Precision & Purpose: Conversations in Neurosurgery & Care Hosted by Emmy Award-Winning Journalist Elizabeth Hashagen

What drives the pursuit of excellence when lives are on the line?

Precision & Purpose, hosted by Emmy Award–winning journalist Elizabeth Hashagen, brings you inside the world of neurosurgery alongside board-certified experts Dr. Brian McHugh, Dr. Courtney Pendleton, and Dr. Iordanou.

Together, they explore the intersection of innovation, resilience, and compassion—sharing their personal journeys, the evolving landscape of neurological care, and the mindset required to deliver world-class outcomes.

From cutting-edge advancements to deeply human moments, Precision & Purpose offers an unfiltered look at the people and principles shaping the future of medicine.

Transcript

SPEAKER_04 0:00

Every decision is deliberate, every movement measured, every millimeter matters. Today we're taking you beyond the procedures. We're taking you on the road to the OR, the years of training, the discipline, the sacrifice. We're talking about the emotional reality of surgical life, what it costs, what it demands, and what it gives back. And we're looking ahead at the future of medicine, artificial intelligence, and how technology is reshaping one of the most human professions in the world. Joining us, Dr. Brian McHugh, a board-certified neurosurgeon specializing in complex and spinal deformity surgery in both adult and pediatric patients, Yale trained, John Cobb Fellow at the Hospital for Special Surgery, former Chief of Neurosurgery at Innova Alexandria Hospital, and current director of the Spine Center at Good Samaritan Hospital. Precision, leadership, experience. In addition, we have Dr. Courtney Pendleton, a board-certified neurosurgeon specializing in peripheral nerve surgery and spinal disorders. Her training reads like a global masterclass. Johns Hopkins School of Medicine, Thomas Jefferson University Hospital, a Peripheral Nerve Fellowship at the Mayo Clinic, Advanced Surgical Training in Japan, Pediatric Deformity Specialization at Schreiner's Hospital for Children. She is one of only a small number of peripheral nerve-trained neurosurgeons in the Northeast. Clinician, surgeon, academic leader. Dr. Jordan Yordanu brings a rare dual perspective to this conversation. Holding both an MD and a PhD, he bridges the operating room and the research laboratory. He not only treats neurological disease, he studies its origins, translating scientific discovery into surgical innovation. At the intersection of neuroscience, technology, and discovery, he represents where medicine is heading next. This isn't just about medicine, it's about the decisions you never see, the science you depend on, and the questions you've always wanted to ask. This is On Call.

SPEAKER_06 2:40

Thank you very much for being here. It's a privilege to be on with you.

SPEAKER_04 2:43

All right. I'm pretty excited to talk uh really behind the scenes and give people, you know, some flavor of your journeys and your experience and really kind of dive into the people behind the medicine. So I have to start with like your origin story, right? Was it always going to be this path, or was there, you know, an interesting way that you got here?

SPEAKER_06 3:04

Yeah, good question. I mean, for me, I think somewhere I always knew I wanted to be in healthcare in some capacity, but I wasn't your typical story. I didn't go straight through to medical school like so many of us do. It's a very pre-programmed path. I actually took time off after college, had to kind of find myself and find my place. I did have an interest in neurosciences and for a period thought I wanted to be a research scientist. Um, but that really puts you at the bench instead of the bedside. And I found I wanted to be interacting with people on a regular basis and have a translational element to the work as opposed to pure basic research. And you have to position yourself educationally in the appropriate way to be able to move forward into medical school, into residency. So I had to kind of stumble a little bit out of college and you know get my resume in order to move forward. So it wasn't as straight of a path as it could have been. But I think in my heart, I knew um, you know, somewhere in healthcare was going to be my spot.

SPEAKER_04 4:08

Okay. And Dr. Pendleton, was that a similar thing, or were you like rocket ship, let's go?

SPEAKER_03 4:13

I was, if possible, a even more circuitous path than Dr. McHugh took. I um I started off college thinking I was going to go into special education. I had had a long history working with a local family who had adopted and fostered 19 kids with special needs, and I was convinced that was where I was headed. And the day before I graduated, NYU, um, I told my very proud parents that uh I decided I wanted to go into medicine instead. They were less than thrilled.

SPEAKER_04 4:41

Wow.

SPEAKER_03 4:42

Really? Yes. So I ended up taking a couple of years, um, like Dr. McHugh said, sort of getting my resume in order in order to move into the space of medicine, um, did a post back program designed for folks like myself who had no medical or science background in college. I was an art and English major. Um, and then from the post back program, which was at Johns Hopkins, went to med school at Johns Hopkins and at that point had sort of found a connection between the work I'd done in special education with neurosurgery, specifically pediatric neurosurgery. Wow. Um, and that was how I ended up in a neurosurgical residency, and from there found my way to spine and peripheral nerve.

SPEAKER_04 5:23

Okay, so Doctor, your dad who now we have to know about your path. Was it a straight line or are all the roads curved?

SPEAKER_05 5:30

Well, mine was pretty gung ho on neurosurgery from the outset. My father was a physician, a pediatrician, so I always knew I wanted to be a doctor, I wanted to be like my dad. Um, and on the path to becoming a doctor, as Dr. McHugh pointed out, you have to position yourself with certain educational criteria. And that's how I fell into starting to do scientific research. I did it at first as a way to kind of beef up my resume and look better for med school applications. And I found myself in a neuroscience program and undergrad at Davidson College doing a ton of research and ended up thinking, well, maybe I don't want to be a physician, maybe I do want to keep doing this research and advance the field instead of treating individual patients. Um and so that's why I kind of sidelined myself when I did the combined MD PhD program uh at SUNY Down State back here in New York. And through the course of that, I got to experience lots of innovation and see how the research world really works while pursuing clinical medicine as well. And then I kind of find my way back into clinical medicine when I realized when I started treating patients, and I felt that personal connection and personal joy from treating an individual patient for me outweighs the personal satisfaction of a scientific accomplishment. And so I kind of veered off to research for a little bit, and then now I'm back doing a little bit of both.

SPEAKER_04 6:46

I think it's also so interesting how each one of you neurosurgery wasn't like the first step, but you ultimately are all in this conversation and ended up at the same destination, which I would hope is exactly where you want to be at this point. So, Dr. Pendleton, talk to me a little bit about uh getting to this seat and how you ended up part of this conversation here. Because you, as I said, it's it's almost like a global masterclass, your resume. You're in Japan, you're you know, you're kind of how did you end up here?

SPEAKER_03 7:15

Um sometimes I wonder that myself.

SPEAKER_04 7:18

In fact, you're like waves. Waves took me here and told me to turn right.

