the point that like you're saying they you may not even notice how sick they are because their body Compensates until they reach some point where they they no longer can compensate and so they can have a sudden very sudden change in condition ⁓ Well, what a terrible ⁓

terrible outcome ⁓ and I hope that they're able to get some information at least that can help them better understand what happened. Obviously they can't go back in time and just a tragic loss, but hopefully they can at least get some information about what happened here and be able to understand better ⁓ what led to this outcome.

Alyssa Burgart (26:15)
Yeah.

You know, and one of the other things I think is also relevant, you know, first of all, in the United States, if you're if you don't live in a major metropolitan area, like you may not have access to a pediatric anesthesiologist. You may have a hard time getting access to an anesthesiologist or a certified registered nurse anesthetist. There's oftentimes long waiting lists in hospitals because not only they can't get access to the surgical time, but sometimes even doing that anesthesia staffing.

Arghavan (26:42)
Mm-hmm.

Alyssa Burgart (26:44)
there's a particularly where there are many parts of the United States. I basically every week, almost every day, I get a text message or an email or multiple emails from recruiters being like, Hey, will you come work in this like random place? We're going to pay you so much money so that you will please come help us in this place. have this desperate need for a pediatric anesthesiologist. ⁓ and so here in the U S there's many areas where

Arghavan (26:58)
I know.

We don't know.

Alyssa Burgart (27:13)
you're just not necessarily gonna have access to the kind of care that a child would be best served by. ⁓ And in Africa and specifically in Nigeria, in a city like Lagos, there's a little bit better access, but just to put the density in perspective, I looked up the anesthesia workforce data ⁓ and the density of anesthesiologists in the United States compared to the US population is almost.

16. So that's like almost as 15.88 physician anesthesia providers per 100,000 people in the US population. And if you compare that to ⁓ Nigeria, it's 0.25. So for every 100,000 people in Nigeria, there is one quarter of an anesthesiologist. And so that means that folks in

Arghavan (27:49)
Okay.

Mm.

Alyssa Burgart (28:06)
Nigeria, not only do they not necessarily have access to a pediatric anesthesiologist, they may not have access to any anesthesiologist at all who is a physician. And so I do think that's a relevant piece of this story in that ⁓ anesthesiologists are, there's not probably as many of us as each community needs and many communities, especially in ⁓

Arghavan (28:14)
Mm-hmm. Mm-hmm.

Mm-hmm.

Alyssa Burgart (28:35)
In Africa in particular, there's a particularly low density of anesthesiologists for the population. And in the United States, again, depending on how rural the area is, you may face similar lack of access.

Arghavan (28:49)
Yeah, and I think just to tie it back to public health here in this country, you know, we're likely going to see less and less access to specialists like pediatric anesthesiologists because of the funding changes in the big, beautiful bill that cut a huge amount of money going to rural hospitals. And then they add, I think it was like a trillion, I'll fact check in the show notes, but I think it was like a trillion dollars. And then they gave back.

And this is what you'll see like Dr. Oz and those guys touting is that they gave back 50 billion with a B, which is like nowhere near the amount of money that's needed. So we're anticipating a number of rural hospitals closing, which means those specialists, even if they had been there, will no longer be able to practice there. And it'll be even harder for folks even in this country to access those specialists. That's a policy choice. I want to be clear. That's a decision that was made by the people who were supposed to be looking out for.

people who live in this country.

Alyssa Burgart (29:45)
⁓ Yeah, absolutely incredible points about the big, beautiful bill and the way that it's going to impact folks.

folks here. And thanks for the opportunity to talk about, you know, I love taking care of kids. I love keeping kids safe. ⁓ So it's a tragic story and I really hope that something good comes out of it ⁓ in this hospital in Lagos. And I do hope that the family, I mean, I don't know that you ever recover from the death of a child, but I think that, I hope, as you said, that they can get information that will at least help them understand what happened. ⁓

Arghavan (29:58)
Good morning.

Alyssa Burgart (30:22)
but switching gears. I have noticed in my feed, and I am guessing in your feed, there is something wild happening in Iran.

Arghavan (30:33)
Wild is the way to put it. Yeah. Yeah. Yeah.

Alyssa Burgart (30:35)
Wild. I thought

maybe you as a ⁓ as someone who has connections to Iran, I thought maybe you might have some thoughts for us.

Arghavan (30:46)
have no shortage of thoughts, as I'm sure you could guess. ⁓ Well, thank you for bringing that up. For folks who don't know, I was born in Iran and my mom and I left when I was a child. ⁓ We still have family there and I've gone back multiple times to visit. What is happening now in Iran is ⁓ another wave of massive protests. And I say another wave because there have been many of these.

ever since the revolution in 1979. So the people in charge right now in Iran that they call themselves the government, I usually say that they're the terrorists who are holding people hostage. ⁓ They're led by a guy named Khamenei, Ayatollah Khamenei, their so-called supreme leader. That's the title that the guy before him gave to himself. That was Khomeini. So it's funny, these two guys, both terrible, terrible people.

