Monthly Archive: September 2016

Paul Blomkalns and David Bryan – “Dates with Cadavers”

David Bryan, Brian Balestri, and Paul "Blah Blah" Blomkalns

David Bryan, Brian Balestri, and Paul “Blah Blah” Blomkalns

“The thankfulness washes away the awkwardness” – Paul Blomkalns

My guest for this episode is Paul Blomkalns – a Nurse Practitioner and a really great guy who I met through my good friend David Bryan.  Both these guys are a lot of fun to hang out with and tell great stories.  But both were quite reserved for the first part of the conversation which really surprised me.  I hadn’t expected them to be so professional and take my little talk show so seriously.  But after lobbing several ridiculous questions at Paul they eventually relaxed and we had a great conversation.
Our topics mostly centered around what it’s like to be a nurse practitioner and included things like:
  • What is the grossest thing Paul’s ever seen
  • Who make better patients – men or women
  • And what he does when he’s propositioned by cougars
I have to apologize for the video and sound quality in this episode.  We recorded this episode at my cabin on a beautiful July day, and I apparently set up the camera wrong so the whole episode is slightly out of focus. Plus there’s background sounds through out, and then near the end I start getting pinged on my phone because we were late for a floating happy hour.
If you only have five minutes, skip to minute mark 44 where Paul tells a story about how he almost kills himself while duck hunting alone.
PS. If you get a chance, leave some feedback in the comments below.

Listen to Episode #3: Paul Blomkalns and David Bryan – Dates with Cadavers | The Extraordinary Friends Show



Paul Blomkalns and David Bryan – Episode 3 Transcript

Paul Blomkalns and David Bryan – “Dates with Cadavers”

The following is a complete transcript of Episode 3 of The Extraordinary Friends show You can also watch it on TV, watch it on YouTube, and listen to it on iTunes.


Brian Balestri: Alright, hello and welcome to the Extraordinary Friends Show. This is a special episode today. We’re at a remote location. We’re actually in what is called the Club House which is at my cabin. Next door to me on my left is my next door neighbor and good friend David Brian. David, you’ve lived up here… Well, you’ve had a cabin up here, sorry, for how long?

David Brian: 20 plus years.

Brian: 20 plus years. We got ours about three years ago and that’s pretty much when we met.

David: Yeah.

Brian: On my right is David’s brother-in-law, meaning both your wives are sisters.

Paul: Correct.


Brian: This is… I only know him as Paul. A good friend that I’ve known for three years, but I don’t even know how to pronounce your last name. How do you say your last name?

Paul: My last name is pronounced Blomkalns.

Brian: Blomkalns.

Paul: Correct.

Brian: Alright. I’ll have to have you write that down for me so we have it correct.

Paul: Alright. No problem.

Brian: So Paul, you are from Louisiana.

Paul: Correct.

Brian: But I probably didn’t say that right, did I?

Paul: No, you said it right. Louisiana.

Brian: Okay. How about where in Louisiana?

Paul: New Orleans. Or just north of New Orleans.

Brian: Is it in a city north of New Orleans?

Paul: Mandeville. But most people have a better idea of where it is by just saying New Orleans.

Brian: New Orleans. Okay. Well, both these guys are wondering what the heck it is that I wanted to do with this whole thing, and it’s pretty simple. I just wanna find out about your job, which is…

Paul: Nurse practitioner.

Brian: Nurse practitioner. And before we started, you were telling me that specifically you were a nurse practitioner, which is different than maybe what I would consider a nurse.

Paul: Very true.

Brian: So how about walking me through what the difference is?

Paul: Nurse practitioner, you obviously need additional education, a Master’s degree or higher. There’s a lot more responsibility as far as taking care of the patients, and there’s also a lot more autonomy. When you’re a nurse, per se, you basically have to follow doctor’s orders based on a plan of care, and when you’re a nurse practitioner, you’re basically giving orders for the nurses to carry out, as far as diagnostic testing, medication administration, any one of those things.

Brian: So… Go ahead.

David: I was gonna say, so what can a doctor do that you can’t per se?

Brian: Good question.

David: Or what distinguishes the two?

Paul: Right now, at least in Louisiana, in order for a nurse practitioner to practice, you have to have a collaborative practice agreement with a doctor, meaning you have to work under a doctor’s… Basically under their license as well. Most other states, and I’m not really sure about Minnesota or Wisconsin, but most other states you can practice independently. One thing in particular a physician can do that a nurse practitioner cannot do is, let’s just say, surgery. But as far as diagnosing patients with illnesses, ordering diagnostic tests, prescribing medications, ordering home health care, etcetera, basically you’re doing the exact same thing that a physician does.

Brian: So are you kinda the lead for nurses? Does every hospital have nurses and then nurse practitioners and then doctors? Or is it…

Paul: Most hospitals now have mid-level providers, is what they call ‘nurse practitioners’. And it seems like there’s more and more nurse practitioners being hired, almost on a daily basis, especially in my hospital, to fill kind of the gap. Especially in the internal medicine perspective, where there’s fewer and fewer physicians. There’s a lot more physicians nowadays in various specialties and not so much just as broad internal medicine. So a lot of the nurse practitioners are filling the gap where we don’t have as many physicians anymore.

Brian: So you’re working with patients on a daily basis, right?

Paul: Every day.

Brian: And are you doing the whole spectrum of things that nurses do for patients, or you kind of like upper end, diagnostic and prescription type stuff?

Paul: Well, I would think it’s more upper end diagnostic and prescriptive stuff. I mean, as a floor nurse, I’d make rounds on the patients. I would take vital signs. I would administer medications that were ordered. I would look at lab values, etcetera. But basically, you would do what’s expected of you to be done on a day-to-day basis, which is listen to the other physicians. My day-to-day basis is I’m the one that’s going in assessing the lab values, assessing the vital signs, assessing the complaints that some of the patients are telling me, as far as what’s bothering them, and then it’s my job to try and figure out exactly what’s going on, etcetera. If somebody’s having excruciating stomach pain, we’d order a KUB, which is basically an x-ray of the abdomen.

Brian: You know, I know what a KUB is. [To David] Did you know what a KUB is?

David: No, I didn’t know what that is.

Brian: No, I’m just kidding. KUB is what? x-ray of the abdomen?

Paul: Basically, in layman’s terms, x-ray of the abdomen.

