Detangle by Kinjal
Detangle is a podcast created by health psychologist and writer, Dr Kinjal Goyal. Each episode is a conversation with an expert in their field, as they dive deep into their journerys and experiences. The conversations are full of insight and a great way to hear, first hand, how the mind plays a pivotal role in almost everything that we do. The guests range from doctors, to writers, to those in entertainment and of course, those from mental health fields.
Detangle by Kinjal
Detangle with Dr. Chetan Pradhan
A conversation that doesn’t cease to inspire.
Welcome to Detangle, where we untangle the complexities of life one conversation at a time. I'm your host, dr Kinjal Goel, a psychologist and a writer. Our guest today is Dr Chetan Pradhan, one of India's most prominent trauma surgeons and also a dear friend. Welcome, doc. Thank you for joining me on Detangle today. For those who don't know, you tell us a little bit about your scope of workplace.
Speaker 2:Thank you, kinjal. Hello everyone, I am Dr Chetan Pradhan. I'm basically from Pune. I did my MPBS as well as MS from BJ Medical College and later on joined Sanchez Hospital after working with Dr DD Tanna in Mumbai for a year and since then, for the last 28 years, I have been doing exclusive trauma surgery. So by trauma I mean I deal with all sorts of accidents, injuries, falls and various problems with the musculoskeletal system. So I'm an orthopedic surgeon to begin with, specializing in trauma surgery. That is what I do the whole day and sometimes the whole night.
Speaker 1:Well, let's get started with our formal questions. Let's see where they lead us. How did orthopedics and trauma come about for you? Was it something you always planned or did it eventually happen?
Speaker 2:No right, since my school days I was very fascinated and completely floored by my family doctor, and since then I wanted to be a doctor. So when I joined BJ Medical College, my first stint into the operation theater in Sassoon Hospital was an eye-opener for me, because that was the day when it was clear to me that I would be a surgeon, and that is what was interesting as far as the career was concerned. But then, later on, when I did my internship, that was the time when I had to see a lot of orthopedic patients and that is how I started liking more and more orthopedics and I decided that, orthopedics being a specialty in itself, instead of doing general surgical work I would go into orthopedics. Therefore I joinedopedics as my post-graduate course.
Speaker 2:I passed my MS, my residency was at Sancheti hospital and there was a lot of trauma in those days that Sancheti was treating it still is. But then I went to Mumbai and worked with Dr DD Tanna, who is considered like the god of trauma in the country as of now. So through him I got really interested in trauma. The most important advantage of being in trauma is that it is never, ever boring to do trauma surgery. It usually encompasses everything from head to toe. So each and every case is different, each and every patient is different, and there's a lot of variety in your work, so you don't ever get bored of doing the same surgery again and again. And that is how I started liking trauma. I developed more and more expertise in it and I came to do only that.
Speaker 1:So you were wandering in the right direction and eventually found your path.
Speaker 2:Yeah, I would say it's thanks to my mentors, my teachers, who directed me in the right path.
Speaker 1:Fabulous. So, doc, this is a part which interests me about your work. Trauma as a field has a huge overlay with psychology. You see patients and families trying to kind of come to terms with what has just happened, and it's usually sudden. So tell us about your experience with the emotional trauma that comes along with the physical one yeah, I think that's a beautiful question, because trauma is not just physical it is more mental, to not only the victim but also the family, true, so so it will involve the entire family, not just that patient.
Speaker 2:unlike any other disorder, right, it is very, very sudden. You said absolutely right. Nobody knows when an accident will happen. The next moment you wake up you are in a hospital bed, so you are not really prepared for it. And that is the difference between other ailments and trauma. Basically, the person who is on the hospital bed is traumatized physically as well as mentally, so he is primarily repressed. We deal with a lot of depression on a daily basis. Very often, as soon as you declare to the patient that you've undergone an accident, you have broken a few bones here and there, the first thing, that first thought that comes to his mind is probably that's the end of his world and he'll never be the same again.
Speaker 2:And that is exactly the emotion which he conveys to his family and the family also starts thinking on those terms. Especially if it's a child, especially if it's a girl, unmarried girl, then the family starts getting more and more depressed. And that is where my role comes in, or the role of a psychologist comes in, that the first thing that we need to tell that today, in today's world world, today's era of modern technology and high-tech orthopedics, it's not the end of the world. Most of the trauma victims can make a normal again. So depression is the first sentiment. Despair or, you know, all hopes move on at us. That is second emotion that we deal with on a daily basis.