SPEAKER_03 7:23

That would also have been a great answer. Um, so you know, really this started back when I was in medical school. Um, I wasn't really sure at that point what I wanted to, what I wanted to do. I'd gotten to medical school and was sort of finding my own path. Um, got paired with a mentor who was himself a pediatric neurosurgeon and just was really drawn to that practice, saw a lot of connections between his patients and the children I'd worked with back in my special education employment. Um, and from there, I started working in a brain tumor research lab, which really pulled me into both the science and the clinical aspect of something beyond just pediatric neurosurgery. And that was sort of the moment where I realized neurosurgery as a field was someplace I think I could find a home in. Um, and that brought me to my residency, which um, you know, the match system is how I ended up in Philadelphia at Thomas Jefferson. And that's sort of where I developed my love of peripheral nerve surgery. Part of our rotations were we worked at in children's hospital in Philadelphia. And I happened to be rotating through there at a time where there was a very high volume of um obstetric peripheral nerve or brachial plexus injuries and then subsequent repairs, was very much drawn to the complexity of that anatomy, the ability of the patients to recover. And I saw a lot of connections between those surgeries and my background really in art, where it was a lot of, you know, fine detail work with your hands and a lot of creative out-of-the-box thinking. There wasn't one set, you know, how to get from point A to point B, which appealed to me in many ways.

SPEAKER_01 9:02

Dr. Pendleton really is a wonderful physician. Saw me through my emergency neck surgery, gave me wonderful care, and never makes me feel like she's in a rush. So grateful that I was sent to her.

SPEAKER_04 9:13

And I think it's so interesting because you take a look at the path and there's so many unexpected turns. Was that the same for you?

SPEAKER_06 9:21

I mean, not with the art background, obviously. And I can't say or claim I'm creative in any way, but you know, I got into spine surgery partially because it is very mechanical. There's a lot of physics behind it, and I never wanted to be a I wasn't really into car engines or anything like that as a kid, but something along that line where working with your tools, with your hands, getting into the the biomechanics of the treatments was very interesting to me. And you're able to learn about that in an esoteric intellectual way and then actually apply it in the patient. That was appealing. So I think dissimilar from Dr. Pendleton, but also similar, it it is that underlying thread of what's interesting about it that engages you. Um, the pediatric part for me was just less so from a background of working with kids. I do love kids, I've got three of my own. Um, but the nature of scoliosis is such that there's a population that's kind of 60 and older, and then there's a separate population, unfortunately, that's that's usually either teenagers or even infants or juvenile.

SPEAKER_04 10:28

Right, right. Now, if medicine hadn't worked out, where would we be having this conversation right now?

SPEAKER_05 10:35

I had an uncle who was in in Shevala family owners and insurance, so it would have been something like finance insurance related. I was always very good at math and numbers spoke to me, but I I'm glad medicine worked out because I don't think I would have been happy.

SPEAKER_04 10:49

Right, because there is, I would think, such a large amount of fulfillment to your job.

SPEAKER_05 10:53

Oh, absolutely. Like I said, I I almost veered off into the research world of staying in a lab all the time, and it's it was that patient interactions and seeing the improvements on an individual level that I could do with my own hands on a patient that I operated on that really brought me back into clinical medicine.

SPEAKER_04 11:09

Now, when you started training, what would you say surprised you about it? Not the hours.

SPEAKER_05 11:14

Not the hours. Prepared for the hours, the emotional toll that that it can take on you. Um especially, you know, everybody has an occasional outcome that's bad out of their hands. And have being able to push past that and go back to work the next day and treat the next patient. Right. The resiliency that I saw in some of my attendings in in training was the was a big surprise and something I had to learn for myself because as much joy as you get from s helping an individual patient, you can feel just as much sadness when you can't help a patient.

SPEAKER_04 11:50

Sure.

SPEAKER_05 11:51

And to move past that to the next one is takes a lot of resiliency.

SPEAKER_04 11:56

Absolutely. To stay committed, to stay connected, and you know, to not let it weigh you down emotionally.

SPEAKER_05 12:02

Exactly. And then to still be able to have that connection with the next patient and not close yourself off to kind of protect yourself from the from the bad.

SPEAKER_04 12:11

Sure. And Dr. Pendleton, was there anything that surprised you?

SPEAKER_03 12:15

You know, I think similar to uh to Dr. Jordan it was the challenges that were posed by times when not only were you not able to help patients, but as he alluded to, no matter what you did, even with the best possible care, patients have poor outcomes. There are complications and risks to everything that we do. And statistically, somebody, some patient somewhere is going to have one of those complications. And that doesn't necessarily make it anybody's fault. These things are known risks, and everybody going forward with the surgery was made aware of them, is aware of them, and agreed to them. It doesn't make it any easier when it's your patient or in training, when it's your attending's patient who you were assisting with. Um very much. And you know, patients, their, you know, their families. You met their spouses, you know, their cousins, their neighbors, their children. And you feel this immense responsibility, not just to the patient, but to that entire sort of support system that you've interacted with. And it was unexpectedly difficult to be able to build those connections. And when something didn't go as planned, or someone who had a poor outcome because of either the nature of the disease or something else outside of your control, you know, to be able to move forward and not just move forward with the next patient, but move forward with those patients and continue maintaining that relationship.

SPEAKER_04 13:57

And I would also think, you know, obviously your job is very physical and you're hoping for a physical outcome, but there is so much mental and emotional that is connected to all of it, to the patients and the relationships that you have, and of course to the outcomes, Dr. McHugh.

SPEAKER_06 14:14

Yeah, it's true. I mean, I I would answer in a similar fashion to to both Dr. Iardano and Dr. Pendleton. Some of it was a pleasant surprise, although now that I'm a little bit older, it's it's difficult. I don't know if anyone ever saw the remake of 21 Jump Street. Oh there's this scene in there where the guys are picturing kind of, you know, like Navy SEAL training. They're trying to be police officers in a local community, and the training is AK-47s and all this high-intensity stuff, and it cuts to a scene of them riding bicycles around a very quiet park, and their jobs to get like a cat out of a tree or something like that. And they're very disappointed that what was advertised is sort of not really what the actual job is. So one of the surprises for me that's a pl in a pleasant way was for better or worse, neurosurgery proved to very much be as advertised, right? Like the intensity that you thought you were getting, you're very much getting. And to what my colleague said, that's good because that's what you wanted. On the flip side, you find out pretty quickly that that is both physically, psychologically, mentally very challenging.

SPEAKER_07 15:24

Right.

SPEAKER_06 15:24

And then as you move on in life, and if you're gonna have a family or have an outside balance with personal relationships, that's a big part of navigating things, trying to find out how to handle the challenges of that intensity and not have it you know break down or ruin other aspects of your life. Uh many of us unfortunately uh don't do so well there. So there's a very high divorce rate and substance abuse rate and neurosurgery, and it's all stress-related ultimately at the end of the day.

SPEAKER_07 15:54

Right.

SPEAKER_06 15:55

Um, but you know, the trailer definitely, you know, the movie lives up to the trailer, so to speak.

SPEAKER_04 16:00

Okay. Okay. Now, Dr. Pendleton, I'm wondering, was there a mentor or is there a mentor who helped shape, you know, the type of doctor that you've become and maybe gave you some clues as to how to handle the emotional toll that comes with this?

