Transcript
Welcome to the SAWC Difference Makers Podcast, where breakthroughs meet the bedside.
I’m your host, Dot Weir. Let’s dive into today’s conversation.
Dot Weir: Well, welcome, everyone, and thank you for joining our podcast today. I am so happy to be joined by a friend and a colleague, Emily Greenstein. Emily is from Fargo, North Dakota. You know, Emily, we’ve all seen the movie Fargo, and so we all think you live in the tundra and plow through snow and find things out there. But I’ll talk to you about that.
First of all, I’m going to have you introduce yourself, basically, and then I have a few other things to talk to you about.
Emily Greenstein: Sure. Sounds good. Well, thanks, first of all, for having me. Like Dot said, my name is Emily Greenstein. I’m a certified wound and ostomy nurse practitioner in Fargo, North Dakota.
A lot of times, when people think about Fargo, they think about the movie or the TV show, so I get a lot of questions about the wood chipper. To disclose all, there is a wood chipper here, and it is a tourist trap, but they do have one on display. So yes, there is one here.
And, yeah, a lot of times, the whole tundra thing—it is nice here for about a week every year. Right now, it’s really hot, actually. It’s kind of funny because we didn’t really have spring. We went from 30 degrees to 90 degrees in 2 weeks.
Dot Weir: Oh, serious.
Emily Greenstein: So it kind of varies. Right now, it’s pretty warm. It’s in the 80s and humid. So it’s summer officially.
Dot Weir: Well, I’m going to invite myself because I want to come visit you sometime, mostly because of the next things that I want to bring up.
So just for the people who are listening, I stalk Emily on Facebook. Not really. I mean, we’re friends on Facebook. And she is one of the ones that I will open up every single post that she does because she has this incredible work-life balance. And I think, with someone with your busy travel schedule, speaking schedule, and work schedule, that’s such an incredibly important thing.
So you have 5 kids, 5 children, right? Don’t you have a daughter who just graduated from high school and is going to play basketball somewhere? This is how much I look at her posts. But it’s more than that. It’s your farm and what your children are involved in. To me, it is such a wonderful way to be raised.
But I’ll tell you what I just did in the hour between these 2 podcasts I just did. I was so proud of myself. I went out and refilled my bird feeders. I filled my critter feeder. I planted a cucumber plant and a pepper plant in my aboveground planter, which I have one. You have, like, 10.
So, I mean, you just have this fascinating life. You have got work-life balance down, in my opinion. Talk just a little bit about your family life, because it really is fascinating.
Emily Greenstein: Sure. So we have a very crazy, very busy schedule. We have a big schedule at my house with things on. And I will admit, sometimes kids get forgotten at places, and they’re so used to it, they’ll just text me and be like, “Hey, is someone coming to get me?” It happens.
But like you said, I do have 5 kids. I have 2 of my own and then 3 stepkids. Our oldest is turning 21, and he plays football in college. So we’re busy with that in the fall. And like you said, our daughter just graduated, and she’s going to Central Arizona to play basketball next year. So that’s been busy with graduation, trying to get all that figured out, but that’s done, thankfully.
And then I have the 3 younger boys. My 2 are 15 and 12, and then my other stepson is 15 too. So I have 2 15-year-olds who just got their driver’s licenses, so I don’t know if that’s a good thing or a bad thing.
Dot Weir: Good and bad, I guess.
Emily Greenstein: But they’re really busy, and they’re all into sports. And then, like you said, we do live on a farm. So we have about 10 acres. My husband ropes. He roped in the PRCA in the past, but now he’s semi-retired. So he just does a lot of local rodeos and that kind of thing. And then he helps the kids because my one son is in 4-H. So that takes up a lot of time. He goes to horse shows. He does projects.
That’s why we have a lot of animals. He likes showing animals. So right now, at our house at any given time, we have anywhere between 5 and 7 horses. We have a donkey. We just acquired 5 goats.
Dot Weir: They’re so cute.
Emily Greenstein: I know. They’re such a pain in the butt. And then we have 2 sheep. And then he also just acquired 2 rabbits because he now thinks he is going to start a rabbit-breeding business. So we have them. And then, like you said, I have a very large garden now.
So we’re pretty busy. Our set schedule with all the kids’ stuff—because the boys are in baseball too—is every day. I work until 4:30 or 5:00 usually. I get home, I make supper, we have supper, then we go to baseball, and then we come home. Luckily, in North Dakota, it is light out until like 11 pm now, so we have a lot of time. Then when we get home, we end up feeding all the animals and then kind of get up and do it all over the next day.