Speaker 1:Right, so any injury, any pain, any surgery will obviously have an emotional ramification, like you just said but do you see any difference between elective surgery as against emergency surgery when it comes to emotions?
Speaker 2:Yeah, elective surgeries are different, for example, say, spine surgery or a knee replacement.
Speaker 2:So there, the patient is suffering from pain for a long time right that is why he comes to me and when I advise him, say you need a knee replacement. It is this kind of an operation and it's going to get you back on your feet soon enough. So he's mentally prepared for it. He's ready, he knows that this is something which I need to do to get rid of my pain, so he is totally prepared for it. In trauma it is exactly the opposite. He is totally unprepared, so his mental capabilities do not come to terms with that injury or the treatment immediately. He takes a long time and some people take really long time to accept, first of of all, that this is what has happened, this is what will be required to be done, and God forbid if they really end up with significant disability. Then you know, there's a lot of depression that sets in, sometimes pathological, or sometimes they even become suicidal.
Speaker 1:So you come face-to face with the role of the mind in post-operative healing all the time, but do you feel that some patients need more analgesics if they show signs of depression after surgery?
Speaker 2:Absolutely. This is a very true phenomenon and this is what the mind does in terms of having a fantastic effect on your body, both positive as well as negative. So what we call a psychosomatic is a very true pathway. So I have seen number of patients who are very, very positive you know, there are certain communities, I would say who would, or patients who blindly trust you.
Speaker 2:They'll say I know I have broken a leg. Do whatever you want to do. Whatever you do, I'm going to walk in a few days. So they begin with a very positive outlook. Though the injury is the same, your outlook matters the most in terms of recovery. Exactly opposite are those patients who keep crying from day one. They do not understand that they can become normal again and they take almost double the time for recovery as compared to those who would be positive from day one. They recover in half the time. Their wounds heal in half the time. Their bones heal faster. Those who keep crying end up with complications, delayed healing both the wounds as well as the bones, and something goes wrong with them. Basically, there is a huge amount of delay and that is purely because of the mental outlook. So I would definitely agree with you that mental outlook does play a big role in recovery and you see the whole physical ramification.
Speaker 1:I mean, what we see in the mind is what you're seeing on the body, so I'm sure it's a very strong visual yes a dog. You've risen in your profession. You've reached the apex slowly but steadily. I'm sure you've seen a lot of hurdles in your own life. Tell us about those.
Speaker 2:In terms of my career, I would say there weren't many hurdles, except the fact that one really needs to work hard in this field. You need a lot of patience, you need a lot of perseverance, because trauma is something which is an emergency always, so you need to be working 24 by 7. Fortunately, I have had very good teachers, very good mentors who guided me and made me what I am today. But, to name a few hurdles, most of them are personal ones.
Speaker 2:I found very little time for my own hobbies or myself, I probably could not give enough time to my family, my child, my son and before I realized that he grew up and now I feel probably I could have given him some more time. So there's a lot of sacrifice that you need to do on your personal front being in this line. Second thing is you need to be really updated.
Speaker 2:So, for example, what I learned as a resident is now in the museums. So the technology changes a lot. There is a lot of advancement in the science almost on a daily basis, so need to keep upgrading, updating. You need to be studying very hard almost on a daily basis because you need to know in order to give it back to your patients. So those were the hurdles the third thing was.
Speaker 2:Trauma in those days was done by each and every orthopedic surgeon. So to portray trauma as a super speciality was really very hard. Everybody used to ask me what different are you doing? Everybody is doing. But then my mentor, dr Sanchity, told me no, trauma is a speciality. You do that well and you will be a good trauma surgeon. In fact, let me tell you that trauma is one of the most intricate and difficult surgeries in orthopedics because every case is different. There's no set protocol, there are no SOPs. You open up and you decide on table what to do, what is the best for the patient. So it took me quite a while, almost more than 20 years, to develop this specialty and to make it as a super speciality in orthopedics Fabulous, unlike the West, where it already was. A super speciality in orthopedics Fabulous, unlike the West, where it already was a super speciality, True.
Speaker 1:So, doc, like you said, in trauma surgery the stakes are high. The expectations, the grief, the relief everything is running high, not just for the patients, but for you also, as the doctor taking care of them. How do you deal with such intense emotions on a daily basis? How does it affect you personally?