⁓ reigns of terror on their people and their names are so similar Khomeini and Khomeini. Anyway, so the guy who's currently there who's very old and decrepit is Khomeini, not to mention evil. Did I mention evil? Anyway, so that's the guy who's there now. And ⁓ because this regime that's been in place since 1979 has been so terrible in many ways and we can talk about the different ways, ⁓ the people have had many uprisings.

trying to get rid of this government. Now in the early years, there were some people, not all people, there were some people who thought reform would be possible, like that we could work with what's here and make it better. I don't think there's very many people of any left who think that way. ⁓ It's a need to wipe this all out and start over a regime change. so,

This started, this current wave of protests started just before the new year, the US new year, the Persian New Year is in March, but for us, ⁓ late December. And ⁓ it's just been like in other waves, but much bigger, it seems, massive outpouring of people in the streets in over 100 cities all over the country. And they're chanting a lot of things that we've heard them chant before, which is death to the dictator, death to hominy, death to the Islamic Republic.

⁓ Which I don't think leaves a lot of ambiguity. I just want to point that out. I don't think it's like, do they like their government? No, they fucking hate their government. like, we don't want these people anymore.

Alyssa Burgart (33:16)
Do they like their government? Okay.

Arghavan (33:19)
Well, you know, there seems to be some confusion on that point on the interwebs. That's why I said that, because there are people suggesting the specific line I heard was that they love their government more than they love foreign intervention. And let me just be clear, they do not love their government at all. There are pockets, right? Like anything else. I'm sure there's like a handful of people you could find and there are people who are paid by the regime or they're related to the people in the regime. Sure, I'll give you that. But the vast majority of Iranians in Iran

do not even remotely like much less love really anything about this regime. So they're pouring out in the streets, this time sparked by the economic catastrophe that has happened, has been happening in the country. My father died and he lived in Iran in 2011. And at that time, the US dollar was about 1000 Taman or 10, sorry, 1000 Taman, we'll say that. There's Riyals and then there's Taman.

Doesn't matter. Anyway, 1,000 to a month. And then now it's like 150,000 to a month for $1. And there's been a steep rise in the inflation just the last couple of years. And so what happened in late December is that there were some business owners, people in the bazaar, who said, this is untenable. We cannot function. We cannot run a business like this. So it was sparked by this economic collapse.

And you'll see that in like Western reporting that people are protesting the economy. But that was the spark. And then immediately it turned into the same thing that they've been protesting over and over again, which is the tyranny of this regime and wanting to have a different life.

Alyssa Burgart (35:02)
Does the current regime also believe that affordability is a liberal hoax?

Arghavan (35:08)
Yeah,

I'm sure they do. Like our government here. No need to worry about affordability, folks. Just keep on existing as best you can, even though you can't afford milk or meat. You know, wages, I mean, all the things that have been happening for a long time, wages are really low, jobs are unavailable, unemployment rates are high, young people don't see a future. And that's part of why, you know, people have been for

Decades leaving Iran right people who could people who had the means like my family and many other families And the result of that is that our families are so distributed everywhere like I like like other Iranians I have a cousin in Portugal and I have a cousin in Australia and a cousin in Canada and other family in Iran And that's how our families are just dispersed all around the globe. It's because of this regime It did not used to be that way and it did not have to be that way, but it's because of this regime so

So people are pouring out into the streets night after night in huge volumes. The estimates vary. Some are saying millions. I've even seen somebody who said 30 million. I don't know. But when you see the videos, it's extraordinarily impressive, the number of people. And they're coming out even in religious strongholds like Mashhad and Qom, which are like the two most religious cities in the country, which should be, you would think, the ones who are most aligned.

with the regime and are the ones that have had lesser representation in previous waves, but even in those cities, people are coming out in huge volumes. And so once this started happening, for those of us in the diaspora, we started thinking, okay, great, like this is another opportunity, maybe this time they will be successful. At least I think that's what a lot of us are hoping for. In the meantime, the regime has been doing what it pretty much always does when there are massive protests like this and it's a whole playbook.

The playbook involves things like just randomly shooting at protesters. ⁓ And they do that. You can see these videos if anybody wants to see them. They're widely available on the internet. The people of Iran are not armed. They don't have a second amendment like we have here. So they are in the streets with nothing but their fists and some rocks on the side of the road. these, you'll see them, these security forces, just.

around and just open fire. They don't care who they're getting. They're not targeting anyone. And in fact, they're not even targeting necessarily anyone who's protesting. Like you just happened to be out, you were going to the restaurant down there, whatever. You could

Alyssa Burgart (37:37)
It's

just terrorizing the population.

