Zibby interviews renowned orthopedic surgeon, Dr. Erin Nance, about her thought-provoking and revealing debut essay collection, LITTLE MISS DIAGNOSED: A Surgeon’s Guide to Breaking Bones and Bending Rules, which offers a raw, unfiltered look into the exhilarating but complicated world of healthcare. Dr. Erin Nance shares her journey in medicine, from her first day on the job treating her brother after a life-altering accident to exposing the power imbalances, burnout, and ethical dilemmas doctors face behind closed doors. She also discusses patient advocacy, the gendered challenges of medical training, and the unexpected power of TikTok storytelling!

Transcript:

Zibby: Welcome, Erin. Thank you so much for coming on Totally Booked with Zibby to talk about Little Misdiagnosed, a Surgeon's Guide to Breaking Bones and Bending Rules. Congratulations. 

Dr. Erin Nance: Thank you, Zibby. This is the book launch day, so I feel like it's the birth book day celebration, and I'm like so thrilled I could be sharing it with you.

Zibby: Aw, happy book birthday. Yay. And I'm sorry this episode is not coming out then, but you know. It'll come out eventually, and I hope by then I can look back and see how awesome your Hope Hub day and everything was and how massively successful the book will be because it's so good. And as you know, I inhaled it in two days and I'm obsessed with the book, so, yay.

Dr. Erin Nance: Thank you. I, I, I met your husband yesterday and I said it's always a good sign when the husband knows of the book. I feel like it's the same thing with my husband. I'm like. If I hear something about his work, I'm like, okay, I know that's a big important project, or I know.. 

Zibby: It's so true. 

Dr. Erin Nance: Sorry, I took it as a compliment.

Zibby: Yeah. I am often reading next to him, and so I'm like, oh my gosh, listen to this. Oh my gosh. Listen to that. Like, turn down your, you know, Instagram reels. I need to focus here. Okay, so tell listeners more about your book and what they can get out of it. 

Dr. Erin Nance: Of course, so Little Misdiagnosed is a memoir from my time as a female orthopedic surgeon in New York City, and it's about a girl who worked her whole life to become a surgeon, and when she finally does, she realizes it's nothing like how she imagined it would be. So that's kind of the, the big gist for, for people who are fans of the Pit or Grey's Anatomy or any kind of show that really humanizes doctors. I really wrote this book to number one, humanize what it feels like for a patient to be going through, you know, the medical system and, and difficult diagnoses and times.

Um, but then also to get the point of view from the doctor, what it feels like trying to help people, like what it feels like trying to work within a system that sometimes actively pits us against the people we're trying to help. 

Zibby: Okay. I learned so much about being an orthopedist, by the way, at the moment.

One of my kids wants to be an orthopedic surgeon and so I am like, we'll be giving this as a gift. And also I pretend like I am a doctor. And so this book has, has fueled my own knowledge, but it's not really, I mean, it is about medicine obviously, and we all learn so much. And your dad was such a, like warrior is the medical doctor at Lennox Hill and oh my gosh, learned so much from him as like a fixer.

But it's really your story. It's a coming of age in medicine. It's your and your family. How, can you talk about what happened with your brother? Or do you wanna not talk about it because it was so moving? 

Dr. Erin Nance: Okay. So before I wrote this book, I started a very popular, um, social media channel called Little Misdiagnosed.

And I believe that every person has one netflix Worthy story about their life. Right? Or or at least lifetime worthy. 

Zibby: Hallmark channel. 

Dr. Erin Nance: Yeah, hallmark Channel worthy. And I knew, for me, that story was the story of my first day at work as a surgery intern. And what happened was I was on night shift, uh, night float, they call it.

At Lenox Hill Hospital, it is my first day. It's July 4th weekend. Everybody knows that's the crazy weekend. Don't go to the hospital because all the new people are starting. And my very first page I get is actually a phone call from my mom. And you know, I'm like, mom, I'm at work. Like, stop calling. You know, like I told everybody like, don't, don't call me.

Uh, and she, she said. It's your brother. He, he was in an accident and we didn't have much details at the start, so I just, I, I kind of brushed it off and I said, I was like, oh, make sure, you know, an attending reads his films. It's the first day people may, may not take it so seriously. And then I got a call from another brother, um, who filled me in on, on what actually happened.

