Episode 15: Jamie O'Neil, MD

Dr. Jamie O’Neal shares his path into medicine and surgery, the moment he realized surgery was the right fit, what it really takes for a hospital to function as a trauma center, why prevention matters, and why communities often underestimate the value of round-the-clock trauma readiness.

Transcript

SPEAKER_04 0:13

Well, hello, and welcome again to Medical Mastery, the podcast of the Emerald Coast Medical Association. I am your Amaranthine host, Don Davis MD, and I am very pleased to be here today with a friend, a surgeon, and I think our youngest board member now for the Emerald Coast Medical Association, Dr. Jamie O'Neill. Dr. O'Neill, thank you for being here today. Good to be here. It is good to be here, okay? And you're going to prove that here by talking about everything that you know, okay? So it's a very small repertoire of information. Well, you know, Chris will fill in some of the gaps here, hopefully. That's what production does here. And by the way, shout out to Curiosity Marketing for making us sound smarter than we are here. So thank you, Chris. Um so uh, Jamie, welcome here. Welcome to Emerald Coast Medical Association, our uh podcast studios here, uh, which should be familiar because this will also be our um board meeting room. Uh spoiler alert.

SPEAKER_02 1:07

Um so why don't you start off by telling me where you're from? Uh born and raised in South Louisiana, right outside of Baton Rouge. Um, spent most of my life there until uh after medical school. Went from LSU undergraduate medical school at LSU in New Orleans, and then we moved out from there. And uh after training, we did try to move back home for a couple years to work and less than ideal job situation, and then uh through some mutual acquaintances from Louisiana, found some people here and moved here. All right.

SPEAKER_04 1:42

Well, uh look, this is great, but uh anytime I get a chance, it's uh being a fellow Louisiana person, um I I love to talk about it. So let's go back a little bit to um a place that I called home for a while, which is LSU. Um there's a time and a place for everything, and it's called college. And you and 35,000 other friends is a good place to go. So um tell me about what you majored in.

SPEAKER_02 2:03

I did biochemistry with a chemistry minor was ultimately what I finished in. It was not what I started in. I kind of had a meandering path and thought I might at first do something in uh sciences, and after an undergrad job in a research lab, I realized I hated benchwork.

SPEAKER_04 2:21

It's totally different than the actual science that you learn about, right? Totally different. It was a lot less exciting, a lot more Doing science is different than learning science. Yeah. And and it's also kind of elucidating because um, you know, that that whole process was similar to me. I had biochemistry degree with chemistry minor and some other stuff. Um it's that, you know, um we kind of get this idea that science is just facts, and really science is a deductive way of learning out whatever the truth is. That's that was kind of um an interesting process to learn along the way that you're not just learning disjoint facts, you're kind of learning how to think about things. So um, so that's one of the things that I learned down at LSU. But um, there's also some other things to do at LSU. Uh that's so um did you find yourself um how do I put this uh distracted uh while you were there?

SPEAKER_02 3:12

Uh just like most other people at LSU.

SPEAKER_00 3:16

LSU, yes.

SPEAKER_02 3:17

Yes. Uh big football scene, big party scene. So I had my share of fun, but I did finish college in four years. So now you're just bragging, okay?

SPEAKER_04 3:24

We get it, Mr. Latina. Um so uh I I found that pretty interesting relatively early in my career at LSU that um I would come home or come to the dorms or something like that after having been to class and realize that many of my friends had not gone to class or anything like that. And I was like, oh, okay, so maybe there's a little something different about how um my thought process was about the whole thing.

SPEAKER_02 3:50

Uh you probably had the same thing in Louisiana, but they had the topp's scholarship. Yes, indeed. So I had the topp's scholarship, which was great, because otherwise I was gonna be paying for college. So I I always had in the background a financial incentive as well, because I knew I was gonna do something more after college, and so in the back of my mind, I was trying to milk the most I could out of the top scholarship, you know, hence four years and such, but I had my share of fun during those times. It wasn't all books and whatnot.

SPEAKER_04 4:19

No, it wasn't. Um now uh what did you think was um insightful or what what did you learn from biochemistry that that um you think was kind of new and innovative at the time that maybe you didn't know going in?

SPEAKER_02 4:33

Um that's a broad subject, yeah. Uh I don't truly know how I ended up falling in biochemistry at first. I at on the surface uh I meandered, I knew it was in the sciences kind of undecided. I looked at engineering for a while, and somehow I was like, I like biology, I like chemistry, and biochemistry was an amalgamation. Yeah, so it seems like great. And uh I I really did love it. I thought it was great, like you're saying, knowledge. But when you try to apply that knowledge to ongoing research and discovery, it's a grueling process. And as I didn't enjoy the grueling process, but uh a lot of the traditional stuff you would learn in the sciences, scientific method, studying, researching, and then trying to apply it. It you know parallels to a lot of what's medicine, no?

SPEAKER_04 5:22

Yeah, you know, I I I I do think you can kind of extract some data points there that would lead to a future career in medicine, and not just from knowing the substrate of the amino acids or anything like that, but but but actually kind of learning how to think about things that I think would kind of promulgate itself in the future.

SPEAKER_02 5:40

I uh I found that a lot of the actual content from biochemistry isn't very helpful in the day-to-day of my job, but the ideas that were all overarching ideas, and uh always had a medical background from that standpoint. I grew up in a small town. Um my grandfather was a family physician. Oh, okay. He graduated from LSU New Orleans in 1962. Nice I was a few years later than that, but uh I was always at his clinic, which was very close to my home growing up hometown. Um, and so I just grew up around him seeing that. Um probably uh, you know, family medicine is now different today than it was decades ago.

SPEAKER_04 6:18

Yes. I mean, especially that small town family physician, because I mean that's kind of a catch-all. You're gonna be doing everything, you're gonna be birthing babies, you're gonna be taking care of sick kids, probably even home calls.

SPEAKER_02 6:30

I mean, it's it's uh I went on home calls with him whenever I was young. Just he took me along and he stitched me up many times, too. Yes, exactly. Sometimes you get paid in like milk and eggs and other things like that. He's got many stories about milk and eggs, and I think to this day, my grandmother's still alive, uh, 90. But to this day, people still bring her produce from time to time and random game animals that are.

SPEAKER_04 6:52

Of course, yes, exactly, as as South Louisianians do. Um so um, so you went from there, maybe you had your mind's eye on either uh maybe a scientific course or maybe even medicine kind of dripping there in the background. Um take us from you doing, and and I should say, uh I worked in a biochem lab too afterwards. So there's a lot of very similar to it. I understand that concept of, oh, this is not nearly as cut and dry as you would think it would be. It's a lot more exciting on TV. It is, yes, exactly. Real science is not all that much fun. Um so you go from there and you decide to go into medical school. Um tell me about that transition point or that that thought process where you said, like, no, I think I'm gonna try this because it's it's you're gonna start going over a lot of hills and humps to do that.

SPEAKER_02 7:38

Somewhere, I forget exactly when, end of second year of undergrad, third year, I realized that I wasn't gonna be doing benchwork research for whatnot. And so I started looking at what I can do, and then that whole time frame trying to keep school within four hours from scholarship perspective, or four years from scholarship perspectives. It's like, what can I do? And so you change majors, you lose a bunch of credit, and I knew I was always gonna do something more grad school-wise or assumed I would. And um, medicine being a familiar background, I was always peripherally interested in it, and so I started looking more in that route. And so at some point around then, I was like, I'm gonna go this pathway, and so you still was able to maintain a biochemistry major, and then minor in chemistry wasn't a far stretch from that standpoint, and so I tailored it to that direction.

SPEAKER_04 8:24

And yeah, you know, once you start down that pathway, then you this is what I I kind of think of as the cursus honorum in terms of how you're gonna go through life from there, because it's not really handed in front of you how you apply for medical school. I mean, you have to start looking it up and you have to research, and it's there's nothing that's fed to you. You have to go, oh, I've got to go get this record or go take this test. I mean, to this day, I I don't even know how I figured out how to take the MCAT. I mean, there's there's information available, of course, but but you have to start looking this stuff up and you have to start moving towards it. And you've got to start saying, geez, you know, while you guys are doing this thing over here that might be fun. I'm gonna be kind of pursuing this other thing.

SPEAKER_02 9:06

And uh, hindsight now, uh, you know, it's not really a regret per se, but knowing that I went to medical school, I wish I would have done a different major that would have been more useful. You know, whether it's a language, or something like that. Or just something, you know, but it like I said, it's not really a regret, but uh I really did enjoy college and no knowing I went to medical school, but at that point you switch and then it's like, oh, you're gonna add an extra year. It's like, well, I'm not doing that.

SPEAKER_06 9:32

No, I know better than that.

SPEAKER_04 9:33

Uh yeah, two of my favorite courses uh uh undergrad were um Shakespeare, uh which was fantastic, and then a history course that I had taken, which was really, really one of my I I love to read too, that's something I really like.

SPEAKER_02 9:46

So one of my favorite course. And so you read the whole series up until that time, which this the last one wasn't out, but then you read all the uh subtext and other yeah, yeah, yeah. It uh it was more of just a by that point, it was just an easy credit. But it was entertaining.

SPEAKER_03 10:16

I'm not sure I got any extra credit for doing the Shakespeare course, to be honest with you, but it was something that I wanted to do. It's not as uh in-depth as Shakespeare, but it was just one of those like uh I don't know.

SPEAKER_04 10:24

I think I think there is, but you you know, I I also found some excuses during that time, like with some of the courses that I had taken to read things like Beowulf, you know, things that I would never just pick up on a whim and like, you know, I guess I'll just pick up the Iliad and see what's going on there. No, you needed some kind of direction. You read it and then you talk about it and you have somebody to guide you. So yeah, thankfully, much smarter people than me that could guide me because I'm not sure I understand that now. So um, but either way, so now you've made it into medical school. Did you did you cast a wide net, or did you say LSU, New Orleans is probably where I want to stay? I want to stay a little bit close to home.

SPEAKER_02 10:58

Um I looked around at other places and uh still true to this day, school is expensive. That's for true. That's for true. Hashtag yeah, and you know, the top scholarship for undergrad, and so you look around and it's like, ooh, I'm gonna be in debt no matter where I go, but I can be in twice as much debt if I go to one of these private or out-of-state schools, or I can look locally. LSU is a great school, especially for Louisiana residents. Yeah. And grandfather went there and whatnot, and I knew other people um from growing up that went there, and I've always loved LSU, and you know, New Orleans is not a bad place to live for a period of time.

SPEAKER_04 11:33

I I had realized pretty quickly that I wasn't mature enough to live in New Orleans at that time. I eventually would, but med school was not a good time for me to be in New Orleans, I can say that.

SPEAKER_02 11:43

So uh I applied to, I think, in the end, I think I only applied to three schools, and it was the Louisiana ones. It was LSU Tulane and uh LSU Shreveport. And I can't remember exactly the process. I think I might have gotten waitlisted for Shreveport or something. I don't remember the time frame. As soon as I got accepted, I got that letter, and and I remember I was in the backyard of my parents' house, my mom walks around the corner with a letter, and it's a thick letter from LSU. It's not a it's not a thin one-page uh letter, and I was like, oh, this is this is a good thing. And uh you open it up, and it's like you've been accepted to LSU New Orleans, and so pretty much the same day I called and cancelled all the other ones.

SPEAKER_04 12:22

I was like accept well you you know you could pay two and a half X that to go to Tulane, which was an option. I never even heard back from them at that point. Rendered that uh pointless. Um well, you know, I I remember distinctly it was it was it was odd because you know my acceptance letter was really the financial aid that had come. They did not send the formal letter. And so I called them and I'm like, um, you're saying financial aid. Does this mean that I'm in and and of course, you know, all the Oh, we forgot that one. Oh, was that supposed to be the um so I guess we've got to let them in now. Anyway, um, but but that was a really thrilling moment. I mean, that that was an unbelievable, just like, oh my goodness, this is incredible. I can't believe I did this. And it's almost quickly replaced with the wait, am I going to do this now?

SPEAKER_02 13:10

Like this is gonna be hard. Getting back to uh like at the time in Baton Ridge at LSU, uh fourth year, final you know, two semesters. I think I I found out like right between or right around the end of the the yeah, between like the winter semester, whatever. And so then they're like, oh, maintain a 3.0 uh GPA and all this stuff. And so the the final semester of undergrad was really fun. And I skirted the edge.

SPEAKER_04 13:36

We were biting nails there, yeah, exactly. Hey, look, you gotta get your yah yas out there. Okay, so you did. It was fun, we had a good time. Uh yeah, it's uh it's a good time indeed. Um, so so you get into medical school now, and um the learning curve all of a sudden changes pretty dramatically. Uh, you know, the the courses in biochemistry I remember distinctly were, you know, the the two semesters and a summer semester in terms of lab and biochemistry, you learn that in about six weeks in medical school. It's coming at you rapid shot, and you kind of have to keep up with a hundred or a hundred and fifty of your smartest colleagues. It's a totally different experience when you're into it.