But like I said, if it weren’t for Google calendars or iCalendars, we’d be lost because my husband and I sync them, and our motto is “divide and conquer” a lot of the time.
Dot Weir: Absolutely. Well, the reason I wanted you to tell all that is because people see you at podiums, and you are such a wealth of knowledge. We’re going to talk about your background in that. Who would ever know that you had this whole other rural kind of life and busy schedule? And a lot of times, your kids can travel with you when they don’t have all the other stuff going on. I know your boys, anyway, travel with you. Like they were just in Indianapolis with you, I know.
So anyway, I’m just impressed by your ability to do all that and then accomplish all the other things that you do. So you’re a difference maker professionally as well as in real life. And the impact that you’re having on your children—the positive impact that you’re having on your very wholesome life for your children. So anyway, kudos on that.
Tell us a little bit about your clinical background.
Emily Greenstein: Sure. So I’ve been certified in wound and ostomy care for about the past 17 years. Prior to that, I worked as a nurse in a transitional care unit.
But it was kind of funny how I got into wound care because I didn’t really have any inkling to do wound care. But the unit I was working on closed, and one of my friends was in wound care, and she was like, “Hey, we have an opening. Why don’t you come work with us?” And I was like, “OK. I don’t really know anything, but sure.”
So I went there, and then I got certified as a wound nurse. I worked there for about 5 years until I finished my nurse practitioner degree. And then I loved it so much, I just stayed in wound care.
Dot Weir: So where was that previously?
Emily Greenstein: It was a wound clinic that was under vascular surgery. So I got quite a bit of background with vascular surgery. I was able to scrub with them sometimes, which helps. So then I knew the whole patient kind of background.
I also took call for the trauma team. It was kind of funny because it was like a per diem position, but I was basically their personal nurse, which worked out good because then I would see the patients right away when they came into the hospital. So I knew their entire plan.
The problem with that was it was supposed to be one weekend a month, and then pretty soon it turned into every weekend. That was just too much with the kids and everything else. So I stopped doing that, which was fine.
Then 2 years ago, I left that practice and came over to where I’m at now. Where I’m at now is a podiatry clinic, but they also have hyperbarics. So I got certified in hyperbaric oxygen therapy last year.
It’s been really nice coming over here because it’s more of a focus on diabetic limb preservation. So I’m able to hone the wound care a little bit more. There’s not all the other outside stuff. We’re able to run more like a coordinated treatment center, which is really nice.
And then other than that, like you know, I do a lot of speaking for different things. I try to do a lot of education because I do feel like there are not enough people out there wanting to do education, especially for wound care, because it is kind of fragmented. There are a lot of different specialties that practice wound care, meaning every level from LPNs all the way up to surgeons. So it’s kind of nice to be able to do education to everybody.
The other thing I like with the speaking—and I do a lot of speaking—is because then you get to meet so many people and you get to learn from other people around the country. And I even do some international speaking. So that’s been really interesting because it’s nice to talk to people who are taking care of patients in other countries, and they still have the same problems you do. So you know that it’s not just you. It’s everywhere.
So I kind of always find that interesting, that it doesn’t matter where you live. You’re usually faced with some of the very same obstacles, whether it’s patient compliance or access to health care or access to supplies. Everybody kind of deals with the same thing. So that’s been really neat. I really enjoy the networking and the connecting with people.
Dot Weir: Yeah, the resources seem to be so varied. I know we were both at Yuma. It’s so varied in different countries in terms of access. We think we have it so bad here, but we really do have it good in terms of being able to at least get dressings for our patients.
And you’re coming over from a vascular service to the podiatry service. What a great blend of those specialties, especially since your focus now is limb preservation because that’s such a huge part of it.
When I’ve spoken with Emily on different occasions from the same podium, she always has great vascular studies. It just rolls off your tongue, what you’re looking at, and you explain it so well to the audience that makes it understandable and usable information. So that’s one of the things also that I wanted to talk to you about.
Like me, and probably more you, people often ask me 2 kinds of questions: how to get involved in speaking, and then also, how do I speak for companies? You and I were chatting before we started about our philosophy on that. But you had a great way of putting it in terms of, you know, we have a lot of young difference makers out there who are just waiting to get their break.
And from an SAWC standpoint, I get a lot of emails: “You need to let me speak at SAWC.” Well, let’s talk about that. But it’s also, you know, you need a mentor. We try to have like 20% new speakers at each of our meetings, and we do that.