SPEAKER_03 16:16

So I think, you know, over the course of all my training, there have been a number of, you know, folks who have served in that mentorship role through med school. It was um Alfredo Quinano Sinajosa, who is uh down at Mayo Clinic in Florida. Um he was the brain tumor research laboratory that I worked in. He was both a MD PhD, he ran a laboratory and had a full clinical practice. And he was really the first insight I had into the tremendous intensity behind neurosurgery, like Dr. McHugh alluded to. Um and I think he prepared me well moving forward. Um and then residency, um, one of my attendings, uh, Dr. Jack Jallo, spent a lot of time working with him, and he really helped me develop not only my surgical skills, um, he helped kind of nurture and support my interest in moving into peripheral nerve surgery, in addition to the spine that we did together, um, and really taught me the importance of a sense of humor and maintaining work and personal life boundaries. Um, and then Rob Spinner, who is out at the Mayo Clinic, and really helped form me into a peripheral nerve surgeon and helped give me a lot of insight into how I wanted to build and maintain my clinical practice once I got into an attending position.

SPEAKER_04 17:31

Sure, sure. Now, for for you, Dr. Your Dad, was there someone who really shaped you? I know you mentioned your dad was a pediatrician.

SPEAKER_05 17:39

Yeah. Uh same as Dr. Pendleton. There's many people along the ways that help push me in certain directions. Uh, when I think of a mentor, you know, I my mine goes to the most immediate two mentors that I had in training, one uh in my residency, Dr. Vikram Krabu. He is the kindest, gentlest, most caring person I've ever met in a hospital or out. And he is someone I I aspire to be as compassionate as he is. And he's uh he's a brain tumor surgeon, so the patients that he's treating, most of them, you know, their lives are measured in weeks to months after he meets them, and he still maintains this great relationship with them. And then in my in my fellowship in functional neurosurgery, um Dr. Nader Paradigan, uh just a pinnacle example of an of an efficient clinician in a in a functional practice. Yeah.

SPEAKER_02 18:33

I love that. Dr. Ayardanu is truly exceptional. From my very first visit, Dr. Ayardano took the time to walk me through everything before surgery, explaining my condition, the laminectomy procedure, and what to realistically expect. He never rushed the conversation and made sure I felt informed and confident going into surgery. The surgery itself went extremely well, and my recovery has been closely monitored. After surgery, Dr. Ayodanu continued to be just as attentive, checking in, answering questions, and clearly explaining the recovery process and next steps. That level of care made a huge difference in my peace of mind. I am incredibly grateful for his skill, professionalism, and compassion. Huge thank you to the best neurosurgeon. I would highly recommend Dr. Ayodano to anyone needing spine or neurosurgical care.

SPEAKER_04 19:16

Okay, so Dr. McHugh, who was who was the person that, you know, reached back and kind of pulled you up?

SPEAKER_06 19:22

That's a great question. And I to everyone else's answer, I think it's a lot of people along the way. It's hard to name just one person, but um part of training is also these folks who are teaching ultimately in the attending role, they're letting they're kind of bearing it all out there, right? They're letting you see their failures, how they deal with stress, and a lot of it's just watching and learning examples set by people. And uh now that you mentioned a couple examples come to mind. One of our senior uh brain tumor surgeons at Yale when I was there was uh Dr. Pete Meyer. He taught me a lesson once we had a devastating outcome in a middle-aged gentleman who had a big family and he wasn't going to make it as a result of a complication from the surgery. And some of the things that surgeons can do when that happens is sort of avoid the situation because it, you know, in a way penetrates deep down and can create fear and anxiety about doing your job. And he made a very interesting point where he said this is not where you run uh from your complications. Like these are patients you need to engage with even more. Um, and your gut instinct will be to not go into that room and meet with the family because it is a negative outcome that you know you kind of had a hand in to some degree, not at your fault, but still. Um and some patients can feel abandoned by that behavior. I don't think physicians mean it. I think they are just managing their own emotions in a way that isn't putting the patient first. And so he taught that lesson to me, which I'm forever grateful for. And the other one that comes to mind was um Dennis Spencer was the chairman of that department for a long time. And he did epilepsy surgery, which is very complex for patients with seizures. And he had a young child who actually passed away uh from an you know, not not directly surgically related, but obviously a very impactful, you know, complication to that case. And he, just like many of us, had to be back on the job the next day, kind of dealing with that day's issues and kind of watching from a distance manage that what I'm sure was an amazingly difficult emotional load and continue to put one foot in front of the next um and deal with the family and the and the fallout was uh I'm sure they know it to some degree, but the trainees around you when you're in that role are watching and learning from everything you do, right?

SPEAKER_07 21:46

Sure.

SPEAKER_06 21:46

Um and certainly innumerable others that I'm just not you know, they're not coming to mind now. But uh it's an observation apprenticeship type program. And so you're really learning from everyone, even the folks who are kind of doing it the wrong way, right? Yeah, you're watching them and saying, okay, that's not what I want to do if I'm in practice one day. And I have those uh mentors too, but it we won't mention them by name.

SPEAKER_04 22:09

Leave them unknown at this point. But I wonder too, if if someone, you know, was still in this, you know, kind of learning phase and they're they're a sponge and they're trying to soak up as much as they can. Um, what piece of advice would you give to someone who's entering this space now?

SPEAKER_06 22:25

Yeah, that's a great question. And I don't know if this is getting at the question you're asking, but you reminded me of another mentor. His name was Charles Duncan. He was the pediatric neurosurgeon at Yale and the residency director when I was there. And he had a very bad day one day, and he was sitting there and he looked at me and he said very quietly and humbly, some days you get the bear, and some days the bear gets you. And he just walked away. And it we I don't know if he remembers this, if he ever hears this, but it was very impactful to me to see, you know, he's very senior at the time, probably seven years old, and had all these accolades. And um, you know, to know you're not always gonna win, right? And that's okay. Um, and that would probably be advice to someone coming into it. Like, there's no way you're batting a thousand, like it's not gonna happen, right? So it's not real. You've got to be ready for the downs and be able to deal with them.

SPEAKER_04 23:18

Sure, sure. And what about for you? What advice would you give if you were in this mentor role now?

SPEAKER_05 23:25

Uh huh. Again, watch what everybody's doing, learn from everybody's outcomes because one day they're gonna be your own outcomes, and take the opportunity that you're given in when you're in medical school, when you're in residency, to be part of the care of a patient that belongs to another physician and pay attention. Pay attention to everything.

SPEAKER_04 23:46

Because I'm I would imagine there's so much happening around you and so much to take in that you know it would be difficult, I would think, to try to absorb all of that and then be able to emotionally handle that. So, Dr. Pendleton, is there a piece of advice that you would give to someone or something that you learn from one of your mentors that really sticks with you?