Arghavan (37:39)
Absolutely. So that's one thing and they do that. I mean, that's in every uprising that's been the case. I mean, the first that I recall massive incidents was in 1988, which was not in response to a protest, but they just killed a bunch of political dissidents just because that's what they did. I mean, that's part of how they consolidated their power over time was eliminating any opposition. Anyway, so they do that.

You have massive protests, you have the regime coming out and killing anybody and everybody to try to get them to be scared to go back home and stop protesting. And then they turn off the internet. Now, in the past, probably the longest time they had the internet off before was in the 2019 protests, which was in November, called Bloody November. They killed somewhere between 1,000 and 1,500 people, we believe. It's often very hard to know because they cut off the internet. So it's hard to get accurate information.

Alyssa Burgart (38:24)
Mm-hmm.

Arghavan (38:35)
The internet has now been off in Iran for, we're recording this on Thursday, January 15th for about a week. And it's not just the internet, it's also the phone lines. So people have difficulty communicating with each other. And for those of us who are outside the country, it is very hard to get in touch with anyone inside the country. So a lot of people, if you have any Iranian friends, those who are listening, they may not have any idea whether their family members are still alive or not. And this has happened.

You know, it happens now and then like it happened certainly in 2022 as well with the woman life freedom movement. But this is a really sustained period of time. And it's, like I said, it's also the phone. So it's really difficult. They're doing that also so that people can't communicate with each other and organize for these protests. And then they do some really, really sick and twisted things like they...

There's so much that we could talk about, one thing I want to highlight, because people may have seen videos of this, is they took all the bodies in a certain area to a forensic center, Katharie's Act, and you see these videos of just body bags, pavement covered in body bags. And it's hard to know how many people were there. I saw one person who was

physically there and then had left the country because they were visiting from somewhere else. So they left and they were able to share what they saw. They said there were two warehouses with 3000 or 4000 bodies in each one. And this was just on one day. And there are just body bags everywhere. And so people can come and see if their son, their daughter, their brother, their sister is there. And it sounds exactly like it is. They have to walk around these body bags, open body bags, look at the face.

see if it's someone they know and then I mean it's just horrific and then if they find someone if you find your sister your brother your your daughter your son then you have to pay the regime to claim that money because you have to pay for the bullet that killed your loved one yeah it's really yes that's how they frame it we have to charge you for this bullet that we had to use on your loved one and if you don't want to pay us that money by the way it's in

Alyssa Burgart (40:43)
That's how they frame it?

Arghavan (40:54)
It's variable amounts from what I've seen online. Again, it's hard to verify exact information, but it's like thousands of US dollars, which I just told you was 150,000 Taman per $1. It's a huge amount of money.

Alyssa Burgart (41:08)
I mean, it sounds

like there's also an administrative fee. It's not just the bullet. You got to pay for the person who shot it too.

Arghavan (41:14)
Right, right, of course. We've got to cover that person's salary. they make you pay.

Alyssa Burgart (41:16)
Uggh...

So

it's an untenable, I mean, it almost sounds like it's a fake. Like, who can pay it?

Arghavan (41:28)
So a few people can, right? And then they just make money. The regime makes money off of that. And then it's psychological torture for everyone else because some of the other options, like some people have been offered the option of you can sign a form saying that your loved one was a member of the Basij, which is one of the paramilitary forces. And then that way, guess what? They can claim the death on their side and say that it was their own person who died, not a protester.

And that can change the ratio of the numbers, right, of how many protesters are dying versus how many security forces are dying.

Alyssa Burgart (42:04)
This is a really great example. I'm so glad that you explained this. mean, all of this, I really appreciate. But also, ⁓ the idea of how it is that a government can manipulate data to tell a particular story. And that, think, is a really prime example of how people on the ground are being essentially coerced into admitting to something or claiming that something has taken place in a way that makes it the government can basically fudge the numbers.

Arghavan (42:17)
Mm-hmm.

Well, and this is how they do everything in the Islamic Republic of Iran. mean, they are well known for coercing confessions from people. They have no ethical standards for torture of prisoners. So they might take a protestor.

Alyssa Burgart (42:52)
I mean,

as an ethicist, I just want to be clear. I don't think there's any ethical justification for torture, but just for... No, no. Yeah.

Arghavan (42:58)
Yeah, yeah, I didn't mean like there's an ethical torture. I mean, they have no ethical boundary that limits them.

Sorry, I probably didn't word that well. There's no boundary for them that says like, this is a behavior we can't do. I there was a report that, you if people are up for it, you can read on CNN from, ⁓ I think it came out either in late 2022 or early 2023 about the systematic sexual assault of prisoners in Iran. But that's just one part of it. But

The point is that they'll take a protester who was just like normal person who decided they wanted to chant for their freedom on the street and now they take them and then they make them confess to murdering a Basij member or attacking a Basij member or whatever, or the IRGC, the Islamic Revolutionary Guard Corps. They will convince people to make these confessions because they'll say like, we won't.

kill your mom or your sister or your wife or whatever. I mean, they just do all sorts of, I mean, I think for most Americans it's hard to fathom. It's like things you've only seen in movies, but these are real things that happen there. So this is this making people pay for the bodies or agree that their loved one was actually a military person. That's all part of the same game. And I just wanna add one more little level to this, how you claim a body of your loved one, because this process that they've put in place in our culture,

Alyssa Burgart (44:10)
Mm-hmm.