So talk a little bit about that. You had a great way of putting it. How can people get started in this?
Emily Greenstein: Sure. So first of all, I always say, first things first, let’s make sure that you’re comfortable talking to an audience. Sometimes people think that they can do all this talking and whatnot, but then they get in front of a large audience, and because of the stress and the nerves, they’re just not able to do it.
So I always say, you know, start small to see if you even want to do this. You might think you want to, but you might not. So my advice is start small. Start with education at your own facility. Start running an education day, speak to them, or maybe a local conference, just to make sure that you’re comfortable with public speaking to start with, because public speaking isn’t for everybody.
I know people who are great clinicians, but they just clam up and are terrible with public speaking. It might not be for you.
The other thing I always say, if you’re trying to get in with a company, it’s not looking for somebody who’s looking for a speaker that you’re going to utilize their product. What you want to do is back something that you believe. So something that you’re already using, that you’ve already had good results with.
And a way to start is to do a poster. You can do poster presentations. And even if at first your poster isn’t sponsored by a company, if you have really great case studies, or if you have a really good thing that you saw, or a really good idea, doing a poster will get your foot in the door.
And it’s also another way to promote yourself and to become familiar with public speaking, familiar with how conferences run. At SAWC, myself and Dr Tickner do a session called the poster oral abstracts. So if you’re submitting a poster for SAWC, for example, and you select oral abstract as well, then you could get selected to do a presentation during that presentation.
So what it is, is each presenter has about 3 minutes to present their poster to the audience. But we kind of prompt the questions so that you know what to say. That’s a really good way to get your foot in the door at the conference, a good way to know if you can do any public speaking, and to get your project some recognition.
The other thing is just talking with your local reps. Say, “Hey, I got these great cases. I want to do a poster. Is there any way that the company would be willing to maybe sponsor it or willing to sponsor me to present it at this conference?”
Even if you don’t go to a national-level conference, some of the local conferences also have poster halls. So maybe starting there and then working up from there. That’s kind of my advice.
I always say you’re not going to be able to be like, “Hey, how about I use this product, and I can speak for you,” or “I can do that.” First of all, if you’re a provider, there’s going to be extreme pushback from wherever you work because of Medicare. You can’t use a product based on what you’re getting paid to use the product. That’s very frowned upon.
And plus, when you’re speaking about something, if you don’t really believe it, or you don’t have experience with backing it, and you don’t have good results, you’re not going to come across as believing that this is a great product. You’re going to come across as a sales pitch. And I find that’s really hard. And you can tell that in some presentations, that people are doing it more as a sales pitch, that they actually don’t believe in the product or they haven’t had good results with it.
Dot Weir: Or really use it all that way.
Emily Greenstein: Yeah, or don’t have any experience with it.
Dot Weir: To that end, the most critical piece is setting it up at your hospital. Number one, that you’re allowed to take those pictures. You should have it in your consent. Sometimes it’s in the consent for treatment. Otherwise, they have a photo consent that it can be used for education, posters, clinical trials, whatever.
So we created a document for it that specifically says in there, when they sign, that your photos and case may be used for education internally and externally. And then it says all the legal jargon about no identifying factors, all of that stuff.
Emily Greenstein: Yeah, yeah, yeah.
Dot Weir: Because it’s really the pictures that are what stops someone at a poster. Data really may, they may stop if you changed your pressure injury rate from 75% to 0, or maybe you found a perfect combination for pyoderma gangrenosum, you know, whatever. But you’ve got to have great photographs.
And I usually have to sign a disclosure at my hospital that I have to recuse myself from some product decisions, which is fine. But you just want to make sure that everyone—that you put a disclaimer on your slide. So there’s a lot that needs to be laid before you do that and make a poster.
As far as going back to the speaking thing, you’re right. Not everybody’s cut out for that, but it is a learned skill. There are actual YouTube videos and classes that you can take and books that you can buy about how to do that. And I think the other thing is learning how to make PowerPoint slides and make them enjoyable and entertaining.
But, you know, you have such a command of a stage when you’re up at the podium. And I hate to say this, but it’s coming through loud and clear today. Part of it’s your voice and your inflection. It’s very loud. It’s not just loud.
Emily Greenstein: No.
Dot Weir: I don’t mean loud. Your inflection—it grabs you. And it makes you want to listen. It’s a nice, pleasant way to listen to somebody speak. So you’re the whole package when it comes to that speaking.
Emily Greenstein: I’ve had a lot of experience. I will tell you, when you talk about the PowerPoint presentations, making it so that it’s appealing, that it looks good. Obviously, everybody likes pictures, like we talked about. So making sure you have a good mix of pictures.