SPEAKER_02 14:18

Yeah, you you go from the pool of, like you said, 35,000 people, and granted, biochemistry is not an easy major, but even still, you're probably at the higher end of that range, and then you get to intern your medical school, and you're not the big fish anymore.

SPEAKER_04 14:34

Just going to class doesn't do it. You're gonna have to be studying quite a bit with some pretty sharp people. Um, what did you like? Your first two years of medical school, and again for the lay audience here, that is a very didactic time uh in our lives where you were kind of just being thrown a lot of stuff. You're not really learning all the things about being a doctor yet. You're really just kind of getting inculcated with as much knowledge as you can think of, and uh, and then some the analogy is drinking from a fire hose. You just get as much as you can. What did you think of the first two years of medical school?

SPEAKER_02 15:04

It's just grueling, it's hard. Um, you know, it's a hazing process almost to some extent. Yeah, it's fine. Uh I wouldn't never want to go back through it. No surprise I did in the first place. But uh I I did it just like everybody else. I'd studied, obviously passed, made it through well enough. Um biochemistry was not easy per se, but I was much, much more well adjusted to it compared to everybody else. So it's probably one of my easier uh courses, the six weeks or whatnot. Uh the most uh difficult or challenging course uh at that time for me was the neurophysiology and pharmacology. Yes. It just some of those things just didn't click right at first, and they got more in depth than we probably needed to for practicality.

SPEAKER_04 15:51

But yeah, you know, uh dorsal columns and other things like that, still to this day. It's fascinating physiology, and I don't know that there's an intuition that really guides me on it. Um now, you know, uh spoiler alert about where we're gonna end up here, because this is gonna be um this is gonna be germane to your future vocation here. Um, but did you like anatomy?

SPEAKER_02 16:13

I did, but uh that's the first class you get to in medical school, and at LSU New Orleans, it was still live, or not live, but uh cadaver anatomy, like real yes, exactly. Real cadaver anatomy. It wasn't vivisection, by the way. I I just want to go away from cadavers in a lot of medical schools, so it's uh I didn't even know that to be honest with you.

SPEAKER_04 16:30

Okay.

SPEAKER_02 16:30

I don't know how they do it, but uh so we did cadaver anatomy, and I at first you're a little creeped out because you never do anything like that before, but I did like it. I didn't necessarily love it per se. Um, but I I I enjoyed it. I was like, this is really cool. It's an honor to be able to do something like this. And I'm you know, learning how to drink from a fire hose at that time, so it was it was a lot, but uh I enjoyed it.

SPEAKER_04 16:54

It was uh, you know, I I had some reverence going into this about you know, I mean, you you're you've got corpses, dead people who die from a room for medical, a room full of them, and they've decided to donate their body to science so that you can learn from them. That's that's an incredible thing for them to donate themselves so that you could hopefully gain some knowledge from this. And so I was reverent to that fact, and then you realize very quickly once you kind of get over the initial hump of shock and dismay, and when you get into it and you're like, Oh my god, this is fascinating. It was that that kind of scientific brain that kicks in and you get to see how the whole things work, and you get the questions from the anatomy professors that say, like, I'm a drop of blood, I'm over here, how do I get over here? And you're like, I have never thought about this as complexly as this uh right here.

SPEAKER_02 17:44

And the same thing with the room full of people, you get to see a bunch of different pathologies because all these people died from something, and so they have different diseases, but also your peers in the class as well. Some people are artists and other people are butchers, yes, and then you got most people in between there, and so you get different levels of skill with the dissections.

SPEAKER_04 18:03

Yeah, and you're gonna start to see is this gonna gray that out? Is it is this an eerie window into the future about what the careers are gonna be like? Because you don't know at that time. Um, so you know, it's the first time uh my particular cadaver had uh died of sepsis, and uh I had no idea what sepsis was. So, you know, it's the first time hearing this word. Well, what is this? So you start looking things up, yeah. And you have to start looking at a lot of things, a lot of terms that start to come to you very quickly. So so you matriculate from there on to the latter years. Now, the third and the fourth year of medical school are a much more intensely clinical orientation. That's your first time where you're really getting into wards, where you're really getting into surgeries, where you're really going to start doing some stuff that is not really classroom-based. It's kind of much more what we would be akin to what being a doctor is like. How'd you find those times?

SPEAKER_02 18:53

My uh first rotation in third year was surgery. And uh uh I guess one thing that helped me is a lot of the times with all the difficult classes, challenges, whatnot, I just put my head down and went through it. It's like the only way out is through kind of a thing. I didn't really have a true pathway. I knew things there were certain things I liked, certain things I didn't really enjoy, but I had had no idea. Uh, like I mentioned, my grandfather, if I would have been in the 60s graduating medical school, I very likely would have gone into family medicine. Yeah, it didn't hold an interest for me um as I learned that year uh anymore, just the field changed, just like a lot of our fields have. But uh I put my head down, did surgery, and I enjoyed it. It was a lot of work, it was you know busy, but it's exciting. And uh the rest of that third year where you go through all the other different, I was like, I was like, oh, this is okay, but I don't I don't really want to do this. This is okay, but I don't really want to do this. I definitely don't want to do this, you know. So it's gonna be got through the end of third years, I was like, oh, it's like I didn't realize how much I enjoyed that first rotation because that was my first introduction. And so at the end of middle into third year, I was like, well, I guess I'm going into surgery at that point. And then you know, fourth year you tailor things around.

SPEAKER_04 20:04

Yeah, yeah. So so that's really interesting because you're kind of making a choice somewhere there in the third year. Do I really like the internal medicine side or the surgical side? Yes, there's neurology and there's psych and there's some other things that are kind of out there. OBGUIN kind of fits somewhere in the middle of those kind of things. But that's really you're kind of you're categorizing yourself. Am I gonna go surgery or medicine? And I found that um the surgical rotation was probably um the hardest I'd worked up until that point by a bunch.

SPEAKER_02 20:33

At the time I didn't know I was working that hard because it was first rotation, it was just a deer in the headlights just going through the room. Right I am, that's just what I'm gonna do is get in here. Um but yeah, it was at the end it was the hardest rotation, but it was also the one that just um touched me or spoke to me the m the most at that point.

SPEAKER_04 20:49

Yeah, so um do you remember some of your early surgical operations that you were in and kind of what that feel was like?

SPEAKER_02 20:56

Um at the time this was whenever I was in medical school, it was post-katrina, but it was a couple years. I started in 2007 and finished in 2011, and uh charity wasn't around, but they in Baton Rouge, uh we because LSU from New Orleans rotated in New Orleans, uh the outskirts of New Orleans, but then Baton Rouge and Lafayette. And so I went to all three of the cities. But at the time I did my surgery rotation, it was in Baton Rouge, and they still had the Earl K Long Charity Hospital. Yes, so I think that played a big part into what I liked because it was very resident-driven, good you know, LSU residents. Um, but I remember being in there several times, just the again the residents were delivering it, and I'm not in this field per se anymore, but I remember doing a chest operation, it was just a lebectomy with the resident and the uh tending standing off to the side, and it's like this is really cool. I have my hand in somebody's chest. And yes. And there's been other times and fields throughout there that was really exciting, but I I don't know, I I remember that when I came doing a lobectomy for uh uh stage one, two lung cancer at armor.

SPEAKER_04 22:00

Yeah. You know, the early okay long, you were gonna get some pretty deep pathology. They were gonna be untreated for a while by the time they came to you. But you know, those are some of the moments where you all of a sudden, you know, I remember one of the early times that I had been with the cardiothoracic surgeon, and I was doing that that was my elective third year was to do CT surgery. And um that first time that you're doing bypass and you kind of take a step back and you're like, this is somebody's beating heart that's right here that we're gonna bypass, and it's a wow, this is incredible that we're doing this right here, and then you know, uh, I mean, kind of getting to see the anatomy live and the physiology live, and it's it's a real moment of like you're you're standing on the shoulders of giants to get to this point.

SPEAKER_02 22:42

I mean that's impressive just from the anesthesia side of it, too, then putting to sleep and then all kinds of different circulatory arrests and whatnot, you know, on purpose and then exactly this time, yeah.

SPEAKER_04 22:53

Um it's it's uh it's more knowledge than you can fully comprehend, and you kind of have to get comfortable with that. But at the same time, it's a lot of knowledge, but then you have to work too, you gotta put in the hours. That that's uh interesting. So so you've decided surgery is gonna be your thing. You're gonna go to um you don't really want a life, so you're gonna go into surgery. And they don't they don't tell you these things at the top.

SPEAKER_03 23:15

They don't advertise it very much. Yeah, yeah, sure, I can do that.

SPEAKER_04 23:19

So um where do you go for general surgery residency?

SPEAKER_02 23:23

I should mention too about this point uh where was it? It was somewhere in right, I think right before third years, whenever I met Jenny. Ah, yes. Yeah. And uh The Future Missus. Yes. Uh which up until this point I hadn't really had a truly serious relationship. I had several you know relationships, but nothing that progressed to that level.

SPEAKER_05 23:42

Yeah.

SPEAKER_02 23:43

And uh didn't know it at the time, obviously, but uh that was when I met Jenny, and uh at some point into third year, beginning of fourth, things started to get more serious. But uh I forgot your original question. I just wanted to poke into that.

SPEAKER_03 23:59

Well, she played into a lot of these decisions after the fact.

SPEAKER_04 24:02

This is amazing just because I mean, it's hard to be a human being during that time. It's really hard to be a human being. And I mean, sure, you've got some good prospects, but like you're signing up for this is gonna be six to ten years of somebody that's just they're working really, really hard and doing a lot of stuff. That's not to say that we're the only field that does that, but this is a pretty intense thing to sign up for. So good on her.

SPEAKER_02 24:27

Well, good on her. I don't know, maybe she was foolish at the time, but I'm glad she stuck it out. Maybe she's foolish now. Either way, the point is.

SPEAKER_04 24:34

So, but you still decided to do uh general surgery residency.

SPEAKER_02 24:38

So like I said, at some point during third year I realized I wouldn't be truly satisfied doing something else per se. And with surgeries at that time, you go into general. I know you can do some specific targeted uh surgeries, but you can go into general and you can pretty much go into most surgical fields from that with additional training. And so I kind of figured out what I was gonna do. Um and so I started going that pathway in in fourth year, and uh I forget the exact time frame of genuineized relationship, but at some point during that early, middle, fourth year, it's like, all right, we're probably early fourth years. Like, we're getting serious, and it's there's gonna come a point at the end of fourth year where I'm moving, I'm leaving. I don't know where I'm going. Yeah, I don't truly know how long it's gonna be for, but it's gonna be for general surgery residence who's five years, so I was like, it's gonna be a minimum five years. I hope it's no longer than seven, but we'll see, we'll see what happens. And uh but I'm moving, it's gonna be hard. There's gonna be a lot of things over the course, especially more early on that are gonna suck. But it's like not saying we need to break up or anything, but just understand what you're getting yourself into. It's like I'm fine, we can move this relationship forward, but this is gonna be tough for a little while. And she was a trooper. I mean, she she had no hesitation.

SPEAKER_04 25:57

I I actually think that that's remarkably mature of you because you know, you don't want this to be transactional, but you also want to say, like, look, we're about to get into a weird place that I, you know, we would love it to be island hopping around and Jeff Pining around the world, but but you may not have that option for a little while until we get to something else. So so good on you.

SPEAKER_02 26:16

But either way, she decided uh and she'd never moved out of Louisiana at that point. I'd never had either, but uh, she always thought she would be a hometown kind of girl. She was in occupational therapy school at LSU. That's how we ended up meeting through friends of friends. And uh whenever I was like, we're gonna move away and from all your family, and it's just gonna be us, and and a lot of the times it's just gonna be you. Yes, exactly.

SPEAKER_03 26:38

And so uh she didn't even hesitate, and you know, here we are, 15 years. Good on you, yeah, good on you.

SPEAKER_04 26:46

Um so um, all right, so you're gonna do surgery residency now.

SPEAKER_02 26:50

Um where did you end up going for I uh I didn't have a direct pathway, I ended up doing a preliminary year at uh MUSC in Charleston. Yes, okay loved MUSC. Beautiful facilities there, lovely area, really awesome place, yeah. Good program too. And uh at the somewhere during that time frame, I had to reapply for surgery and whatnot. And I loved Charleston, loved MUSC, but I started looking at some other places too, and uh Charleston was a little bit too much pretentious or very uh very like a high-class New Orleans. And from a surgery resident perspective, you know, you work very hard, but they expected shirt and tie every day to work and and outside of the operating room, the only place you could wear scrubs was in the operating room, and uh I had like a 10-block walk from the parking lot. There's just a lot of things about MUSC that is like this is great, I'm learning a lot, but it's a lot of things that are not my personality. I'd rather be in flip-flops and a t-shirt thing. And uh ended up going to ETSU, East Tennessee State University, right? And I remembered on the interview over there, it was a good group of guys, they worked their tails off, but at the same time that I we prioritized family because you go to some of these uh interviews and they're at literally at that time advertising their divorce rates. And well, this is This is the badge of honor. Yeah, it's like we just married. It's like I like I like her. I don't know. I don't know why we're talking about this, but you kind of I kind of exos out and I remember going to that place. It's like you're gonna work hard, you're gonna work a lot, but we're gonna prioritize family, you're gonna try and get some time off, and yada yada yada, and then you see all the residents over there. It's like this is it's a hidden gym. And they one thing I was interested in at that time was the the bread and butter general surgery. A lot of places you go, they have especially the bigger centers, they're specialized and more nuanced areas. And uh I loved it. I ended up going to ETSU for in Johnson City, Tennessee, northeast Tennessee. Um spent five years there, and we strongly contemplating staying up there.