Arghavan (44:20)
When something good has happened, like you got a promotion or you got a bonus, you got a new job, it's expected that you'll bring pastries to a gathering and it's like just how you celebrate. And there's reports that when people are going to claim the bodies of their loved ones, not only are they being asked for exorbitant amounts of money, but they're also being asked, where are the pastries? As though it's like a celebratory event. ⁓ So these people are sick and tired.

Alyssa Burgart (44:48)
Thank me.

Thank me for ruining your life. Thank me for murdering your loved ones.

Arghavan (44:53)
Exactly. I mean, that's it's just so sick. And that's why I wanted to share that because people

people seem really confused about like good and bad here. And I know that the world is a lot of gray. But this is not a case where that is true. The Islamic Republic of Iran is the closest thing to cartoon villain.

You know, Schmittler type thing that I can think of in reality.

And yet we have people on the internet who are ⁓ seeming to have difficulty wrapping their minds around the complexity of situation. So there are some people who are saying, well, the Islamic Republic is what funds Hamas. And Hamas is the only thing protecting Palestinians from the attacks from Israel. And so we have to support the Islamic Republic.

And I just want to be clear that that's not a thing that a rational person would say. We absolutely do not have to support the government that is not only terrorizing its own people, but also built terrorist infrastructure around the entire Middle East, for one thing. Then there's the people who are trying to undermine.

Alyssa Burgart (46:06)
Okay, me

some dumb shit that people are saying, okay? Tell me the dumb shit. Let's lighten the mood. I mean, it's all terrible, but give me some laughs. It's all terrible.

Arghavan (46:10)
Yeah.

Okay, it is absolutely all terrible.

that falls into it. So yeah, this thing that like you either have to be imperialist or anti-imperialist. And so if you're anti-imperialist, then you have to be pro Islamic Republic. That's one of the silly things that people are saying.

Alyssa Burgart (46:33)
But also, and also I'm

just gonna say, like if you're American and you're claiming to be anti-imperialist, like it's complicated here, right? Like we are the empire. We are also the empire, you know? So, okay. So people are claiming.

Arghavan (46:43)
Yes.

Yeah, so that's what people are saying that like, we have to support the Islamic Republic if we're anti-imperialist, which is not true. That's neither, I mean, honestly, I don't think that's, it's a false binary is what I'm trying to say.

Alyssa Burgart (47:00)
It's

a logical fallacy.

Arghavan (47:02)
Exactly.

And then there's this whole idea that ⁓ the protests aren't real. I mean, they're real, like there's people there, but it's all fake.

Alyssa Burgart (47:13)
⁓

like January 6 was created by the Democrats as a democratic hooks.

Arghavan (47:17)
Kind of, but more like the no-kings, remember the whole

rhetoric around the no-kings protests was that these were paid protesters, paid for by Antifa, whatever that is, and then like there's some central, I mean, I don't have my Antifa card, you? Anyway, so it's like some Antifa organization or George Soros, I mean, there's all these rumors about who is paying people to come be in these protests because...

Alyssa Burgart (47:43)
trying to paint the the protest at themselves as a conspiracy.

Arghavan (47:47)
Right, and inauthentic, right? Because if you have people who are genuinely concerned about what's happening, whether it's in Iran or the US or France or anywhere else, if there are people with legitimate concerns who are out in the streets protesting, there's a different expectation of how that's going to be handled than if it's all fake, if it's all paid protesters who are only there to make

a few bucks, right? So that's very clearly why in the United States they started all those rumors about how we were all paid. I mean, I've marched in those protests because I am very concerned, as you know, for many things our government is doing. I have not yet received my money. So if there's money to be made, it's like that the money that I suppose you're right. It's like the money I supposedly make for promoting vaccines. I'd like that money to please send it to me anytime. anyway, so this idea that that

Alyssa Burgart (48:30)
Send my check.