And I also get a lot of feedback that they don’t like a lot of words on the slides. They like diagrams, quickly looking at. So it’s kind of funny because I did a presentation a couple of years ago. It was for one of the A&E, the nursing. And what it was, was it was a presentation where it was just pictures. Each slide was—I can’t remember—the total was only 8 minutes for the whole presentation, and it had to have just pictures.
It was some new way to do PowerPoint presentations that they were looking at. It was kind of really fun because you didn’t have any words. Nobody was reading things or taking pictures of the slides. But it was just photos, and it was supposed to be eye-catching photos. And of course, in wound care, we have a ton of those.
Dot Weir: Absolutely.
Emily Greenstein: That’s why I like wound care. I mean, I know it’s important to be in a cardiac unit, and when somebody’s blood pressure goes down, that’s a great day. But wounds are so visual. You can see what’s going on. You can see the results of your work.
And it’s always really shocking when you get a wound, especially some of those huge, like, pyoderma ones or those huge necrotizing fasciitis wounds where it’s like half their leg is skinned, and then in 3 months, it’s healed completely. So it’s kind of funny. When you’re in it, it’s really overwhelming, you think. But then when you go back and look at the pictures, it’s like, wow, that came a long way in a short period of time. So I like that about wound care too.
Dot Weir: So many times, like you and I are both at the planning meeting for SAWC Spring next year, we like things to be very case-based. And we always encourage, regardless of what the topic is—because there are very few topics in wound care where there are not pictures to go along with it. I mean, maybe some nutrition or, you know, I can think of a few things. But it’s so visual. People want to see cases. They want to see what you did.
And you see these lights go on, these aha moments. And they’re like, “Oh, that’s like Mr Smith. Oh my gosh. I wish I would have thought about that.”
Emily Greenstein: I get a lot of that too, and I’m sure you do after your talk. So people will be like, “Will you look at this case? It was a lot similar to the case you had, but we weren’t able to do whatever.” But that makes sense.
So I always tell people, you know, the great thing about wound care is it’s a big area. It’s like a lot of people are in it. But then when you think about it, it’s not. It’s small. So there’s always a phone a friend. I always go, there’s always phone a friend out there somewhere. Somebody has seen it or done it.
Dot Weir: Yeah. And we shouldn’t be hesitant to reach out.
So Emily, share your clinical practice. Do you do inpatient and outpatient?
Emily Greenstein: Yep. So I do round on the inpatient side, and then outpatient, I have a clinic. So it’s kind of nice because it’s a continuum of care then. So I see the patients inpatient and then outpatient.
And then my practice is kind of unique because I’m in a rural area. So I actually go to 2 outreach clinics once a month. So it’s very interesting when I go to the outreach clinics because they’re about an hour away, and the patients are a whole other scenario. Some of the patients won’t leave their house. They won’t go out 10 miles away from their house. They’re very rural settings, a lot of farmers.
So it’s kind of interesting. Sometimes we have to be creative with different dressings and how often they come in and that kind of thing.
Dot Weir: I was just going to say, to really tap into your creativity because these are people who are working outside and getting hot and sweaty and dirty. And, you know, that takes a real creative side to do something to help them.
Emily Greenstein: Yeah. And I will tell you, because these people are farmers, trying to keep a wrap clean and dry in a muddy field is not very easy. But I will tell you, I would like to put in a plug that Amazon sells cast guards for swimming. They’re like neoprene kind of material. Those things are really good. I give them a 5-star review.
Dot Weir: That’s an OK plug. You didn’t give a—yeah, we always have people buy cast covers for showering, mostly because we don’t want them using plastic bags.
Well, that’s fascinating. Do you carry supplies out to those outreach clinics with you?
Emily Greenstein: Yep. So a lot of times I have a rolling cooler that has supplies in it that I bring with me. And then we do utilize a lot of mail-order DMEs. So it gets sent directly to the house, so they don’t have to come in.
The other thing that’s interesting about going out there, and it’s kind of funny because it’s kind of where I’m from, so it’s kind of old home week. It’s kind of nice because it’s small town, everybody knows everybody. So I don’t mind it. It’s just definitely different challenges, though, like I said, with the access to supplies and the people still have to work, and they’re working outside and around animals and all of that. So you have to take into consideration a lot.
Dot Weir: Where you grew up, are they saying, “Oh, hey, Emily, how’s your mom?”