Brian: I have a problem with that word, because you’ve maybe found out on the first episode. So what made you go into this practice, this career? How did you end up as a nurse practitioner?

Paul: Well, my sister is a physician. I didn’t wanna go that route with the tremendous amount of additional schooling and I worked as a floor nurse for many years and then I started working in the ICU and CCU, Intensive Care Unit or Coronary Care Unit and it was at that time that there was so much expected of the nurses that I figured that I was almost acting independently at that time, but was not getting the pay that let’s say a nurse practitioner or a physician would be. And at that level of nursing, ICU or coronary care unit, you tend to get burned out quickly, just because of how sick the patients are, day in and day out. Most, I wouldn’t say all, but a large percentage of patients that are in those units, ultimately do not do well. And after X amount of years that tends to take a lot of wear and tear on you and I decided it was time to get out and go back to school and just practice at a higher level.

Brian: Okay. So, have you seen dead bodies?

Paul: Lots.

Brian: Lots?

Paul: Lots.

Brian: [To David] How many dead bodies have you seen?

David: Two.

Brian: Really?

David: Yeah.

Brian: Personal, relative type thing?

David: One personal relative and my wife’s a physician and she snuck me up to her, in medical school and she showed me her cadaver.


David: ‘Cause you have them for a year…

Brian: This was a date situation?

David: It kinda was. So, you have the cadaver for a year, so they become attached to them. So it was like…

Brian: She wanted to show off her friend. Her dead friend.

David: Exactly. Right.

Brian: Alright. So, you’re not working with cadavers, I assume, right? These are real people… Well, obviously the cadavers are real persons…

David: Now, let me go back on you. Have you seen a dead person?

Brian: I have not. I’ve never seen a dead person. That’s where I’m interested in. Because, my parents are old and my mother… Well, my father passed away, but I didn’t see him until… I guess until… Let me rephrase that. I’ve seen people at funerals. So, not counting people at funerals is what I was thinking. ‘Cause you see them like right after they’ve just died, right?

Paul: More so than I wanted to. But sure, yeah. It’s a part of medicine. We had dates with cadavers too when I was in school.


Brian: But a different kind of date. Okay. This was just to show the cadaver. There was no…

Paul: Well, I mean, no, we go up there and a lot of times, if there was some work to be done, or you’d read on something that interested you in a book that you were gonna have to do eventually anyway, you’d go up there, perform a little work and find whatever nerve you were looking for, a vein or artery and…

Brian: With your date alone?

Paul: Sure.


Brian: Is that pretty good. Get the mood going kinda thing? Or is that pre go to the clubs thing?

Paul: No. Well, probably pre go to the clubs thing. [chuckle] But, I don’t know if it’ll get the mood going. Because you had an interest about dead bodies etcetera, sometimes, other people have the same…

Brian: Yeah. I suppose, if I had a chance, I’d go see a cadaver. Why not? What was the name of your cadaver? Did you name him?

Paul: Don’t remember the name. Don’t remember the name.

Brian: Apparently that’s a thing.

Paul: Yeah? It is?

Brian: So what’s the best part about being a nurse practitioner from your perspective?

Paul: Although it takes a little while, you do get a lotta, lotta respect from the physicians, but you have to prove yourself, obviously, initially. Because, there is a stigma between, at least there is a slight stigma between physicians and nurse practitioners. A lot of physicians do not like nurse practitioners, because in a lot of sense, there is a difference, but in a day-to-day, hospital-to-hospital, patient-to-patient basis, there isn’t that big a difference between what we do and what a physician does, in my opinion. Obviously, opinions vary, but…

Brian: They obviously think there’s a huge difference.

Paul: Yeah, no doubt. And obviously, they’ve been through a lot more schooling, they deserve the respect and the, I guess… How can I say? Let’s just leave it at that. They deserve the respect they get, but a nurse practitioner to me, you do have the luxury of spending more time with the patient, so the patients tend to get… I get more attached. I tend to have a lot closer working relationship with the patients than a lot of the physicians do. I find that nurse practitioners are much more of a patient advocate than a physician is, just because physicians are so concerned about the actual medical perspectives going on and they handle that. Whereas, we go into the whole psychosocial, what’re they gonna be experienced to or with when they go home? What is their home environment like, etcetera. We get social services involved to try and help the patient, not only in a medical basis, but more of a holistic way.

David: So, if I recall, you’re a hospitalist right?

Paul: I’m a hospitalist, right.

Brian: What does that mean?

David: I’ll let him explain it.

Paul: A lot of nurse practitioners, they work in clinics and hospitals, etcetera. As a hospitalist, I strictly work in the hospital. If you’re not sick enough to be in the hospital, I won’t see you.

Brian: Sure, sure. Okay. So, you see the good stuff. From that perspective.

Paul: Yeah. I mean, it’s a little bit different than a clinic level where the people can walk in and walk out at their leisure.

Brian: No emergency, no… Probably not close to death, right?

Paul: Correct. Whereas a hospitalist basically, you’re sick enough to be in the hospital and at times, you’re dealing with life and death decisions on a daily basis. Now with that being said and done I can’t speak with all nurse practitioners, but my particular group of physicians that I work with, there’s not a one bad physician in the bunch. They’re all very, very supportive, all very, very helpful. And as a nurse practitioner, I do not know all the answers to all the questions. And if a patient asked me a question that I don’t know, I tell them, “I honestly do not know the answer to that question, but I will find somebody that can.” And it’s just a matter of stepping out of the room and making a phone call to the physician.

Brian: You don’t just Google it? [laughter]

Paul: I have done that for my own personal education, absolutely because… I’ve only been a nurse practitioner now, for coming up on three or four years. There is a lot that I don’t know in terms of medicine. You can only learn so much from a book, and a lot of which you learn is in practice. And the fact that I have physicians that I do have the collaborative practice agreement with is tremendous just because I have such significant support for those times when I don’t know the answers to the questions.

Brian: So Paul, they’re all good, but some of them are better and some of them are worse than others.

Paul: Very true.

Brian: We’re not going to say names, but there’s probably one that just doesn’t quite get it.

Paul: True.

Brian: And what do you do when you know… You’ve made a diagnosis one way and he or she makes a diagnosis a different way? Do you try to steer him or her into the right direction? Or do you… That seems like a very political situation in effect, right?