SPEAKER_03 24:07

Yeah, I think I would sort of dovetail in with what Dr. McHugh said, which I got advice when before I even went into neurosurgery. Um, we had someone who came and spoke to our medical school class. And the advice they gave was, you know, before you pick anything, make sure that's absolutely what you want to do. That if you're picking particularly one of these specialties that is known for its intensity, its long hours, its potential poor outcomes and complications and diseases that we aren't going to succeed in treating just by their nature. That you should make sure before you do that that there's nothing else that would make you equally happy. And I at the time I remember being like, well, that's kind of rude. You know, who who says that? Like this is it was actually a student interest group for neurosurgery, is what it was. And um, you know, so it's a room full of people who all want to do neurosurgery, and you just see these, you know, young students just flabbergasted. Um and having now gone through residency and fellowship and working as an attendee, absolutely right. If there is something else that would make you just as happy on the on the days when the bear gets you, you're not gonna want to come back. Yes. And it it makes more and more sense as I've gone through this this career so far.

SPEAKER_04 25:26

Right. No, I I love that actually. And I wonder too, you know, when you talk about the amount of time that you've already spent in this space, how much has it changed from like your day one to where you are now?

SPEAKER_05 25:40

Well, the field is always expanding. There's always new technologies coming in. I think, you know, from a from a technical standpoint, one of the things that has changed from the time I started my training till now is uh how we manage intracerebral hemorrhages. Uh, there's a lot of new technology coming out with minimally invasive ways to remove blood from it, it's not something that I I was involved in some of the early trials early on in my residency, but it's not something that I do currently in my practice. But that's one thing, one example of how new technology is going to move the field forward because it's an example of something that was really not done for a while because the outcomes were poor when they were and they outweighed the potential benefits. So now with technology changes, now it's a surgery that can be done more safely. And because of that, the benefits are better than they were 10 years ago.

SPEAKER_04 26:28

Right, right. I I would think, you know, you've seen some technological changes as well. What would you say is the biggest difference from, you know, your day one?

SPEAKER_06 26:36

Yeah, it's a good question. I mean, on the one hand, the technology advances, on the other hand, medicine in general hasn't changed since Hippocrates, right? Like the it's sort of a timeless profession in a way. So there are the main core tenants of it are wisdom passed down over thousands of years. Technologically, uh kind of a similar principle in the spine setting that Dr. Jordan was talking about, the implants, the hardware, the surgical techniques, the postoperative mobilization has all improved. You know, 30 years ago, if you had a spine surgery, you were immobilized in bed, and now we know motion is lotion and we get you up on day one. There's a lot of wisdom that's come from randomized control trials and really getting into the outcomes in patients. Um, but but at the same time, uh much hasn't changed. And it's it's always going to be, you know, taking people who have a bad problem and trying to, you know, journey with them through the solution and see them through to a better place, hopefully. Uh, and that doesn't change, I don't think.

unknown 27:46

Yeah.

SPEAKER_04 27:46

And what what changes kind of stand out to you, Dr. Pendleton? Would you say? You know, you look at this and say, wow, that's completely different than when I started and these kids.

SPEAKER_03 27:57

Yeah, I think one of the most interesting things is sort of true throughout medicine and not necessarily specific to neurosurgery, which is developing this greater awareness of how biases and sort of concepts that we have about, you know, individual groups, subsets of people, however you divide them, may impact how we provide medical care. Um, and that's a long-standing history throughout medicine. You go back to, you know, various, you know, syphilis experiments. You go back to Henrietta Lacks and, you know, the Gila cells that we all used at some point in our medical training in our science labs. Um, and only recently the social history behind that has really come out in a very profound way. And I think that's really changed, maybe not the technical aspects of care, but it has changed, I think, how all of us as clinicians approach patients and sort of check ourselves, you know, how are we thinking about these patients? Would we make these recommendations to somebody else? Um, and I think that's really an impact for the better over the course of my time in medicine. Yeah, Dr. McQueen.

SPEAKER_06 29:11

Yeah, that's interesting. I think one thing I noticed when I was going through medical school is they started to bring cultural awareness classes into the medical school curriculum. And specifically in neurosurgery, one of the things that came up there that immediately impacts care, we're having a lot of end-of-life discussions with patients who may have had devastating strokes or brain bleeds. And you have to decide, you know, are you gonna continue with um you know, ventilated assisted kind of living, or are we gonna air quotes pull the plug? And that's a family decision. And certain cultures, the soul lives in the heart, right? So as long as the the these families you'll talk with them and try and explain that you know the brain is not gonna come back and the patient will not communicate again, etc., and you're getting sounds good, doc. Let's just keep moving forward. And if you're unaware of their worldview, right, it as far as they're concerned, that patient's whole because their soul's in their heart and they're looking for a read that something cardiac happened. It's like, no, the cart, the heart's fine, it's the brain. Okay, keep going. And you can be insensitive in those situations or not understand where the family's coming from. So obviously, physicians in training have a lot to learn. You can't bog them down. But to Dr. Pendleton's point, some cultural awareness is is going to be needed uh throughout your career.

SPEAKER_04 30:32

So I feel like I would be remiss if I didn't bring up AI. You know, I don't know if there is a profession right now that doesn't feel like uh-oh, what is that going to look like? And and you know, what jobs are going to be at risk and how, you know, are things going to change. So obviously where we're standing with it, but also taking a look at the future. How do you think that AI will have a hand or possibly have a hand in, you know, the type of job that you're doing?

SPEAKER_05 30:56

Yeah, I think AI is a wonderful tool, but it is a tool. It's not uh, doesn't, I wouldn't say it would replace the surgeon yet. I mean, I use AI currently to help write notes and to help bring down some of the tedious tasks that are associated with being a doctor, but ultimately it comes down to when I treat patients, I'm treating them with my hands that have gone through more than a decade of training to understand how to work around the very sensitive human tissues in the body that is the brain and the nerves and the spinal forward. And one of the things I've always talked about to my mentors is I love robotic surgery. I think it's all robots are so cool. And there's in the general surgery world, there's the Da Vinci robot where you do lots of intraabdominal surgery. And I I had some time as a uh general surgery intern where I played around with that and it's great, but it still to this day doesn't have the kind of haptic feedback that you get as a neurosurgeon working around nerve tissue. So maybe one day the technology will get there, but the technology has to get there, and then they have to train an I to use that technology before you could really replace surgeons with a robot.

SPEAKER_04 32:00

Yeah. And now, Dr. Pendleton, what do you what do you think? And I also wonder, do people come in with like, you know, they put it in and they and they think now they know your job or know what you should be doing and have this like different information? And, you know, how does that affect the role that you're able to play?