And he was in a diving accident, broke his neck and was a quadriplegic and was being airlifted from the Hamptons to Stony Brook Hospital. So really the the beginning of the book follows that journey from become, you know, starting my first day to now I'm in the family seat, right? And I describe that moment when I walk into the ER at Stony Brook and everyone is looking at me like, oh my gosh.

Like here is like, this is our doctor. You know, like, and everyone is like counting on me. I'm like, I have been a doctor for 10 minutes. Right. I know nothing. And you know, I, I feel like inadequate and I feel so embarrassed. There's like not, I feel so helpless and I just realized that I can do the best that I can do.

And if that means that everyone is looking to me to be the rock, like I'm going to fake it till I make it and be the rock in this situation. 

Zibby: That story. I am so sorry that that happened to you and your family. I loved the way you wrote about it. We, I was near tears reading the whole thing when you collapsed in the, the break room or the behind the scenes and we're just sobbing, you know, how can you not read?

Without putting yourself in your shoes and just anyone reading will think, oh my gosh, like what if this happens to someone I love? And then you show us what it was like. Like all of it. And having the knowledge too from the medical side, but just everything about your family. And I feel like. That was your way in, because reading this book, you kind of fall in love with your whole family and all of those dynamics and your brothers and you being one of four, and the only girl you know, having finished the book, there was one moment where you were outside or on a walk with your brother or something in the wheelchair, and you saw a toe of his move, and then we cut to the end where he's had a baby, which is amazing.

Can you fill in a little more in between. 

Dr. Erin Nance: Of course. So you know, even as. An orthopedic surgeon. I did not know what recovery was going to look like for someone with a spinal cord injury at this point, Christopher Reeve had had his injury, so it was a little bit more, I think, awareness in the general population.

But what I mean no one would have known is that so, so my father was actually the general counsel or attorney for Lennox Hill Hospital. Hospital and one of his first days on his job was when a football player for the Jets, his name was Dennis Bird, was injured on the field and became a quadriplegic. My dad was the one to orchestrate all of that coordination, getting him, because Lennox Hill, we are the team doctors, the jets taking care of dentists from the field to taking him, you know, through, I think he ended up at a hospital, I believe in New Jersey, Kessler.

But anyways. He had this exact like playbook of what to do when someone has this injury and you think, okay, here's a family. The father is a medical attorney. My mother is a nurse, I'm an orthopedic surgeon. It was still so hard going through this process of recovery, getting him the right insurance, fighting for him to get the rehabilitation that he need, fighting to get him, you know, to get a convertible van or a nurse.

There could not been, have been a better equipped family to help with the situation, and it was still devastating for us and so hard. So that's just a little bit of like the, the background of what it's like being a, when you have a family member who has one of these devastating injuries, but when I talk with Kevin a lot, first of all, I want people to know before I ever shared this story online, I actually texted him and I said, Hey Kev, I've been thinking of sharing the story from my point of view about your accident.

Do you mind if I talk about it? And he said, he's like, hell yeah. And I think he's always wanted to be famous like, and. And so, you know, so I I, that, that story went instantly viral on TikTok. And for the purposes of the book, I did want to kind of, it, it is my story, but I wanted to kind of show those moments of his recovery along the way.

So it follows when he is in the, you know, straight after surgery. And things as simple as when you're a quadriplegic, you can't, you know, scratch your itch, you know, when you are in the rehab facility, you are the only 21-year-old among all the 80 year olds recovering from hip replacement and knee replacement.

You know what it's like to move on with your life to realize you gotta get a job, you have to make your own life for yourself. So I'm incredibly proud of Kevin. He actually can walk, I wouldn't call it functional walking, um, but he's able to do so many things. I never thought were possible as someone who takes care of these injuries on a, you know, a fairly regular basis.

Um, so yeah, I'm just kind of like a really proud big sister at this point. 

Zibby: Aw, my gosh. Well, thank you for sharing the story and thank you to Kevin for letting it be shared. Um, so moving, so powerful. So you captivate us with that early on and then. How can we not wanna read every word that you write after we hear the story?