Arghavan (48:41)
that is going around the internet is that these protests are not organic and that they're being organized by the US and or Israel and therefore shouldn't be taken seriously as a people's movement. That idea is not only stupid and inaccurate, it's extraordinarily harmful because it serves that same purpose of undermining the movement that these people are making and simultaneously justifies the government killing these people because they're not real Iranians, they're

put there by other foreign governments to make it seem like Iranians are upset. And you could, look, here's the thing that's when you said, tell me something stupid. Like here's what's not smart about thinking that. In order to believe that all of this is happening because the US and Israel are orchestrating this, what is your explanation for what happened in 2022 or what happened in 2019 or what happened in 2009? Do you know what I'm saying? Like what is your explanation for

the repeated year after year waves of Iranians pouring into the streets saying we do not want this regime anymore. How do you explain that? Are you suggesting that the US and Israel have had this like sustained campaign that every few years they like pay a bunch of people to come out? You know I'm saying? Like that doesn't make any sense. Or are you suggesting that this particular time is different from all the other times because, do you know what I'm saying? Like,

It's not consistent with the history of the country. You have a people who have been tortured by their government for 47 years and you want to tell me that they don't have the agency to go out and protest on their own, that they need foreign governments to convince them to do it?

Alyssa Burgart (50:17)
They like it.

They like it. I mean, this is what's wild, right? I mean, and this is, mean, certainly I don't know why people come up with these wild ideas. ⁓

Arghavan (50:21)
yeah, they like whatever.

Alyssa Burgart (50:33)
I also think there's to a degree this constant othering and the anti-Islam behavior that's in the United States, the extensive Islamophobia, the phobia of anyone from the Middle East, which obviously was incredibly ramped up and used as a tool ⁓ after 9-11, as well as obviously before that. But I think that it's interesting that

Arghavan (50:47)
Mm-hmm.

Alyssa Burgart (51:00)
It seems to me when you describe some of these videos that there are folks who truly believe, like, I don't know who hears about like what it's like to live in Iran right now and thinks like, I would like that. I would like to, you know what, take my rights away, especially like for women. You know, I just, I cannot imagine like why it is such a fascinating thing to convince a population.

that somehow other people are so different from you that they would be perfectly fine living in what you yourself would consider a hellscape.

Arghavan (51:31)
Mm-hmm.

Well, I totally agree. people are saying things like, well, look at the women in Iran now. A lot of them aren't even wearing head scarves. So, you know, what do they have? They're fine. But, know, the point that. Right, right. But the thing is, there's multiple things about that. One is the only reason we are seeing more images of women in Iran who aren't covering their hair is that.

Alyssa Burgart (51:47)
so they're fine.

It's the only indicator we need.

Arghavan (52:03)
A lot of women took a stand in 2022 when Massajina Amini was killed by the government for not having covered her hair adequately enough in their view. And after that, there was this massive movement that went on for months of women. It was a women led movement fighting for rights in Iran. And so that's the reason that you're seeing that more now is that they took a stand and they took a stand despite.

Alyssa Burgart (52:20)
Mm-hmm. Mm-hmm.

You're not seeing it because the government's fine now?

Arghavan (52:32)
Exactly. It's not like, they just all of sudden realized that they were wrong and women do deserve rights after. Like there was no such awakening in the Islamic Republic of Iran, meaning the government. But people will point to that and like things are better now. No, they're not better now. They just, the government somewhere along the line decided not fight that fight as heavily anymore. But they don't have...

Let me give you another example. There's no rules that are actually followed there. And I know people say that here, but I want to give you a sense of what it's actually like when people really don't follow rules. So one of the ⁓ protesters who has been killed was a young woman named Rubina Aminian. I think she was 23. Shot in the head, in the back of the head, mind you, because she was so threatening. They shot her in the back of head. And they did give her family her body.

but they refused to let them bury her body. in the tradition, should be a ceremony, the body should be buried the next day. There should be a ceremony on day one and day three and day 42 and so on after a person dies. ⁓ And so they denied her a proper burial and they denied the family the ability to have any of these public ceremonies that you typically would have. And I was telling this to someone and they said, but isn't that against like their own

rules and their own religion and it's like yes it is and they don't care because they don't actually care about the religion they just care about having control and power and terrorizing this entire country. So those are the types of things that are happening all the time mind you and they had arrested this guy a young guy I think he was 26, Erfon Sulteny who I believe was arrested last Friday and they had planned to execute him on Wednesday.

Like is that what it looks like to have a justice system that's functioning? ⁓ And they didn't, as far as I know, actually execute him on Wednesday, but it's always hard to know with these cases in Iran whether there was a real reason for that or if it had to do with Trump's rhetoric, by the way. know, our country, what I would like to make clear is I do not believe that the protesters in the street are paid for by our country, but does the US care about what's going on in Iran? Absolutely. And if there is a...

Massive shift in the government there and if the people are successful will the US try to control what happens next? Absolutely, like I am not naive to that What I am saying is that the movement that we're seeing in the streets is an organic grassroots movement of people It's not because the US told anybody to go out in the streets ⁓ But that's

Alyssa Burgart (55:08)
I

mean, the US does love to control a regime change. Love it.