Emily Greenstein: Oh yes. Yes. And everyone’s related to everyone. It’s funny because the patients are like, “Oh yeah, I remember so-and-so.” And I’ll be like, “Oh yeah, I know so-and-so too.”
Dot Weir: Emily’s very sharing because I encountered a gal recently who was pretty much thrown to the wolves, in terms of—that’s not really a good way to say that. But she was trained. She took our wound certification prep course, and then she was just sent out to do wound care. Go forth and do wound care. She’s learned a lot on her own, but she wanted to come spend time in our clinic.
I’m in western Michigan. She’s in North Dakota. I think North Dakota is also—so I reached out to Emily. “Do you let people come in and shadow you?” Because, you know, that’s what we all—you’re a whole lot younger than I am. But we all still have to be mentoring these younger clinicians because we’ve got to have wound care be perpetuated so that we have others, not only on the clinical side but also in the whole speaking side, to come back to that.
So, yeah, we want to help build some new difference makers.
Emily Greenstein: Right. And like I said, it’s always good. I always get asked a lot, “Do you take mentors?” And I’m always like, yep, anyone can email if you have questions. I’m not the quickest to respond, but I will respond, I promise, at some point.
Like I said, having somebody that you can reach out to for just a quick, “Hey, what would you do in this case?” Like myself, I had talked to Kara Couch a lot, or Marianne because she’s close to me. And we even share patients sometimes. So it works out.
Dot Weir: So for the listeners, Marianne Opes is in Rochester, Minnesota?
Emily Greenstein: Minneapolis.
Dot Weir: Minneapolis. OK, that area.
Emily Greenstein: Yep. So where she’s at, they are the closest burn center. So that’s why we still share a lot of patients that end up coming back from the burn center.
Dot Weir: You know what? I am so geography impaired. I would not have thought of that.
Emily Greenstein: Yes, they’re about 3 hours away from here.
Dot Weir: That’s not bad.
Well, anyway, thank you, Emily. Anything else to add? I mean, I love your practice. How many patients a day do you see?
Emily Greenstein: So it depends. Anywhere about 15 to 20. Somewhere in there.
Dot Weir: You and I are on different calls together, and you can always—your background’s always blurred—but you can see people coming in and out. They can’t see you, but they come in and ask you questions.
Emily Greenstein: Yep. And then, so that’s what we see. And then we just recently got 2 more tanks. So in our hyperbarics, they’re able to dive 4 at a time. They started there and they went from 6 to 4, so they have the capability. Right now, because it’s summer, it’s a little bit slower. So I think they’re diving about 10 a day.
In the wintertime, obviously, here in North Dakota, it picks up because of frostbite and CO2 poisoning. Before I went there, I didn’t realize how common CO2 poisoning here was. But lots of people use space heaters.
Dot Weir: Oh, my goodness. Yes, yes, yes, yes. You have 4 monoplace chambers?
Emily Greenstein: Yep.
Dot Weir: That’s fascinating. And they had 2, but you just added—
Emily Greenstein: They had 2, and we just opened the other 2 in April.
Dot Weir: OK. So you’re an emergency—you’re set up for emergency dives.
Emily Greenstein: Yeah.
Dot Weir: I mean, that’s something that we’re not. We only have 2 chambers. That’s how we ended up in Michigan because they needed a medical director who was hyperbaric trained. But wow, 4. So CO2, what do you see mostly in the summer? Typical diabetic foot?
Emily Greenstein: Yeah, so we still have the diabetic foot, failed flaps. We see some of those, a lot of radiation burns, radiation dermatitis, that kind of cystitis, that kind of stuff. It’s probably the most common.
Dot Weir: Are you the only hyperbaric provider?
Emily Greenstein: No. So we have 1 guy who’s there full time, Dr Jaya. He is emergency medicine and then hyperbarics trained. And then we have a plastic surgeon who does it part time. She’s semi-retired, so they can take some of the nighttime and weekend coverage and calls.
Dot Weir: Yeah.
Emily Greenstein: And then there’s another ER physician who also works the night-shift rotation, so he got certified so he can cover if he needs to.
Dot Weir: Nice. Nice. All right. Well, I could talk to you for another couple of hours because I just enjoy you so much. But I thank you so much for joining us.
And you guys, Emily is the epitome of a difference maker. I hope you enjoyed our little chat today. Take care.
The SAWC Difference Makers Podcast is brought to you by the Symposium on Advanced Wound Care, one of the leading forums for advancing wound care education, research, and collaboration, and Wounds, the official journal of SAWC.