What was so interesting to me were all of the anecdotes about patients, patient care and your interaction with other doctors. There's one passage or chapter rather that I am still horrified by, which is when the Riverdale student breaks his leg, it, it's an open fracture. So the bone is peeking out of his leg and at at at risk for infection.

And the doctors you tried to reach, one was on the way to the Hamptons and wouldn't turn around and the other was at a concert in the Meadowlands and wouldn't come back and was like, I'll come back tomorrow. And you had to scream at him. I know the chapter was illustrating using your voice, but I feel like what it was illustrating was such a, a, a failure on the part of doctors.

Can you talk a little bit about that? 

Dr. Erin Nance: Yeah, well, I'll tell you when the, the lawyer for Harper Collins, you know, read this book, he said, I found it both entertaining and terrifying. Um, which is, I was like, that's a good, a good reaction. And, you know, I, I wanted to share these stories, not to necessarily like shame people or out people for bad behavior.

But I think people should know like what actually goes on. And that story, me trying to track down a doctor who's on call who's non-responsive or just straight up refuses to see a patient, whether they're out of town or they find out the patient doesn't have insurance. These happen every day, and this was just kind of an egregious example that was, you know, one very memorable because I ended up cursing out my attending as an intern. Something you do not do, uh, but it just kind of illustrates also the power imbalance between the trainees and the attendings, and listen, you have to have a structure to make things work, right?

Medicine is in essence the same structure as the military, and you need that to, you know, move things along to help, you know, with the pedagogy and, and, and teaching. But what it does is creates a culture where those who are lower in ranked. Don't feel comfortable speaking up or trying to like implement any change.

So at this point, I mean I, it's a holiday weekend. There is no doctor available to help this, you know, poor kid. And this could become a life or death situation. So. It took a life or death situation for me to gather the courage to call out one of the attendings. But these like power imbalances are playing out every day all over the country.

Zibby: Oh my gosh. Well that was terrifying and I'm glad you spoke up and I hope more people follow your lead after they read this and do the same thing. You have also a lot of stories where your own personal life sort of intersects with your medical life. So when you decided to have a child and timed it to your, like rotation in your fellowship residency, rather, talk about that and how you had said to one doctor that he had joked Dr A. had joked, I hope you're not pregnant. And then like two weeks later you're like, uh, yeah, actually I'm pregnant. Uh, talk about, talk about that and, and how, how on earth you. Didn't take a day off in your entire pregnancy and were doing all of that despite how you felt. How do you do all that? 

Dr. Erin Nance: Yeah. I will tell you, my pregnancy was the least stressful part of that entire year of, of my fellowship year, which looking back is ab is an absolutely insane thing to say.

But you know, I came from a big family, right? I'm one of four, my mom is one of eight. I love being like surrounded by, by all my siblings and cousins. And I knew going into being an orthopedic surgeon that I was pro that was not gonna be in the cards to have like a big, massive family. Um, although I do write about Dr. Appleyard who has four children and who was just an absolute rockstar, I. But I and I, this is one of those things that to me is more of an unspoken rule, right? There is no nowhere written in stone. You cannot have a child when you are in med school or residency or fellowship, right? But there are some rules in place.

Like for example, in training in residency and fellowship. You are not allowed to miss more than two weeks of work, otherwise you have to repeat the year. Okay? So by all means have your kid and then come back within two weeks so you don't have to repeat another year. Right? So there are just, again, systems in place that make it really difficult, or at least 20 years ago when I was in training to, to have a kid, there is no daycare.

At the hospital for residents, right? Um, so you're on a resident's salary making $50,000 and you need to find childcare at 4:30 AM like, come on. Like that's, that's not reasonable. And I have to say, there was a, I was a second year general surgery resident. There was a gen surg intern who had a child, uh, she had her mom come live with her.

I write about in one of my other surgical interns, she sent her newborn twins to Korea. 

Zibby: Yes. 

Dr. Erin Nance: To be raised by her family while she was in internship. So it's not that it's impossible, right, but do we have to make it so that you have to send your children to a foreign country to be raised by the only, you know, outside network that you have.

