Episode 18: Dr. Christopher Haberman, MD

He sold voicemail when no one knew what voicemail was. He ran FDA omega-3 trials in a vet school lab in the mid-nineties. He was a cardiology-bound resident until a dying patient's family mailed him a letter. Dr. Christopher Haberman took the long road to oncology. And Panama City is better for it.

Transcript

SPEAKER_00 0:14

Well, hello and welcome again to the Medical Mastery Podcast, the podcast in the Emerald Coast Medical Association. I am your Amaranthian host, Don Davis MD, and I am more than happy to be here today with Dr. Christopher Haberman. Dr. Haberman is a hematologist oncologist, as I read here in my notes. Is that true?

SPEAKER_01 0:31

Yes, that's true.

SPEAKER_00 0:32

Oh, wow, this is going to be fantastic. So for all of you out there that are joining us here today, we're really excited about this conversation because we get to find out about a local physician here who is in our community and helping patients day to day. But also I'm a bit of a cancer nerd, and I really love this subject in a lot of different ways because, you know, I think it's been something that's really in many ways been the bane of existence. It's weird coming from a cardiologist that really worries a lot about cancer, but in many ways, cardiovascular disease is something that's pretty treatable. Um cancer is ebbs and flows depending on the disease state of it. So we're going to hopefully get into all of that with you. So welcome. Thank you. Glad to be here. Yeah, well, um, let's start off. Before we get into some of the interesting stuff, let's start off by tell us where you're from.

SPEAKER_01 1:23

So I grew up in Savannah. Uh that's where I was in practice before I moved here. So I was in practice about 15 years before I moved here. Uh medical family. My dad is a retired trauma surgeon. His dad was a doc. So uh one of the kids, I guess, felt obligated to go into medicine. I guess it was me.

SPEAKER_00 1:39

And everybody else had stepped back. So you were left with.

SPEAKER_01 1:42

One's a mechanic, the other one's a computer nerd.

SPEAKER_00 1:44

Well, you know, there's something about um the logic that comes with this. I mean, you know, uh I I often say that um biology is extraordinarily complex, but it is a machine in some sense. So there is that mechanistic thinking that I think probably, you know, uh that that can contribute to our understanding, but also how we try and make people better. Um so your dad's a trauma surgeon, all right. We've had a trauma surgeon here. Uh shout out Jamie O'Neill for for being on the air. Um you know, trauma surgery is uh it's a very interesting life. How did he bring that home? How did you guys witness the the trauma surgeon in your lives?

SPEAKER_01 2:24

So it was unusual because my dad is 90, so he finished med school like in the late 50s, early 60s, went off and did residency in Maryland. Uh he was military. Okay. Um so he ended up in Savannah uh as part of his military obligation. And did a lot of surgery there, as chief of surgery at the health ho uh, the public health hospital in Savannah in the 60s, and all of a sudden somebody got a brilliant idea to open an emergency room in an old hospital. I've been there since the late 1700s, and they never had an ER like that. And they hired him and two other docs to come start an ER program. So three docs ran a 24-7 ER program for gosh, for decades. And then the mid-80s he decided it wasn't for him anymore, and then he went out in private practice and just kind of did no more surgery, uh, did occupational medicine. That was a uh very different lifestyle for him.

SPEAKER_00 3:15

Yeah, you know, uh, I mean, trauma surgeons typically have shift work, or maybe it's a week on and then two weeks off, something along those lines. Um, but it can be incredibly intense. I mean, you're obviously dealing with traumas and you never know what's going to come in through the door. So um I don't know if you ever talked to you about that kind of life or what that was like.

SPEAKER_01 3:34

Oh we heard all the stories, all the interesting uh things in body parts and all that stuff. Of course, we've heard all that, and you hear all the stories. Because in the 60s and 70s, medicine was so different. I mean, you could say anything to anybody. I mean, it just kind of slipped out. You know, you'd see you observe something say, Wow, I didn't expect to see that, or you'd hear the story. So you'd come home with stories. I was I was the youngest of the three, so I was still pretty little when he was doing all that. I just remember his hours were, you know, he wasn't around a whole lot. Um but he did get expend extended vacation the summer. They'd work it out with the three with the three docks, they'd figure something out. So we had a uh break during the summer, but uh it was difficult. I will I will say that. A lot of night work and a lot of shift work.

SPEAKER_00 4:15

Yeah, yeah. And also um heavy lifting, you know, you're we're all gonna lose patience in this game. Um and you know, mm particularly trauma surgeons can see some brutal losses of patience, and so that can weigh on you. So to be able to kind of recollect yourself and move on to the next patient, that that shows a lot of fortitude. So uh sounds like there was at least some some good role modeling there for how to handle these situations. Um also, you know, old school there, uh, which I love, I mean, they didn't have work hours back in. That was not a thing that he he didn't get a chance to say, no, no, no, it's past my call time. I need to go home. That's he was not afforded that luxury.

SPEAKER_01 4:53

No, call for them was they called it heel to toe, it was every other. Oh they just basically lived in the hospital and they didn't go, they went home, but it was every other night. When they were on service, like the surgery service, trauma service, it was every other. Oh, we you know the medicine residents were used to Q4. Oh, yeah.

SPEAKER_00 5:10

And they have plain about that too. Don't get me wrong. No, the surgeons are a different breed, especially uh uh again, the the older school uh surgeons. So um now did he do military trauma surgery as well? I mean, was it was that where he got trained? Is in the military, so battlefield.

SPEAKER_01 5:29

Oh Hopkins, I've heard of it. Okay, yeah. One of those small hospitals. Oh, I got you, I gotcha. Um and then uh part of his military obligation when he was done, that's they gave him the choice of uh mash unit or savannah, Georgia, and obviously the rest is history.

SPEAKER_00 5:42

Okay, I can see why he chose what he chose. Yeah. Um well look, that's really interesting. So you can start to see some sort of formative thought about medicine. Now, when w were you in high school thinking, you know, I'm gonna go ahead and go into medicine, or did you have dreams of doing something else first?

SPEAKER_01 5:59

You know, as a little kid, you you think, oh, it's interesting, the human body's interesting, all that stuff, and uh enjoyed it a ton. Always thought I was gonna be a doc, but uh kind of lost my focus. So I went to a uh private school and uh college was really easy for me. I was well prepared. My prep school made it real easy. Yes. As a matter of fact, it was so easy that uh I kind of didn't do my job as I should have. And uh uh so I I kind of lost focus, and you know, medicine was not something I was probably gonna get straight out of college. I had to have some detours in life. Yeah. Go to grad school, et cetera, and then got back into med school, got back into that frame of mind and went to meds or got in uh to med school.

SPEAKER_00 6:34

Well, th those things are formative to us, and sometimes you know, we take some extant kind of jobs or career choices and then come back to it. And I I think it's you know, I've got several friends, colleagues here, uh former podcast guests that have taken a more peripatetic life uh choice in order to get to where they ended up. But it but it's nice to see how they ended up there. So let's hone in on that for a second. What'd you major in in college? Biology. Biology, okay. Yeah. Um was that kind of a means to an end, or were you fascinated by biology, or was that I think that was the most pre-med tracks went biology.

SPEAKER_01 7:08

Some went chemistry, some went biology, and a few physics, but most of them weren't, you know, uh philosophy or English. You we had to do our basic sciences. So that was that was the route I chose that, and as I said, I really lost focus, whatever, life happened, I don't know, whatever. And um then I graduated, and a biology degree is not very marketable. It's not like you're gonna find a job outside of a lab.

SPEAKER_00 7:32

It's a stepping stone to something else, yes.