SPEAKER_03 32:17

So I think for the to the second part of your question, in fairness, people have been doing that for decades, you know, since Google and WebMD and you know, up to date were readily accessible. And I'm sure before that people were, you know, going to Encyclopedia Britannica or, you know, the local library and coming in with a list of these symptoms mean I have this disease. Here's what I need. Please write the prescription. Right, right. Um, and that hasn't changed. Okay. Other than it's maybe becoming a little more prevalent. Um, I've yet to have someone who comes in and tells me that Chat GPT told them they have a brain tumor, but get a lot of Google said and up to date and WebMD said. Um, I think um there's a role for AI as a as a tool. You know, it's something to add to the surgical argumentarium of how you're able to approach diagnosis and treatment of patients. Um, it certainly can be beneficial in reducing the non-clinical aspects of what we do. So dictating notes, you know, documentation, paperwork, those things that really are not the thing any of us went into medicine for, but are an increasingly prevalent and important part of clinical care. Um, I think AI will not at any point replace surgeons as the primary care providers because really we we talk about the science of medicine, but there's an art to medicine, and it's you know, knowing how to integrate all the different things of not only what the patient is coming to you and telling you, not only their story, but their imaging, documentation from other providers and years of experience that you know because you know. Um, I think a great example to lean into Dr. McHugh's movie references would be Knives Out. Um boy, no, I I don't want to spoil the movie because it's an excellent Who Dun It of Prime Stories, but part of it hinges on multi-year experience of just knowing what something is without having to think about it, without having to Google it, just knowing because for years and years and years you've done this thing and your hands know what even your brain can't put together. Yes. Um, so from that standpoint, I think AI will remain and become an increasingly popular tool. I'm not particularly concerned about losing my job to it at this juncture.

SPEAKER_04 34:47

Okay. Okay. And Dr. McHugh, what do you think? Where's AI?

SPEAKER_06 34:50

Yeah, I mean it's a big topic. We could talk forever on AI, right?

SPEAKER_04 34:54

We could do a whole separate podcast, the next one.

SPEAKER_06 34:56

I think there's pros and cons. Like some of it'll be great for medicine. A lot of the, as many of us are aware, in this country, we spend an inordinate amount of money on healthcare. Um, and it AI has the great potential to kind of compress most of that spend because a lot of it's on the bureaucracy. Um, the other thing you'll hear a lot about in our profession is physician burnout. And a lot of that is based on the record keeping and the bureaucratic side of medicine. And the electronic medical records and the technologies to this point have actually made it worse. You know, the folks from 30 years ago who did it all paper-based were far more focused on the patient. Um, and hopefully AI can take that out of the hands of physicians and automate it. That'd be great, right?

SPEAKER_07 35:39

Right, right.

SPEAKER_06 35:40

On the flip side, there's pitfalls, and we're constantly battling insurance companies to get approvals and authorizations, and they're already putting AI in place to prop up their defenses for care denials and things like that. Um, and that's potentially an area for abuse. Um, to Dr. Pendleton's point, you know, Elon Musk was recently on a podcast and said within three years, everybody will have a robotic surgeon.

SPEAKER_07 36:04

Right, right.

SPEAKER_06 36:04

And he's famous for overpromising and not necessarily under delivering that. So I would, but I would, you know, listen, I I I can see what he's talking about. However, spatial intelligence is different than language-based intelligence. And right now, all of it lives in the LLM world. And so you have to have this spatial intelligence component to really be doing surgeries with robots and things like that. Most people will read about robotics and spine surgery, but for the most part, it's like an actuator arm that kind of tells you where the tumor is or where the spine problem is, and it's largely gimmicky, in my opinion, to at this point, right? Hopefully it develops further. Um, but uh yeah, I was in the operating room the other day and a student was there. And to Dr. Pendleton's point, these tissue planes, they're all they look very similar. It's a lot of haptic feedback, how it feels. The student asks, Dr. McHugh, how do you know you can, you know, remove that piece of tissue and it won't cause an issue? And I was honestly stunned momentarily, right? I'm like, I you know, at this point, I don't even know if I can put it into words. It just there's a probabilistic element to it where it feels a certain way, there's a certain risk to that particular move you're about to make, and your judgment in a split second just says it's worth making that move. There's limited risk, but there is risk. And I, you know, my experience points to doing that particular technical maneuver. And could a robot get there at some point? Potentially. I don't want to be a Luddite or anything, but you know, show me the the when we're all driving around in automated cars, that's step one, right? Right. And then we'll start to worry about the flying.

SPEAKER_04 37:41

Because like the Jetsons were already flying and we're not worried.

SPEAKER_06 37:44

We're not doing the rest right.

SPEAKER_04 37:46

At least not yet. Now, was there an advancement, or is there an advancement that you would say, you know, this happened in my time and has truly impacted patient outcomes?

SPEAKER_06 37:55

You know, we're so not to beat this up, but robotics and spine surgery is a big thing. You'll find it on the internet. Sure. And they're they've been developing it for maybe 10 years. We put these screws in various pots in the spine, and they can be dangerous and they can be misplaced. And robotics has essentially developed like a GPS system for putting them in. It's not perfect, there's still a failure rate, and um technically it's sort of is meant to replace the skill, but it's not quite there. At some point, I think it will be me sitting in the back of the room with you know video game controller, and this will just go in and it will go in at a high, higher level of accuracy than I could ever hope to achieve. But we're not there yet. So that's something that's come onto the scene and you're watching it develop. But just like many things, I think we're quick to latch on to, you know, this futuristic idea.

SPEAKER_04 38:49

And okay, maybe you know, that robot didn't have a fight with his wife last night. Right, right. Or go drink a bottle of wine or have a margarita. So you're like, oh, okay. But then there's that trust factor because I trust you. Yeah. And I feel as though you're gonna do the right thing by me and I believe in you. Now, what if this robot gets shut down? Yeah, you know, or what if something happens that is unexpected at the moment this robot is doing something. There it are trusting a robot.

SPEAKER_06 39:14

I don't know if society ever accepts a role in medicine and surgery where there's no one accountable, right? That accountability and the trust relationship is replaced by a you know robot or a technology. I'm not sure that's a certainly a far bridge to travel right now.

SPEAKER_04 39:31

Sure. And then and then I think Dr. Pendleton, you know, at the end of the day, right, there's all these surgeries that are happening right as we're having this conversation. If then all of that is put on, say, a memory card and uploaded to this AI and it's gonna learn from every case, you know, across the globe because it's not sleeping, right? And then the next day it's smarter and the next day it's smarter. Like, do you think we're eventually going to get to a place where it is going to be, you know, playing a major role in what happens surgically?

SPEAKER_03 39:59

Yeah, I I think I would agree with Dr. McHugh in that, you know, we love, we love hearing about technology. We love fantasizing about, you know, this future where we'll all have flying cars and we'll have completely, you know, robotic surgeons who are kind of like separate from all the basic human foibles of you know, having a bad day. Um I don't know that we're ever going to get to that point. I think it's a very interesting goal. I think the idea of, you know, this sort of iterative learning process of, you know, putting information in and the next day having a robot that's smarter is fascinating. But I think it doesn't necessarily account for the fact that you know you're you you get out what you're putting in. And we've seen this with Chat GPT and this AI where you can constantly put in information and at some point you get this sort of closed loop where you're you're not getting something smarter, you're getting something that is actually worse than what you started with.

SPEAKER_05 41:03

In the research world, whenever we're uh talking about data and and things like that, we there's an acronym, there's a garbage in, garbage out. There's a crasser way to say that as well.

SPEAKER_04 41:14

Okay, okay.