SPEAKER_04 28:55

Yeah. You know, it tends to be how it is. You tend to fall kind of close to where your residency uh program is. Um, and uh, you know, I think there's a lot to be said about that. I think there's this vestigial tale that surgery drags with it almost more than any other medical specialty, in that the pride and honor of you working more than anybody else, or that kind of like, yeah, this is the hardest thing in the world, and I'm still gonna take on more and I'm gonna smile through it. And yeah, I don't ever see my family or my kids. But that's also there, you know, this carries on from the 30s and beyond.

SPEAKER_02 29:33

Some of the things they were bragging about just didn't weren't congruent with me and my personality. And that's why whenever I was at ETSU, I was like, this is we're still gonna work hard, but we're not trying to of course I'm here to learn, but you know, ultimately I'm gonna be able to do that.

SPEAKER_04 29:45

Exactly. It's a I don't want to lose sight of that, and that's that's good on you for having that insight. Um, so now um you're you're now you've finished your transitional year, you're on to your second year of residency, but your first year of actually being, you know, in in surgery residence. Um tell me what that's like. Are you starting to do your own uh surgeries without attendings in the room?

SPEAKER_02 30:07

Well, not they were not necessarily out of the room per se, but it was a lot more hands-on, a lot more senior resident guided than uh previously. And a I forget the time frame, but early 2000s uh legal such and such came about to where some of the glory days of surgeons and surgery residents training without attendings in the room, it's still pockets around, but it was less and less just from yeah, so there had to be more supervision.

SPEAKER_04 30:34

You are getting your hands uh dirty, yes, definitely, and getting in there and kind of learning on the fly and realizing that you know more so at ETSU than uh MUSC.

SPEAKER_02 30:44

You were in the operating room from day one onwards.

SPEAKER_04 30:47

And and you're learning, you know, at the same time, while you have to learn this skill because, you know, um as as Chris Johnson has pointed out, you only have five years to learn this. So um it's a whole new drinking from a fire hose at that time. It's a whole new in terms of just learning how to be a surgeon, but you're also learning the art of medicine at the same time, which is again different muscles to flex of you know, learning not just how to remove a gallbladder, but when to remove the gallbladder and how to take care of it afterwards.

SPEAKER_02 31:17

The easy part is the surgery. It's uh knowing when not to operate and uh what to do afterwards and who's the candidate for whatnot.

SPEAKER_04 31:25

But it's uh Boy and that takes a lot of time, honestly. It takes time after you've finished in order to really get to the oh, this is the right thing to not do anything about.

SPEAKER_02 31:34

It it took several years to get to that lesson. The first thing you're just trying to figure out how to operate, and you don't worry about when not to. You're just so eager and hungry to get in there and do it and do it and do it and do it. Then at some point in the latter years, they try and drill some of that more into you, you start to realize it yourself as well. It's like, oh, we don't need to operate on every person.

SPEAKER_04 31:53

Yeah, I remember um during um med school, my surgery rotation, the the fifth year senior residents, they seemed like they were could do anything. I mean, they were just so confident about anything that they were doing, but rightfully so. And I mean they they they didn't seem to get into too much trouble, and I didn't realize until much later that they were probably scared to. I mean, so um now um did you decide to do anything else after you had finished your residency at ETSU?

SPEAKER_02 32:21

That was another conversation with uh with with my wife, but yes, I uh I did. I'd already you know how we've been doing this for six years. What if, what if? And so I looked at different fellowships and I I really love general surgery. Uh bread and butter general surgery is is fun. If you go to you start looking at lifestyle too, you see the lifestyle of the people who are your mentors and you know where you work, what kind of you want to do. As a general surgeon, if you go to a bigger city, you're gonna have to find a niche almost. You've got to be able to bring something to the table. Got to be able to bring something to the table. Um, so then a lot of people specialize like and whatnot. I we always wanted to come back home to Louisiana, um, was what we thought was gonna be a good thing. Um, but I I liked a lot of different fields. I really did like I wasn't a big cardiac interest, but I loved the thoracic surgery. Cancer's never been a big interest of mine, but obviously it's part of what we do. Um I liked a lot of just the the non-cancer bread and butter general surgery. I did enjoy minimally invasive to some extent, a lot of that. There's a lot of development in that field nowadays. In the end, I ended up settling on uh surgical critical care, which a lot of people associate with trauma as well. So that's the fellowship I did. I ended up choosing surgical critical care at UAB in Birmingham and loved it. Um it it gives you a bunch of different directions. You can do critical care. Just you at some point, if you feel like you don't want to do surgery anymore, you can just go be an intensivist. Yes. Um, you can do trauma um as well as you know hybrid models from there. And I've fallen into more of a trauma route just from the nature of where things go, but I really what I really enjoy doing is more emergency general surgery and critical care. So it's kind of a a tripod. Um what I do now is surgical critical care, trauma, and emergency general surgery.

SPEAKER_04 34:15

Yeah, and I really want to double-click on all that. So, first of all, you go to probably one of the top three, if not top two premier flagship universities in the southeast at UAB, uh, which is not necessarily known until you get into the the medical field of how fantastic of a program that is. And doing surgical critical care. Now, you know, I think the lay doctor, even at this point, would kind of combine those two a lot with surgical critical care and trauma. But do you have some delineation in your mind? Is that trauma surgery versus surgical critical care? It seemed like you had said that that we could call it trauma surgery, but is there a delineation in your mind?

SPEAKER_02 34:55

It's a it's a weird dynamic because when you tell people you do surgical critical care, they associate it a lot with trauma, which is not necessarily wrong because a lot of the programs that teach surgical critical care fellowships through ACGME and whatnot are very heavy trauma focused. Not all, but um UAB obviously has a lot of trauma, and so it a lot of places tends to be weighted on um trauma. And so you get a lot of experience from that standpoint, and then it just depends what your interests are, just like a lot of places you gotta find your own niche.

SPEAKER_04 35:28

Yeah, yeah. Well, it seems like an interesting one to to have there. And you know, your it seems like your grandfather primary care. Um certainly there's emergencies that can happen in that, but perhaps a little bit more uh laid back field. Yeah. That's certainly what I thought I was going into whenever I started. And then as things go on, I actually enjoyed critical care more than I thought that I would. I did too.

SPEAKER_02 35:54

I was surprised by that. I really enjoyed it during training and right.

SPEAKER_04 35:58

And and one of the things that I liked about it is that like you you had more control over things than perhaps you would elsewhere. Um, but still, it's you're dealing with you know some would say cynically in our field, you've got sick patients and not sick patients. And the sick patients can die within 24 hours and the rest fall into not sick. Okay. Um and so now you're gonna start dealing with sick patients, or at least that's gonna be where you you make your profession here. That's an interesting transition to make.

SPEAKER_02 36:29

Kind of backtracking a little bit to that led my direction. Um, I've always, like I said, meant liked reading, and I've always been very interested in health and nutrition. Read a lot of books about that. And so I was going through medical school, my grandfather in the back of my mind, family physicians. A lot of primary care is trying to focus on long-term wellness, which many patients don't listen to the recommendations. Believe you me. Yeah. I got very frustrated in the the medical school time frame with it's like this is all they need to do, and they're gonna be fine. And so the I I didn't like the idea of struggling with chronic disease from a primary care standpoint for my career. I was like, what can I do that's not gonna have to manage ongoing chronic disease just from just wasn't me. There's people who do it and do it great. Yeah. That wasn't what I was interested in. So I started looking more acute, and that was also how I ended up going into surgery and then surgical critical care, where you're doing critical care, you're doing emergency surgery, you're doing trauma. You can still help people, you're not worrying about their whole life, but people need somebody to help in and of that moment. I'm gonna bridge you over troubled waters so we can worry about that other stuff later. Exactly. So that was a big part of my decision pathway as well.

SPEAKER_04 37:41

Yeah, you know, I I've always been fascinated by trauma because it seems to probably many doctors, um, but certainly the lay public, that would be overwhelming. You have no idea what's really coming in. You've got a gunshot wound. That that'll be the call over. EMS is coming with a gunshot wound. You don't really even know where the gunshot is. No. You're you're gonna find this out probably on the fly as they're coming in, maybe even with chest compressions going on at the same time. Um versus somebody who's just had an explosive aneurysm. I mean, there's a variety of different things of traumas that can come in, MVCs that can come in, where you have no idea there's gonna be a combination of broken bones and internal injuries, visceral injuries, and bleeding diatheses, and all of these things are coming in at once. How do you even sort that as a trauma surgeon when they're when they're coming in like this?

SPEAKER_02 38:31

I think uh uh you fall back to your protocols and your recipes per se. It's like uh years ago they came out with ACLS for cardiac. We have ATLS for trauma, advanced trauma life support, and it's basically an algorithm and it gives you the guides. You go through these primary steps, there's these middle ground steps, and there's these next steps, and it's like if this, then this. And at some point, it's like if you can't get through those first three steps, then you go back and repeat the first three steps, and you don't move on to the next step until you're done. You stabilize those first three steps, and you know, at any point during that the emergency situation, you can go to the operating room, you can do maneuvers in the trauma bay, whatever it may be. But you fall back on your protocols, and only once you get really comfortable with that, and it even took me several years out of training to get more comfortable with that, then you can be a little more nuanced and you still have your guidebook, but then you know when to step away from it. That's the the point. It's like we have these rules, we have these protocols, they're there to provide comfort, a framework, but at some point you've got to step away too.

SPEAKER_04 39:37

So that's that's the art. When you realize that you're stepping outside of guidelines and you know what you're doing, that's a really uh interesting place. It's a good place. Um But do you find that the training just snaps in for you? Like all of a sudden a trauma comes into you. Hey, Dr. O'Neill, we've got a trauma coming in, bay four, uh, five minutes out, gunshot wound. Do you find yourself just immediately going into that? I know exactly what I'm gonna do?

SPEAKER_02 40:00

That's the other good thing about uh where you work as well. Um at established trauma centers, which we do have here in Panama City, it's a it's a level two trauma center. It's not just you and your training, but the whole facility is supposed to be on board. So you're supposed to, in theory, have trauma nurses, trauma uh ED docs, everybody's supposed to be on the same page. Everybody's been through some element of training for a trauma patient, so you're not having to you know rewrite the book every single patient. So a lot of things are happening, but yeah, you have to get in that mindset and you have to make sure everybody's in that mindset. It's obvious when there's a new person, uh, whether it's a nurse, a tech, or whatnot, that hasn't experienced that because you know you overcome it, obviously, but you can tell whenever somebody's out of their element.

SPEAKER_04 40:43

Well, and it seems like you know, you've got to kind of be quarterback leader position, and everybody should know their role. Like, no, we need two large more IVs right now, don't worry about anything else because the other stuff is gonna be taken care of from somebody else, and you know, let's get blood supply online, you know.

SPEAKER_02 41:02

On that note, too, is like whenever you're taking the test in medical school, whatnot, it's like what's the next best step? You know, I hated those questions. Hated those questions. Do all of them, yes, because it's like we're literally gonna do all of these and they're almost always gonna happen at the exact same time. Yes, and that's what's going on in the trauma bay. A lot of these things are happening at the same time, but if you have to sit somebody down, it's like we're gonna do this first and then this and then this and then this. But in in practice, a lot of them occur simultaneously.

SPEAKER_04 41:28

It should it should snap. Uh I found for myself in code situations I've at you know, the first rule of a code is take your own pulse. Um I found actually I get a lot more calm. It's it's it's I it's you know, some sort of success breeds um some confidence in that. But you know, I find I can take a breath here.

SPEAKER_02 41:50

I can kind of take piece of the situation. And when the person who's in charge of the room is calm, it really diffuses down to everybody else. And I've noticed that through training as well, and I've tried to manifest that in my own practice, and I feel like I've been mostly successful with that. But you can definitely, from again from training, see the rooms, whether it's a code situation or big trauma. Everybody's on the same page, but the people who are a little more frantic or a little loud or aggressive uh tend to have a different scenario.

SPEAKER_04 42:22

Try and talk to the medical students about yelling. Never helps anything in these situations. It doesn't. It doesn't. You can be calm, you can talk to the people, you can get feedback, believe it or not, you can even joke in those situations. That's actually helpful to kind of to take the temperature down a little bit. But so so you you and and again, trauma is large and broad. You can have people that fall from a ladder, you can have uh house collapse on people.