SPEAKER_01 7:34

And uh sold voicemail.

SPEAKER_00 7:35

Oh.

SPEAKER_01 7:37

Uh, which was a really tough job because it wasn't voicemail wasn't around. Everybody had answering machines. Yes. And they're like, why do I gotta pay for voicemail? And then I came up with uh a little niche for realtors and uh kind of moved up that way and realized that wasn't for me, and then went to graduate school, and then that's what got me plugged back in.

SPEAKER_00 7:55

Gotcha.

SPEAKER_01 7:55

So started academics essentially all over by going to grad school and then uh uh went then. I was a pharmaceutical rep-and then went to med school or got into med school.

SPEAKER_00 8:04

Yeah, you know, this is sometimes great to go into something totally different, like sales, where all of a sudden you realize, oh, I really don't like this. Maybe, maybe really holding down on the books would would probably help me get someplace where I could kind of use my brain in a different way. Um what'd you do in grad school? Uh physiology. Physiology, absolutely.

SPEAKER_01 8:24

Yeah, so it was at a vet school. So all my all my colleagues were all veterinarians working on their PhDs. I was the only non-veterinarian uh working on my master's, and really was just to beef up my uh my application for med school.

SPEAKER_00 8:36

Now, what were you studying more specifically in the labs that you were doing?

SPEAKER_01 8:40

Renal physiology.

SPEAKER_00 8:41

Oh, very cool. Okay.

SPEAKER_01 8:42

So the guy I worked with and got my uh assistantship from, he that's all he did. You know, when you get in a big university setting like that, they carve out this one little thing.

SPEAKER_00 8:51

You get more and more precise and specific, and um may have been the upper pole of the kidneys. Um, you know, I mean he you can get pretty precise there.

SPEAKER_01 8:59

It was fascinating because stuff y'all use today. It was all the all the baseline lab work on omega-3 fatty acids and uh all its effects for antihypertensive properties and cholesterol and all that stuff. These are all FDA trials and things that we did. So uh it was pretty fascinating stuff. And this is the mid to mid to late 90s, mostly mid-90s. So omega-3s, we didn't know anything about them, and then all of a sudden now it's you know it's a pretty hot topic for you guys the last 20 years.

SPEAKER_00 9:23

Indeed. Indeed, it is. And and it's also it kind of harkens to how we learn things in, you know, on a metascale. Um, you have to start off with the physiology. It always starts with that. You have to understand how this process works, what the cells in the kidney are actually doing, how they're filtering. I mean, it's this is a tremendously evolved mechanism here in order to maintain the things that you want and get rid of the things that you don't want. And that homeostatic mechanism, because it can flex quite a bit, depending on how much water and salt you've had. I mean, the kidney is absolutely fascinating to do that. But you have to understand all that, and then we say, how can we take care of perturbations of the system in order to effect necessary changes that we want? So that must have been a great mechanistic way of thinking in order to kind of get your brain right about how to think about the body. Yeah, it is. Physiology I found to be um difficult, but also one of the most rewarding things because I I kind of constantly talk about cardiac physiology. And so and now um, you know, the kidney physiology doesn't necessarily lend itself to eventual oncology. So there had to have been some sort of transition point along the way where you said, I'm never dealing with kidneys ever again, or uh did you feel that after you had gotten your master's degree?

SPEAKER_01 10:37

You know, it's it's hard to s you know when you go off to med school, you don't you don't know what I mean, you sort of know what you want to do. I mean, even coming from a family with physicians, you think you know what you're getting into, but you really don't. As you know, you they they pressure in a lot of times in med school to make decisions about, you know, maybe go do primary care, we'll give you this loan repayment. Uh they lure you in and say, hey, you're gonna do this, you're vulnerable as a first-year med student, and uh you just don't know what you want to do. So you try different things, you learn, learn the first couple of years, you do your clinicals. And well, I mean, when I was done with med school, I was actually gonna do cardiology. That's what I thought I was gonna do.

SPEAKER_00 11:11

But you wisened up. Good on you. That was a very smart decision on your um You know, it's it's so true that we kind of have these preconceived. I was going into primary care. I I I knew that going into it, and then came out the other end thinking something differently. Um But you also, you know, it's done in Kruger effect. You have no idea how little you know until you get into that. And it must have been quite an accomplishment on your part because you would kind of I mean, there must have been some doubt coming out of this because, like, well, you know, I mean, I had taken my time during undergrad and I'd gone through graduate school. There's a feeling of relief of just getting in, and then you realize the fun hasn't really even started. You're you're you're just now getting into this whole thing.

SPEAKER_01 11:57

Yeah, I mean, I'm I was I guess I was one of the weird guys. I I enjoyed med school, I enjoyed residency. It was like one of the most fun times of my life. My wife and I talk about it regularly. I mean, it was it was different. We didn't have much of anything, as you know this as well as I do. And indeed. Uh we enjoyed everything we did. Uh the work hours were brutal because, like you said, we didn't have work hours. Um it was, it was a different time of my life, but I enjoyed it. I enjoyed training. Uh I had fun with it.

SPEAKER_00 12:23

I I really enjoyed working at high levels and really kind of you know, steel sharpening steel, and you really being pushed a little bit more to your limit to how much can you learn about a subject in two months? Because you had two semesters in undergrad and now you've got six weeks to go. And and then you simultaneously, while you're trying to learn this subject, you're also feeling like if I want to be a professional at this, I need to know this. Like I, you know, it's it's it's holding yourself to a kind of a different standard that maybe I hadn't done before.

SPEAKER_01 12:58

And you know, it was Yeah, I think you I think you realize when you're an intern, you realize you think, oh, I know so much from med school, you just don't know how to apply it that well because you haven't really been interns weren't unsupervised, but they you know they kind of let the the reins off a bit. And you know, I thought my internship, I said, I there's no way I can learn more uh than I've already learned. Then you realize in internship, I was like, I learned more in internship than I've ever learned in my entire life in one year.

SPEAKER_00 13:24

In one year, yes.

SPEAKER_01 13:26

And then you go on to your second year when you're now the supervising resident, and you're saying, I can't possibly learn more. And then then you're the supervising, you're the decision maker. I mean, there is a there's an attending around and always available, but then by third year, you're you're comfortable. Uh and then like you and I did, went off and did a fellowship and you think, oh wow, and then you get out and fellowship and you're like, I didn't realize I could learn. And then the real test is when you're out there after you finish fellowship and you're truly on your own. That first year in practice was eye-opening in the sense, I never thought I could learn that much again. And then it's just it's exponential, and it sort of does plateau out with experience like everything, but I'm still surprised even here. I mean, I see pathology that I never thought I'd see.

SPEAKER_00 14:09

You can still be humbled. You can still be humbled all the time. Yeah, and you know, um extremely rare cases stick in your mind, and uh that's something that I never got as opposed to our dermatologic colleagues that can read a book and memorize everything. That was never my talent set. And so um so I had to match it with a story. And the story was typically a patient that presented with all of a sudden I see this obscure thing, and I'm like, oh, that's Enoch Shawn Line Purpera or something. You know, I mean that that was when I can do, oh, that was Mr. Wilson. I I know exactly what locked-in syndrome is now because of I remember this patient that had this kind of thing. So now um so you're going through medical school. Now we typically have to choose we're gonna choose eventual paths, but you kind of have to think between medicine and surgery. Now, you would think you had some surgery kind of built into your lineage there. Did you consider doing surgery at all? Not once.

