Intro: Chas and Marco Salmen grew up in the Roaring Fork Valley, the sons of Dr. Paul Salmen and Nancy Reinisch. They went on to study medicine after high school. Today, they are doctors at North Memorial Hospital in the city where their Lebanese great-grandparents settled, Minneapolis.

Gallacher: So here you are back to your roots. How did you come to practice medicine in the same hospital at the same time?

Chas: Marco came first to train at Hennepin Medical Center, the county hospital in Minneapolis. Marco was doing emergency medicine and internal medicine. He did two residencies combined into one.

A couple of years later, I was looking around for my family medicine residency. My wife is also from nearby, in Wisconsin, so we thought about getting closer to my family here in the Twin Cities and her family in Wisconsin. I was excited when I was selected to come train in family medicine here.

I did my three years of residency and joined the faculty at the University of Minnesota right around the same time Marco took a position in the emergency room here at North Memorial. So we both graduated from our residency programs and started first attending clinical positions here at North Memorial together, right at the same time.

Gallacher: Describe what it’s been like working together during this COVID-19 pandemic.

Marco: When COVID-19 first hit, it felt like it upended the traditional practice of emergency medicine that we were doing. All of the little things that were somewhat easy became harder. Just popping in and out of a patient’s room to tell them a little bit more, to speak to someone, all the way up to the really significant things like admitting a patient to the hospital.

Some patients need to be watched because you’re worried about something to do with their heart or whatever. Those things that we did with ease were suddenly much more difficult.

Gallacher: Many of the patients you were dealing with in the emergency room had to eventually be transferred to the COVID-19 ward upstairs where Chas was.

Chas: Yeah, I got used to patients saying, “Wait a second, didn’t I just see you in the emergency room?” And I would tell them, “No. That’s actually the other doctor Salmen.” It was really confusing for patients because we’re in masks and they can only see our eyes.

The first few months, there were lots of different stressful waves of COVID-19, and we had no idea what was going on. I remember feeling very nervous for Marco and the ED docs that were the first people seeing everything that came in the door.

PPE was scarce, the guidelines weren’t clear, the ERs weren’t set up to accommodate big surges of patients with infectious symptoms going into the same rooms one after another.

Gallacher: You both have young families. You are deep in the COVID-19 in the hospital, and then you have to try to go home and be safe with your wife and kids. How have you dealt with that?

Marco: One of the most frequent conversations that I had with colleagues and with Chas in the first month of COVID-19 was, “How is everybody doing this?” At first, some people weren’t hugging their kids, but we slowly developed safety routines that allowed us to relax at home.

I took showers at the hospital after every shift, changed into clean clothes and tried to emotionally leave my work there. At the beginning there was a part of me that just wanted to disappear for a couple of months. But, during the ensuing weeks and months, I came to see what a privilege it was to have a role to play, to have some way to contribute and help in something that feels so globally helpless.

Chas: In the very beginning there was just so much uncertainty. We were getting the reports out of Italy where 70% of the hospital staffs were getting sick. It was red alert, and Marco and I remember talking about living separate from our families.

But we figured out some systems that made us feel like, “OK. We can do this.” So it quickly got better. Our work environment is not as fun as it … I mean, it’s weird to say that the hospital was fun, but there was just that collegial atmosphere of people working together. I think that’s been replaced with a shared sense of real purpose.

Gallacher: And then came the death of George Floyd.

Chas: Yeah. George Floyd was another big hit. The clinic where I work was partially destroyed. The community of North Minneapolis and Minneapolis was really grieving over that event. Our hospital and clinic serve a large part of the African American population in this part of Minneapolis.

So I think both in terms of COVID-19 and issues of social justice, I think there has been a steeling of our resolve to be advocates and to be there on the front line. COVID-19 and George Floyd reminded us, and, despite the challenges, I think it has reinvigorated many of us with that spirit of common service.

Marco: The death of George Floyd was a terrible tragedy that added to the stress of an already overwhelming summer. I remember driving into work in the afternoon and seeing everybody boarding up windows like the Passover ghost was coming or something horrible was about to arrive at night. It was a deeply sad and ominous time.

Chas: I think it was easy at first during COVID for us to say, “We have to just focus on clinical acuity. The sickest patient needs all of our attention.” But what we quickly saw was the way our African American patients and other minorities were impacted by COVID-19. Vital services, clinics and other resources were suddenly much more difficult to get to by public transportation, by the hours changing, by things going remote. If you didn’t have Zoom or a cell phone, you were really isolated.

Gallacher: So you quickly realized you’re working with a broken system or at least one that was really out of balance?

Marco: Yes. There was a time, after George Floyd’s death, when there wasn’t an open pharmacy for miles around the hospital and around these communities. So even if you wanted to prescribe something for somebody, there wasn’t a pharmacy open.

Chas: Yeah, syndemic is a medical anthropology term that comes to mind. That’s when two different epidemics converge and create compounding impacts. All over the country we’ve been dealing with multiple syndemics this year.

Through all this chaos, it’s been reassuring for me to know that Marco’s in the emergency room. I have gotten to know all of his colleagues in the emergency room. Sometimes in medicine, there’s weird … not rivalries but just arbitrary division between the guys in the emergency room and the guys upstairs.

Gallacher: Teams.

Chas: Yeah. Teams. The men and women on one side feel like the way they do it is the way that it should be done. But this pandemic brought down a lot of those divisions, because we’ve seen the ways that we have to work together to get our patients the care they need.

Our hospital has done a really good job, and when I talk with colleagues at Valley View in Glenwood, I think they are doing the same. This new cooperative spirit is the silver lining out of all this.

Gallacher: But now things are changing.

Marco: Yeah. I’m very excited and at the same time harboring some sadness that there’s a major transition happening. Right now, I’m packing up the car to drive to Colorado. I’m moving my family back to the Roaring Fork Valley. That has been a long-term dream that I’m excited to actualize, but it’s going to make the daily life quite a bit different for Chas and me.

We have been able to get together with our families. One of the things that affects me most is that our kids won’t get to see each other in the afternoon. It’s made us cherish the moments of the last six months. Just last night, I had to have Chas jump my car. I’m going to miss him and our times together.

Gallacher: Are you going to practice emergency medicine at Valley View?

Marco: Yes, emergency medicine and internal medicine. Being able to do both of those at Valley View Hospital is a unique opportunity. I’m excited to be back in the mountains, in the community where I grew up.

Chas: I’ve got to sign off here in a few minutes because my shift is about to start. This will be one of my first shifts knowing that Marco’s not in the hospital anymore. I’m so used to swinging by the doc’s lounge and grabbing a sandwich and bringing it over to the emergency room when he’s there, just to see what’s going on in the emergency room and give him a sandwich and hang out for a few minutes. So I’ll have to adopt one of Marco’s colleagues to be my eyes in the emergency room.

Gallacher: What are you going to miss about your little brother?

Chas: Marco’s my best friend. We go for runs several times a week. Bumping into him at the hospital has just been a really fun experience, but it’s been confusing for others.

We get each other’s pages all day long. Different nurses trying to reach the other doctor Salmen. So the hospital staff will probably be relieved to not have to deal with the confusion anymore.

I’m excited that Marco’s going to be back in Glenwood because it means whenever I get to come home, I get to see him. I’m also excited for Valley View because I think they’re getting an awesome doc. We’re definitely going to miss him, but I think it’s the right move. I’m excited for him and his family.