Paul: It is. It is. And ultimately, a nurse practitioner, I think I’ve said it already before, we are the patient advocate, and if I feel very, very strongly in a situation where I am right and you try and approach the physician with, “Hey, look, you know I think maybe we should look at things a little differently. This is my take on the lab values, the diagnostic tests, etcetera. I think we’re going this way with this problem.” And if they’re totally against it, well, in our hospital, we do have a hierarchy of commands. And if I’m not getting anywhere with a potential, what I would say, problem, something that may hurt the patient, I just go up the hierarchy of commands and go to another physician that’s at a higher level with my respective group.

Brian: You can’t juts put them in a headlock, right?

Paul: As much as I’d like to at times, no, that doesn’t work.

Brian: Doesn’t work that way. You’re dealing with all sorts of stuff on a regular basis, especially if you’re at a hospital because people are especially sick. Does anything gross you out?


Paul: Yes.

Brian: What stuff grosses you out? Is it a type of thing? Or is it a smell? Or is it…

Paul: I would say, two things in particular. Sometimes, some of the wounds I see…

Brian: Really?

Paul: Are particularly foul smelling.

Brian: It’s the smell?

Paul: It’s the smell. And I just had a patient the week before I came up to vacation that actually had a wound that was infected enough that when we started debriding it, it was full of maggots.

David: Do you ever almost throw up?

Paul: Oh yes. I’ve left the room several times, gagging. Yes I have.

David: Is that the grossest thing you’ve ever seen? Or what is the grossest thing you’ve ever seen?

Paul: The maggots are pretty bad.

Brian: So wait a minute, can you give us… Without obviously giving us the patient, what was the context where a person would have maggots in their… Where was the wound? What was the body part?

Paul: Lower leg…

Brian: Lower leg, and…

Paul: Above the ankle, into the calf. It was an elderly patient that obviously, the family had…

Brian: Neglected? Or… Really?

Paul: Neglected somewhat and a diabetic to boot. And when you have diabetic wounds, they are very, very slow to heal, and they often get more and more infected. And a lot of the, I guess, poverty-stricken areas, even down towards New Orleans, they don’t have air-conditioning, so they leave the windows open, etcetera, so that flies can come in, lay their eggs, etcetera.

Brian: In a book, the Richard Sharpe series, they would talk about using maggots to… Intentionally, put maggots on a wound because I guess, the theory is, they only eat dead skin.

Paul: Correct.

Brian: So the maggots are not necessarily a bad thing. Just gross…

Paul: It’s not necessarily a bad thing, but if you’re not expecting it and you’re already dealing with the smell of the wound, and you go in and help start to debride things, and then, all of a sudden, there’s worms…

Brian: What are you saying there? Debride? Okay.

Paul: Debride. Removing dead or dying tissue.

Brian: I’ll explain here. This goes on public access and podcast, and so, I make show notes. And I’m gonna look up debride. So you were working with this patient. Was he awake? Or was she awake?

Paul: Oh yeah.

Brian: And did he… Is it a he or she?

Paul: He.

Brian: Did he have any idea that his leg was filled with maggots?

Paul: No.

Brian: Were you the only person working on him?

Paul: No. No.

Brian: So who took over when you were like, “I’m out of here”?

Paul: They had an ET nurse, which is basically a wound care specialist nurse. That’s all she does, is go in and assess with wounds.

Brian: Oof! So you said there was two things, if I remember right.

Paul: Right.

Brian: What was the other thing? Sponge baths? Is that…

Paul: A what?

Brian: Sponge bath. Do you ever have to give a sponge bath?

Paul: No.


Brian: Do they do that still?

Paul: No. I don’t think.


Brian: I don’t know. I thought that’s what they did.

Paul: The nursing assistants and…

Brian: Oh, that’s entry-level stuff?

Paul: Entry-level stuff. Student stuff that they… Just like anything else, it’s a rite of passage. They make them do some of the lesser desirable things. [laughter] No, I mean, obviously, the patients get bathed every day, but no, I haven’t done any “sponge bath” in, really since I was a student, so… I’m a nurse, I mean…

Brian: But you have done them?

Paul: Oh yeah, sure!

Brian: Do they always pair up the gender so like, women are doing men, or men are men… Is it just like whoever is the patient is…

Paul: They try and do that, you and try and have as much… Protect as much patient modesty as you can, but that’s not always the case, so as far as bathing is concerned, you try and match genders, make the patient feel as comfortable as they can.

Brian: I gotta believe that’s awkward for everybody involved.

Paul: Oh no, it’s awkward, and, I mean, they tried to stop sponge baths in the ’50s, by the way. [laughter] We have nice little throwaway cloths that you heat up, that they’re nice and warm and wipe ’em down, you don’t usually need any water or anything.

Brian: Okay, so effectively a sponge bath, but it’s not a sponge and a bucket of water and… [laughter] Alright, so I interrupted…

Paul: Right. It is awkward, but a lot of times, the patients are so extremely grateful that they were actually… Got clean, that the thankfulness kind of washes away the awkwardness that you had during the… So it’s just like, when you’re feeling disgusting and take a shower, how good it feels, same thing.

Brian: Right. [To David] So, back to your dates, did you ever do, like, a sponge bath date with…

David: No, but I was kind of wondering, as a patient, can you request a nurse do your sponge bath?

Paul: I guess you can request pretty much anything, but we do often come across patients that are sexually inappropriate and because of that…


Brian: Wait, wait, wait. They came in sexually inappropriate or they became sexually inappropriate when they saw who their nurse was?

Paul: Either one or all of the above, and a lot…

David: How often are you hit on?

Paul: It’s happened on occasion.

Brian: Really?

Paul: More 30, 40 pounds…

Brian: Lighter?

Paul: Lighter. Before I became calorically…

Brian: Challenged.

Paul: Challenged… [laughter] Or gifted.

Brian: Gifted, yes. Alright. [laughter] So. Male or female? Both?

Paul: Both.

Brian: Nice!

Paul: No!


Brian: Well, you know, hey! You just know that you have options, I guess. You are happily married…

David: It’s always good to be wanted.

Brian: Right, exactly! Exactly, exactly. So what’s the second thing that grosses you out?

Paul: When people get impacted.

Brian: [To David] Do you know what that means?

David: Yes. Do you know?

Brian: I don’t. I think like a tooth might get impacted, but I don’t…

David: Or your colon might get impacted, too.

Brian: Mine won’t.


Paul: Mine neither, but… No, when a patient’s colon becomes impacted and they can’t use the bathroom, can’t defecate.