Arghavan (55:12)
Well, the US loves to make a mess out of everything is how I would phrase it. yeah, so there's just all sorts of different ways that you can see how they have terrorized the people ⁓ time and time again. And so it's like, it's not confusing why the people, that's where I get a little bit lost in this idea of like other people are paying these protesters or that the reason these protests are happening are because anyone else, like they have plenty of reasons.

to be coming out into the streets. And it doesn't take more than like a two minute Google to understand that. And so people who are doubling down, like I made a video about this and somebody actually even made a stitch of my video saying all sorts of terrible things to me and about me because of some people at some protests in the US had an Israeli flag or whatever. What does that have to do with me? Absolutely nothing. But he was saying that people like me in the diaspora

who are saying these protests are not because of the US and Israel are lying and that we're trying to take advantage of our own people. So I mean, it was like extraordinarily bizarre the things this guy was saying. So there's just lots of weird thoughts out there. And I think people get really confused also on the point of Palestine. I do think they really get stuck on.

thinking that is the Islamic Republic is somehow protecting the people of Palestine and I wanna be clear that they don't care about the people of Palestine anymore than they care about their own people. ⁓ And I can understand being anxious about what people perceive to be one of the few protections for people in Palestine. Like I would never deny that, I understand that anxiety. But this regime is actually causing...

instability in the entire region and I think the whole world would be, certainly the Iranian people, but the whole world would be better served with them being gone and that's what these people are fighting for. And they're literally risking their lives. mean, reports are, as I said, we don't know exactly how many, but some of the reports are 12,000 people protesters killed within two days. And I believe the number of people killed in Ukraine in that war with Russia over the last several years is like 14,000. We're talking about in two days. And those are

likely under estimates. So anyway, then our president, I should, this is last thing I'll say, our president yesterday said that, because if folks don't know, very early on Trump was like, well, if they kill protesters, if they kill protesters, you know, we're gonna help the people of Iran because what's good for the goose is not good for the gander. Anyway, he had said that.

And of course, I know as someone who sits and lives here in the United States that that's meaningless, right? But and that he absolutely does not care about protesters in Iran any more than he cares about protesters in the US. But he said that. And for some Iranians, that was a ray of hope. Like maybe there's somebody who's going to help us in some way. It wasn't clear in what way. And it doesn't have to be military intervention. But it was like we're going to do some thing. Right. And then he said it again, like a couple of days later. And then yesterday.

Alyssa Burgart (58:11)
Hmm

Huh.

Arghavan (58:25)
They asked him in the Oval Office about this and he said, well, they've stopped the killing. They've stopped the killing. They're not doing the executions. And so we're just going to wait. yeah, exactly. Yeah. What are you talking about? And then the reporter followed up and then he goes, you know, I talked to some important people and ⁓ they said that the protesters had weapons. you know, that these things happen. Basically, that's what he said. These things happen.

Alyssa Burgart (58:35)
What? Anyway, I just...

Arghavan (58:54)
So

Alyssa Burgart (58:55)
We spoke last week about Renee Nicole Good and how she was essentially executed.

in an unlawful stop, you know by ice in in Minnesota and and since then we've seen Additional, you know people are just getting pulled out of their cars ⁓ People are being shot someone was shot in the leg today, you know, and so we're seeing I do not think that these are disconnected for the president of the United States who is promoting and Seems quite happy

Arghavan (59:11)
Thank

Mm-hmm.

Alyssa Burgart (59:28)
about ICE behavior, which he has massively funded, has driven, you know, this really authoritarian.

Arghavan (59:29)
Mm-hmm. Mm-hmm.

Alyssa Burgart (59:36)
you know, invasion of all of these cities in the United States with the way that you've described him responding to what's happening in Iran. Like, I don't think that these things are disconnected. I think that he would be very happy to be a supreme leader.

Arghavan (59:51)
absolutely, I agree. I'm sure he thinks that that's a strong man. But I think the thing is, what is particularly, I mean, you know that there's no love lost between me and this guy. But what was particularly galling to me is to go from a position where you have dangled some sort of carrot in front of the people of Iran. In fact, in one of his posts, he said, keep going, take over the institutions, encouraging people to risk their lives.

That is what he was doing, encouraging them to risk their lives. We will be there to help you to go from that to, well, but you had weapons, so you deserve to die. that is a particularly despicable thing to do to a people who are, quite frankly, desperate for help and are being murdered by their own government. But I agree with you that, like, of course, it's fine for him because that's how he's going to justify everything here. But he now has

made it easier for the regime there to justify killing even more people because he's kind of bought into this lie that either he's fed or he came up with, I don't know, probably fed because I don't think he like, you know, has the capacity. But he just is now parroting this point to say, OK, well, I guess they have to kill 12,000 people. I mean, just think about that for a minute. Like, even if you think there could be some people in Iran, there might be some people who are able to smuggle in weapons from somewhere else. Sure, that's possible.

But you think 12,000 of them in one day and you think they were like all in the same place. You think they were like easily targeted. And if they had, if there were that many people with weapons, wouldn't there be more casualties on the security forces? Like it doesn't compute if you actually try to think it out. But of course he's counting on people not doing that. And then just shrugging the shoulders and being like, oh, well, if the people are gonna fight back, then some of them are gonna get killed. But that's absolutely not what is happening. It's the security forces and you can see them. There's video, it's all over the internet.