SPEAKER_02 42:48

We separate it uh into two categories roughly blunt and penetrating. Penetrating obviously being stabbing, shooting, impalements, um, and then blunt falls from a ladder or car accidents, and you can have combined a car accident, you can have a blunt trauma, and then also get impaled with something. Sure. Sure. It's not always isolated, but in general, blunt versus penetrating. And it kind of lets you know pathways in your mind.

SPEAKER_04 43:09

It starts to get your algorithm cooking for the things that you're you're you're kind of training. And and and you know, I've I've talked about this before in the podcast. It's it's awesome when you're in the middle of a procedure and like you're just flowing. You're you're almost not even thinking just it's a flow state of this goes here. Your body kind of starts to do the the right things.

SPEAKER_02 43:28

Especially when you have a good team and you've worked with them before. During uh my you know, we might talk about this at some point, but during my early uh time as uh in attending out of out of training, I did locums for a little bit. And so you pop in and you do all this, which you still have, you have all your protocols and algorithms, but it's with people you don't know. Yes. And so you fall back on the algorithms and the protocols and the system. But it's so much better when you have those people you know, you know their capabilities, you can trust them, and you have they know you as well as they know what you're gonna want, they know exactly what you're gonna do.

SPEAKER_04 44:00

Exactly. They can hand you the instrument that you're looking for immediately. And yeah, that's really amazing. You know, there's also an element I'm going to always call back to the things that I know how to do that that I try and talk to medical students about, which is on EKGs, don't jump right to the most conspicuous finding. You need to go algorithmically there because otherwise you're going to miss something. So I would imagine there's something similar here. You're so worried about this gunshot wound over here that could have called visceral organ damage, but you can miss the collapse lung or something like that that you've got to kind of make sure that you're going through your your.

SPEAKER_02 44:36

It's like rooting the chest x-ray. You don't start to the most obvious finding unless you absolutely have to, but you go through it in your mind, kind of like the EKG or the ATLS protocols, ABCs. It's yeah, we try to make you dumb it down a little bit. Not everybody's a cardiologist. So we're way dumber than that. What are you talking about? So airway, breathing, circulation, disability, environment. So you go through your ABCs, and like I mentioned earlier, if you can't get through it, you start over at A again and try to keep it very simple.

SPEAKER_04 45:03

Yeah, long before you go towards your secondary survey and other things that are that are going on there. So um now, you know, this can also be um you've got the scientifically curious doctor mind, which is that, you know, uh uh the ABCs, I have to take care of this patient, I have to get them stabilized, I have to take care of the acute surgical, I've got to decide whether or not we're gonna go into surgery. But also these are, I mean, by definition, incredibly uh traumatic events um psychiatrically. And you're gonna have families that you're gonna have to deal with, and you're gonna have to give some really terrible news. I mean, that's just the nature of the beast.

SPEAKER_02 45:39

Yeah, uh obviously people can die in the trauma bay despite all your efforts. So that that immediate process is is hard because it's the shock right there. And like you said, you have to talk with family, and we did everything, there was nothing we can do. And you you learn a lot of empathy, sympathy, trying to put yourself in their place, and uh that's something they don't really teach you in training much either. Um you kind of have to pick that one up on on your way as you go along to some extent. And I think they could probably do a better job of training or exposing that.

SPEAKER_04 46:10

Yeah, I think they could. I'm not entirely certain how. You kind of just have to throw yourself into that.

SPEAKER_02 46:16

Um I uh I had a very good uh I feel like I had a very good, well-rounded experience. I remember one time in uh medical school, not one time, but one of the rotations I did was a hospice rotation. I chose to do it just from that standpoint, try and get a little bit better breath with people who deal with this often. And even during a fellowship, uh I had a very good program director who's like, you have nine months that we have to do the core of your fellowship. Nine months. It's like then there's three months. It's like if you want to just continue doing the core training, we can do the core training. But what are you interested in? What do you want to do? What do you think is gonna better develop your knowledge base? And I ended up choosing a couple different things, but uh uh I went and did pathology, and uh so we did autopsies, and I learned how to do like a lot of our post-trauma autopsies. I went and um helped out with that, and um uh did some imaging stuff too, like some advanced imaging. Um I am by no means capable of reading an echocardiogram, but I can hear the on-the-spot bedside uh echoes.

SPEAKER_04 47:19

Um yes, but but also what a dimension that that brings to you. I mean, uh to understand what tamponade is. I mean, again, if you've got blood or any other fluid that's surrounding within the pericardium that's keeping the heart from functioning, it doesn't matter if you're bleeding anywhere else. It doesn't matter if you're not even oxygenating. If your heart stops, okay, uh game over. And so so having to be able to recognize that and utilizing different tools really uh is a great.

SPEAKER_02 47:47

We had one particular patient I remember in training who was this big muscular guy who I don't know if it was a shotgun or a BB gun, but one BB penetrated his chest into his uh uh myocardial area, and uh we watched him develop cardiac tamponade in front of our eyes as we're he was still awake and talking. We f saw the the pericardial uh blood, so we made attempts to go to the operating room, which we were successful. But as we're in the operating room going to sleep, we essentially had to do a crash steronomy on him at that time, which was very again exciting. Yes, exciting. You I've literally watched cardiac tamponade develop and all the things you hear about pulses paradoxis and whatnot. It was you're turning blue, it was it was educational. And then you don't ever forget that.

SPEAKER_04 48:33

And then you can you can kind of see when you when you learn about these pathologies, you learn them kind of almost in discrete steps of you've got coo small breathing, and then you've got pulses paradoxis, and then you've got your tachypnea, and kind of these other things that kind of build up to it, and then you realize that's actually a contiguous spectrum of this manifestation of a disease, and it's really, oh, now I see it. This person's very sick, but still now I see it.

SPEAKER_02 49:00

Uh just one little tiny injury, you know. This one little BB, um all it takes.

SPEAKER_04 49:06

Yeah, you know, and and we'll we'll kind of come around to some some futuristic topics here, but that I've been I've been thinking a little bit more about that lately of just um, you know, as we're getting closer and closer to our future where we escape longevity velocity, as it is said, uh, it does strike me sometimes, and you've seen this writ large, how fragile life can be.

SPEAKER_02 49:28

Oh, yes. Yes. And uh that was uh we we're starting to talk about those family discussions. That was the acute ones. The ones that are a little more challenging are the ones once you and that's the other thing I really like about this field is you get the patient, and it's not chronic care, but you get the patient in the hospital, whether it's emergency general surgery, you know, somebody septic, or a trauma patient where it's a bad injury, you admit them in the intensive care unit, you operate on them, or you get help from your colleagues to operate on them, you take care of them their whole length of the hospital stay and into the regular floor and then discharge, follow them up as an outpatient. Um, but you also have those hard conversations at some point in the ICU where whether it's brain death or a non-survival situation, or the patient's aged and maybe wouldn't want some of these things done on them. So then you have to learn how to talk with families about a lot of those situations. And that's the whole thing with hospice, you change the focus from quantity of life as opposed to quality of life. And you get to have all kinds of discussions with people. And there are certain people that can do it better than others.

SPEAKER_04 50:30

That's true. And um it's it's changing the goals of care, uh, you know, from fixing everything to uh making it as least symptomatic as possible. Though those are those are really interesting and heartfelt conversations that you have to have. Um so and honestly, that strikes me as more as of an internal medicine side of things than it is surgical side. That's not typical of things that I hear from surgeons.

SPEAKER_02 50:54

One of the uh I remember this from MESC, one of the physicians I trained under, he was one of the trauma and surgical critical care docs, um, Dr. Erickson, and he basically told me at some point during that first year is like a surgical intensivist is basically a medical intensivist with a knife.

SPEAKER_06 51:11

Yes. Yeah.

SPEAKER_02 51:12

Who who can get out of trouble if there is something that comes up? And so there there is a a lot more of medicine as opposed to surgery in critical care, but obviously it's yeah, once you get to pressure support and inotropes uh medications that keep you alive when you're very, very, very sick.

SPEAKER_04 51:28

Yes, vent management, yeah. That's that's very medicine-sized. Um now I would also imagine in the surgical critical care world, and I I think I've heard this about you, is that um you are some of the surgeon's best friends too, because you will be managing a lot of patients that are critically ill while surgeons are going to go do other surgeries and other things like that.

SPEAKER_02 51:50

Is that would you be relating to talking with Chris recently? I believe that's I don't like to talk to him, but uh yeah. So surgical critical care doesn't just encompass trauma patients. It could be any bad surgical patient, as well as uh some planned surgeries, you know, cardiac surgery can fall under that, transplant surgery can fall under that. So it depends on where you go as to what type of surgical intensivist you may find. Here in our small community, we're a little more broad-based and general. Um, but yes, so some patient comes in, whatever it may be, diverticulitis, their sepsis, septic, um, they get surgery by, you know, one of my partners or whatnot, and then they need the intensive care unit. And so they'll give me a call and say, hey, this is what happened, this is what you know what's going on. Can you help out with this patient? And so we'll consult from an intensivist standpoint and get them through their sepsis shock, whatever it may be. And uh it's like, oh, we polish this up for you, it's all yours now. We're sending them out of the unit.

SPEAKER_04 52:48

Well, and you know, so so that's that's a wonderful transition point to have you that can kind of focus in on the things that you know, because it's kind of it's you're thinking in different quadrants of your brain. You're kind of uh thinking about things a little bit differently as you're going from the medicine and um you know intensive care side to the surgical side.

SPEAKER_02 53:06

Um so so it's kind of turning on different parts of your brain, like you know, if you I'm very bad at quoting data as well, but they have done studies over the past years, couple decades, that critical surgical patients who are taken care of by surgically trained intensivists have a better overall outcome. I'm sure um when compared to medical intensivists. And it's not giant margins, but it's uh statistically significant improvement. Yeah. And it's not across the board either. There's some.

SPEAKER_04 53:34

I can imagine. And and it's also probably getting your team focused in on the right thing. Uh, you know, when you get a lot of people moving together to kind of focus on one different area, that's that's a lot better. Um, but you know, some some major sickness that you wouldn't really realize, certainly from the lay public, uh, things like ischemic bowel or having to do uh some sort of open abdominal repair and keep it open afterwards. Um, those are kind of intense situations. You need somebody that can manage all the other things. You don't think about, well, how do you get nutrition in that standpoint? How do you how do you keep your IV fluids there because your your body will want to get rid of a lot of that? So that's why we have pros that can do this kind of stuff.

SPEAKER_02 54:12

And just like every specialty, you start to take some of those things for granted, then you're like, oh wait, they need they need me to do this part. Yeah.

SPEAKER_04 54:19

No, that's a good point because you know we we tend to fall from when you get consulted from the ER, it's like, well, of course this is, you know, um avianodal reentrant tachycardia. How could you not know that? And then you you gotta take a step back. This is what I see all the time. They're seeing trillions of other things that are coming in that are kind of all different ways. So so that subspecialty niche is sometimes nice.

SPEAKER_02 54:42

Yeah, and that's that's why you consult people. It's like I don't see this all the time, I just need a little help.

SPEAKER_04 54:47

Yeah, and I I do love that that esprit de corps about medicine in general, which is that um, you know, I I tell the medical students, look, if you're gonna consult somebody, have a well-formed question. If you're out over your skis and you need help, send a beacon out. Everybody will come running. Everybody will come and say, Yeah, dude, I heard there was somebody really sick. Well, what kind of help do you need? And we'll bring everybody to bear on the situation.

SPEAKER_02 55:11

One of the terms we use is like the ship is sinking. Let's get people on board to help prevent the ship from sinking. Let's not wait till the ship is sunk.

SPEAKER_04 55:18

No, no, no, no, no. Don't try and raise the ship from and bring them on now.

SPEAKER_02 55:22

Just bring them on now. The ship's going down, it's we're going down together.

SPEAKER_04 55:25

We're gonna do this, yeah. Exactly. We'll at least be playing music while we do it. So uh now uh let's take a so you you finish your fellowship training. Where did you decide to go from there?

SPEAKER_02 55:34

Uh so I mentioned we always wanted to go home um to Louisiana and uh looking around Louisiana, um, I'm from closer to Baton Rouge. Uh my wife's from closer to Lafayette. Yes. Uh it's a nice little corridor there on the I-10. Yeah. Yes. Yes. And uh I never wanted to be in a big city. I never wanted to be at a big, I did I mentioned already I had a bad taste of bench research. Yes. So I was trying to look for a place that didn't overly involve like a research-heavy component.

SPEAKER_04 56:00

Not really an academic center that shows.

SPEAKER_02 56:02

Yeah, so I wasn't looking for academic center, and uh so New Orleans had a lot of academic center. Um we didn't really want to live there per se. Um at that point, uh, we had three children as well. I neglected to mention it. Uh so interestingly enough, I you know, moved away. Uh Ginny and I, just the two of us, and at some point we said we we had some family members who had some trouble getting pregnant, and it's like, well, we don't know if that's gonna happen to us. It's like let's just stop trying. So, intern year of surgery residency, Jenny got pregnant with twins. So neither one of us What a perfect time. Yes, neither one of us remember much about intern year. Whether Nobody's gonna sleep here. All right. Nobody's sleeping here. Uh so it was, you know, it's like the things you just get through and put up with, and like you think back now, it's like I don't want to do that again. Yes, exactly.