I don't think that's really, you know, a very supportive system. 

Zibby: Oh my gosh. Tell me more about your TikTok fame and how you reversed engineered the algorithm and how the use of these other platforms can really augment the most sort of essential profession around saving people's lives, healing others.

Because you don't think about TikTok as a big healer. 

Dr. Erin Nance: You know what? The reason why I started Little Misdiagnosed was I had another channel called The Hand Doctor, and I got a dm. You didn't even know doctors had dms, right? It'd be a lot easier to get medication antibiotic, and this woman is a desperate.

She said, dear Dr. Nance, uh, I don't normally talk to strangers on the internet, but I'm desperate. I've had 10 years of fingernail pain and nobody believes me. I've seen five doctors. They can't find anything wrong with me. They make me think, feel like I'm going crazy. Is there any way you could help? And because I couldn't help myself, I said, you know, dear, desperate, uh, I too don't normally talk to strangers on the internet.

But out of curiosity, do you have a little blue dot under your fingernail? She said, I do have a little blue dot. So I told her, you're gonna ask your doctor to get an MRI of your finger. It's gonna show you have a GLO tumor. You're gonna get a hand surgeon to take it out and you're gonna be cured immediately.

And so about six weeks later, I get another dm. OMG, Dr. Nance, I got the MRI, it showed I had a mass and they took it out. It was a glos tumor and I have no more pain, you know? Thank you. Thank you. And you know, now what this woman did not realize is if you go onto Google and put in PubMed Glos tumor, my name comes up, or my maiden name Erin McDermott. 'cause I'm one of the world's experts on glovis tumors. Okay. But she didn't know that when She messaged me, right? And what she was looking for was someone who would believe her because if someone believed her, then someone could help her. And so that's when I started sharing just these stories of me kind of being a patient advocate.

These examples of me really fighting for patients and listening to patients. So people and, and everyone was just gravitating to these stories 'cause they're like, oh, like I wish, that's how I felt. You know, I wish I had a doctor who was fighting for me. Um, and then I was getting inundated, and when I say inundated, I'm meaning over 10,000 messages and emails and dms, a week of people asking me to share their stories.

Zibby: Mm. 

Dr. Erin Nance: So that just one person wouldn't have to go through what they went through. And so. One person wouldn't feel alone in what they were struggling with. And that's really how my channel went viral. And I used the medium of storytelling to get these messages across. So I did a very viral series called the 31 First, 31 Most Commonly Misdiagnosed Conditions in Women.

And I would always start the video off with a patient story about. What happened, and then I would go into the details, the facts about, you know, what this condition is, and then always a call to action for people to share their experience and their stories. And if anyone is listening, who wants to make a TikTok and go viral, the key to virality is the comments.

There are more likes for the comments than the original video. So if you make something that compels someone to share something of their own, because people are going to resonate with that comment, right? And then they're gonna talk about their experience. Someone's gonna resonate with that. And that would be my, my big takeaway is make a piece of content that makes somebody feel something.

And feel compelled to pass that on. 

Zibby: Wow. Okay. Well, thank you for doing that. And all of the people who you've helped by doing that. And I, I literally like, I'm like, wait, am I still interviewing Dr. Nance? I'm so compelled. I feel like, felt like I was watching a video myself. Oh my goodness. 

Dr. Erin Nance: Why write a book?

So it was funny because I had not really intended to write. Well, that's a bit of a lie. Three or four years ago, I thought I would love to write a book. Right? But I didn't really know where to start. I, I didn't know how to do it. I knew I had the story that I wanted to tell, which was that story of my first day of work, but I didn't really know what else like a book would amount to, so I ended up writing that chapter, um, down, I sent it to a couple of friends.

I sent it to someone who I didn't know actually, and I said. Can you read this and just tell me if it sucks. Okay. Like, you don't know me, like feel free. You know, like be brutally honest. And she was like, I love it. You know this, this is great. But again, I didn't know like what to do with it. Like, I don't know, do I write it as like an essay and send it to the New Yorker? Like, I, I don't really know. So I just sat on it for a long time, actually. And then when I started my, my TikTok channel and I did these video stories, then I thought like, okay, like this is now kind of like a, maybe a collection of something. I had a ghost writer reach out to me.