Brian: Oh so, constipated would be the early stage of impacted, maybe? On the spectrum of…

Paul: Right.

David: What do you do to unimpact them?

Paul: Well, there’s obviously oral…medication that you give…


David: What if the oral medication doesn’t work?

Paul: Fleets enemas.

David: What if that doesn’t work?

Brian: Wait, wait, wait, what’s that? It’s just an enema?

Paul: Fleets enemas, and if those all don’t work…

Brian: Fleets?

Paul: Fleets.

David: Have you ever had to physically go in and unimpact?

Paul: Absolutely David, you must be married to a physician.

David: Must be.


Brian: When you say go in, what do you mean?

David: Well I’ll let him explain what that means.

Brian: Well, maybe let’s hear what you think it means first.

David: I mean, physically…

Brian: With a hand or the Roto-Rooter, or…

Paul: Digitally…

David: With a finger, yeah.

Brian: Is that the most high-tech device that we’ve come up with for that situation? [laughter]

Paul: It can’t be the most high-tech device, but it is effective, and it does happen. And even to this day, I’ve written orders for nurses to digitally dis-impact patients which I had to do, obviously, when I was a nurse. And they’re so squeamish about it, they’ll almost do anything to avoid it while the patient’s… And not always, I’m speaking broadly, but sometimes just a new nurse that is not comfortable doing it, say they tried and it didn’t work or whatever, and the patient’s literally writhing in pain, biting at the sheets, etcetera. And you just go in and do it, to help the patient.

Brian: When was the last time you had to do that?

Paul: About a month or two ago.

Brian: Really? It was a patient, not someone you knew?

Paul: No, a patient.

Brian: Okay, just checking!


David: Not sure where you’re going with that…

Brian: So… Not to get too gross about it, but once you get it started, does everything kinda… Happens?

Paul: Typically. Typically, yeah.

Brian: Flows on its own from then on?

Paul: Typically.

Brian: Maybe like immediately like, whoosh, I feel much better.

Paul: Saying the same thing. They’re obviously embarrassed, but soon the embarrassment gives way to… They feel better immediately.

Brian: So much better.

Paul: No, they crack jokes the next day a lot of time when we make rounds. “Hey, boy that wasn’t fun at all.” It’s like, “Well it wasn’t fun for me either.” [laughter] But, in the same sense, they say, “Thank you so much, I was really, really in tremendous agony”, so…

Brian: Wow. Alright, so back to the doctors and nurses, do you think… I think it’s different now, but classically people think of nurses as being female or… Is it generally a female role, or… ‘Cause I know a couple of nurses now that are male nurses. But is it 50/50, is it regional?

Paul: I wouldn’t say it’s 50/50. I’ve never worked anywhere expect for just outta New Orleans but there are a lot of male nurses now in the field, and it seems like every year, more and more are going into the field and there have been, I mean, obviously, there’s a stigma. There’s been movies about male nurses and…

Brian: What movies are these?

Paul: What is that? Meet the Fockers.

David: Meet the Fockers, yeah. The whole Fockers series. Have you ever seen them?

Brian: I have. With Ben Stiller?

Paul: Ben Stiller.

David: Ben Stiller is a male nurse.

Brian: Is he really? I didn’t realize that.

Paul: So, it’s always… There was a joke on that?

Paul: You get joked at initially. It’s funny as much as I was teased and basically ridiculed being a male nurse early on, now, it…

Brian: Who was doing this?

Paul: Friends. Extended family, probably my brother-in-law…


Paul: At one point in time. I don’t remember, but I’m sure it’s probably came on.

David: I don’t recall but you never know.

Paul: Don’t put it past you.

Brian: [To David] There’s probably other stuff you don’t recall, right? So, yeah.

Paul: But it’s funny once you specialize, whether you become a nurse practitioner, go into nurse anesthetist, it’s hard for me to say, but once you start to get to those upper roles of a nursing, male or female, nobody, I haven’t heard a crack since. So…

Brian: Sure. Between female doctors and male doctors, are one more comfortable with male nurses than the other?

Paul: I don’t think so. I mean I can’t speak for all the hospitals, I’ve only basically only worked in one my entire career. But just like almost in every other profession, regardless of what somebody thinks about you initially, whether you’re male, female, just out of school, been out of school 10 years, you have to prove yourself in whatever profession that you’re in, to prove that you’re capable, that you do know what you’re doing and you can be trusted, not only making decisions on your own but if you don’t know the answers to the questions to where you can’t make educated decisions, you look for somebody that does.

Brian: Being comfortable asking for help.

Paul: Right. That goes a long, much long… It means a lot more to people if you’re willing to admit that you don’t know something versus making a misdiagnosis, prescribing a wrong med, and potentially harming the patient.

Brian: You can prescribe meds?

Paul: I can, yeah.

Brian: The whole spectrum?

Paul: You can, and there’s also an additional hoop you have to jump through in order to prescribe narcotics outside the hospital. I prescribe anything and everything except for narcotics. Now, in the hospital, with my collaborative practice agreement with the physicians, we prescribe narcotics but they’re actually seeing… When we place order on the computer, they’re watching what we’re ordering.

Brian: Okay. So, there’s checks and balances?

Paul: Oh, there’s obviously checks and balances, but when a patient… The patients I have, I admit into the hospital and I discharge from the hospital, so when a patient gets discharged from the hospital, I’m actually the person that’s writing up prescriptions for them to go get filled as an outpatient.

Brian: So, would a narcotic example be Valium?

Paul: Valium.

Brian: Any other good stuff?

Paul: Vicodin, Percocet, you know, all those. With that comes a whole other gauntlet of responsibilities, liabilities, etcetera. Some nurse practitioners have jumped through the extra hoops, paperwork, meeting with the State Board of Nursing in order to get that, to do…

Brian: To do the narcotics?

Paul: To do the narcotics. I do not necessarily want that added responsibility and…

Brian: So, you can’t get me Valium if…

David: I was gonna say, were you looking for a connection, or…

Brian: I had Valium as part of eye surgery and that’s… Not that I’m saying it should be a recreational drug, but it felt really good. I have to admit that.

Paul: Can’t help you captain.


Brian: So, I had a couple other questions about… So, back to the worst part of your job, because that’s… I find intriguing. Who are the worst patients? Who are the worst types of patients? What kind of patient drives you nuts? Or are you just, you’re cool with all of them, none of them bug you?