SPEAKER_04 56:52

That was I don't know that that was fun, but certainly it's formative.

SPEAKER_03 56:56

Uh yes, it was definitely formative.

SPEAKER_02 56:58

So anyway, so at this point at UAB, we have three children. Um New Orleans is a great place, but it you know, we had only lived there for school. We didn't want to, we didn't have any other true family there, so we didn't want to necessarily live there. Didn't want to be in an academic center per se. Baton Ridge was an option, but it's just it's kind of a mess of a city too. It's got LSU, which is amazing, but outside of that, it's not uh post-Catrina got weird, so yeah, and it's that grand thing. It takes an hour to get to Baton Ridge from Baton Ridge. From Batonridge. Anywhere you want to go. Somehow, yeah. I'm not a big fan of traffic, uh that that daily grind traffic. Oh man, and that that'll have it. Yeah, um Lafayette was a good middle ground for both of us. We had a bunch of family and peripheral connections there, and they had a good hospital at the time. It was uh level two, I think, and it was aspiring to be fully ACS American College certified. So it was it was a good fit and uh had you know had some connections there. Um in the end, it turned out not to be uh a great situation. The surgery and taking care of patients was amazing, but it was the the setup, and they still are struggling with some of the organization of that program.

SPEAKER_04 58:04

Yeah, and I I think this is an important point to talk about for you know graduates that are coming from your residency or your fellowship that goes out into your first job. Um yeah, you want to make a really thoughtful uh approach to your first job. Um you certainly want to um, you know, you're you're gonna get a brand new contract with more money than you've you've ever known ever known what to do with, and that's gonna be an immediate satisfaction in a lot of different ways. Um But there's a reason why I call it a first job. It's very likely to change. And you might make some mistake because you've been so worried for so long about can I be, can I be a trauma surgeon? Can I do this thing that you haven't had a lot of business insight or the questions even to ask, or how to even think about what this job would be like. It's a whole different world that you're not used to.

SPEAKER_02 58:57

I think uh at some point in third or fourth year of fellowship of residency, I went to the American College of Surgeons conference. It's the Mecca for surgery, it's huge. And I went to one of the resident uh presentations at that point, and at the time, you know, this is over a decade ago now. Um gosh, it might be longer than that. But uh the average job from an out-of-training surgeon was 2.7 years. And it's like as we moved to Lafayette, I was like, well, that's not gonna be me. This is this is home. We're gonna be here for yeah. I lasted five. So almost five years.

SPEAKER_04 59:30

Yeah, so it was longer than that. It was almost two acts. Um, but still, there's no shame in that. And that's what I want to kind of uh take you're gonna have to kind of sometimes iterate to find the thing that's gonna work with you. There's plenty, I mean, the stories are are uh long and glorious about how many times people have been promised certain things and different contractual obligations, and then you know the wool gets pulled over your eyes and you come out and you're like, wait, wait, none of that was true. I was hired by a used car salesman, essentially.

SPEAKER_02 59:56

It's uh I thought you were doing surgery. I bought a lemon. I bought a lemon.

SPEAKER_04 1:00:00

Okay, well, interestingly enough, um, so um so you had this experience where you know, um I've said before on here, my father-in-law says experience is what you get when you don't get what you wanted.

SPEAKER_02 1:00:11

So you had this experience, it was great, and I I remember uh starting it, and I loved uh I loved Lafayette, I loved the hospital, loved the people I worked with. Got to do some really cool, crazy surgery. I didn't realize how violent of a region uh Louisiana was right there. We were doing a lot of uh violent crime. That is true, Cajun territory. New Orleans is not Cajun. Lafayette and the surrounding terries are Cajun. That was surprising how much penetrating trauma there. Anyway, but I remember the uh my first like real case from a trauma standpoint at that hospital. I'm just popping in there, it's like my first day um in the doctor's lounge trying to figure out how the computer works, and I get a call from uh my partner who I'd never met yet. Oh I hadn't met this one, and he's like, Are you gonna come down to the trauma bay? I was like, I can, why? He's like, There's a trauma here, and I want to leave. I was like, Oh, and I guess I will. Okay. Yeah, I'm in the doctor's lounge. I'd been to the trauma bay, but I still don't know this hospital well, so I don't know how to get there.

SPEAKER_03 1:01:09

Yeah.

SPEAKER_02 1:01:10

And so I finally get there, and I don't really know what the presentation was, but evidently there was these three large men under their carport, large, large men, many hundred-pound men, just having a little conversation, and and uh somebody came in with uh an AK-47 and shot them. And two of them ended up being happens all the time. Yeah, though I think had to go with you know different surgeons, vascular orthopedics or whatnot, but one and and my partner looked at me and was like, You got this? And I'm like, again, like first day out of training. I guess so. And I was like, I guess so. And he pats me on the back, like, all right, call me if you need, and he just leaves. And at that point, I it it felt like an hour, but I just stood there and it's like took a deep breath and it's like, let's do this. Here we are. What do we do with the code?

SPEAKER_01 1:01:58

Take your own pulse, yeah.

SPEAKER_04 1:01:59

Yeah. And uh you just flip a switch and yeah, and um I I remember calling uh my program director after I'd done the first left and right heart catheterization after training, like as a as a real cardiologist. I called him and I was like, Man, I did it, and the patient's alive and everything. And he goes, they all get easier after this. Yes, and so uh that was that that kind of calmed me down more. But but either way, so but you're in it now and you're doing it, you're doing the thing that you were kind of trained to do, and the seven years of training feels like maybe it was enough-ish.

SPEAKER_02 1:02:36

Uh oh that that's interesting too, is because uh general surgery, you're you're there for a many years, and you think you're gonna see everything, and then you realize you don't see everything. And uh some of the rare general surgery things uh you know, you hear about your cohorts in training, it's like, oh, I've I've done like six of these, and six in some cases is a lot. Um I had never done ephemeral hernia in uh training. I don't know why, just missed it. All my chiefs, co-chiefs had done several. It's like sure, it never happened to me in training. Okay. Have no idea. But studying for the boards uh after general surgery residency, because there's a few just traditional cases you have to know. True. I studied the inguinal canal to where I could just bread and butter backward, forward, backward, forward. My first general surgery case in laughter. Out of training, yeah, out of training was an incarcerated femoral hernia. And you just you sit there and it's like, just look at what what is going on? It was uh okay, this is what we're gonna do. Yeah, this was like it worked out great. Everything went fine. And I mean, you I've operated in that area plenty of times, so it's not like I didn't know what to do, but it's just the it's like wow, this is this is you know coming get you.

SPEAKER_04 1:03:51

It's it's it's kind of a confidence boost too, in that like you can go into uncharted territories. You're not gonna dive way out, but you can go into some uncharted territories and be like, okay, I can I can get through this. You know, I'm not gonna let it get yourself sometimes. Oh man, 100%. Of course, that would be the first case. Why wouldn't it be? Why wouldn't it be?

SPEAKER_02 1:04:12

So that was my introduction to you know big boy surgery, where there's you know you still have partners, but there's no attending at your back and you're out of training, and uh from there, like you said, everything got easier. Yeah and that's not necessarily easier, but you you changed at that time.

SPEAKER_04 1:04:27

Yeah, and so you so you're figuring out how to be a dad and a husband and a real life doctor and and kind of uh change your life a little bit. After five years of you working out that this wasn't this relationship, working relationship wasn't gonna work for you. Tell me about where we went from there.

SPEAKER_02 1:04:42

One of the things I really liked about the job where I was, except for the employment situation. The employment situation is what soured me and caused me to end up leaving. But uh it was a rural-ish town, uh Lafayette. You know, we had a university, and uh we also got the the surgical residents from LSU, New Orleans, they would come rotate through us. So I was technically an assistant professor of some sort on paper. I guess I I think they just needed a warm body in the hospital too. I noticed the longer that title gets, the less prestigious it is.

SPEAKER_03 1:05:11

That's exactly what it was.

SPEAKER_02 1:05:12

But I got to train residents, and uh we had first years and I think fourth years, and every now and then there was like a second or third year that would pop in for the most part. I'm probably forgetting exactly how that goes. But I really loved working with residents. I mean, I was at ETSU and then UAB, it's very resident heavy, and I was just like almost one more level you get to work with residents. And I got to meet several good people over the five years I was there. At the end of whenever I was realizing I'm I'm looking for a new job, um, LSU is a big place, they have a big community. The residents at Lafayette started to hear that I was looking at leaving. Well, they called some of their other residents who turned out to be Chris Johnson and Allie Moody and Colone Castellucci, who were also employed at this hospital here. And uh they all individually called me over the course of a few weeks and said, Hey, come check. Check this place out. We're looking for such and such in your job. And I'm like, I'm not moving to Panama City. And and uh at some point during that whole several week process, I was like, All right, I'm I'm act actively interviewing at places, we'll come look. Sure. And uh Jenny again, she'd been a trooper throughout all this training. I cannot emphasize enough how much support, like she was the backbone through all of this. But whenever we had finally gotten home, that was I told her I promised her we're gonna be home. She didn't want to leave. Of course. And she aggressively didn't want to leave. And at some point, it's like, baby, I don't care where we go, I don't care what we do, but it's like I can't work here anymore. And at some point she kind of got on board. We went on a few interviews and she just wasn't happy about any of them. And we come to Panama City and we were driving around looking at the hospital. She's like, All right, this is gonna happen. It's like I like this place, we can live here. I'm like, done, sign. And uh, you know, nowhere's perfect, no hospital system's perfect, no practice is perfect. Of course. Um, like I mentioned, I really loved where I worked, where we lived, family, and the hospital thing, the employment situation got a little onerous. And here, you know, it's not perfect, but it is perfect enough, you know.

SPEAKER_04 1:07:09

Yeah, and and I I do like the vibe check that you can do for places, um, because this is you know a very similar story that that my wife, previous podcast guest, um, had said about you know, she came here interviewing, not really wanting to come here. She didn't want to come back home or anything, but then she came here and was like, I actually liked it and everything. And I I love this place. This is this is home as far as I'm concerned.

SPEAKER_02 1:07:31

And so it's it's coming up on three years for us, and you know, at this point, whenever we moved, uh she's like, How long are we gonna be here? It's like at this point, it's like, I don't know. We're just gonna take it one day at a time. We don't anticipate leaving, but of course at this yeah, I didn't anticipate leaving Lafayette either. No, it's we've already bought and sold two forever homes.

SPEAKER_04 1:07:51

How many forever homes can you have? I don't know. We'll find out.

SPEAKER_02 1:07:54

It's not here, it's like we just bought a home here, and so we're not we're not calling it anything, it's the place we live right now.

SPEAKER_04 1:07:58

It's the place that you live for right now. No, and and again, um, I think you've got to find your professional fulfillment, but also you gotta enjoy the people that you're working with. You gotta love going to work, you gotta love coming home. Those are really important things. So, well, uh, you know, our community is a lot better because you're here. So all right. Well, I think we got through your life. Let's talk about some other stuff for a little bit. You ready for it?

SPEAKER_02 1:08:17

Sure. I will say I the one thing that was really helpful about moving here, we didn't have as strong a community in uh Louisiana, Lafayette, where I was from the physician standpoint. And I think it was actually Chris, Chris, and Allie, I can't remember who, but uh pointed out ECMA to me. I was like, you should join this. And I don't know what it is, sure. And so I joined and then really fell in love with the collaboration with the ECMA. It's been it was helpful for a new person to the area, but also it's just it's fun for a lack of a better way to describe it. Good community. I really enjoy the people I've met and the the goals of the the group.

SPEAKER_04 1:08:52

Yeah, and it's a very supportive environment, but it also kind of focuses in on we want doctors to be able to treat patients the way that they want to be. We want to empower doctors to be able to do the things that they want to do. And that includes having a life and having a community and having kind of a very um wholesome kind of environment to do the things that we do here. So so it really was important to me too.

SPEAKER_02 1:09:14

So um and it had nothing to do with me coming here, but then after I got here, I was like, this is this is great. I was like, I wish I would have known about this before because it just would have seemed a good deal.

SPEAKER_04 1:09:23

What a resource. And and now you find yourself you are our newest and youngest board member here for MRCOS Medical Association. Well enough about me. Let's talk about you for a little bit, okay? So um now uh tell me what uh what does a day in the life of your practice now look like?

SPEAKER_02 1:09:43

So obviously trauma, emergency general surgery, surgical critical care is not the traditional Monday to Friday 9 to 5 model.

SPEAKER_06 1:09:51

Yeah, yeah.

SPEAKER_02 1:09:51

And I I don't know that so so shift work is it's essentially shift work. Um it's one of the few, if not things are changing a little bit, but it's one of the few, if not only, surgical fields that is true traditional shift work, um, almost like an ER or whatnot. And uh we have to have 24-7 coverage, and not just 24-7 primary coverage, we also have to have 24-7 backup coverage. And this is at every verified trauma center. Right, right. Um so you have to have enough people that can manage 24-7 primary and backup coverage, and at bigger centers, obviously, there's more, but uh so it's not a set schedule. And every every there's a bunch of different models, but we don't have a set schedule, but in general it's work a week, off a week. And we do 12 hour shifts over here, and so I'm on for 12 hours primary, whether it's daytime or nighttime, and then the opposing 12 hours I'm on backup call. Um, so it in general, work a week, off a week, primary call, backup call during that time. And that's the the schedule per se. Yeah. But like I said, it's not a rigid Monday through Sunday.