SPEAKER_01 15:06

It's not that I it's not that I didn't like it. I mean, we can talk about residency later, but it's it's not that I didn't like it, it just wasn't for me. It wasn't my calling. I was fascinated by it. I love doing the cases, I had fun with it, but it just wasn't for me. I didn't want to I didn't want to do surgery. I just knew from the start. And I and the other choices, you're right. It's either you go the medical route or the surgical route. And in gynecology, that goes more the surgical route as well. That just wasn't for me. Single gender medicine wasn't something I really wanted to do. Yes. Um, and then pediatrics, I didn't really want to uh treat children and their uh parents, so some went medicine, some went adult medicine, and then that opens up all the opportunities, all the different fellowships and different subspecialties you can uh go into.

SPEAKER_00 15:48

Now, um so where did you do medical school? Mercer. Mercer, okay. And so then you move on from there after you finish the the um kind of one of the best years, which is fourth year of uh medical school. Um I spent it all the way. I didn't live in Savannah at all. So you're doing various different places, yeah.

SPEAKER_01 16:07

Yeah, so the first two years it was in Macon, it was where all the didactics were, and then the last two years we had the option to go to Savannah or stay in Macon. Well, I was from Savannah, so it was an easy decision. Um and then third year is standard for everybody. But yeah, fourth year I spent Vermont. I went all over the place.

SPEAKER_00 16:23

What a great way to experience medicine in a lot of different places. And and you start to see the similarities and differences between uh you're comparing and contrasting different academic programs in various different places and kind of seeing rural, big hospital and those kind of things.

SPEAKER_01 16:35

They're interviewing you as much as you're interviewing them for residency.

SPEAKER_00 16:37

Indeed. And you're also what you find out kind of in hindsight is you're almost interviewing for life. You're you're testing the waters in various different places to see like, do I could I see myself doing this? Could I see myself living here? And so that was that was kind of formative for me too.

SPEAKER_01 16:51

Um now, so where'd you do your residency? I did it in Birmingham. I did it at Baptist Health Systems there.

SPEAKER_00 16:57

Okay, great. And um so your work hours jump up uh a lot from medical school. Um the amount of knowledge that you have to learn while also working jumps up significantly at that point. Um you're really working for a living. But you know, as you said, I I loved my intern year. Like that, that was that was really uh a great time and it was extraordinarily hard work. Um so sometimes you kind of forget about the work hours a little bit because you know you you just again you learn so much and so many formative things. I can still have my attendings over my shoulders and and and hear them saying things about just general patient care that I think was great. So um and then how did you decide from there on fellowship?

SPEAKER_01 17:41

It was fun. I was I was groomed being groomed for cardiology. Yeah, I was getting the guys at UAB, they were I was rotating with them, you know, a couple of the big names there. They were I was doing rotations with them my second year, and then I was moving, I was uh I was on call, I was on service, I was on wards, and uh took care of an oncology patient that was wouldn't have the the greatest time at things. A lot of a lot of our oncology patients in the hospital, unfortunately, many of them, it may be the end of life, that's why they're in the hospital. They may have exhausted all the standard care therapies and not doing so well. And their doc really hadn't addressed kind of, you know, code status and you know, hospice or what are the treatment options. I mean, this is in the early 2000s, so there wasn't, you know, once you kind of exhausted treatments, there wasn't a whole lot left beyond kind of routine chemotherapies. And I took care of them, the husband or the patient wasn't doing well, and clearly looked like he was eminently going to code that night. And I had this lengthy discussion with a family member, and uh, after tears with them, certainly with me, it was very emotional. Um unfortunately, the patient ultimately passed, uh, was a DNR, so he didn't have to go through uh being CPR, etc. And uh kind of went and went on and did my job, and about three or four months later, I got a letter in the mail from the spouse's wife, and it was this long drawn-out mail email uh letter that said, you know, I appreciate you spending the time with me, ultimately made the the right decision. I'm I'm glad I'm glad we met with you and not somebody else. I'm glad we didn't pursue CPR, et cetera. And it was it hit it hit pretty hard, and then I realized that the oncology patients, much like you guys, I mean, there's a lot, they're very thankful when you're doing something for them. Uh they're extremely thankful, and it was very gratifying, and it was entirely different than some of the other subspecialties I've been exposed to. Um as a resident, you get exposed to the worst in oncology patients because they're the sickest. You don't always see what's going on in the clinic. And then I realized I better get in the clinic and see what outpatient oncology is like, and that's what that's what flipped the switch.

SPEAKER_00 19:41

That is awesome. Um and you know, it highlights um a discussion that we as physicians should have with patients, which is um meaningful thoughts on outcomes of of changing goals of care, of palliative care, of DNR. Patients, in my experience, they understand typically what's going on. They at least have some sort of visceral feel for if they're dying. And so to have that direct talk with them and talk about the things that you can and and won't be possible. I I think that is just it's so formative and it is an incredibly emotional experience and is one that is absolutely formative. Um so I've had a couple of those experiences, same thing, in residency that certainly uh moved me. It didn't move me towards oncology, though, I can tell you that. Um so good on you for for feeling that out. Um well oncologists all are a little different, as you know. Cardiology is pretty different too. So um now um, you know, one thing that's a little inside baseball from the internal medicine perspective, because you know, uh w we know this, but but for the lay audience out there, you have to do three years of internal medicine residency, and then you can choose fellowship if you so choose to after that. And there's several different subspecialty fellowships, whether it be nephrology or cardiology or infectious disease or hematology oncology. And um, you know, you would think that one of the things that kind of surprised me is that internal medicine doctors, the hospitalist team, they don't write chemotherapies. That is basically all to the oncologist. So once you hit that standpoint, once we went to the this patient has some sort of aggressive cancer, we're going to start them on chemotherapy, that went over to the oncologic world and didn't really come back this way. So there is some sense of you almost not knowing about that until you really get into it with fellowship. Is that was that your experience?

SPEAKER_01 21:39

Absolutely. And the first few months of fellowship, I'm sure it was the same for you. They're all focusing on, you know, they put the big guilt on you. Oh, no one in this program has ever failed internal medicine boards, and you're not going to be the first. And then you've got to learn all these new drugs that most of them we've never even heard of because all the stuff we're tested on is on the ancient chemotherapies that are still around and effective. But a lot of the modern therapies, they come and go because a new one replaces them within a year. So there's just this tremendous pharmacologic turnover. So you're trying to learn all the new pharmacology, the dosing. These drugs have narrow therapeutic windows with dosing. You don't want to give too much, too little, whatever. And then you're studying for your medicine boards, which is your biggest test to date. Yes. Clearly. Because if you don't pass if you don't pass your boards in fellowship, that is not well received. Does not look good. So many times you don't have a job. That's right. That's right. So you have all this pressure. And medicine boards were, I want to say they were in August, and you start fellowship around, I started the week before the Fourth of July, but usually late June, early July. So I mean you're thrown into the brand new system. Most of us go to a new hospital because we don't stay at the same one we're at, and then you're having to do your medicine uh review and maybe go off and do a board review class. There wasn't a ton of online options just because it wasn't around.

SPEAKER_00 22:51

Yes. Well, in and the other thing about this that that I found is that it was, you know, as a cardiology fellow, um I'm expected to know cardiology. And I I and I didn't. No, I I mean, you know, I I I certainly knew the basics from internal medicine side. Um but in terms of like, you know, real bread and butter cardiology, you have to learn that. Now you're expected to know it because you're a cardiology fellow at that point. The patients expect you to know that. And so you feel almost out of suit because I've got to look up a lot of these things. Like, what on earth does this medication do? I don't know what this kind of thing is, and you know, it's something that you're gonna be expected. You didn't really know how to treat cancer at that point when you're being thrown into it.