Go on the streets and start shooting. That's it. That's it. You don't have to have a weapon to deserve to die in the Islamic Republic of Iran.

Alyssa Burgart (1:01:52)
Absolutely not. you know, one of the other things that you've talked about, you mentioned it earlier, the, you know, really the digital blackout that's happening and people can't reach the internet, you know, they can't get on the internet, they can't use the phones, it's very difficult to connect. And like, I mean, you and I couldn't talk to each other right now, if that was happening here. And, you know, so I've just been thinking so much about, you know, we are so deeply reliant on the internet and on our phones in order to be able to live our daily lives. And so to

Arghavan (1:01:59)
Mm-hmm.

That's right.

Mm-hmm.

Alyssa Burgart (1:02:21)
to take out access to the internet is a huge blow to communities that have really, you you need to be able to communicate in order to flourish and in order to organize and just imagining what it would be like to suddenly not have access to communication is, it's a very stressful idea.

Arghavan (1:02:41)
Oh exceedingly, we're so tied to our devices and they are too, just like we are. They're not like a different kind of people. They have the same needs that we do. I, right. That's a dream world that somebody wants us to believe in. But the last thing I to say just about the digital blackout is people have said, oh, well then are all the things we're seeing fake? And you know, people do have Starlink in Iran. There are satellites.

Alyssa Burgart (1:02:51)
They don't care about the phone. They're happy to be terrorized. It's fine.

Arghavan (1:03:11)
⁓ And there are multiple people who were there visiting and have left or just crossed the border To be able to send communications So the fact that we're seeing some things come out of Iran doesn't mean that like people are lying one way or the other It's just that we're not seeing anywhere near the volume of what we would see if there were connectivity as there should be ⁓ and and everyone has a right to that there is by the way a movement to ⁓

I think it's digital to satellite. There's a way apparently that any cell phone can connect to satellites, but it has to be turned on and ⁓ the Islamic Republic won't turn it on. So people, Iranians are organizing to try to get other governments to turn on that functionality to get around this digital blackout. ⁓ I don't know if that will happen or not. But anyway, just to explain that we are getting some images, but that's because of workarounds to the digital blackout,

Well, and even you can just go back to 2022 in Iran and ⁓ there was a much more limited internet blackout at that time. So we got tons of videos ⁓ and I will just say, okay, really the last thing. So it's somebody, there's a video of a young woman who has ⁓ lit a photo of one of the Ayatollahs on fire and then she lights her cigarette from that photo and it's gone quite viral. It happens to have been in Toronto, which I didn't know actually when I first saw the video. So this young woman was in Toronto.

And somebody was using that as an example of how we're being flooded by fake information, basically. That's not really in Iran, so it doesn't really matter. And I just want to point out that there is no shortage of images of women inside Iran doing things that are equally as brave and rebellious as that. In fact, there's a photo and a short video that went viral of an older woman in Iran.

Last week who was in part of the protests and they were asking her, know Why she's there and isn't she afraid of dying and she said what is there to be afraid of I've been dead for 47 years So, you know, there is no shortage if you're looking for images of women in Iran In fact, I have a video with one of them pinned on my in my tik-tok You're looking for photos of women in Iran standing up to this regime. There's like absolutely zero shortage of that. So you don't need to pretend

that this one video that happened to be in Canada is the only evidence that women in Iran are caught up with this regime. Anyway.

Alyssa Burgart (1:05:32)
Well, I really appreciate you. I really wanted your perspective, ⁓ you know, as someone who was born in Iran, who obviously has so many connections in Iran. So I really appreciate you being able to share that. I know this has been really painful and I know it will continue to be painful, you know, for you and your family in ways that I can't imagine.

Arghavan (1:05:52)
Well, thank you for sharing the space and allowing me to talk about it. I think it's like one of the few things I can do, right? Like I can't, I don't run a government, so I can't make policy changes that are gonna help my people, but I can at least talk about it.

Alyssa Burgart (1:06:07)
Well, how about a palate cleanser? Take two and call me in the morning. What is, what are you using to interrupt the doom scrolls today?

Arghavan (1:06:07)
Yeah, okay.

Yeah.

there, intermittently, there are people who decide that they are going to learn how to do the dougie. And what is interesting to me about it is that for some reason, lately, some of them have been documenting that journey. So they'll be like day one of learning how to dougie and then day two, and then they go on. And so there's this guy who is in Japan who has been doing this for the last, I don't know if I'm caught up, don't know, 20 some odd.

Alyssa Burgart (1:06:27)
Okay.