Paul: None of the patients in themselves bug me. The family members, because there’s always a multitude of them, they’re oftentimes… I’m never intimidated by any patient’s diagnosis and/or personality per se. Some of the family members can wear you down, break you down quickly.

Brian: Because they think that you’re misdiagnosing or that you’re not showing enough attention?

Paul: Anything and everything. Anything and everything. A lot of times, basically, and I’ve had… You go into a patient’s room. You’re talking to the patient. They’re telling you problems. You’re explaining to them the plan of care, what your thoughts were, etcetera. You have family members basically writing down every word that you’re saying.

Brian: I’ve done that. I turned on the recorder on my phone last time my wife was in the hospital. I can’t remember it word for word, so why not record it?

Paul: I’ve had that happen. I’ve had… Gone into the room and had family members on their iPad, and I go into the plan of care is, etcetera. “We’re gonna do this because of this. We’re gonna do that because of that”, whatever. And they’ll be, “Well, it says right here on WebMD. Shouldn’t we check for this with these diagnoses and… ” [laughter] No. It’s not quite that simple and that is kind of a dangerous thing for the family members if they’re not medically inclined to think they can get more educated than a clinician just by looking on WebMD for a few minutes. So, like I said, patients, I think, they’re all different. I think they’re all challenging, which is one of the reasons why I enjoy my job so much. As far as anything, or anything I can’t handle, no I don’t know the answer to every question, however, I would much rather take care of a single patient in the room than take care of the patient and three or four self-proclaimed “doctors” in the room.

Brian: Alright, can you tell the difference between male patients and female patients? Like are one better at being a good patient or not?

Paul: Well, I hate to say this, ’cause we’re all male here. As far as a patient that’s in pain, I would rather take a female patient any day, with any kind of pain.

David: Higher tolerance?

Paul: What’s that?

David: Higher tolerance? Pain tolerance.

Paul: Much higher tolerance.

Brian: Do you think that’s true?

Paul: Absolutely, without a doubt.

Brian: Well, how do they measure that?

Paul: I mean, I guess you don’t really… But there’s no scale to measure it on, but seriously, I would take a patient… I would take a female with a knee replacement any day over a male.

Brian: Oh, I guess that men are just kinda wimpy, kinda whiny?

Paul: They’re wimpy, they’re whiny, they want more pain medicine. [laughter] It’s like clock work. Absolutely. Any extremely, exceptionally painful procedure and/or diagnosis, I’d like to take a female, any day.

Brian: Hmm. What about celebrities? Have you ever had anybody famous come in that you’ve had to take care of?

Paul: Locally famous, not necessarily famous throughout the country. So yeah, I’ve had some…

Brian: What was the local… Famous for like TV show, or athlete, or something?

Paul: I’ve had some local sheriffs come through, a time or two. I’ve had very prominent attorneys come through which are almost at celebrity levels down there, some of ’em with all the advertising they do.

Brian: So on the sheriff…

Paul: Few musicians, etcetera.

Brian: Oh, really?

Paul: Mm-hmm.

Brian: So the sheriff, did you kinda say, “Take a look at my name, so that if anything happens, you’ll remember who was taking care of you.”


Paul: No.

Brian: Like when I did that digital thing for you…

Paul: No.


Brian: You ever have to do that for…

Paul: No, no. Never. Never tried to get out of a…

Brian: I would think you’d get out of any ticket for the rest of your life, if that was the situation.

Paul: Right. No. [chuckle] I haven’t asked, but… Maybe I missed out on an opportunity.

Brian: How about hot patients?

Paul: Yeah.

Brian: So do you ever just, go… Now, how do I say this? Do you just turn that off ’cause you’re a professional? Or is that hard to do?

Paul: I mean, it’s not hard to do. You’re a professional, now, obviously you do see patients that are 98 years old that are shriveled up like a raisin. You see…

Brian: These are the hot patients you’re thinking of?


Paul: No. No. No.

Brian: Okay. Just… [laughter]

Paul: You run into 30 to 40-year-old patients that are… Have taken good care of themselves and are attractive, but that’s as far as it goes.

Brian: [To David] Were his arms crossed like that, before I asked the question?

David: I think so.

Brian: Okay. Alright.


David: You tryin’ to pick up on a tell?

Brian: I don’t know. I don’t wanna be… I don’t think you have to worry. We’ll just cut out anything you don’t feel comfortable with but…

Paul: No, I’m fine.

Brian: Yeah.

Paul: No problem.

Brian: I don’t think you’ve said anything that…

Paul: No. Indeed, some people are obviously more attractive than others. But at a professional level, that’s it. Have I been propositioned by young patients? Yes, I have. I’ve been propositioned by… I was just telling [chuckle] my wife not too long ago that…like an 89-year-old propositioned to me.


David: So wait, what did she say? What did she say?

Brian: Did she want to go swing dancing, or what did she…

Paul: She basically asked me to crawl into bed with her and warm her up.

Brian: Is that part of the service you offer?

Paul: Not even close.

Brian: Okay.


David: Well, what are the chances that’s exactly all she wanted?

Paul: Well, I mean, it could have been. Could’ve been. But I guess I could tell by the tone that it was something in addition to that. And then I’m just like Mrs. So and so that’s…

David: So now what if a 25 year old patient asked you to do the same exact thing?

Paul: Then the comment is exactly the same. That…

Brian: You’ll have to wait till my shift ends.


Brian: I get off at seven.


Paul: No. I say, “That comment is totally inappropriate, and…”

Brian: You say that?

Paul: Absolutely.

Brian: Awe, that really takes the fun of it, I would think.

Paul: It does, but I’m there to…

Brian: Do you say. [whispering] “…because people are listening? I gotta say it…”

Paul: No. [chuckle] No.

Brian: The reason I’m getting to ask these questions ’cause I know that you’re a man of integrity, and you wouldn’t do anything like that, but…

Paul: True.

Brian: Does it feel pretty good, when someone propositions you?

Paul: No. Not from a patient, no.

Brian: Really. Just the doctors?

Paul: No.


Brian: [To David] He can’t be broken. He can’t be broken.

David: Just give him another drink.

Brian: I know. Do you need another drink? We can…

Paul: No, we’re good.

Brian: …do a pause here. So my daughter is thinking about going into the nursing practice. Do you think it’s a good industry? Is it a good career to take?