SPEAKER_01 23:37

No, not in the first number of months. You're it's just as again, another that's that learning curve. You think you can't possibly learn at the rate that you're gonna and it's exponential.

SPEAKER_00 23:46

Yes.

SPEAKER_01 23:47

And then it kind of all seals in all the primary care and everything else. Because a lot of times when you're in fellowship, uh we're able to moonlight as internal medicine attendings on round services and things like that. Or one of our attendings, you know, one of a lot of the oncology attendings did medicine teaching as well. They'd go on vacation, say, Hey, can you fill in for me and do rounds uh this week? And you know, we'd always oblige, because if an attending asked you to do something, yes, sir, it's uh what do you want me to do? Yes. Um But yeah, you so you learn all that, you're applying it now back to all the stuff you know, and it's just again, the learning curve's tremendous. It is truly exponential.

SPEAKER_00 24:21

Um did you find at some point, because we're gonna talk about some specifics about um chemotherapeutics, radiation, and kind of the our our bread and butter oncol oncologic uh therapeutics that we have. Um but did you find yourself that as you matriculated through first, second, third year of uh on oncology fellowship, that things started to come a little easier to you? There was a little bit more intuition that could guide you. You were making the right answers on the yeah, yeah, absolutely.

SPEAKER_01 24:48

Uh it you start picking, it starts getting easier. You see it's it's just a lot of it's pattern recognition. Yeah, you once you've seen the eighth colon cancer and the treatment really isn't a whole lot different for the other seven. You see the patterns, it's like you know, DKA, it's like all that stuff. You learn the pattern recognition, you get familiar with it, and then it's it's autopilot.

SPEAKER_00 25:09

Yeah, you know, part of the training, I think, especially in oncology, had to have been yes, you have to learn all the pharmacologic standpoint and certainly all of the physiology and cancer biology. But you're also learning a lot of emotional um connection with patients. I mean uh uh there's very few things I can think of that probably cause more fear than a cancer diagnosis in patients. And so they're gonna come to you in an incredibly vulnerable state. Part of that is empowering and it's helpful to us because we get to see people, you know, and and really come to them altruistically to help. Um but that has to be an emotional uh burden to carry home and into other relationships.

SPEAKER_01 25:53

It's it's like all forms of medicine. There is no doubt. There's an emotional component. Patients will either open up to you or they're not. They're not going to open up to you. So if they want to open up, you try and get it involved as best you can. But you also have to have a little bit of a barrier for yourself. So when you go home, you're not an emotional train wreck either. Uh but we all have good days and bad days, there's no doubt.

SPEAKER_00 26:13

That's true.

SPEAKER_01 26:13

It is tough. There is an emotional component that you don't always you don't always see that in fellowship as much because you're just learning, you're in that book, and you know your tendings are all over you and pushing you around and just getting the job done. And you know, you just have massive amounts of work. You're at these massive medical centers that you know we're nowhere near that anymore once we get out of fellowship, unless we stay in a big city.

SPEAKER_00 26:34

That's right. That's right. The number of patients are the number of patients. True. Sorry, we've got 40 on the service today. Get to work. That's right. And then that's what you have to do. Um, you know, everybody deserves treatment. So um I was talking about something that many patients fortunately don't know a lot about, and that is probably one of the I don't know, scary is the right way to say it, but but one place that I don't enjoy going at all, which is the bone marrow transplant unit. Um that is a place where um you've had to spend a fair amount of time uh just in your training alone. Um why don't you talk to our lay audience perhaps about what the bone marrow transplant unit is and how that kind of comes into play and why that is a it's a really tough place to be, but good god do you guys do excellent work in those places?

SPEAKER_01 27:22

Yeah, so I'm not a transplant doc, but as you say, we all do just like the bone for you guys. I mean, you you spend time there as far as training. We have a lot of patients here that we send for transplant. So there's no transplant centers here locally, but as far as spending time in a transplant unit, these patients can be the sickest of the sick. They're always teetering on a balance beam, and we're sitting there nudging them to push them off with all these different perturbations that are out there, infectious uh causes, and they're just the sickest of the sick as they're trying to recover. Um, it's basically an ICU uh ward that's all isolation because everybody's got a mask up and gown up because they had none of them have immune systems. The transplant units, you know, transplants today, things they're the same as they were when I was in fellowship. You have auto-transplants, which is where I donate my own cells uh for my own transplant. Then you have the aloes, which can be related donors, so it's another person donating to the patient, whether it's a related donor or an unrelated donor. And each one has its own set of mortalities and uh risks and et cetera. Um then that just will bridge on for the f for the rest of the talk, I know, but it is stuff called CAR T and then this biospecific antibodies. I mean, there's all this stuff that's coming that I think eventually will land back into the community and the smaller programs, but right now transplant which really is in the bigger academic centers for the most part. Yeah. Um they are the s potentially the sickest patients because they have no immune system. They just can't fight anything. Any infection is a you know potential life-threatening.

SPEAKER_00 28:58

Yeah, and this is maybe a good segue transition point to talk about um some of the treatments that we use for cancer. And we'll kind of cover what cancer is and and uh some of those issues too. But um for many cancers that we have, including a lot of the humanologic malignancies, uh that's blood-based cancers, um if you if it is such an aggressive cancer, or if it is growing so much, or if your bone marrow is putting out so many of these cancerous cells, we come upon a treatment strategy where we try and obliterate the bone marrow. And we try and obliterate the bone marrow typically using poisons. That's effectively what chemotherapeutics are. The hope is that we will kill enough of the cancerous cells but still leaving you intact. And that's a very narrow balance sometimes. So for these patients that are in bone marrow transplant centers, you are obliterating their entire blood supply, their entire bone marrow supply, and therefore their entire immune system. So they have no ability to fight off any infection whatsoever. This is where you learn in training that um a one branch of the white blood cells are the neutrophils, uh, some of the white blood cells, and there is no greater emergency than a neutropenic fever. That means somebody that's still able to mount a fever, despite them not having very many white blood cells at all, that's a true emergency. They are incredibly sick because you know your white blood cells can kind of mediate a lot of your your fever resistance and other things, or your your ability to create a fever. So um these are extraordinarily sick patients who are really teetering. They can't eat anything, they don't look well, they don't feel well, many of them can't even talk. And that was just it was a very formative experience going to codes in bone marrow transplant centers. That that will really land home on you. And and um, so that's I don't know, that was a very formative experience to me and going through training that I think really landed on me and made me say, I don't want to do this.

SPEAKER_01 31:01

Yeah, transplant's tough. It is a tough uh subspecialty within our within hemonc, I tell you. Yeah. Um and you're limited so much geographically too, because there's not transplant centers everywhere. So uh but yes, they are the sickest of the sick, and you absolutely wipe out their bone marrow. They have no way to fight off anything. They're on multiple antibiotics, antifungals, all that stuff, and many times on medicine to maintain a blood pressure because they need pressors. Uh they're getting gallons of fluid in them, they're not eating. Nutrition status is tenuous at best. Yes. Uh they're getting nutrition through a central line. I mean, it's it's it is tough. They have mouth sores, it's it's a difficult time. Uh, fortunately, the mortality rates and things are better, supportive care is better. Um the treatment of this problem called graft versus host disease with allo transplants is better. I mean, there's there's definitely improvements, and supportive care is much better than it used to be. Um, but it is an exciting time in medicine for everything. We always have up-and-coming things. There we're trying to limit toxicity and you know, trying to use less chemo, more targeted treatments, and things like that.