They said, have you ever thought of writing a book? I said, no, not really, but, and he, they said, well, you know, you know I could help you. I'm sure you have a lot of literary friends. Said, I don't have any literary friends. I said, but I do have one really big literary friend, and this is my friend Jenny Jackson, who is the author of Pineapple Street, and she is a, is an editor herself, and we had coffee.

And Jenny said, you are the storyteller. You, you don't need a ghost writer. Uh, like you're, you're the one who has the, the stories. So within a week I was contacted by three agents. We worked all summer on writing the proposal. I think that's what it's called. And that October is when that 31 for 31 series was going super viral.

And I said, I think we have to take the book out now. And I was very fortunate that I signed with Day Street at Harper Collins. They were the first people to believe in me. They, they absolutely saw the vision from the start, and what I really appreciated about them was it's actually not that easy to convert an audience from one platform to the next, right?

It doesn't mean because you have a million followers that they're necessarily going to read your book. And it's also doesn't mean that just because you have a viral video that that's gonna make a good chapter. So even though the book is chronological in nature, I try to write it like a chicken soup for the soul style book where you could just honestly pick up any chapter and be entertained by the story and get like a life lesson from it.

'cause I, I'm sure all your readers are like really serious highbrow readers. But if they're like me, I have a lot of books where I just like read the first couple of chapters and then I abandon them. Um, so I wanted to make it a book that, yes, you could read it, cover to cover, or if you just wanted to read a couple of chapters at a time, you could do that as well.

Zibby: Amazing. Well, well done. I think it's so consumable because it's so voice-driven. Like I feel like you're just talking to me and. It's less a book than like the most engrossing conversation. So.. 

Dr. Erin Nance: That's a huge compliment. And it's funny when I. Did the audio book, um, you know, I said like a first time author and they, I think they were impressed because I, you know, I, this is kind of what I've been doing for years, right?

I've been talking one-on-one in these videos. And this is also a secret for people who are not on TikTok. Um, TikTok is not a platform for dancing kids. Okay? TikTok is an information sharing platform and for me. And I tell this, you know, people say like, what, what? Why is everyone watching these get ready with me videos?

Right? It's not about the makeup, okay? It is a cue that someone is about to tell a story, and TikTok is really at the heart of it, a storytelling platform. So I tell people also, if people are kind of of my age, I'm in my, you know, early forties. The best place to start is on TikTok because no one you know is on TikTok, and it's so less cringey.

I mean. If you look back on your first videos and you don't feel cringey, you're not doing it right. Okay? It's, it's meant to feel awkward. It's meant to feel cringey. Um, but you learn from it. And listen, there is a creator, his name is Mr. Beast. He is the world's most famous, um, influencer. And people ask him all the time, how do you make a viral video?

How do you get people to watch your videos? How do you make everything go viral? And he tells everyone. The question you should be asking is, how can I make this video the best possible video I can make? 

Zibby: Mm-hmm. 

Dr. Erin Nance: And just, just start and you will grow from it. You will learn from it. I prefer storytelling.

Other people do more, you know, vlog style or you know, clip styles. You can experiment, um, with the different strategies. And for me, I, I feel like medicine lends itself to storytelling so naturally that that's, that's my preferred way of, of getting both education across and also as a way to humanize medicine.

Zibby: Love it. Erin. Thank you. Thank you for all that you do to help so many people. Thank you for this book. Thank you for even the entertainment of it, the emotional ride, the openness and vulnerability, and the hope. I know hope is such a critical part of the journey. You had hope for your brother. You have hope for so many patients.

You have hope for people out there who are struggling and that is in short supply these days. So thank you for that. 

Dr. Erin Nance: Oh, you're so welcome. You know the real takeaway is that the most powerful drug is hope, and that people are good medicine. 

Zibby: Love that. Congratulations on Pub day. Go celebrate. 

Dr. Erin Nance: Thank you. 

Zibby: Bye Erin.

Thank you. 

Dr. Erin Nance: Thank you, Zibby. Bye.