Paul: It’s been good for me. It’s been good to most of the people that I’ve worked with for years. I’ve steered a couple younger nurses to go into, especially the nurse practitioner program and they have. And they’ve come out, and they’ve been very thankful and appreciative.

Brian: Okay, so break it down, how many years of schooling do you need, post high school, to be a nurse? Like an entry-level nurse?

Paul: Coming out of high school, initially, as far as prerequisites concerned, you need a minimum of two and that’s really taking a lot of hours, more likely three, to get your pre-nursing done. Nursing school…

Brian: Entry level into a hospital as a nurse or a clinic?

Paul: No. That’s just prerequisites before you go to nursing school.

Brian: Oh.

Paul: From there, you go directly into a three year nursing program. At least to get your BSN, your Bachelor of Science in Nursing.

Brian: So it takes six years, post-high school, to be a nurse?

Paul: To be a BSN.

Brian: Okay.

Paul: A Bachelor of Science. Now, you can get into an Associate’s degree, etcetera, which I think is significantly less. But I think those nurses can’t do IV push medicines. Basically their hands are tied as far as what they can or can’t do. If she’s gonna go into it, she wants to get a BSN, where she doesn’t need somebody to give her IV push medicines, etcetera. And then, nurse practitioner program from there is an additional two years.

Brian: So how many years of post-high school, have you had?

Paul: How many post years of high school have I had?

Brian: Yeah.

Paul: I went to LSU for four years, and that’s just because for a while I didn’t know exactly what I wanted to do, so basically I have a lot of credits toward a general studies degree with a minor in microbiology. Went to nursing school for three years, and then I went back and got my master’s, which is an additional two years. So, for myself, I did nine years of schooling past high school.

Brian: Holy buckets, that’s a lot!

Paul: It is.

Brian: Wow! Way more than I’d be willing to do, I think. But you wouldn’t have to do that many, if you knew, going in…

[overlapping conversation]

Paul: No, no. Yeah, you wouldn’t have to do that many. A lot of the laws and rules are changing now to where the nurse practitioner profession is gonna be a doctorate program now.

Brian: Really?

Paul: So I think the best that you could do now, as far as time, would be two years of prerequisites, three years of nursing school, to get your Bachelor of Science, plus four years. It’d be nine years to get your nurse practitioner now.

Brian: Jesus! You’re doing serious stuff, so I guess it makes sense. I just had no idea it was that much.

Paul: It’s a lot of schooling. You’ve got the same thing with anesthesia. It’s basically, it’s almost exactly the same thing, and they’re making anesthesia now a doctorate to where you need to go four years post.

Brian: Okay.

David: Now, do they want you… Can you go right into your BSN program, into these programs? Or do they want a certain amount of work experience first?

Paul: You can, if you have an exceptional grade point average. Sometimes they do pick you up basically right out of school, etcetera, but I would say unless you’re total top of the class, even if you have anything less than like a 3.8 GPA, a 3.9 GPA, they typically want you to work in your profession for two years to get the experience working with patients before you go to graduate school.

Brian: Alright, so we’re burning through our time here, and I wanna ask you about the other part of your life, which is you grew up in Louisiana, right?

Paul: Born and raised, correct.

Brian: Born and raised. All right. And as part of that, you are… Are most Louisiana… What would be the plural of a person who comes from Louisiana?

Paul: Louisianians.

Brian: Louisianians. Are most Louisianians outdoorsmen like you? Is that a common thing?

Paul: I wouldn’t say most, if… From where my region, where I live, which is Southeast Louisiana, I would think most of Southeast Louisiana people would dabble in fishing or hunting, if not commercially, or guide services taking people fishing for a living, they do it just recreationally, to catch fish, have fun, put some meat on the table, etcetera.

Brian: So, to that end, we’ve talked before, you have a wide range of animals that you’ve killed and eaten.

Paul: Correct.

Brian: What are some of your favorite non-cow, pig or chicken foods?

Paul: I love… One of my favorite soups is obviously, or maybe not obviously, turtle soup. To me, that’s…

Brian: So you trap, or shoot, or hunt? How do you catch turtles?

Paul: Most of the turtles are caught just basically on jug lines, which is basically a piece of meat or a piece of fish tied to a Coke bottle, that are spread throughout the swamp, anywhere from as many as you wanna do, from 10 to 100.


David: Now I’ve heard, though, turtles are just nasty to have to clean.

Paul: Yeah, they’re disgusting.

Brian: So worse than the things you’re seeing at your day job?

Paul: No, I wouldn’t say that, but they’re nasty and difficult to clean. I don’t have a whole lot of experience cleaning ’em. Fortunately, I have friends that are a lot more experienced with me. If I say, “Look, I’ve caught a turtle, can you help me out with it?”

Brian: So they’ll clean it for you?

Paul: Yeah, sure. They want some of the meat, obviously.

Brian: Okay.

Paul: Sure.

Brian: How big are these turtles?

Paul: I’d say your average snapping turtle might be 20, 25 pounds. That’s a good one. But a big alligator snapper can push up to 100 lbs.

Brian: Really?

Paul: And that’s an extremely rare turtle because it’s extremely old.

Brian: Yeah.

Paul: And in fact, my father and I caught one on a jug line. This was many, many years ago. We always talked about how great it’d be to catch a real old timer, one bigger than a washtub. And we caught it, and my dad was just terrified that it was gonna bite my hand off, trying to unhook it. And then we started looking at this thing after we hooked it. It wasn’t hooked bad. And we started talking about how old it was, probably easily over 100 years old and…

Brian: Really?

Paul: And one thing led to another, and we felt sorry for him, and we set him free.

Brian: Took some pictures, I hope.

Paul: No, back then we didn’t bring cameras in the swamp. No camera phones. It was way before all that.

Brian: Wow. How do you know… They obviously lived to over 100 years, and you figure by size, it had to be. Would they be better tasting after 100 years? It seems they’d be pretty…

Paul: Nah. I think all turtle meat is the same. It’s not like an old, old cow or an old, old pig.

Brian: What else have you eaten besides turtles?

Paul: Well, crawfish obviously. Frog legs is another thing that I really, really like.

Brian: You like frog legs?

Paul: I do.

Brian: [To David] Have you had frog legs?

David: Oh yeah.

Brian: So, you’re not from Louisiana, right?

David: No, I am from Louisiana. I grew up in Louisiana.