SPEAKER_00 32:06

Right. Getting more specific for the cancers that we are trying to treat there. Um now, uh, I'm gonna transition back. So so you finished fellowship, you come out to work in Savannah, you're doing are you doing private practice at that point? Okay, so you went into private practice. There's always a pull generally towards academia. That that's what your training programs are trying to get you into.

SPEAKER_01 32:27

The training programs, yes, with the uh with us, no.

SPEAKER_00 32:30

Yes, exactly. No, we're ready to get out there and and start seeing people. How'd you find your first uh years of practice?

SPEAKER_01 32:37

Uh I enjoyed it. I really did. I enjoyed where I was. Uh I had really supportive partners. It was a bigger group at that time, uh counting me. There were seven. I was the newest guy, so the last new guy was hired about five years before me. Um I knew a lot of the docs because my dad was a doc in the community. So I knew a bunch of the senior partners. Uh they're very supportive. Um, you know, they they didn't kind of throw me to the wolves. I didn't experience that. Yes, call was difficult, but if I had a question about procedure things, because that's that's the issue when you're brand new in practice, is how does this hospital do it? Because I just came from one that did it entirely different. That's right. You know, procedurally, you got to learn that. And I had good mentor mentorship from my senior partners uh if I needed it, but you also have that you you know, you don't want to do that, you know, you don't want to be the one that's calling your your senior partners all the time either. Um but yeah, it was uh it was fun. We had a we had a good time, learned a ton again, that exponential learning curve, uh, met a lot of good people. But the thing that I think a lot of lay people don't understand is when you start a new job, especially in private practice, you have to build a practice. It doesn't show up on your doorstep. I mean, these busy docs of mine, yes, they needed to hire somebody because they had outgrown, you know, being able to see all the patients efficiently. Um, but it's not like you walk in day one and you have a busy practice. It takes years to build a practice. And that's why physicians don't like to move. It's hard to start over. It's it's a challenge. It's you know, you got to get out there and be a politician, shake hands, you know, smile and primary cares, yes. Meet everybody. Yes. Because especially now with hospitalists and you don't see a lot of primary care docs, but it's it's it's tricky. So it's it's scary all in one, but I mean, you know, your senior partners hopefully look out for you. Uh and my practice took great care of me. I cannot say enough good things about them. It's uh uh and we can get to why I left later, but uh uh yeah, they did they took good care of me. And in turn, I mean I was very successful and did a great job there and had fun.

SPEAKER_00 34:35

Yeah, yeah. I mean, and and so you say 15 years that you practice there. Isn't that right?

SPEAKER_01 34:40

Just shy of 15 years.

SPEAKER_00 34:42

Well, let's let's get into now. How did that eventually take you to coming here to Panama City?

SPEAKER_01 34:47

So my wife's from southwest Georgia, and they used to vacation here. I mean, I grew up in Savannah, you know, the only beach I knew anything about was Tybee Island, and the water's brown. You take a cup of water from Tybee, you can't see the other side. The sand is brown and hot because it it absorbs all the heat. We have a seven-foot tide on average, so all you're doing is moving chairs all day long. Uh you know, none of this stuff. You come here and it's like this is Caribbean clear and green and beautiful. So we'd go on vacation, or she used to vacation here, so she introduced me to it, and I said, Wow, there's another beach out there, besides going, you know, the Caribbean or whatnot, and and then Savannah, and uh loved it here. And uh and then uh opportunity came available and it worked out well. My practice was going the wrong direction, in my opinion. They had formed an alliance with a hospital, we came less autonomous. Um, and once that happened to me, it lost the spirit of medicine. I used to go to the satellite clinics because that was my thing, was to do rural medicine. I enjoy going to the small towns and go out there to the hospital and stuff like that. And uh it was always real busy. And then with the bigger hospitals, they kind of wanted to abandon that model to a certain degree, or they wanted to change it. And I was like, that's just not the spirit of the agreement. So I uh uh reached out over here. We'd had property over here for a number of years, so I realized that transition wouldn't be too hard. It's just timing-wise wasn't the greatest time to move here because of COVID. But you can't always pick what time and uh decide to make the move in in 2019 and moved here right when COVID got started in March of 20.

SPEAKER_00 36:17

Yeah, and you know, we were still recovering from Hurricane Michael, which was uh, you know, that still has a long tail here, and so COVID was a very interesting time. Um, and you know, it's a part of that you look back in hindsight and don't we didn't really recognize it at the time of how formative it would be, but you know, we were still out there frontline infantry and seeing a lot of very sick patients coming in, and that it's really uh that that was a difficult time. Um but but you made the transition and you have to know a little bit more about business at this point. I mean it's not just the oncologic medicine or the physiology or anything like that. It's it's you've got to learn how profit loss sheets and other things like that. So true. And so you came over here, been practicing, excuse me, ever since.

SPEAKER_01 37:04

Has it been going here? It's great. I I can't complain. I like the community. Patients are very grateful. Um, I think you're starting to see the attitude change here locally. When I got here, it seemed like everybody wanted to go out of town to do all their medical needs, and then COVID hit and it made it, I think it put up a lot more barriers, but then more docs started coming here.

SPEAKER_02 37:23

Yes.

SPEAKER_01 37:23

Um, we started getting more and more docs and subspecialists, and I hopefully that mentality's changing where I don't have to go out of town to do all my treatments. That's exactly right. Um, that was the biggest hurdle day one, as I was just so frustrated that every time I'd see a new cancer patient, like, oh, I'm going to MD Anderson or I'm going to Mayo or I'm going wherever. And I was like, You understand we train at these programs. We didn't train in Panama City. Okay, we bring that expertise with us. That's uh we live here because we want to live here.

SPEAKER_00 37:50

That's right. And you are perfectly comfortable with saying, Whoa, this is a very rare cancer. You would be served best by going to MD Anderson or Mayo Clinton or something along those lines. Or this is wheelhouse, and we can take care of this with you being at your home, which is much more favorable than going to get hotels and other things and the and the travel of all that stuff. I mean, certainly, you know, um the physicians that I found that are most confident in themselves would say, get a second, third, fifth opinion. I would totally fine by that. But I will be honest with you about the things that I'm comfortable with, and I'm pretty comfortable with this, and we can take care of this here and at your own comfort.

SPEAKER_01 38:30

Yeah, you hit the nail on the head. If if you run into a doc that says don't get a second opinion, you need to run. Run, yeah, yeah, yeah.

SPEAKER_00 38:36

Uh run, don't walk. Yeah.

SPEAKER_01 38:37

Yeah. Um, because you're right, we're all comfortable with that because we're comfortable on our decisions. Somebody overlooks our shoulder at an academic center and says, Yeah, I agree with exactly what you're doing at home, stay at home.

unknown 38:47

Yeah.

SPEAKER_01 38:48

It's reassuring to the patient, though.

SPEAKER_00 38:49

Yeah, it's reassuring. I I I don't necessarily need there, but but either way, the patient's getting that, you know, because they're they're having to suffer through this. So um now, uh, you know, you had talked about um building up your practice and how difficult that is. I would bet it's a little bit more difficult to get into your office now. Is that fair to say?

SPEAKER_01 39:09

Yeah, it is. I mean, it's definitely busy. Uh because again, started all over March of 20, and then you can't go out to the community because it's shut down because of COVID. So you can't, there's no way to introduce yourself. You have to do paper media, you have to do internet and social media, and that's really starting to explode in the early 20s. And it was tough. It was tough to build a practice. Uh certainly there was already referrals that partners were were kind of feeding my direction to get me started, but uh hey, you gotta start over again. And but yeah, it's definitely it's busy now. We're actively recruiting. Um, it's no secret that we're actively recruiting. It's tough to recruit here. I'm not sure I understand why.