Speaker 2:So initially, in the early part of my career, it used to affect me a lot seeing especially young children or you know, red winners suffer, getting disabled. But then, as the science advanced, as we saw some good outcomes coming out of improved technology, improved techniques of surgery, this aspect has changed. So today I can confidently tell my patients that don't worry, you are not going to lose your limb or life and I can, with my expertise, my science, take care of you to an extent that you can go back to your work Right, so this aspect has changed Emotionally speaking?
Speaker 2:yes, it does affect you. It does take a toll on your mental health a lot, because whole day you are just hearing negativity. You are dealing with only the negative vibes. You are hearing pain everywhere around you and therefore it tends to make you kind of negative yourself. So I used to meditate, I used to. Your outlets are your friends, your family. You tend to spend quality time with them and get out of it. But then over the years these emotions start becoming a little blood, to be honest with you. So now today I'm not really festered or bothered by looking at a grotesque wound or a bad, a bad patient. I need to. I've told myself that I don't need to think, I don't need to be emotional. If I have to help that person, I have to keep my emotions away and I need to concentrate on how best I can apply my knowledge. So there is nothing emotional about it. It's all about protocols and it's all about science right.
Speaker 1:Has there ever been a moment that you would define as the most?
Speaker 2:joyous in your career, any case that comes to your mind. You know there have been enough instances where I have to leave a party or leave a ceremony, a family function in the middle of the night and go and attend to a crushed food or a polytron. At that time you feel bad, kyaare. I have to leave everything and go. But then you know, once you reach there, that your being there is going to make a huge difference in his life. And then you know that perhaps he might die in the next half an hour. And then, of course, it's a teamwork, it's not just me, the whole team gets on.
Speaker 2:And a few months later, when he walks back into your clinic without even realizing how he was, when he walks back into your clinic without even realizing how he was when he came, he or she, that gives you a different high, let me tell you. It gives you a completely different high than any substance on this earth can give me. And that has been my motivation. I am sure it is the motivation for any surgeon, any doctor, for that point.
Speaker 1:How wonderful. That brings me to another question, doc. How often do you see substance abuse causing intense trauma due to negligence or accidents, and is this on the rise amongst youngsters now?
Speaker 2:yeah, a very pertinent and a very useful question, because in the last 28 years that I've been in practice, I see this rising exponentially. And this is really a bad thing, because all our youngsters, all our teenagers are I say all, because it's more than 50% Previously we used to see only only, you know, boys drunk and getting into accidents. Today we see even the girls getting drunk, getting high, and it's not just alcohol, let me tell you. Substance abuse is rampant Smoking, weed or joints or everything is going beyond control in our young population and every single day or night, to be specific, we see accidents because of that, ghastly accidents, injuries that can actually ruin their lives at a very tender age and at that time they probably do not realize the gravity of the situation.
Speaker 2:And when they do realize that she or she will never be the same again, it really hits them very, very hard. They are not able to mentally cope with it. They get suicidal tendencies, the family is distraught and everything goes for a toss, and this is completely avoided. Unfortunately, it is very much on the rise and it is very, very common amongst college girls and boys.
Speaker 1:I think this needs to be spoken about more. I'm glad we're talking about it now because there are some things which people seem to have accepted that this is what the generation is doing, but, like you said, it's avoidable and it should be avoided no, I don't think it is acceptable.
Speaker 2:The parents have to put their feet down and say look, there is a limit. You have to be home by this time or you have to stop when your brain tells you that you know you are losing control. So those traditional teaching that we had in our days is still very, very valid, because people do not say, people see only the social side of it, people do not see the this negative side of it which we do. So when you see uh, boys and girls from very good families, educated families, uh, so-called high class families, indulge in all this, get into real bad accidents and injuries, you feel really bad that this shouldn't have happened to this boy or this girl true, doc.
Speaker 1:You and me come from a generation when things were simpler, like you said, but they were more isolated. Also now, with social media, whatsapp, etc. Things travel super fast. Now tell me, do you see this affecting the atmosphere in your casualty or emergency room? Does Does this increase the pressure on the doctors?
Speaker 2:Yes, very much. This is probably the bane of technology in modern medicine today, because I'll just give you an example. One person comes with a fracture. His friend as I'm seeing the x-ray on my viewing box takes a photograph from that and circulates it on his social media. People take multiple opinions right away. They get it right away and even before I can counsel him about the management, he knows what is to be done.