SPEAKER_04 1:11:00

Sure. There's gonna be vacations and times where you need to cover a little bit more than that or less than that. So um, yeah, you know, I I don't I'm not certain the lay public realizes how incredibly important it is to have trauma in your environment and in your community.

SPEAKER_02 1:11:15

I mean it's it's a it's a huge deal and it's it's it's neglected to somewhat. It's like nobody needs a trauma surgeon and until they do. You know, same thing. Nobody needs a heart cath uh emergently until like you're with an elephant on your chest in the emergency room. So it's uh it's somewhat underappreciated. Uh we we do a lot. Um trauma, I think still, you know, as of several years ago, it was a fourth leading cause of death for all comers. Once you get past cardiovascular disease, cancer, um, yep, trauma's right there. And for the younger population, under than 45, more men than women, but still it's the leading cause of death. Yes. So it's uh it's a huge deal, even in smaller communities. And I mentioned Lafayette was a more dangerous, penetrating, violent crime. Panama City is much much safer. That's good to know. That's good to know. So it's a great place to raise a family.

SPEAKER_04 1:12:07

You know, there's a lot of things that you can talk about, and I I have a huge talk to my patients about prevention. It's much easier to prevent cardiovascular disease than it is to actually treat it. And we can prevent a lot of things from a cancer perspective by decreasing our risk factors, exercising, watching our diet, no smoking, that kind of stuff can certainly help. Um preventing trauma is a little bit different.

SPEAKER_02 1:12:31

It is it is different. Um part of it has to be policy, and yes, some of these things have developed over literally decades. Um, way back when, when cars came around, you know, cars were cars, they weren't seatbelts, but there also weren't interstates. Then you develop interstates, people are going faster. Seatbelt laws got developed at that time. Deaths drop down. I think we're gonna see an interesting shift with because car accidents are very prominent. I think we're gonna see an interesting shift in the coming decade. We're talking about uh technology, self-driving cars and all these robotaxis, whatnot. It's gonna dramatically decrease a lot of the car accidents. Only good.

SPEAKER_04 1:13:05

Well, yeah, great. Um you know one place that I've noticed it actually was um going skiing 20 years ago versus skiing now, where it was you were really uncool to wear a helmet then and now everybody wears it. It's very, very few and far between that you're not wearing a helmet.

SPEAKER_02 1:13:24

And I think it's for the better. A lot of our business here locally would not be here if people wore helmets. Um you know, whether it's you know laws regulating uh motorcycle helmets or whatnot, we would have a lot less uh injuries if people just wore helmet. It's it's crazy. Yes. Um but that's part of the the pre prevention is seatbelts, wear a helmet. Um one thing that's come about over the past many years, I'm sure you've seen it too, is the advent of these e-bikes and all these uh battery powered situations. Well, uh people who didn't formally wear helmets on bikes don't wear helmets on these e-bikes. Some of these e-bikes can get very fast. I mean, they're in the level of uh motorcycles to some extent. So we're seeing a lot locally, because you can rent an e-bike or steal an e-bike on the beach for nothing. And we're seeing a lot of people who are uh coming in after these multiple times a week, devastating e-bike injuries. Um we're not a pediatric trauma center, but we still do pediatric stabilization, triage and the other. And so uh fortunately we don't see two to as many kids, we see more adults, but it's it's prominent out there. So a lot of that prevention is, and that's another thing about being a trauma center, is we actually have people at our hospital who are strictly focused on prevention. They'll go uh we had a helmet giveaway during one of the races where they we had in our our hallway, we had like two dozen boxes of bicycle helmets, all different sizes. Yeah. So it's a helmet giveaway. Um our uh uh one of the big things through the American College of Surgeons that you may have seen that they've been promoting over the past many years, it's called Stop the Bleed. It's just bystanders if you somebody in a car accident, you know how to apply a tourniquet, pressure, things that we take for granted, but in the field. Yeah, yeah, just like bystander CPR. If somebody knows how to do it, they can start it. But if you don't know how to do it, same thing with somebody's bleeding to death, then you you you don't know that you need to just put pressure on there. It sounds simple, but it's it saves some lots.

SPEAKER_04 1:15:26

Yeah, indeed. Well, and also um, you know, be careful as we get older going up on ladders. Uh I mean, you know, um I'm sure we get some occasional boat trauma, and usually that's probably got some alcohol related to it.

SPEAKER_02 1:15:43

There is a very big preponderance of substance abuse and trauma, but it's not a hundred percent. Right. But uh a lot of our trauma patients, whether it's substance abuse, uh alcohol, drugs, whatnot, um one thing that's interesting here as opposed to back where in Lafayette or even where I trained, this is a tourist destination area. Yes. So we get some interesting seasonal traumas. You just know birds who come in uh during the wintertime, and we actually have some people who come here to convalesce after an injury or a surgery, and they're not used to the condo that they're in, and then they trip and fall or fall down the stairs, or they are going to celebrate and they have a drink at dinner, which they don't normally do, and that's right. Any number of things. One thing that we've seen that almost happens every year is you get I'm I'm making up this story, but in my mind, this is how it goes. Somebody's driven many hours to get to the beach, they get their condo, they run out to the beach, they see the water, it's beautiful, and then they dive in and they break their neck on a sandbar and then become a quadriplegic. We we see we see some of these things routinely.

SPEAKER_04 1:16:46

There's the spring break crowd that will almost annually have a fall from a balcony, too, which is I mean, we get a lot of falls, uh, you know, whatever it may be.

SPEAKER_02 1:16:56

And I said there's less violent crime, there still is violent crime. So we still on occasion see uh gunshot wounds or stabbings, the the prisons here. I don't know what they do in the prisons here, but we have a lot of stabbings from the prisons. Shank or be shanked, I guess.

SPEAKER_04 1:17:10

Well, uh and again, it just it it it denotes how um necessary it is to have uh a good trauma unit, a good trauma-trained um surgeons and staff and people that are ready for this kind of thing, because that's gonna be quite literally life-saving. And I mean that's that's really where you measure yourself from the trauma perspective is are we saving lives? And and you guys are.

SPEAKER_02 1:17:33

And we actually have data to prove that. That's the other thing about being a verified trauma center, is not only are you supposed to, there's a it's a huge deal. There's a two, three hundred-page book that describes what you have to do to be a trauma center, not just have trauma surgeons, but orthopedic surgeons, neurosurgeons. You have to have the capability of 24-7 OR, blood banks, um, EMS reasons, there's a whole list of things. Um, but we have all of that here. Yes. And it doesn't just it spreads out to these other departments because we're capable to do trauma, we can do all these other things better too. So there's a lot of peripheral benefits of trauma.

SPEAKER_04 1:18:08

Yeah, yeah, exactly. You know, one of the other things that I love about uh the esprit de corps from from uh trauma surgical perspective is that if there's a massive casualty event, I don't care if you're on call, if you're not on call, you're gonna come and you're gonna go take care of the situation. It's a clearing call to everybody, and everybody says, okay, we're all coming in uh to do this kind of thing. And so I've seen that a couple times, and it's always really uh amazing to see.

SPEAKER_02 1:18:33

We've had a couple of them here that uh yeah, a school bus, we had a school bus crash one day, and so we had a bunch of little kids come in. And they they fortunately were all it was okay. Yeah, yeah. We had to send us a few people out, but you don't know what you're gonna do.

SPEAKER_04 1:18:48

You don't know what you're gonna get. And and you also have to be careful about you know the the post-trauma adrenaline. Hey, this person's walking around and actually they're walking around on a shattered femur or something like that, and then they yeah, yeah. So um well, I'm happy to have you around. Um we're gonna talk a little bit about the future here. What is the biggest issue facing your specialty? And I'm gonna call that trauma surgery uh in the near future.

SPEAKER_02 1:19:14

Locally or nationally, or what I think you can go either way. You can do yes and. These people don't tend to have the best financial system. So a lot of the times for hospitals, locally as well as everywhere else, trauma tends to be uh run in the red. Yes. And so you've got to have the special hospital that does this, and there are other incentives, whatnot. But it doesn't tend to be the most profitable endeavor for a hospital.

SPEAKER_04 1:19:50

That's a really great point because I mean, you know, as a community, as a society, we want somebody there 24-7 that's ready for whenever trauma occurs because it doesn't just happen at three o'clock on Tuesday afternoon. That's not that's not I mean, it happens then too, but but it'll happen in the middle of the night. So we as a society want that. There's high value in having that. We have to find some way to remunerate hospitals and physicians and teams for doing that for this very valuable um service that you guys provide.

SPEAKER_02 1:20:23

And I'm I'm very naive on a lot of health funding, and it I don't think anybody in America's figured it out because we keep changing things all the time.

SPEAKER_04 1:20:31

That's right.

SPEAKER_02 1:20:31

But uh there's a way to figure it out, and we should strive to do it because it's necessary.

SPEAKER_04 1:20:37

It is, and you know, I mean, we we keep having this insurance talk, and we're hoping to, with the Emerald Coast Medical Association and this podcast, have some discussions about various different facets of healthcare insurance and how that really shakes out in ways that maybe would be surprising. But this is one area where I think we could really make a huge difference to make this. We want to incentivize um healthcare units, hospitals, physicians to be around for traumas. We want them to be ready and well rested and well paid, frankly, for providing this essential service for, you know, whenever us or our family members get injured or or have some other traumatic event. I want you guys there.

SPEAKER_02 1:21:18

Want to be there too. Okay, good. I hope they still want us here is the you know, that's always the problem too. You have you have some power being private practice and having your own, but it's not a practical setup in most places.

SPEAKER_04 1:21:30

It's harder to do that private practice unless you're in just a gigantic city that could provide that service consultatively.

SPEAKER_02 1:21:35

Yeah, it's not the my method here, so we're all employed by the hospital ascension. Um so that's one of the the the hurdles everywhere. Uh some things that's uh coming about in the future uh that's really interesting is there's a lot of civilian uh military uh reciprocity as far as data and research goes. They do things better than us, and then we do things better than them, and we we share a lot. Uh as you know, whenever you go give blood donations, they fractionate the blood. So you get packed red blood cells, you get fresh frozen plasma, caroprecipitate platelets. So there's a lot of different components to blood. Blood is not just red blood cells, yes. It's a lot of great stuff that we need. So when we transfuse somebody in the hospital in the civilian life, we start with red blood cells. Well, if we're having to do a lot of transfusion, you're just giving back somebody red blood cells, you're not giving back all those other substances. Whole blood's becoming the one of the big areas of massive resuscitation and trauma using whole blood just from the get-go. From all the things that you need in this, yes. And that's what they do more in the military, and from their standpoint, it was more of a a need. You know, the military guys they have all their blood types, so if they have a problem going on, they'll just over the loudspeaker, everybody who has type A negative blood, come donate, and we're gonna use it right now. Yes. We can't really do that here. So that's one of the hurdles that they're trying to do is uh a lot of big centers already have been using whole blood. We don't have it here, and it's more from a acquisition and distribution standpoint. Um there's different shelf lives with whole blood versus component blood and whatnot. So figuring out how to do that everywhere is one of the new and developing areas of trauma and trauma resuscitation.

SPEAKER_04 1:23:13

Um I I I love that thought because um, you know, there's a couple ways where technology I think could potentially help us. First of all, with whole blood substitutes, I can imagine a scenario where we're going to be able to create artificial red blood cells, etc., and coagulation factors and other stuff that we could inject that don't necessarily have to be stored in a blood bank or something along this line.

SPEAKER_02 1:23:34

Oh, the plasma expanders. I don't know if you remember the the history of those, but headastarches and some of these other things, they were uh coming about. I'm I'm sure I don't know the full history of them, but they were big whenever I was in training. It turns out they had some adverse consequences, and we typically don't really use these plasma expanders or head-astarchers. But at some point somebody's gonna figure out one of these components that can be you know manufactured essentially, and we won't be as reliant on blood or blood components. Yes, and it's not there yet, but there's stored work extraction and other things.

SPEAKER_04 1:24:05

No, and I think that that that is coming around the bend uh relatively soon. As soon as somebody cracks that one, it's gonna that's gonna change things real big. Yeah, I've also heard about um some I think it's sub-Saharan African delivery with drone to blood products to various different places that I think is more remote areas. Yeah, I could imagine the scenario where all of a sudden we're doing that to remote trauma sites, uh whether that be on the interstate or something somewhere that you can while while we're getting you set up, we're gonna start to transfuse you whole blood or something along those lines.