Arghavan (1:06:48)
days. The last video I thought was day 21. ⁓ And every day he's posting a video of himself attempting to do the dougie. the, I mean, the videos are funny, but the comments are even better because a lot of people are saying things like, I don't even remember what the dougie looks like anymore.

Alyssa Burgart (1:07:06)
Well, that's what I was just trying to think

of. was just going, you were like, people were trying to relearn the dougie and I was like, wait, which one is...

Arghavan (1:07:13)
Yeah, you need to, I'll put, we'll put the link obviously in the show notes, so you should watch these. But the thing is what they're saying is they've been watching this guy do it for so long that they've forgotten what it's supposed to look like. That's what they're trying to say. And then there's other people who are like convinced that he actually can do the dougie and he's just playing a game. So they're like.

Alyssa Burgart (1:07:23)
⁓ god.

you

Cause he's not improving.

Arghavan (1:07:36)
I think he's improved. I think he's improved from his first one, but he's not, he's certainly not there. So they think he's like intentionally being not good at it. it's like all the comments are like, well, here we are again. See you next time tomorrow.

Anyway, so we'll put it open a link to that in the show notes ⁓ You know, love I love a learning journey. And so just to be clear I'm not trying to make fun of anyone who's doing these things and I came across a tutorial by the way I'll put a link into that to you but a tutorial because I have never been interested in learning how to Dougie but now that I see these I'm like because there's another one that was a young woman who was Committed to learning how to Dougie before her wedding. ⁓ That was the last one I saw where she was posting like daily videos of her journey to learn how to Dougie and

I can just say that's never been a goal of mine, but now that I've seen these, came across this tutorial and I was like, let me see if I can Dougie. Maybe one day I'll post a video about it.

Alyssa Burgart (1:08:36)
You can post, you can take us on your journey.

Arghavan (1:08:38)
Yeah. Anyway, what's your recommendation these days? What does the doctor recommend?

Alyssa Burgart (1:08:44)
⁓ Well, I have two. So one, ⁓ Noah Wiley, who plays the main doctor on The Pit and was also one of the main doctors on ER back in the day for folks who were fans of ER. So he plays the main doctor and ⁓ he was on Jimmy Kimmel and did a ⁓ like a skit, a kind of like Saturday Night Live's skits. He did a skit ⁓ talking about how he is not a doctor.

but how he plays one on TV because he's able to say all these complicated words. And he goes on to spend the whole time basically making fun of RFK Jr. and his whole administration, but in a very tongue in cheek way. And it's very funny. ⁓ So I thought that was very amusing. I think you'll like it. So I will send it to you and I'll put it in the show notes. ⁓ The other thing is I, so I like Saturday Night Live. Like every year it's not, you know, not every season's the same like

Arghavan (1:09:20)
Amazing.

I'm sure I will. Thank you.

Alyssa Burgart (1:09:39)
people can calm down for people who are like, sucks. But I find it enjoyable and I like to, you know, take a little break from the drama of the things that you and I think about on a regular basis and I'll watch like little, little Saturday Night Live skits. So I really like one of the current cast members who's Marcelo Hernandez. And he has a really, really funny Netflix, Netflix special called American Boy. And Marcelo Hernandez, his mother escaped from, from Cuba. And so

Arghavan (1:09:41)
Thank

Alyssa Burgart (1:10:09)
My best friend growing up, her parents had escaped from Cuba as well. And so I grew up in this Cuban household hearing the whatever, various things. And it was really funny for me watching Marcella Hernandez. I haven't actually watched the whole thing. I was like, I am going to dose myself on this because I'm laughing so hard. And I was like, I want to save this. I don't want to.

Arghavan (1:10:27)
Thanks.

Hmm.

Alyssa Burgart (1:10:35)
I need to be able to laugh like this. Like, I don't think that I have belly laughed in that way in quite a while. So, American boy, I will put a link in the

Arghavan (1:10:43)
American boy.

Well, that is it for this week's episode. If you didn't like what you heard, this has been the Mel Robbins podcast. If you liked it, don't forget to subscribe to and follow The Present Illness. Leave us a review if you can, or least a rating, ⁓ and tell other folks about us.

Alyssa Burgart (1:10:59)
You can follow us on all the places we're on. TikTok, Instagram, we are on YouTube. We're @thepresentillness and you can stay on top of all of our TPI related news.

Arghavan (1:11:08)
We will be back next week with more headlines, hot takes, and doom scrolling, hopefully with some laughs.

Alyssa Burgart (1:11:14)
Until then, agitate, hydrate, take a nap. We'll see you next time on The Present Illness. Production by Arghavan Salles and Alyssa Berghardt, Editing by Alyssa Berghardt, Social Media by Arghavan Salles, and Original Music by Joseph Uphoff As a disclaimer, don't take medical advice from two random ladies on a podcast, even though we're doctors. The show is for informational purposes only. It's not medical advice. Please make sure that you take any of your medical questions to a qualified professional.

Arghavan (1:11:28)
Thank