Speaker 2:But typically any fracture or any problem has multiple solutions. So I have to first of all take into account all those solutions before I even speak to him. I have to give him all those choices. Not all of them would be pertinent in his scenario and because of this tendency, there is a growing disbelief or mistrust, which affects the doctor-patient relationship. Somebody who doesn't indulge in that, for example, a village farmer who may not have access to this. If I tell him, okay, you have a broken bone, I'll fix it, he'll believe me, he'll be happy about it, he will be positive about it and he will get out of it within no time.
Speaker 2:But this I am not against taking multiple opinions. That is the right of every patient, but it need not be all the time on social media. Every piece of knowledge on the internet need not be always accurate, and there is a huge role of the treating doctor to correlate that piece of information with the physical state of the patient lying in front of it. So it's not. I mean, unfortunately, the era of Google experts, medical experts is on the rise, but then not everything given on Google may be applicable in your scenario.
Speaker 1:True. Do you also feel that the profession is under threat? I mean personally. Your safety is not something you can take for granted anymore, but how? Do you recommend this be taken care of by hospitals, by juniors, by other doctors. Do you have any suggestions?
Speaker 2:taken care of by hospitals, by juniors, by other doctors. Do you have any suggestions? Yeah, that's a very, very hot and burning topic, as you can see, it's there on newspapers every day and primarily it's it's a problem with both the sides. First of all, let me tell you there is a very shift in the perception of the patients in terms of the treatment that they get. That may be because of the rising costs or you know, the plush posh hospitals that they see around, but then there is an unfortunate expectation that in whatever condition your patient is brought in, he should walk out absolutely brand new. So this is not. This is a human body. This is not a car which is damaged which you know comes out of a body shop looking brand new.
Speaker 2:So the patients, their relatives, have to understand that medical science has limitations. Every doctor prides his level best to get his patient to do well. There is, I don't know, any single doctor who would purposefully harm his patient. It's not possible. So the expectations from the patient's point of view are rising that he has to become non. If those are not met or if something goes south, for example, if the patient dies, then he may in spite of having gone down because of medical reasons or natural reasons, the blame game starts. The blame is like he died because the doctor was negligent. Now, this need not always be true, but this is what is happening.
Speaker 2:So if I start telling the relatives that your patient is critical and he may die, there are mopsies, there are adverse reactions, there are very negative connotations to all this. Instead of trying to understand what I am trying to say or what the doctor is giving you, the details about the reactions have become very different. The reaction, first reaction, is why, then? What are you doing? Why can't you cure it? I am. The other round is that there is probably a lack of communication also. So if the communication channel is good, it is very clear, very honest, then this can be avoided. So right from the beginning. If there is a healthy communication between the patient, the relatives and the doctor that this is how it is, then understanding becomes much better, these untoward incidences are avoided and the doctor patient relationship also remains on a better note. But unfortunately this is not happening now and it's getting the. The sanctity of this relation is threatened on a daily basis.
Speaker 1:So the respect, the kind of deference that doctors enjoyed earlier is now under threat, because people now treat this as a paid profession. I've paid your fees now you do what you need to do and you're out.
Speaker 2:Yes. So it's looked at like a business, and I would say rightly so, because the profession is also under consumer law. So, if the law itself is saying that you are a consumer and this profession is under a consumer law, so you give money and you should get your money's worth, then the society will also perceive it in the same manner.
Speaker 1:So there are many, many layers of subtle changes that need to be brought about, like you mentioned, death Now, when a patient succumbs to his or her injuries, the next step is the hardest for friends, family and the doctor the news that their loved one has died. How does a doctor learn to break this news? Are you taught in medical college?
Speaker 2:Oh, that's a very good question. Unfortunately, the medical curriculum does not include counseling. There are some changes being incorporated currently, but when? In almost two years ago, there was never anything in the medical syllabus as to how to break the bad news. So everybody, every young doctor, every young resident, just learns from how his senior does it. Okay.
Speaker 2:So my resident will sit next to me when I'm declaring death to a relative or bad news to any relative, and he'll observe me and he'll absorb that and he'll do the same. Unfortunately, there is an urgent need for psychologists like you to go and teach us, teach all the young doctors, as to how to do proper counseling, and this not only involves declaring death but all sorts of counseling, you know. Right.
Speaker 2:So if there is a way of, or a scientific way of, telling the family that, okay, your patient has been involved in a serious accident, then we would always welcome.