SPEAKER_02 1:24:36

It's interesting in uh training at ETSU or in Johnson City, so right in the heart of the Smokies and Cherokee National Forests. Beautiful area. Well, in some cases, to go 10 miles, it would take you four hours. If you had to go around ridges, mountain, whatnot, well, the helicopters hop back and forth, no problem. So for a lot of those areas like that where we have the technology here, we're not in sub-Saharan Africa. Right. I think it's gonna be real big for some of these areas that can't, you know, right here in Florida, we're very flat, and you can get wherever you need to go driving. But there's some areas even in our country that could benefit from some of the drone deliveries that you're talking about.

SPEAKER_04 1:25:09

Yeah, yeah. I think so. I think there's um some brighter days ahead, even for trauma. I mean, there's some really clear-cut brighter days ahead for cardiology, GI, radiology. I think that that that technology can really help a lot of. A lot of stuff bleeds over, too. Yeah. Like you're just saying. Absolutely, absolutely. So um so um now, how do you think um AI is going to integrate into your field?

SPEAKER_02 1:25:33

A lot of the generic ways that it's integrating into everybody's field, you know, you have it at your fingertip. Uh you you know, open evidence is a great AI program on your phone. I don't know if you've used that app before, but then all the the routine AI apps, you can just you have the world at your fingertips. And if nothing else, you know, it could be the middle of the night and you want that second opinion from a colleague, but it's like, oh, let me just see what this says. And you can sometimes get just an affirmation or maybe a different perspective on a specific patient situation. Um, I've used some of the AI programs myself just with routine patient care, just to this is what I'm doing with a patient. Let's see what AI says, because my patients are gonna be using AI. Right, right. What is the computer and Googling telling my patients so I can be better informed about how to have that conversation with them? Um so that's uh in my mind, that's some of the generic that everybody's gonna use it for across specialties. As far as trauma specific, I don't I don't know yet, but I know it's coming.

SPEAKER_04 1:26:30

Yeah, you know, uh I recently found with a uh with a patient that um had um Fabri's disease. No, I wouldn't have known about that. I would have had to really claw back some some medical school stuff for for this particular disease process, and and indeed uh I had to in terms of looking it up and having some interaction. But I could imagine some interaction that you would have with in a trauma scenario where the your the AI says, oh, by the way, this patient has Fabrice disease, so you might want to use or FFP or something along those lines where it would just be like, and you've got that kind of, oh, you're still doing the thing that you're doing, the ATLS survey and other things like that, but there's also some background, oh, because by the way, this patient's got an EF of 10%, we're gonna start them on more inotrope-friendly pressure support as opposed to to dynamic pressure support.

SPEAKER_02 1:27:22

That that's a good point. We have uh uh across the board, doesn't matter if you're in a big city or little old Panama City, there's a few specialists that are essential to a trauma center that are hard to come by. One's ophthalmology. You can't always ask uh an ophthalmologist uh a question that you may need to ask, so AI is good, but more so what you were getting on. And one problem we had here right at first that's since been uh fixed was we didn't have an on-call hematologist. Oh and so you get some of these patients that you could otherwise take care of at your facility, but somebody who's got a chronic lifelong, you know, even something more common von Willebrand's or hemothelia, or you get some of these. Rare blood disorders, like I know Ish how to manage it. If we had a hematologist here that could help out, no problem. But you have to transfer some of these patients out to specialty center that has it. Again, like I said, we've since resolved that uh to make it a little bit easier for us. But you can use AI for some of those rare blood diseases.

SPEAKER_04 1:28:19

Of course, of course. And you you you want your trauma surgeon thinking about you know stopping the bleeding viscous and not necessarily the you need to infuse Adams TS13 for this patient.

SPEAKER_02 1:28:31

Like that is a totally different another thing like we were talking about, there's all kinds of developments from the hematology standpoint that are new meds, you know, atoms, whatnot, uh that they have different. It's like, oh, I've not even heard of that. It's like, yeah, it's that's new about these past couple years. So it's it's again when you're asking for somebody else's opinion, that's not your level of expertise. Sure, sure.

SPEAKER_04 1:28:51

No, I I I think having because you know, you're kind of with AI, you've got this potential for having 3,000 very smart doctors that are around you at all times that is looking along this case with you. And so I think there is going to be some benefit for that in in all fields. And hopefully it will also bleed into the safety factor too. I mean, maybe we'll know how to better design cars, or maybe with the self-driving cars, we're going to virtually eliminate traffic accidents, which would be great.

SPEAKER_02 1:29:19

And uh another thing we haven't really touched much on is uh the psychiatric and psychological impact of not just acute trauma care, but you know, people get PTSD from a whole range of things. Of course. We don't uh and it's coming more and more prominently is telemedicine. I think uh COVID really pushed a lot of the telemedicine forward. We don't have a psychiatrist or psychologist psychologist uh on staff, but we have telemedicine. And you know, you roll in the TV monitor with the camera and and whatnot. And so we if we need to emergently have somebody you know psychiatrically evaluated, we have that means and ability.

SPEAKER_04 1:29:55

But how are the psychiatrists doing their physical exam? No, that's exactly right. I mean, utilizing the tools and the technology to kind of affect different outcomes, but also starting to think about this from uh a little bit more holistic perspective, I think that's uh that's really great. I'd love to hear this that we're taking care of patients in the long run.

SPEAKER_02 1:30:14

Yeah, that because the acute trauma, a lot of the times, like we talked about, it's exciting. Then you get that case that you've saved a patient, but have you really saved them? And it's it's hard to have that emergent discussion with the family. It's like this is a life-changing, they're never gonna be the same. The the best case we can hope for is they're gonna be 24-7 care with a ventilator and a feeding tube. It's like, do everything for my baby, save my baby. And it's like you in that minute, you've got to do it, but then people don't realize the consequences of those initial actions. So there's a lot of aftercare that comes into trauma that I I don't mean it uh this way, but it's a huge burden on the overall healthcare system. Of course. Whenever you have a functioning member of society and then they're completely dependent, and it drags the family down. And I've I've seen it through the years of just you know, you try and do everything you can, and you know, the patient's alive, but there's different definitions of alive.

SPEAKER_04 1:31:09

Um you're not judging these people. You've seen this written large, you've seen how this happens and how it can really take on families, and of course, you want to do everything you can to save them. And and this is one thing that you know I try and impress upon, and we we can say this now to the lay public. Most every patient makes it out of the surgical OR. Just about every I mean, a high, high, high. Most patients make it out of the trauma bay. So we just we don't lose a lot there. We've gotten very good at keeping people alive. I say this from the CT surgical perspective. I mean, valve replacements, uh, LVADs, bypass surgeries, these patients get off the OR table. They just uh somehow amazingly, we've gotten very, very good at that with a a combined team approach in a lot of different ways. Now, how they do from there, that's where outcomes start to differ a little bit. But we can get patients in the OR and out of the OR. We can do that. Um the long-term thing is different implications there.

SPEAKER_02 1:32:04

So I've uh in my career even with trauma, I've only lost a couple people in the operating room, and it's it's a bad day for everybody, but it's it's odd too. I mean, you're there for you know, you need to be there, but uh you know, but it's yeah, it's it's rare, and and I think people need to know that more.

SPEAKER_04 1:32:23

Our our surgeons are pretty talented nowadays. So what recommendations do you have for young health professionals just beginning their career? Don't major in biochemistry.

SPEAKER_02 1:32:35

Might second that. Some of the videos that uh I've seen social media uh aside, uh I think the the young population seems to be a little bit more focused on themselves as well. So a lot of people are gonna have a little bit of a- that looks maxing?

SPEAKER_04 1:32:53

Is that what we were talking about?

SPEAKER_02 1:32:58

Uh there they seem to be a little bit more well-rounded, or uh not well-rounded, but more focused on themselves. So they're gonna take more time for themselves before they commit to uh an aggressive field like this. Yeah. Um hindsight, I wish I would have done a more fun major, like we mentioned. It would have been nice to take a year off and travel the world, do something crazy, you know. Just be well-rounded.

SPEAKER_03 1:33:18

Yeah, be well rounded.

SPEAKER_02 1:33:18

Yeah, yeah. Be be a person. Be a person first, and everything else will fill in. There's no there's no clock. I mean, I went from school to school to school to school, but you don't have to do it that way. I knew several people that had jobs in, of course, before industry.

SPEAKER_04 1:33:35

Yeah, I know some very successful interventural cardiologists. Shout out Dr. Kaswani, um, for um who was an engineer before he had gone into interventional cardiology. And again, just as successful.

SPEAKER_02 1:33:46

So, so um it's gonna be hard no matter what you do, but there can be other pathways that meander a little bit first.

SPEAKER_04 1:33:52

That's right. And oh, I did want to hearken back to something that you had said, which was really important and crucial, which was um, and this is back during your training for surgery, which is um do the thing that you can't not do. If you say, Man, it's my raison dietra to be a surgeon, well then do that. If you say, I could do it.

SPEAKER_02 1:34:11

Yeah, I've seen some people go down that pathway, and it's just it's not gonna be fun. But uh, even uh the worst, I think, is uh some of the people who are in medical school or even surgery residency who are just doing it to appease more often parents. Yes, those are the ones that are the most detrimental to me. So not only did you take a spot from somebody who's very interested, you're probably gonna either burn out or just like phase out and the investment of society that they have in you is gonna be for naughty.

SPEAKER_04 1:34:39

That's the most disheartening. That really is. That really is. And you know you can be just as smart, just as sharp, and hardworking, but if that's not the passion that drives you, just find that thing. Find that thing. Yes. Um tell me what you do for fun. What are your hobbies?

SPEAKER_02 1:34:53

I mentioned earlier I like reading. I've always loved reading. Yeah. So uh that's a very passive hobby, but uh it's something I do all the time. I've been doing it my whole life. Uh become a big uh audiobook junkie in the past many years as well, so it gives you time to do more than one thing at a time. And yeah, uh so I like to read. Uh more actively, I've always loved the water, which was one of the big draws about Panama City. I grew up on the water to some extent, but it was more of a lake, and then we would drive to the coast in Louisiana. We had a family camp in Grand Isle that we would always go to. That's very nice. That's down deep. Yes. Oh yeah. So uh beaching, uh swimming, fishing. Um whenever I was 11, 12, uh learned how to scuba dive. Me and uh dad uh learned how to scuba dive, so I've been diving since. Okay. Um love scuba diving. Try to get more into spear fishing since being here, since a little bit more routinely love fishing. Yes. So spear fishing was a natural uh progression from there. Um we actually uh we've been boat club members since being here, but we recently uh canceled the boat club because we bought our own boat.

SPEAKER_04 1:35:59

Oh look at you, Latida Butting uh sailors.

SPEAKER_02 1:36:03

We have a nice new sailboat. Um we have our first planned uh big trip uh next week. Where are you going? Um just Pensacola. Pensacola. Hey, look that's great, that's great. Um it's gonna be a good coastal test if we can bring uh four children there and back again. Yeah, exactly. And everybody stays together, that is great. So uh love uh cooking too. Um growing up in South Louisiana, you always have good food and I always love to eat. Um I realized not everywhere uh has good food, and so if you want to eat good food, you've got to learn how to cook it to some extent.

SPEAKER_04 1:36:36

Man, South Louisiana is a special place for that. And I mean, you know, there's there's been uh uh I had alluded to it earlier, but you know, there's some idea that New Orleans is Cajun. New Orleans is not Cajun. New Orleans is that. Yes, and Lafayette is Cajun. Both of those are different cooking methods and kind of different cooking influences, and then they each have their own version of the other subject. Oh yes, exactly. And but they're fantastic food. I'm not here to say that they're healthy, I'm here to say that they are absolutely delicious, and some of that stuff will ruin you from other things.

SPEAKER_02 1:37:09

Yes. And uh so again, love cooking and seafood, and yeah.

SPEAKER_04 1:37:14

So uh Well, uh I wanna I want to probe in just because I'm you're one of the most prolific readers that I know of. And um certainly sci-fi is perhaps uh one of your uh I don't know if that's your favorite genre, but you certainly covered a lot of different territory there. Um what is your favorite sci-fi series?

SPEAKER_02 1:37:34

There was there's a lot of books that I've read. Uh there's one recently that's coming about, they're making a movie of. I'm looking forward to see. But Andy Weir, who wrote The Martian, he wrote Project Tell Mary, they're about to make a movie, and I just found this out, so I'm excited to see that one.

SPEAKER_04 1:37:46

Yes. Loved loved that book, by the way. Really fantastic. And uh I was actually sad that in the previews they had kind of ruined what I thought was probably the most oh my god moment of the whole thing. Uh so anyhow.

SPEAKER_02 1:37:58

One one thing that I really like in a uh is a series, like a long mini-month spanning. You know, you're you're reading a dozen books or so, and uh you get that first book where you learn the characters in the whole time, like you're so I really love those. Uh sci-fi-wise, there's the Honor Harrington series, there's the Vorkosigan series. Those are two big ones that I really liked if you've not read them. No, they're not huge, thick books, uh, but they're they're great. Great. I like that character development over a series. Yes, yeah. Um standalones can be fun too, like Project Hail Mary, but I sure really love the series.

SPEAKER_04 1:38:32

You know, Indy Weir has kind of a unique scientific bent. That's that's kind of one of his themes that science.