SPEAKER_00 39:50

I I don't fully understand it either. Um, beautiful beaches. Um, your money goes a long way in the state of Florida, there's no state income tax. Um maybe we can get curiosity marketing on that. Chris, you gonna work on that for us?

SPEAKER_01 40:01

Okay, so uh I would I would I would love it because I mean we're we're you know using headhunters now. Yeah, we've had candidates come out and you know that's sometimes it's the spouses, whether it's male or female. Yes, they're used to the big city, the uh the amenities that go with being in a big city. Um, you know, then they talk about food, they talk about all the big city stuff. It's like, but you don't understand, the quality of life is so much better. Uh you know, you go to the big city, just like cardiology and every other subspecialty primary care, I don't care. You know, on the street corner, there might be 15 doctors right there. And the competition is different. You have these communities that are actively recruiting and and certainly saying, hey, please come here. We'll we'll make we'll make it work any way you want it to.

SPEAKER_00 40:43

Well, and meanwhile, I can golf cart to my kids' schools, which is, I mean, this is you know, and you can get waterfront property here, and and you could I like to say I could go from my house to England, which is you know, that's not something you can say in a lot of places, so it's you could. It'd be a trip. Um so uh so yeah, so love this community and and really glad that that you're here and and and have built such a busy practice here. Now I want to transition to start talking about a hobby horse of mine, which is cancer in general, and that's something that we haven't really spoken about exactly. Um why don't you tell our lay audience uh and our professionals what exactly is cancer?

SPEAKER_01 41:23

So I always use the example of a cancer cell is a cell that has an on-switch and no off-switch. So it ignores all the normal signals uh when it touches a neighboring cell just to shut down. So normally it's just like building a neighborhood. You don't build on top of your neighbors, you build up to your property line or whatever, and then you're done. Cancer cell ignores all boundaries. So once it gets that abnormal mechanism, DNA switch, whatever it may be, then it just grows and doesn't stop. Now, some cancers, as you mentioned, some can be aggressive, meaning it grows faster, some grow slower, some are observational, some are you need to start treatment yesterday. I mean, there's all there's all different uh types, obviously, treatment options, you know, growth rates, and you know, something that's an aggressive cancer doesn't necessarily mean it's a bad thing.

unknown 42:08

Yes.

SPEAKER_01 42:08

Uh, you know, I think that's a big misconception out in the community is oh, it's aggressive. No, well, you just want to start treatment. Aggressive many times means it'll respond to therapy very quickly because those cells that are actively growing are more susceptible to the toxic effects of chemotherapy or the immune therapies or whatever. So uh but yeah, it's uh it's on switch, no off-switch. That's what I tell people.

SPEAKER_00 42:31

Yeah, and and so this really starts to get into a deeper level of the physiology of cancer here. So so we're really running um two different dichotomous ends with all of our cells in our body. There's something called the hay flick limit, which is the number of times that your cells can double grow. Um, and and there's a limit to that amount of time because at some point those cells are going to senesse, which is our doctor way of saying die. Um this is the reason that we age, is because our cells and our organs and our various different tissues are senescing over time. But if they don't senesse, that means they start to grow forever. And if they grow forever, that's all of a sudden cancer. So those are the two dichotomous ends that we have. Are we going to age? Are we going to grow forever and have cancer? And those are the different areas. Now, our bodies are forming cancers all the time. We are forming there's there's different cells that all of a sudden break their slippery bounds and start to go out of control, but we have an immune system that tends to find those and kill those. Other cells say, hey, look, there's this guy over here that's building his house on my property, and so our immune system takes care of that. And that's happening all the time with this. But occasionally some slip by. And that's what starts the massive or the the the meta-cancer issues that we end up dealing with. Um now when you think of cancer in your mind's eye, do you think of these as all separate types of illnesses or separate types of uh Disease processes, or are they all kind of the same in your mind?

SPEAKER_01 44:04

I look at them differently because all the treatments nowadays, everything's catered to the specific type of cancer. So it's very, very cancer-specific, most treatments are. And a lot of it's not at the DNA level, looking for mutations and things like that. So we're we're always trying to get away from the toxic effects of chemotherapy to find something more targeted, take advantage of a mutation a cancer cell may have, um, you know, growth pattern, whatever. I mean, these scientists, that's what they're looking for. By by honing in on a target to take advantage of, then you many times can overlook some of the common toxicities that you see with a generic, as you said, poison, kind of like weed killer, you know, many times might kill her grass, and that's the effects on the bone marrow, whatever. Whereas a targeted therapy may be specific to one specific mutation that only this cell is gonna have, or only a handful of normal healthy cells may have. So the toxicities many times can be limited.

SPEAKER_00 44:57

Yeah, in other words, you're not gonna feel that you're taking this medication. It's not gonna hit your cells nearly as hard, cause the sickness and the nausea and all the other things that go along with it. It's really gonna be focused on killing the cancer cells. Really a modern marvel in terms of our pharmacologic uh armory that we have. Um so uh so yes, we want to get m more bespoke. And I think you said something really sage about the aggressiveness of cancers that super hyper-aggressive cancers respond very well. I think um, and and you'll correct me here, um, things like Hodgkin's lymphoma, a specific type of of uh of your lymphomatous tissue grows excessively. It is a blood cancer, is how it's considered, and it is hyperaggressive, which means you can give a certain set of well-tested chemotherapeutics that cause the tumors to melt away, I think is the the verbiage that was used, at least in training.

SPEAKER_01 45:52

That's exactly right. Yeah, unfortunately, sometimes these aggressive cancers by treating them and they respond so quick, then they cause other problems downstream. Yes. And so we're preventative, you know, we try to be preventative of that and trying to explain that, but it's it's overwhelming to the lay public. I tell patients all the time, I say, you know, I try and explain this to doctors and they don't understand. Of course. And you're getting a crash course, and you know, you watch out what you read. Um we mentioned briefly on AI and Google and all that. It's you just gotta watch what you read. Um, and everybody everybody wants to know everything instantaneously about whatever today. If your car has a squeak, you're gonna get on Google and try and self-diagnose, and you're gonna go the the mechanic and say, I think it's my fan belt, and it might be Lord knows whatever it might be. So it is, and you know, we're we're the Web MDs and stuff of the world, they're they're helpful, but they can be a hindrance for sure.

SPEAKER_00 46:44

I will say this to my patients oftentimes. You can look up any of the stuff that I just said. I wouldn't advise it, but you can go look all of this up because again, you start to go down this pathway of of seeing the worst. One of the things that we didn't even realize honestly we were getting trained in is the wisdom is to kind of know the things of like, yes, you know, this could be subacute sclerosic pain encephalitis. It's not. But you know, I I understand where you could look at these symptoms disjointedly and the AI, the algorithm would spit out, oh, it's this thing over here. Or, you know, you can have um there's ST segment elevations. Not all ST segment elevations are myocardial infarctions, okay? And not not all of the dangerous EKG changes are indicative of you having a heart attack. Um but if you go look that up immediately, they're gonna say get to the hospital immediately whenever so so you kind of have to tark patients off the the edge sometimes and say, like, look, again, uh, it's not sometimes, it's a lot of times.

SPEAKER_01 47:44

Google with a uh ingrown toenail will have you an amputation tomorrow.

SPEAKER_00 47:47

Indeed, indeed, a necessary amputation. Um and and it's part of um kind of the interaction that I have with patients here, and I say this oftentimes on here, which is that I know what I want to do typically within the first minute of seeing a patient. I've got an idea of exactly where we're gonna do. The rest of the time, and I'll spend a fair amount of time with patients, is going to be getting you to buy in for getting the patients to to think, first of all, that I care, which I do, secondly that uh I understand what I'm talking about here, and I can explain it a little bit to you so you can kind of get on board a little bit with it as well. These are incredibly deep. I mean, for me to ask you, tell me about cancer. I mean, that's an extraordinary centuries of work have gone into this kind of thing. And so that's um that's something we have to consider in our patient interactions.