SPEAKER_05 41:15

But that holds very true with the AI models and the learning. So to your examining point, if you could feed all the data into the AI model, then yeah, it could become a great surgeon. The problem is collecting that data, we don't have the technology to do that right now, as we mentioned. We do surgery with our hands, and there's things about that that we can't articulate then. And even if I said, Oh, I write down every step of the surgery that I did and exactly how much pressure I applied to each bite of a kerosene that I took or something like that. If we had that information and could feed it into a model, right, then yeah, we could probably make a robot surgeon. The problem isn't the surgical technology, the problem isn't the robotic surgeon, the problem is not the LLM to decipher all of it. The problem is how do we get the data? And the way we get that now is by going through 10 years of residency training and practicing.

SPEAKER_04 42:02

And that makes me think of the of the student who asked you, like, how do you know you can do that? So the AI's not asking you that. If you're inputting your data at the end of the day, how would you articulate that? It's something you just do naturally because you have that experience.

SPEAKER_06 42:15

Sure, if we had Elon here, he would probably say, listen, this is how we do it. You know, once once we have robots and and there is actual development of spatial intelligence and we can input that kind of information, it's only a matter of time. Maybe that's true. It's just uh hard to imagine the you know to to Dr. Jordan's point, the amount of compute you would need. It the a good analogy might be when they're doing full automated driving, right? Everyone or plenty of people feel comfortable doing that on a routine drive. The surgical analogy is a little bit more like having an automated driver in a hurricane with trees falling in a war zone, right? Because it's constantly changing. And in real time, you're making pinpoint decisions and adjusting protocols and and little things like pressure and and et cetera. Technically, you know, we're not anywhere near there right now. Right. But I know it's an exponential growing curve.

SPEAKER_04 43:10

So Yeah, Dr. Pendleton. Um, Dr.

SPEAKER_03 43:13

Nano had uh sort of sparked a thought in me, which is you know, this garbage and garbage out. We've all heard this, I think, going through our our training. And you know, one thing that we don't account for when we talk about, well, what what if we gave all this data, even if we collected the haptic feedback, the millions of little moments that go into us having a successful surgery, you know, what we we don't often talk about, but is a reality, is there every day somebody makes a mistake, something doesn't go right. You have, you know, the Dr. Death podcast, you have folks who are deliberately choosing to do incorrect things for a variety of reasons. And who is then going to be responsible for weeding that out? Who's making those choices? Because if you took You know, Chris Dunch's case log and fed that into AI, well, you're going to end up with a robot who now knows how to do all these surgeries poorly. Um, and not to not to point them out specifically, but I think we all most of us probably watch that podcast, and that becomes certainly a concern for absolutely what not only the guardrails, right?

SPEAKER_04 44:22

For that information, right, Dr. Mikhil?

SPEAKER_06 44:25

Yeah, I mean the other thing that's true is even if you fed in all the information, unfortunately, this may be somewhat uncomfortable, but there's a lot of unknown in medicine. So especially in spine surgery, a lot of it is hotly debated. The the clinical evidence is um controversial, and there's a huge gray area that we practice every day that just comes down to judgment. And perhaps an LM LLM can learn judgment. I'm not saying it couldn't, but if you gave it all of our latest, you know, randomized control trial data, there's still a huge gray area, and all of that's actively debated at the national meetings. So to the degree that um you know it knows more than any human or all of what humanity knows, we're we still don't know enough to exclude the art component of practicing. And I don't know how AI ultimately performs in that space.

SPEAKER_04 45:19

I I wonder too, when you're explaining to someone the type of technology that goes into what you're doing right you know today's surgery, how do you explain it to them to un so they can understand what's going to happen and and you know the role that you play?

SPEAKER_05 45:32

Try to dumb it down, not to be crass, but into what I believe would be layman's terms. So when we talk about navigation in the operating room, which is something I use a lot in my especially of functional neurosurgery, we'd say, Oh, it's like a GPS system for the brain and things that are you know more common in in the general parlance. Um things like that.

SPEAKER_04 45:53

Yeah, that no, that makes sense. Do you have a certain way that you're able to explain to patients so they understand what's going to happen and and I guess how you're using the current technology so that they feel as though, okay, wow, you're up to date, you know your stuff, and like this is you know, this is the best care I'm going to get.

SPEAKER_03 46:10

Yeah, I think you know, some of my mentors were really instrumental in helping me understand or see how they translated these things into layman's terms. Um particularly with nerve surgery, it can get very complicated because you know, these nerves are not just one solid structure, they're made up of thousands of little pieces that you're trying to put back together and then they have to heal and recover. And getting folks to understand it's not an instantaneous, we put this nerve together and everything's gonna be better can be very challenging. Interestingly, I find plumbers, carpenters, electricians are the best suited to understand a lot of these analogies because nerves are nothing if not electric cables. And so that really resonates. Um, and similar for the spinal cord, you talk about spinal cord injuries. This is this is all electrical transmissions. There's some chemical transmission as well. But in general, um, I tend to go with a lot of those analogies. Um, for nerves, we used a lot of like if you're standing on a garden hose, right? You stand on the garden hose, the water can't get through. That's how compressed nerves are. That's how do you fix it? You take the foot off the garden hose.

SPEAKER_04 47:25

Um and I always find like those kind of examples is like the aha moment, you know, where people go, oh, got it, you know, and that's that's sometimes you know the art of being able to articulate what you do day to day. I wonder too, though, you hear this term, or I hear this term, minimal minimally invasive. What does that mean today? Like what does that actually mean? I know. I was thinking it's a lovely phrase.

SPEAKER_06 47:49

Yeah. As Dr. Pendle was talking, I was actually thinking about something like that, where this is where AI can be a great resource for patients, especially. And I think I use it, and you and so do many of you, I'm sure, for things where you're not an expert in that field. Now I can come to that space, say it's in a meeting with your accountant. I would just be trusting what my accountant's telling me, but now I can come in pretty well informed.

SPEAKER_07 48:10

Dr.

SPEAKER_06 48:10

Pendleton mentioned earlier Google, I could have done that, but I really never did because it doesn't allow me to interact with the intelligence. So I've seen a little bit of this, and I think we're all gonna see a lot more of it, where patients come in with more researched and appropriate questions. But for the most part, we're not getting those questions, right? People say, Oh, it's done minimally invasively. Great. You don't have time in the meeting to say, do you know what that means? Or are you aware of the various options that are out there? Right. I think we're gonna start seeing that more, right? People saying, Hey, do you do this minimally invasively? If so, is that endoscopic or is that through a tube? Do you use neuromonitoring as a safety adjunct? Things they're just unaware of, which now, if you're a patient listening, you can put that into an LLM model and know that that's should be a routine part of your care. And you might want to ask your doctor those questions.

SPEAKER_04 49:00

Right, exactly.