Speaker 1:There always is. Actually there are the right things and there are a lot of wrong things also.
Speaker 1:I mean when I'm talking to any consultant in any field, my first line is you need to unlearn some things first. One of the first things that doctors say to their patient when they're very relieved to see there is nothing organically wrong with them words, nothing is just stress. Now that is the first line every medical professional needs to unlearn. You cannot say it Even if a patient has see from a doctor's perspective. You know that. Okay, thank God it's not a tumor, thank God it's not a spinal issue and the backache is because of your work stress. So your relief is coming out as demeaning or not validating the patient.
Speaker 1:What the patient hears is it's nothing, when it's actually something, yeah. So somebody said oh, the pain is in your head. And the patient said but I also am in my head, right, so I'm living with the pain. So that's where I mean things can start no, but I mean you are right there.
Speaker 2:Then there is a dictum that you cannot call any pain psychosomatic or being in the head, unless you have ruled out absolutely everything possible right and that is an answer to your previous question also what is changing is not just this feeling of mistrust, but that is why doctors are becoming more and more and more defensive, because they are worried about litigations nowadays oh yes yes so I see this from both sides.
Speaker 1:All the time I see patients who have been told that, look, something is wrong with you, we need to investigate, and endless investigations are carried out. By the end of it, the patient is tired, fatigued and says, look, I'm done. On the other hand, I've also seen patients who've had symptoms which the doctor could not diagnose in time, said okay, this is stress. They oversold anxiety. It turned out to be something purely organic.
Speaker 2:So you have to have a proper balance of both. True, and for that your clinical training, your clinical acumen, your gut feeling gives you far more insight than any other investigation. So I'm personally very conservative on investigations. But clinical judgment has to be there. Your clinical exposure tells you that this has to be something, and not just psychological.
Speaker 1:True. A very important question from me to you, doc. The mental health of medical professionals is at risk worldwide. A high IQ doesn't mean a doctor can't suffer just like anybody else. Do you see more colleagues reaching out for help for emotional concerns now, or are things still waiting to change?
Speaker 2:Yeah, things are changing. They are far better than what they were before. What I see as a change is a lot of young doctors residents are is a lot of young doctors, residents are getting burnt out, stressed out. You must have read the recent suicide by a top-notch medical resident. So this is happening Now. This is happening very, very frequently and at a very alarming rate. So what has changed? The residency has almost remained the same. The workload was always the same, the facilities were always the same. Nothing has changed. But the perception that I am being tortured or I can't bear this, I can't come out of this, is changing. So I feel that in the residency phase itself there has to be some counseling, psychological counseling, which must be done to the residents Because they are unable to bear the stress of even medical training, which is very. I see a lot of young residents and doctors get into alcohol abuse, sometimes even substance abuse. Smoking is rampant. If you see their parties, everybody talks about doctors' parties going and that's because they are dreaming for stress relief. Right.
Speaker 2:But one must learn to deal with the stress, because stress is an inherent part of our profession. By good means, scientific means like, say, meditating, hobbies, reading and going to a counsellor if need be, and that is a change I see happening. So I see quite a few of my colleagues resort to psychological counselling if they are under stress. They are more open about it, they talk more openly about it, we amongst ourselves to definitely discuss. And then one thing leads to another. Somebody says okay, you go and meet this person, he'll help you.
Speaker 1:So that's good. At least we're moving in the right direction. Doc, if there was some advice you were to give your own 16-year-old self, what would you say?
Speaker 2:16-year-old I would say drive slowly and carefully, because I've seen some ghastly accidents at that age and I would say that you know. Achieve a work-life balance. Try to get into a situation where I would have been able to manage my time in a better manner. What happened when I was 16 years old and later on during college life was that you study your heart out. You get into medical college and then into your profession and work was always the worship. But today, if I see the younger generation today, I think they are far more smarter than what I was at 16 years. They know how to balance their work and life very nicely. So that is what I would like to change.
Speaker 1:Nice. We've all heard of a physical first aid box, a box in which we keep our band-aids, antiseptics, etc. I'm sure you know it better than all of us. But if you were to have a mental first aid box, something which would just make you happy anytime you opened it, what would you put in your mental first aid box?
Speaker 2:the first thing I would put is my favorite playlist of songs and music. Second, a list of books because I am, I like to read a few good movies and enough phone numbers of all my friends where I could just go and unwind myself. And at the end, which is probably more important, is the number of a good psychologist whom I can go to and ask for help.