SPEAKER_01 48:32

Absolutely. Yeah, you're right. We know most of the time before we walk in, we know exactly what we're gonna do, and it's the rapport, it's the uh compassion, et cetera.

SPEAKER_00 48:41

Yeah. Um you know, one of the things that I found that was interesting um with uh you know my limited experience with uh oncologic training was that you know sometimes on um, for example, cardiology, you know, we have some guideposts, we have um a first-line therapy, a second-line therapy, we have some general um, you know, which statin do we want to use? We've got some idiosyncrasies that we would consider there. Um I was surprised at how once you stage and grade, well, great and stage a cancer. So in other words, feel out um how aggressive it is, if it's advanced, how far it's advanced, um, once you do that, then it goes into an algorithm where it kicks out a this is the chemotherapeutic regimen, this is the dosage that you should be giving to a patient most of the time, if not all the time, it's it's dose based on your body surface area, so some somewhat proportional to your size. And it's kind of once you get all this information in, we've got just this this hollowed, august body of knowledge from oncology studies that says, okay, this is the thing to do for this patient. So there's there's some art there, but there's still a lot more of it goes to the computer system, it spits out this is the regiment usually.

SPEAKER_01 49:56

It is algorithm-based for sure. I mean, that's for consistency. You you 30 years ago you had guys shooting from the hip. I mean, they just would say, Yeah, you know, I think this will work, it looks like it might, and they just kind of make up some own regimen. And you know, you didn't have a lot of choices 30 years ago. I mean, I can't imagine how many drugs there were in the mid-90s compared to where they are now. Uh you talk to some of the older attendings in training, they're like, We had five drugs when I started in the 70s. I said, you don't understand, you know, you have this many now. Um, but you get these guys shooting from the hip, just kind of making up a regimen of sorts. I mean, they think it might work, and sorcery or alchemy or something. The guidelines and uh algorithms are important, they're tried and true. They've kind of gone through all the big medical centers and kind of their their approvals. Uh we all have guidelines. I mean, American Society of Cardiology has guidelines, we have guidelines, and we try and stick to them as best we can. Unfortunately, there's not a not everybody fixing fits in that box, and then it's like you said, then it's wisdom, and then it's knowledge and it's experience. Um, you know, I used to hear from patients all the time, I don't know, four or five years in the practice, oh, I want to see the new doc. They got all the knowledge. It's like, no, they probably don't want to see the new guy. You guys got to learn how to apply all the knowledge. Yeah, they may be up to date on some of the studies, but we all keep up with that stuff. Patients don't quite understand that. They they have the reverse idea of what's actually true.

SPEAKER_00 51:22

Yeah, you know, and when you look at chemotherapeutic trials, new drug trials, um, it's sometimes shocking to see results that are say, taking a median survival, I'm gonna make up something for pancreatic cancer, say, and takes a median survival from seven months to ten months, and that that is a huge breakthrough. And it's hard for us to think about because we think in our minds, well, that's just three months. And in reality, that is such a tremendous breakthrough. Also, you're taking into account statistically, this is average on patients. So clearly there's a signal here that whatever we are introducing is is making some significant difference. But you know, our oncologic colleagues uh will will say, like, oh no, this was big, you know, in order to get those those kind of it seems like medial improvements, but but they're actually really huge things when you when you look at these trials. Um now we're gonna move on to how is AI gonna affect your world?

SPEAKER_01 52:25

Well, that's an interesting one. You know, we're in the infancy of AI, I like to think. And it's you know, AI AI to us 20 years ago was autonomy with computers, they're gonna rule the world, they're gonna do all the nukes and all that stuff. And it's just, you know, it's it's good at pattern recognition. Uh, you know, how much does it self-learn? I don't really know. I'm not a computer guru, but it's it's it's gonna change. I mean, I have patients pull up a you know, chat GPT or something, and they say, you know, this is the stage colon cancer you said I had, this is what they're gonna tell me, and they print out this seven-page report and hand it to me, and uh, they're like, Do you have time to read it? I was like, No.

SPEAKER_03 53:05

No.

SPEAKER_01 53:06

And I said, I I'm I'm sorry, I don't know what you're trying to tell me, but yeah, AI, I think it's gonna change things a lot. I think it allows the computers are able to search vast amounts of information instantaneously. The problem is, is the the experience isn't there. I mean, it it's you still got to have the human mind to kind of look at that and say that's ridiculous. So an AI bot couldn't tell, you know, if I got a 95-year-old patient that's had a stroke and a heart attack and they're in a wheelchair, it'd still say treat them aggressively like a 40-year-old patient because it's not looking at them and making a clinical decision about what we think is best. Uh, you know, and then the family inputs things, the patient obviously has the ultimate decision. But yeah, AI is gonna change medicine a ton. I think it's going to it's gonna change what we all do. I don't know that it's gonna put us out of business per se, but I th that's gonna change things dramatically in the next 15 years, I'm sure. Because we've seen the change just in a year.

SPEAKER_00 54:01

Yes, yes.

SPEAKER_01 54:02

I mean, it's it grows fast.

SPEAKER_00 54:05

Well, there's you know, there's certainly the knowledge base that I think is gonna help with. I'll come back to that in just a second. But um I do like the idea of AI helping us with the more tedious parts of our lives, like um documentation. If it could be if if you could just say uh we're gonna do CHOP R on this patient, and it just sends that out to the pharmacy and that's taken care of, that would be a huge because you know that gets us to seeing more patients, that gets us home to our families a little bit more, that gets less of the tedium of doing these notations at the end of the day. Because you you know, your thought process, your your your real your value is there, the interaction with the patients, you know, making the medical decisions. It's not really the documentation. That's that's for billing purposes. And so I see that would be extraordinarily helpful. And we've already started to incorporate that a little bit into our practice.

SPEAKER_01 54:55

So absolutely. I use an AI dictation system, but there's still a human there. Yes. There's a human that reviews it and makes sure or listens to the actual transcription and says, yeah, that's not quite what he meant. Right, right. Um but it's it's that AI transcription is pretty good.

SPEAKER_00 55:09

Aaron Powell, it's getting good, yes. It's getting it's it's being able to sift through the conversation and kind of pick out the the germane parts, which I I I appreciate. Um I I've I've given this example before, uh I'll often say to patients, I'm assuming you're not doing a whole lot of cocaine or methamphetamine, and then they typically come back with, oh, just a little bit on the weekends. And the note will say, Patient admits to cocaine on the weekends. And so you have to kind of be able to catch a little bit of some of that tongue-in-cheek uh parts. But um but I think it is getting better. Now, in terms of the knowledge base that it's coming from, you're right that you know it is physically impossible for you to read every single oncologic journal and every single trial that comes out. That is just not possible. So having this repertoire of information that it can sift through, you know, that says um maybe if you bring it along with you on cases that says, hey, did you consider blank on this? And then you can kind of use your own wisdom and your own experience to say yay or nay, that might be helpful to us.

SPEAKER_01 56:08

Yeah, I think so. I think it'd be helpful. I think it could be interesting to see how it affects radiology too. Oh yeah. Um because of the the pattern recognition and stuff. I mean, it's good at picking up patterns. I'm not gonna ignore that.