SPEAKER_06 49:01

To get to the specifics, minimally invasive is a great topic for today because that's something we're always pushing the envelope on. And we've advanced a lot, right? Like if you go back just 20 years, this was all largely open surgery for spine surgery anyway. Um, and I think that's probably true for brain surgery, but I'll let my colleagues answer. We've gone from that those, you know, call it a four or five-inch incision in your neck or your back, somewhere along your spine, down to small tubular retractors, down to even smaller endoscopic incisions where it's camera-based, and that's gone a long way. We we would used to cut spine surgery specifically off for kind of patients over 70 years old, just say, look, it's it's too invasive. You can't, you're not a candidate. And your alternatives are not very good, right? Now with the minimally invasive procedures, it opens it up to a whole uh higher risk cohort of patients that will do fine with the surgery. And hopefully, you know, as long as they recover appropriately, um, they'll do really well clinically. And that adds, you want to have a long life, but you also want to have a high quality life, right?

SPEAKER_04 50:04

100%. Absolutely.

SPEAKER_06 50:10

That's one of our goals. And mainly they said, Let's let's get there for a lot of folks.

SPEAKER_04 50:13

All right. If we look ahead 10 years from now, what excites you?

SPEAKER_05 50:18

Well, to go back to what originally brought me into medicine and neurosurgery is, and to Brian's point about Elon Musk, what excites me is the ability to interface with the brain through surgeries to restore function and possibly even enhance function. So some of the stuff that Elon is talking about with Neuralink, I was involved in some research with that back during my PhD. It's always been about 10 years out, and I'm hoping at some point during my career we get to those through those 10 years. And hopefully my career is more than 10 more years. Um, so that that's what I'm excited for is to expand what I do as a functional neurosurgeon with treating movement disorders with electrical uh devices in the brain to just expand the role for that and improve patients' functionality and restore function in parapelagic patients, spinal cord injury patients, uh, people whose whose minds are there but their bodies are failing them. Right. That's what really drives me. And I hope to see more improvements in that part of the field.

SPEAKER_04 51:18

Yeah, I love that. Is there something that excites you, Dr. Pendleton?

SPEAKER_03 51:21

Yeah, similarly, there's a lot of movement in fields surrounding uh nerve injury repair. You know, how do we not just surgically um repair them in terms of technical abilities? That hasn't changed in quite some time. Some of the adjunct treatments have or the adjuncts that you can put in during the time of surgery have developed, but really at its core is trying to understand how do you make the nerve heal faster and better? How do you reduce the likelihood that you form painful neuromas that can be tremendously detrimental in someone with nerve injury? And that's all lab-based research. You know, there are some ongoing clinical trials, and I think that's really fascinating to me. Similarly, it's always been about 10 years out and 10 years out. Um, one of these decades, um, hopefully it will really start to move the field forward, you know, in leaps and bounds. Um, and I got into this field because I wanted to help people, you know, help people have better function, help people have better quality of life. And I hope at some point in the not distant future, the technology will sort of catch up with that desire and help me move my patients' lives in a better direction. All right, Dr.

SPEAKER_04 52:36

McHugh, I don't know.

SPEAKER_06 52:37

She just threw down the I mean, strangely in my world where it's it's a lot, uh, most of what we do is a lot of wear and tear, kind of mechanical stress on your spine that breaks down. We all kind of deal with it as we age. Sure. So the actual hope would unfortunately put me out of business. But as a for my patients and for you know family, friends, you know, if we could just come up with a medicine that would stop, you know, wear and tear, we call it osteoarthritis. And you don't need knee replacements, hip replacements, spine surgery, that'd be fantastic.

SPEAKER_07 53:08

Yeah.

SPEAKER_06 53:08

Uh, then I I wouldn't have a job, but it'd be the best way to be, you know, laid off essentially. Assuming that's not immediately on the horizon. Um, in our field, we've always looked to we're we're behind the times from our orthopedic colleagues who do knee replacements and hip replacements. They're motion-preserving technologies. You maintain the normal motion of the joint, even when it's worn out and needs to be replaced. In the spine, we're still doing immobilization procedures. We're fusing necks and backs. And we've known the whole time that's not the most physiologic uh solution. It's just proven to be much more difficult to come up with a big back replacement or a neck replacement than near a hip replacement. But we've always been working on it. Um, so hopefully that technology is developing now and continues to develop, and we we do have that down the road of back replacement and neck replacement where you're not quite as good as new, but but certainly the frame. Yeah. Yeah.

SPEAKER_04 54:04

I wonder too, uh, if we talk about, you know, we've talked about the emotional toll, the pressure, right? Um, what keeps you coming back? What makes you still love it?

SPEAKER_06 54:14

Yeah, I don't know. That's a great question. Should have burned out a long time ago. Um, I don't know. It really is a to Dr. Pendleton's point from earlier, where someone tells you, you know, if there's something else you could do, you should probably do that.

SPEAKER_07 54:27

Right.

SPEAKER_06 54:27

If you follow that advice and take a cohort of doctors who have, it really does sort of feel like a calling. And the idea of walking away from it is just a non-option, right? It's kind of what you do. And there are plenty of things in life like this, right? Like um, I'm thinking of athletes, painters, performers, all types of professions. And for me, it feels that way. There really is a love of kind of being in the operating room and actually physically doing the surgeries that offsets the ultimately the stress and the emotional wear. And and I although I do think if you are unsuccessful at um appropriately managing that stress, that we do see people depart the field, and I think a lot of it is they just never crack that nut. And if the stress remains, you know, a hundred percent, you won't come back. Right.

SPEAKER_04 55:16

Right. And what about for you with the, you know, obviously there's the pace you've been on call and having to like run around in here and the pressure and all of that. But what keeps the the joy and what keeps you doing it?

SPEAKER_05 55:27

It always goes back to can I help this patient in front of me with their with whatever problem they're coming to me with? And thankfully, uh in in functional neurosurgery, I can have huge improvements in patients' quality of life. If you take someone who's got a central tremor and they can't even pick up a cup to take a drink, and then we put a wire in their brain, and the next day they're back to you know, useful functional hand is incredibly impactful. And as a surgeon, it's something that I take great joy out of. And so while not every case has such a fantastic immediate outcome, it's those moments like, yeah, that's definitely got to fill your cup.

SPEAKER_04 56:05

That's gonna make you feel good and coming back the next day. What about for you?

SPEAKER_03 56:09

Yeah, I think similarly, you know, again, I got into this because I wanted to help people. And what I've really enjoyed in my time working as an attending is not only am I able to help people, um, but specific to the peripheral nerve work, you know, I'm one of a handful of peripheral nerve-trained neurosurgeons, not just in the Northeast, but but in the country, there's not but maybe half a dozen actually approved fellowships for this. So people who do this are few and far between. And what's I find really cool about that is when patients come in and they tell me they've been looking for somebody for you know months, years sometimes. Even if I can't make their particular problem better, even if it's not surgical, even if they're outside the time frame for repair, I can still make their make their life a little better because, well, now they have answers. We can have a conversation. And I think that's not knowing is terrible. There's a basic human desire to want an explanation.

SPEAKER_04 57:09

Yeah.

SPEAKER_03 57:09

And so that's been really great. That you know, obviously having patients who wake up and they're like, I can use my hand now, which also happens in some nerve surgeries, is it's phenomenal. But it's nice to have something else to draw on for those times when I can't make them better. Right, right. Dr. McHugh.