Speaker 2:I love the sound of these books, so I would not hesitate to give your number at the end of that list so that I can go and ask for him.
Speaker 1:Well, that's fantastic. Before we come to a close of this discussion, I leave the floor open to you. Is there any question you would like to ask me as a psychologist?
Speaker 2:Yes, there are two burning issues that are going on right now. We did deal with it partly. One is issues that are going on right now. We did deal with it partly. One is training young doctors into looking at the psychological aspect of the patient as well. So I think you all, as a team, should do something about it. I'm talking of doctors only, not the general population, because they need to be trained very early part of their career. And the second thing is getting rid of this substance abuse issues in the younger population, because I'm sure it's going to blow out of control in no time. And there was a movie called urta panjab, oh yes, and it's not just panjab. I see it happening everywhere, absolutely. So these are the two things which you need to address on an emergency basis. So please do something about it. How do, if I have to ask you a question, how do you declare demo?
Speaker 1:I think one of the first things people need to learn is how to read a room. There is no right or wrong process, there is no user manual, there is no guide which will work for every family. For example, if you are declaring death to a family which is more than three people present and you know that they have each other for support, it's always best to give the details, announce the news and walk away so that they have that little time to be with each other. But if somebody is all alone let's say it's a couple one has just passed away, the other one is alone. Stay with the person.
Speaker 1:It's okay to step out of the doctor's shoes at that moment and be just a human being present with them till somebody else walks in. So these are simple ways of reading a room. See how that person is reacting. Are they having a fainting spell? Are they taking it? Well, offer whatever little support you can. It could be a glass of water. But again, read the room. If there is somebody else to bring them the water, step away, because that professional line is a very thin one. So every doctor has to know how is the person reacting to the news? You will break the news in a formal, objective way. What happens after that is very important. How long you stay in the room is very important. So this is what doctors should learn.
Speaker 2:And I think you know you develop that sense, that gut feeling as you do it more and more, that okay, in this scenario, this worked okay, and then you build upon it another thing that is very common is that patients who are involved in major accidents so made by major I mean a fellow passenger has died in that accident, that kind of a major accident they tend to get a lot of nightmares. That's a medical phenomenon, yes, and there is medical treatment adequately to deal with it, which primarily involves sedating them so they sleep without any drinking, but still they do get it. How do you advise a psychologist's approach to deal with addiction?
Speaker 1:So there are two things at play here, and this happens very frequently with small younger patients.
Speaker 2:They keep waking up in the middle of the night remembering those incidences or getting jittery about.
Speaker 1:There are two things at play here. One is the survivor's guilt. When you have survived when somebody else didn't, and if there are more than one person who has died in that particular accident, you feel worse that it could have been me, maybe it should have been me. So that is one thing at play. The other is, of course, ptsd post-traumatic stress disorder. Now, post-traumatic stress disorder can happen irrespective of somebody else dying in the accident or surviving.
Speaker 1:Medication is the first step, always the first step, but therapy has to be started soon after. Unless the patient understands what is happening, they will not be able to get over it, because ptsd presents itself in very physical ways. You have a racing heart, you suddenly have night terrors, like you said, blood pressure will rise. So people will feel that something physically is continuously going wrong with them. Unless they come to terms with the fact that, okay, this is happening, but this has an emotional origin, they can't deal with it right. So you need to have a psychologist involved. The minute you identify ptsd as a surgeon, you need to step away. What people do is they try to step in and they try to do what is not their job. You're not trained in psychotherapy. As a surgeon, you're not supposed to know psychotherapy.
Speaker 1:So the best thing is identify and get somebody else involved so that they can deal with it in the right way.
Speaker 2:Yeah, that is what we commonly do, but then by the time you experts come in, how do I deal with it? Medication, medication, okay.
Speaker 1:Till then it is medication, because it's not usually that long till you can find a psychologist. But, doc, this has been a phenomenal conversation. I mean I think we've covered everything from your younger years to the younger years of the doctors practicing today. We have covered so many important topics like declaring death to substance abuse. I mean what we see as substance abuse is something affecting a whole generation, but to see it practically breaking bones or practically causing trauma which people may not recover from. I think this perspective needs to come out. People need to understand that it could be them on the wrong side of the scalpel very soon. So thank you so much for taking the time and thank you so much for sharing all this.
Speaker 2:It's been a great pleasure to do this.
Speaker 1:Well, we wish you all the very best in your career.