Brian: How did you guys end up here?

David: When my wife did her residency, she did it up here, and we just stayed. I grew up in New Orleans also, so I’ve eaten all these. I’m not an outdoorsman, but I like to eat all the stuff.

Brian: So you’ve had turtle, frog legs.

David: Yep. Turtle soup is a delicacy down there.

Brian: Does that mean it doesn’t taste good?

David: And it is good. And it is good.

Brian: It does taste good.

Paul: Oh, you better believe it.

David: My kids are picky eaters, and they like turtle soup. There’s a restaurant down in New Orleans. That is what they’re known for. {David texted it to me later. It’s called the Commander’s Palace}

Brian: What else have you eaten? Wild boar, anything like that.

Paul: Oh, yeah absolutely. I may hunt wild boar with my kids, friends, I have lots of friends from actually up north that come down to hunt wild pigs with me. And in that certain situation, some of the people that come down to hunt with me, they’ll shoot the bigger pigs just for the trophies, the heads to mount on a wall. I tend to let those go because they’re a pain to clean, a pain to handle. When you’re dealing with a 300, 400 pound animal, there is nothing easy about cleaning them, getting them in or out the boat, etcetera. So I tend to shoot the smaller ones, which are better eating.

Brian: So there’s a story apparently, where you were hunting ducks up here in Wisconsin.

Paul: Yes.

Brian: Tell that story because I’ve heard it’s interesting.

Paul: Well, after Hurricane Katrina, the hospital that I was in basically almost shut its doors. I went back down to relieve the crew that stayed for the storm, then came back up here [Wisconsin]. They said they’d let me know when they needed me again, so this was the place to go. And we came up here, and my wife wanted to try duck hunting with me so went back to a lake that we have and did some duck hunting.

Brian: When is this? What time of the year?

Paul: This is late October, into November, so it was cool. It was cool up here. And so, I just figured at the time we’d shoot them and they’d drift to the bank and I would swim over, not swim over but go pick them up and that would be the end of it.

Brian: So you didn’t have a dog along or anything?

Paul: No, no dog.

Brian: Just gonna wait for them to float over.

Paul: No pirogue. No canoe. No anything to go get them.

Brian: What was that middle thing?

Paul: Pirogue.

Brian: What is that?

Paul: Pirogue is basically a Cajun dugout canoe, and they’re not dugout anymore, but basically a very, very small canoe with lower sides that you use to go through the swamps, etcetera. It’s not as long as a canoe. You can maneuver them between cypress trees a lot easier and better.

Brian: So you got none of that. You’re just on the shore shooting ducks.

Paul: Nothing. Just on the shores, shooting ducks. Wife got cold. She said she’d go ahead and go back in. And I was still waiting for the wind to blow the ducks over. Well, the wind took and quit when the ducks were mid-lake.

Brian: So you got a bunch of dead ducks floating out in the lake.

Paul: Right. And they’re not moving at all, and I’m waiting and waiting and waiting. And finally, I decide… Actually, Sarah was cold, but she stayed to watch me go in the water. Then she said, “That’s enough. I’m leaving.” [laughter] But I knew I couldn’t swim with my clothes on, so I figured I didn’t want to shoot ducks and let them go to waste or rot or let another animal get them. So I stripped down naked and…

Brian: So, middle of November, you’re buck naked on the edge of the water.

Paul: Mm-hmm. And I take the…

David: There could be a Bravo series about this.


David: Don’t they have… All the Naked and Afraid and all those, you know?

Brian: I’m just trying to figure out, is this a hunting best practice? “Well, they’re dead, might as well take off all my clothes.”

Paul: No, it’s…

Brian: Is it a Louisiana thing? [To David] Have you ever heard of anybody doing this?

David: No.


Paul: In hindsight, no, it wasn’t the brightest move, but I didn’t wanna…

Brian: Did it work?

Paul: No, it really didn’t. I think out of the ones we shot, I only retrieved, or was able to retrieve, one because when I swam out there and actually got a hold of them, I was almost freezing to death to begin with, but on the way back, about halfway to the bank, I had hypothermia setting in rather quickly.


Brian: And as a nurse practitioner, you actually knew the symptoms and knew what the heck was going on.

Paul: I wasn’t a nurse practitioner then, but I did know the symptoms. And I did stop twice along the way, thinking that it would be shallow enough for me just to walk out. And I went under, both times. The second time I went under, I almost didn’t make it to the surface again because your muscles just don’t work well anymore. And I told myself that if I stop one more time to try and walk out, I’d be left floating in the lake.


David: At what point did you think to yourself, “This was not the best decision I’ve ever made”?

Paul: The first time I went down, which at that point, I let go of the ducks that I had.


Brian: Okay. You were swimming with one hand and got the ducks in one hand?

Paul: Right. And at that point it was like, my life or the ducks and…

Brian: Or the dead ducks.

Paul: Right, or the dead ducks. And so that finally, like I said, I promised myself I wasn’t gonna stop swimming and I finally did get to the point where my next stroke actually dug into the mud. And I dug my way out and put my clothes back on as best I could, even at that point, putting my clothes on seemed like an eternity ’cause you move like a sloth.

Brian: You just… Nothing functions.

Paul: Nothing functions. And what does function, functions exceptionally slow.

David: I was just thinking what the obituary would have read.


Paul: So yeah, it wasn’t a bright move.

Brian: Was it your will to see your wife again or just sheer embarrassment like, “I gotta get outta here ’cause I don’t wanna because this is an embarrassing way to die.”


Paul: I think it was the will to survive, see my wife again, family, sure.

Brian: Alright, so do you have any quick questions?

David: No.

Brian: ‘Cause we’re gonna do lightning round, which is the last thing we do. Lightning round is a series of questions…

Paul: Just like [Jim] Cramer.

Brian: Like Cramer. He does that?

Paul: Lightning round, sure.

Brian: Alright, let’s do it. So quick question, so who’s the funniest person, present company, well it doesn’t… Who’s the funniest person you know and why do you enjoy their humor so much?

Paul: I would have to say a good friend of mine, back home in New Orleans.

Brian: What’s his name?

Paul: Name is Kurt Gretch, he is actually a car salesman by trade.

Brian: Really?

Paul: Yes. But he owns a large percentage of the car dealership so he’s not only a salesman but he’s extremely intelligent, extremely witty, extremely dry humor. But a very, very, very humorous individual.