SPEAKER_06 57:27

No, I think one of the things that ties uh the three of us together, even though we practice different subsets of neurosurgery, is this idea of relieving suffering, but but pain is a central point for a lot of these people. And one of my hopes for the future, a lot of patients who have bad spine issues are riddled with pain, um, nerve damage can cause a lot of pain. And if someone like Dr. Jordan can have a technology at some point where if we can't fix it, he can at least alleviate the pain in a functional way. Um, that would be a great outcome for so many people. Because I, you know, as someone who doesn't live with horrible pain, I can only imagine, right? It's it's it's a nightmare.

SPEAKER_07 58:10

Yeah.

SPEAKER_06 58:10

And it's something that kind of ties neurosurgery together. It's not the only thing we deal with, but it's really there in a big way. And we haven't solved that problem. There's no magic wand to kind of take your pain away. And there's the possibility of that is out there. We just don't we don't have it yet. That'd be a big hope.

SPEAKER_00 58:28

My name is Siglinder, and I'm from Germany. Since I was very healthy all my life, I never expected to have a problem called um scoliosis.

SPEAKER_06 58:41

I had the pleasure of taking care of Miss Reeg several months back. Such a sweet woman with a really bad problem in the lower spine that uh is not uncommon.

SPEAKER_00 58:51

I used to take my bicycle every day. I like to go out. I went for my pilot license. As it got worse over the over time, I came back in here.

SPEAKER_06 59:00

Fortunately for her, we took her to surgery. We do uh these cases fairly frequently. Um screws in place into the individual vertebrae to act like anchors, and then you're using long rods to basically pull the spine into a straight position that's ultimately supported by these long rods that I call railroad tracks because you have two on both sides.

SPEAKER_00 59:24

I'm telling you, what a different, you know, I couldn't wait to get my normal life back and uh maybe go back to flying. You know how it is up there being all alone, just you in the airplane? And uh you just feel free.

SPEAKER_07 59:38

Yes.

SPEAKER_00 59:39

And I don't think if I had the pains I had before the surgery, I don't think I would have been able to do that.

SPEAKER_04 59:46

All right, so there is this glass bowl on the table for a reason. Interesting. And we've really gone in depth on a lot of different topics, and now we're not. So this is kind of like your speed round. You're going to literally take a random question out, and whatever that answer is, I want to hear it. Don't give it a lot of thought. Give me a real honest answer right away. Okay.

unknown 1:00:08

Oh, great.

SPEAKER_04 1:00:10

Drum roll, please. You're welcome.

SPEAKER_06 1:00:16

I just have to read this, right? What's a hobby that helps you decompress? No, I'm gonna be so cliche on this. If you say golf, so unfortunately, so golf. But here's why I think it's this is this is why it's important for surges, I think. So I picked it, I did play as a kid for a while and then I dropped it, right? Okay, and when I was training as a resident, it's we call it Q3 shifts. That means every third day you work the full day, starting typically at like 5 30 in the morning, and then through the evening, and then through the next morning until around noontime.

SPEAKER_07 1:00:55

Okay.

SPEAKER_06 1:00:55

And then you go home and then you just kind of rinse and repeat, and that's your lifestyle. And part of getting through training is obviously that can become onerous, doesn't allow for a lot of outside activities, and it can become depressing. And so as I started to fall into this bit of depression, I was like, I gotta find a way to get outside and do something or exercise. Sure. But you don't have a ton of energy either. You're tired.

SPEAKER_07 1:01:14

Yeah.

SPEAKER_06 1:01:15

So I went back to the driving range, and you're outdoors, fresh air, and fresh air. Yeah. The mechanical elements of the golf swing for people who like to think through problems, it's very, it can be very addictive and mechanical.

SPEAKER_04 1:01:28

You don't have to adjust to golf. I was joking. I promise. Bad question. You better not say golf. That's all I have to say. No matter what the question is, the answer is not golf. I'm just kidding. Okay.

SPEAKER_05 1:01:45

It's upside down.

SPEAKER_04 1:01:46

Oh, okay.

SPEAKER_05 1:01:47

Oh, what's your favorite sandwich? That's that's a very easy one. I'm uh pretty uh consistent with roast beef, pepper jack, cheese, lettuce, tomato, mayo on a on a hero.

SPEAKER_04 1:01:57

So it has a little bit of a LEGA kick to it with the pepper jack.

SPEAKER_05 1:02:01

Yeah, and sometimes I'll put like uh sweet peppers on it too. Whoa.

SPEAKER_04 1:02:06

Okay, okay. And Dr. Pendleton?

SPEAKER_03 1:02:10

Introvert or extrovert. Oh, I was just hearing on uh my main news source, which at this point is Instagram Reels, which is like TikTok for grown-ups, um, that there's actually a new, a new type of personality, which is a mix of those two, where someone is extroverted when they wish to be and introverted the rest of the time. So that would definitely be me. I can be very extroverted and social. Yes. I would much prefer to be home reading with my cat.

SPEAKER_04 1:02:35

I love it. I love it. Now, listen, as we wrap up today's neurosurgeons roundtable, I do want to thank all of you for your time, for your insight, for this amazing conversation. And we're actually gonna have a lot of other extras that we're gonna put up on social. I don't know if you're aware, but there are going to be more questions like this uh in your future. And for everybody at home, uh, we thank you so much for joining us today. And of course, you know, having such a thoughtful discussion hopefully really um resonates with the people at home who are watching this. Conversations like this really bring such clarity to complex medical conditions and the treatments that are really available to patients. So before we close, I would like to go around the table, ask each of our physicians to just share where patients can learn more about them and how they can schedule an appointment if they would like to connect with your practice. So, Dr. McHugh, I'm gonna start with you.

SPEAKER_06 1:03:26

Yeah, sure. We've got a website. Uh, I have a website called McQueeneurosurgery.com. Dr. Pendleton, Dr. Jordan, and I are all on the uh back and next specialistofnework.com website. And we have offices all around Suffolk and in Nassau County. Um, and you should be able to find out all about how to get in touch with us there. There's a main number and uh an online form.

SPEAKER_04 1:03:50

Okay, and Dr. Pendleton, if somebody wants to specifically you know schedule an appointment and get to know you.

SPEAKER_03 1:03:55

So that would be similar on the website. There's one central number, and I believe that central number, option three, is what connects to my admin who is responsible for getting folks on my schedule.

SPEAKER_04 1:04:06

Perfect. And I know you're busy, I do.

SPEAKER_05 1:04:08

You want me to give out my cell phone number? Yes. No, uh, I have the same main number as Dr. Pendleton. I think my uh option is option four. I only know this as I hear it in the background when the office staff is talking about it. Um but often, you know, once you get into seeing me, I I do give I do give my cell phone out to a lot most of my patients, and I'm I try to be as available as possible. Obviously, you can't always pick up the phone when you're operating, but you might be doing a podcast.

SPEAKER_04 1:04:38

So thank you again to our panel today for sharing your expertise and your story, and thank you to everybody who tuned in and watched our neurosurgeons roundtable. We appreciate you being part of this conversation, and we look forward to seeing you next time.