SPEAKER_02 1:38:36

Just announced that he's writing another standalone novel that's gonna incorporate AI, but uh he's gonna avoid, I think, some of the AI relationships. I was reading an article about it the other day. Looking forward to that one coming up.

SPEAKER_04 1:38:46

He's good like that. Um but you know, um uh uh we've we've talked before about things like the Expanse series. That's probably uh middle series for you. Uh that's a nine book series, but it's great. They even made uh the T show of the first six books. Uh yes, uh which was really good. Uh but the book series was was incredible. It's great. And uh then the uh you know I just started the Red Rising series, which I've I've that one's good too.

SPEAKER_02 1:39:10

It it led me down in the end. The first trilogy is better, and uh there's still one book to come. He's it's good the whole time the whole time through as well.

SPEAKER_04 1:39:19

Well, I I I'm I really enjoy this because whenever I start to talk about some new hey, did you hear about the sci-fi book? You've invariably read it and read the whole series and know the lore and everything like that.

SPEAKER_02 1:39:28

I like outside of sci-fi too. There's some other good uh you know, the like the more Lord of the Rings style. I like the high fantasy. I like I like fantasy things that aren't real because it's a good escape from everyday life and uh you know reality to some extent. Yes. Um so it's so like Brandon Sanderson. Brandon Sanderson's great. I've read all you know the Mistborn trilogies, and those are good. Uh one that I I I don't know how I fell into this. There's a a new genre. Um I I'm I'm trying to think of how it's it's like lit RPG or literature role-playing games. Have you heard of this? Okay, no, I haven't. This is interesting. I was uh speaking AI, one thing that you can do with AI, if you have no idea what book you want to read, you can get into one of these AI programs. Look, I like the expanse, and I like this book, and I like this book, I like this author style. I'm looking for something that has you, whatever you want to type in. Give me some reading recommendations. And that's what I did, and it spits out, you know, garbage in, garbage out, but it spits out whatever you uh you some recommendations. That's how I got on this uh lit RPG. I think I think I'm saying that right category. Yeah. And uh there was one of the books is called Dungeon Crawler Carl.

SPEAKER_04 1:40:38

The other one is uh I think you've mentioned this one before.

SPEAKER_02 1:40:41

Yes, yes, and I heard it's it's very funny and it's funny, it's hysterical. It's a complete it it's basically like a video game in real life where these people are living their life and for whatever reason their life has turned into a video game, and there's power-ups and uh special it's uh it's kind of like uh Ready Player One in that it's like pop culture mixed in with pop culture. Yeah, yeah, which I think is one that I'm reading right now uh because I finished the the current Dungeon Crawler Carl Carl series with seven books so far. They got a few more pending He Who Fights Monsters. Okay. So it's it's just ridiculous non-real stuff that's again that fantasy genre. That's a good fun escape from. Yeah, one of the things that too I put in the uh the AI thing was good audiobook production quality. Because over the past many years, whenever Amazon got into this with Audible and whatnot, there's some really good production quality audiobooks out there. Sound effects, different voices, and uh so that's one thing that I'm looking for now, too. Is I don't want somebody to just read me a book. I want to be captivated by it and immersed. And so there's a lot of good ones out there too.

SPEAKER_04 1:41:52

Yeah, I hear um the uh Harry Potter series has gotten rave reviews that they've just redone it and it's supposedly very highly produced. Yeah. Um same thing with Lord of the Rings, I think, has some good voice acting.

SPEAKER_02 1:42:03

So I yeah, so I'll put it on whenever I'm doing whatever, you know, running, working out, um, doing task, cutting grass, whatever it may be.

SPEAKER_04 1:42:11

I'll just put my headphones on and well uh whenever I'm coming to my next series, I'm gonna come to you and just just get the the preview of whether or not it's worthwhile. So I could I could recommend several good long series eighty seven book series. No, no, no. It's kind of tough to chew through sometimes. So um all right. Um you ready for some rapid fire questions? I don't know. Lightning round? Is this what's gonna happen here? It's lightning-ish round. Okay, you can expound upon it if you want, okay? Fair enough. All right, who is the smartest person in history?

SPEAKER_02 1:42:40

Smartest person in history. Yes. Are we talking about just like intelligence smartish stuff?

SPEAKER_04 1:42:45

You can take it wherever you want to here. This is no rules. I'm not trying to cramp you into a box. Smartest person in history.

SPEAKER_02 1:42:52

I mean, honestly, I don't know. I don't even know where to go with that. Like cliche, I just want to say Albert Einstein, because that was the first thing that popped in my head.

SPEAKER_04 1:42:58

But it's uh it's not a wrong answer. Yeah, I don't know.

SPEAKER_02 1:43:01

I don't know. I'd have to marinate on that one, but just off the top of my head, that's that's modern day, which uh a lot, you know, political stuff aside. One of the people that I think is incredibly smart is just Elon Musk with all the stuff he's doing. It's just crazy. Yeah, I mean And it's not just him, but it's no, I agree.

SPEAKER_04 1:43:17

He he's he's got this entrepreneurial vision about things, and I think he speaks towards this idea of purpose, of getting your purpose, a unified goal. His goal, he wants to make us a multiplanetary species. How do we do that? And then he starts and then and then he retrospects to the things that he has to do. Well, we'd have to build a company, we'd have to keep people alive long enough. We'd just all these other things kind of fall from that. But I think there's a really um important point there, which is that find your purpose, find your why first, and many other things will start to fall from that. But he's also got some some high intelligence and some high capability, high agency in order to get this stuff done. SpaceX, Tesla, the Boring Company, Tex AI, yeah, yeah. And he's uh building Colossus now, a large I mean, you know, all these things are really it's it would be an incredible feat for any one person. So um to have all of them together is and maybe, you know, um with self-driving cars, we again make motor vehicle collisions.

SPEAKER_02 1:44:16

It's definitely gonna go down. They've already, I think they're eight to ten times safer based on the data, which is insurance companies that will give you a discount for using the Tesla actually has their own insurance, but it's not approved in every state, you know, whatever legal issues there are. But yeah, they give you benefits based on your driving history.

SPEAKER_04 1:44:35

Yes, and uh we you do drive a Tesla.

SPEAKER_02 1:44:38

So so you know, I I I bought it for the the smart uh self-driving, and I our other vehicle is uh a Yukon Denali, and my wife preferentially takes the Tesla because it's just so much more fun and easy to drive to drive because it's driving you. And uh it's it's wild. The the the electric part of it turned out to be a boon as well because it's just easy. It charges in my garage when I'm not using it.

SPEAKER_04 1:45:02

That's right, that's right. A lot of creature comforts in that car too. So really cool.

SPEAKER_02 1:45:06

Highly recommend it. I don't I don't see us not having a Tesla or comparable vehicle from here to now.

SPEAKER_04 1:45:12

Yeah, my wife and I said with our last cars that we got, it's probably the last ones that are going to be non-electric, so we may as well enjoy it while we can. Uh so it's amazed how much I like it. So uh apropos to that, um, if we can live to be a thousand, should we do it? Yes.

SPEAKER_02 1:45:28

At night, do you want it too cold or too hot? Kind of not either, but on on the edge of too cold as opposed to too hot. That's the right answer. I just want you to know.

SPEAKER_04 1:45:39

Okay, so objectively. Um if you could go right now back to when you were starting medical school, what's one thing you would tell yourself?

SPEAKER_02 1:45:50

If you would have said undergrad, I would have said choose a different major. Med school is where I focused here. Medical school onwards. Uh I don't know that I would change from medical school. I'd just keep going for the work.

SPEAKER_04 1:46:04

Um, what is one current medical treatment or therapy that we do that we are gonna shudder at that we did 15 years from now?

SPEAKER_02 1:46:14

Um I think there's several things that we are gonna look back and say it was a little barbaric. Um not because it was wrong at the time, it was right at the time we knew. But uh it's one of the things that's interesting in surgery and trauma. We literally have to hurt people to help them. Yes. And uh if you think about some of these, uh I think vascular surgery is one of the big areas, especially from your standpoint, cardiology. People used to get their chest cracked open or big open aneurysm repairs. We can do things so much nicer indivascularly with these small little cuts or incisions. So there's gonna be a lot, I think we're gonna get a lot more minimal from a general surgery standpoint. We used to do big open incisions on the belly, and now like Chris is a wizard with the robot. There's some things that are uh I I just think some of the harshness and barbaricness of surgery is gonna go away as more, I don't think it'll ever truly go away, but it's gonna change in ways that we haven't been able to foresee.

SPEAKER_04 1:47:16

Yeah, it's it's been an interesting thing too, because you know, as we're getting better at minimally invasive, as we're getting better um in percutaneous uh stinting versus having to do open repair and bypass, the question is will your surgeons get less practiced at that?

SPEAKER_02 1:47:34

That that's a I I could spend a whole nother podcast just on talking on that subject. But uh one of the things too that you made me think of, we were talking about AI. Uh as the evolution of oncological therapy came about, you know, that's the the famous Halstead model, like more surgery is better. More surgery.

SPEAKER_04 1:47:53

Breast cancer is a surgical disease. Breast cancer is a surgical disease.

SPEAKER_02 1:47:56

We need to remove more. Yeah. And we still do breast surgery, but from the we've completely totally removed them. Yeah. As AI and some of these, you know, we again shotgun chemotherapy and radiation, as we're getting better, now there's these biologics that have come about. I think AI is gonna really progress. There's gonna be a point where some cancers, you you take a pill or get an injection, and it's gonna evaporate the cancer, for lack of a better word. And so some of these former surgeries that we did are gonna disappear.

SPEAKER_04 1:48:24

I totally agree. Now that we're getting oncotypes, the actual genotypic genotypic expression of the cancer. Specific to that individual cancer, bespoke to that cancer, um, you can now get much more bespoke treatment.

SPEAKER_02 1:48:37

So I I think that's a really some of that I think is gonna just go to the wayside. I mean, uh the one of the most horrific surgeries a general surgeon or you know, traditionally can do a whipple with all the pancreas. I mean, whenever they melt that pancreas tumor away, and you don't have to do that anymore.

SPEAKER_04 1:48:52

It's gonna be so great. And uh just for the lay audience, um, a whipple procedure is where you have to remove um uh tumor mass from the head of the pancreas. And the pancreas is a retroperitoneal organ, it's it's which means it's kind of deep into our body, really posterior, close to the spine. Very difficult place to get to. And in order to find it and remove it, you have to remove a lot of other stuff too.

SPEAKER_02 1:49:16

It's a you're gonna be looking at uh eight-hour long procedure, and then once you get it removed, you gotta put Humpty Dumpty back together again, and it is not a physiologically ideal reconstruction.

SPEAKER_04 1:49:26

And so you're changing around the visceral organs and how they're gonna be flowing, and so it's a it's a it's a monster procedure. If we could get to where we never had to do another whiple because we were taking care of pancreatic adenocarcinoma, better. What a what a boon to humanity. So um all right. Uh well this is that wasn't exactly lightning, but you know we can't. No, no, no. We we can expound upon this. Um, so uh now we talked about uh your book series. What book are you reading right now?

SPEAKER_02 1:49:51

I'm on the He Who Fights with Monsters series. Um that's my audio book that I'm I'm usually got a few going at a time.

SPEAKER_04 1:49:57

Yeah, some hardcover book. Uh An iPad book or something.

SPEAKER_02 1:50:01

Yes, and I have my Kindle book and I cannot remember the name of it offhand. But I'm reading a book on Kindle, and then I've got an associate ass sorted uh set of ma magazines that uh Cruising World is what I'm reading right now. Okay.

SPEAKER_04 1:50:13

All right, good. All right. Um and then uh last thing here, what's the best song of all time? Best song of all time.

SPEAKER_02 1:50:19

Uh I love music. I've always got music on. Uh one of the things that irks my wife sometimes is I just I don't listen to it. Uh I just like the background noise. And I don't know. Uh even in the operating room, it's like, what do you want to put on? I was like, just put something on. It's like the absence of noise is more disturbing to me than unless it's just more conspicuous. It's completely uh awful. I don't know, maybe the voices in my head start talking when there's too much silence. Don't let them do it. I'm not sure. So I I can't, and I listen to a whole bunch of different genres of music. So me just like picking one song out, I I I'm not having it.

SPEAKER_04 1:50:57

Hard to decide. I I don't know. Fair enough. I'll let you off the hook and say, um, well, um thank you so much, Jamie O'Neill, for being here uh with us on the podcast. Thank you for being a member of our community. Thank you for being on the board here at the Emerald Coast Medical Association. Um, and thank you for saving all the lives that you do. Um, it's really uh it's wonderful to know that my family, God forbid, should they need you, that you'll come a running. So thank you so much for being here. And thank you to the audience for helping us make medicine better together. Glad to be here.

SPEAKER_02 1:51:30

Thanks, Donnie. If I had to put you on the spot, what's your number one song?

SPEAKER_04 1:51:33

Oh, uh it's uh it's called Um Mission Control, and it is from No Knife. And it's I thought you would have been a Taylor Swift fan. Well, uh, that's second best. So it's all right. Thank you. Yep.