Brian: Good deal. [To David] What about you? Funniest person you know? Putting you on the spot.

David: Boy you are. I don’t know, I’d have to think about it.

Brian: Alright, think about it. What else? Paul, second question, come back.

David: Aw, don’t come back to me.


Brian: Isn’t there any like your brothers, or your buddies or the other teachers or anything?

David: Oh, yeah, I mean to say, it would be… It’s just a group of us, I guess we get together and…

Brian: You have a good time.

David: Have a good time. Pour a few drinks, everyone gets a little funnier, you know.

Brian: Everyone’s funnier with a few drinks. [To Paul] If you inherited $10 million what would be the first three things you’d buy?

Paul: 10 million? A very large piece of property.

Brian: Okay. Here in Wisconsin or down in Louisiana?

Paul: With 10 million I could retire and be up here.

Brian: Okay. And like you’re talking 100 acres or something like that?

Paul: Yeah, a hundred, couple hundred acres or something like that.

Brian: Step one. Item two?

Paul: Item two, I would probably purchase a big condo on the coast of Florida or Orange Beach, Alabama, etcetera.

Brian: Okay. We’re burning through it pretty quick. Alright.

Paul: Yeah, we’re doing alright.

Brian: The last item, or a third item?

Paul: Whew. That would be a tough one. My wife a new car.

Brian: There you go, nice. [To David] How about you?

David: I was just thinking he had two big things for him when he throws his wife a…


Brian: Well she gets to stay at the property.

Paul: Well, sure and she wants the beach place worse than I do so…

David: I, you know, me I would buy a place down in New Orleans, I mean ultimately…

Brian: Oh, really?

David: I wanna retire half the time up here, half the time down there.

Brian: Okay, winters up here, summers down there?

David: Correct.


David: I want the extreme heat, the extreme cold, I want no comfortable climate at all.


Brian: Perfect. Yeah, you got it figured out. He’s got it figured out. Nicknames in high school and/or college? Did you ever have a nickname?

David: Appropriate nickname for this show.

Brian: Inappropriate is fine.

Paul: No, I mean my last name is…

Brian: What is your last name again?

Paul: Blomkalns. B-L-O-M-K-A-L-N-S.

Brian: Somebody couldn’t come up with a name that would play off that?


Paul: I mean one of my friends, good friend of mine back at home, when I would introduce myself to people, and it’s not a common name anywhere in the world but especially in southeast Louisiana where you have a bunch of Cajuns, etcetera, they’re like, “What? What? What do you say? How do you spell… ” Good friend of mine, he just said, “Oh, don’t worry about it, his name’s Blah Blah.”


Brian: That stuck?

Paul: Blah Blah has stuck for probably 15, 20 years now.

Brian: So there’s a whole crew of people who call you Blah Blah?

Paul: That is correct. Paul Blah blah.

Brian: Paul Blah Blah. [laughter] That may be how I’ll remember you. [To David] What about you?

David: You know either one or two things. Either DB, which is my initials.

Brian: Okay. David Brian.

David: Just like a lot of lazy friends, which is easier. Or I had a group of friends that used to call me Hoss.

Brian: Hoss?

David: Hoss.

Brian: Like…

David: Like Gunsmoke.

Brian: Gunsmoke. He was the big smart one, right?

David: I don’t know if the big smart or the big dumb one…


Brian: Hoss, what was…

David: Well how about you? We’re gonna throw it back at you.

Brian: My nickname was Brady in college.

David: After Brady Bunch? Greg Brady?

Brian: It was after the dad actually. It was before it was known that he was gay, not that that matters. But that was…

David: I thought maybe it was Greg Brady ’cause you had a thing for Florence Henderson?

Brian: No, no, no. Well so did, theoretically…

David: Right.

Brian: Because I was so mature, apparently, was the deal. That’s my theory. Okay, if you were in a zombie apocalypse and you had a choice of three different weapons: The weapons are nunchucks, chainsaw, or a four-iron. What would you choose and why?

Paul: Four-iron, swing it around in circles, more rapidly. Probably do a lot more damage quickly. A chainsaw would tend to wear you out in a hurry ’cause of its weight.

Brian: You gotta worry about gas.

Paul: Gas, right. I don’t know how to use nunchucks and I figure my bad golfing skills would come in handy.

Brian: Same thing for you?

David: You know originally I was going to say chainsaw but…

Brian: The gas part?

David: Yeah, gas part and the weight.

Brian: Yeah I suppose. Alright, would you rather have a significant speech impediment…

Paul: Some people say I do.


Brian: That’s kind of why I asked this question. Or a Jersey accent, which would you choose?

Paul: I’ll stick with my Southern speech impediment.

Brian: Southern speech impediment? What about you?

David: Oh, Jersey accent.

Brian: So he doesn’t have much of an accent at all, do you lose it after living here so long?

David: You lose it, you lose a little bit, and it’s a hybrid.

Paul: By the way, both of you guys are the ones with the accents.

Brian: Oh really?

Paul: Oh yes. Not me.

Brian: So sounding like Johnny Carson like we do, we have the speech impediments. Okay, alright. Last one would you rather… And this one I think is a good one for you for outdoorsy. Would rather… We are running out of time. So would you rather throw trash like your McDonald’s bag out the window in Yellowstone or park in a handicaps parking spot on Black Friday? You gotta do one.

David: That’s an easy one.

Brian: For you?

David: Yeah.

Paul: I’d park in a handicapped spot.

David: I’d park in a handicapped spot ’cause there’s plenty of them, no one ever uses ’em.

Brian: Really? On Black Friday? And you’d do same thing.

Paul: Absolutely.

David: Put it this way, if they’re gonna fight the Black Friday crowds to begin with, they can’t be that handicapped.


Paul: My point exactly. Most of the people that I see with handicap stickers that pull into the parking spot in a hurry, they walk 10 times better than I can, so no. No trashing Yellowstone.

Brian: Alright. We are out of time. So I wanna thank my guess here Paul Blah Blah or as I’ll learn…

David: Blomkalns.

Brian: Blomkalns. Paul Blomkalns. I really appreciate you doing this, I know you were a little nervous about how this was gonna go. Do you think it went okay?

Paul: Oh absolutely, the Bourbon helped obviously. [chuckle] But no, all said and done. No, great.

Brian: And also my good friend David Brian, you’re a great co-host, well done. Alright I think we’re set, thanks a lot guys.


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