SPEAKER_00 56:20

Absolutely can. It absolutely can. And yeah, I think um, you know, the the really um technophiles among us would say radiologists are cooked. So because uh the you know, the AI is is gonna get very good. Now that affects my family for sure. Um but maybe pathologists too. I don't know. Um I don't know.

SPEAKER_01 56:38

I mean I think they're still gonna have to have, you know, gray-headed docs uh that are out there with experience and saying no, but in 50 years, I don't know.

SPEAKER_00 56:47

Patients still want the human touch. I don't think there's any doubt about that. And that kind of interaction and being able to sit and take time with them, I think, is is still really worthwhile. Um so uh watch this space. I I love this idea because it it also kind of bleeds into something that has been uh you know something that I've been thinking a lot about, which is what does a cure for cancer look like?

SPEAKER_01 57:11

Well, I mean a cure for cancer, obviously that'd be the greatest thing that uh medicine. Yeah, yeah. What a moonshot, huh? Um it seems like a moonshot, you know, but it's it's I I don't know if it's inconceivable. I mean, obviously that's what these companies are looking for, but I I I don't know. It is it is I mean, we're getting better. We certainly the treatments are better. We've kind of hashed on that or gone over that a little bit. Uh but yeah, the cure is the ultimate goal for all of this is the cure for whatever disease state may be. But cancer, absolutely.

SPEAKER_00 57:44

It it certainly seems like there is genetic change. There has to be. That's the only thing that can really drive the cell differently, okay? Is is it could be epigenetic, but but but some sort of change in the DNA of that cell that allows it to all of a sudden escape its typical senescent bonds. And it's the same thing that if you go from a contained cancer cancer that all of a sudden goes to spreading via lymphatics or hematologic, um that had to have been a genetic change. And that's what you're looking for in something called oncotypes. Um you want to talk a little bit about oncotypes for the same thing.

SPEAKER_01 58:23

So oncotypes, uh a tool that we use for it. I call it a chemo decision tool, because that's basically what it is. So what it is, it's uh um a genetic test used for breast cancer patients. They have to have a certain pattern in breast cancer, a certain subtype of breast cancer. So it's the majority of breast cancer patients are candidates for oncotype. Uh, it can't have metastasize. Um, and what we'll do is uh um it's a genetic test on the cancer genetics. So the the trick about genetics is we all think genetics is what we got from mom and dad. So those are called germline mutations where what are inherited somatic mutations are acquired, or what is the cancer genetics that's different? So noncotype looks at a number of genes, and based on its patterns of expression, whether it's there or not there, uh they assign each gene a number and then they come up with a recurrence score. And the score, it's not a percent. Patients fall into that trap. If we tell them they have a five, they think, oh, it's five percent. No, no, it's just a number on a scale. Right. It's like a blood sugar. It's a number on a scale. If it's above this number, we all will, it's a it's a yes or no. You get we will recommend chemotherapy, whether you take it or not, that's up to you. So if they have a high recurrence score, uh, we'd recommend chemotherapy for prevention. And then there are numbers associated with the percentages of you know what percent are going to metastasis at nine or ten years, et cetera, et cetera. If it's below that score, there's almost no benefit to chemotherapy. So what it tells me is what we always traditionally were taught on pathology is what does it look like on the outside of the cell? It's like buying a house. If you drive up to a house and you say, Wow, that's a beautiful piece of property, I want it, you would never buy it without walking inside. And that's what these onka types and these other genetics do. They open the front door and you look inside, and what's the DNA on the inside of the cell? So what we're learning is DNA is more important than what we see histologically. So it's the code, it's the instruction code that drives everything recurrences, metastatic potential, and all that. And that's what all these scientists are trying to figure out at this point. You know, it's not you and me doing this in our labs, it's all these academic centers, and they come out with all these new tests. And the problem is now we're getting so flooded with these onca type-like tests. I'm not saying onca type competitors, but tests that are similar to them or look at DNA, predictability patterns, and you know, every three to six months we get a new company saying, mine's better than that one. It's like, well, this is the one that's been the gold standard. We're comfortable with it, we're resistant to change because we're comfortable with these numbers. Yes. It's validated, it's tried and true. Oncotype's been around 20 plus years uh or 20 years. It's it's it's just what we're comfortable with. Um and we trust the company that developed it. So they come up with new tests, we're more willing to go with what they have than some uh biotech I've never heard of. But uh right now it is a it's a mess.

SPEAKER_00 1:01:11

Well, it it's also interesting because now you're looking at the genotype of the cancer. And so you if if it's flipped whatever switch that we have, that genetic marker that says this is much more likely passed into metastatic cancer. Even if you don't see metastases, you're going to treat it as just because it's it's very specific to us now that this is telling us this is going to this has escaped the local bounds. Trevor Burrus, Jr. Absolutely. Trevor Burrus, Jr. Yeah. That's a really phenomenal technology because it's not that we're seeing these in distal syndrome lymph nodes or anything like that or distal spots. We just say, oh, this has the exact characteristics that we see in metastatic cancers, therefore we're going to treat it that way.

SPEAKER_01 1:01:53

Aaron Powell Absolutely. It's it's and it's a fascinating time now. The kind of up-and-coming things that are kind of superseding onchotypes and everything else are these tests that look at what is called circulating tumor DNA. So cancer cells, as they die off, just like any other cell, they release DNA into the bloodstream. So now it's a DNA fingerprint, much like if I leave a drop of blood at a crime scene and I did, you know, it's my blood there, they're going to come back to me and say the DNA pattern is you. It's, you know, one in seven billion chance it's somebody else.

SPEAKER_02 1:02:22

Yeah.

SPEAKER_01 1:02:22

Well, they can fingerprint the their own cancer. So somebody comes in with colon cancer or whatever, we'll take the tissue block, send it to the lab, they'll fingerprint that specific cancer, and then they'll make a probe. So what we do is we'll get a blood test, and if they detect any of that DNA by that probe, it's called a it'll be a positive test down to you know down to some sensitivity.

SPEAKER_00 1:02:42

Of course. Of course.

SPEAKER_01 1:02:43

I can't picture one cancer cell in your entire body. Not yet. But it's much more sensitive than imaging lab work that we have, because everybody wants to know what's the I want to test to tell me if I have cancer. I'm like, well, there's not one. Yes. Or I want to scan, I want to scan my whole body. Well, you understand that comes with risks of radiation exposure, you know, an allergy to contrast, I don't know, whatever. And you know, everybody wants all this. And it's like, well, these tests I think are for medicine in the next 10 years, they're the holy grail of the sorts as far as detection. Um the next step will be then be you know, what are the holy grails for treatments for these? And do we treat somebody with a positive blood test that doesn't have a positive scan? And I have this discussion 10 minutes before I walked in. Uh, somebody with a positive blood test and a negative scan. I mean, they're looking at trials now. Should we treat these patients before they get radiographic progression? And you know, all of us that are deep down inside say yes, but then when when do we stop treating them? Do we do it three months, six months? How do we do that? Well, the test goes to zero, then do we stop? We we don't know. So it's the it's a fascinating time. But I've been saying that every five years, I say it's a fascinating time. Well, these new things come. And you're excited about it, and you're like, oh my gosh, and then you try and explain it to the lay person, they try and read about it, and it's it's just hard to it's hard to explain it. And then then you get a pet lay person that has a positive blood test with a negative scan. Well, the shoe's gonna fall off. We just don't know. Three months, six months, five years. I don't know. So then you got to deal with the emotional aspect of it weighing on their mind. Are they gonna uh are they gonna change their uh behaviors in life? Are they gonna become more aggressive uh reckless because now they think their cancer's coming back? And uh, it's just it's uh there's more to it than just a positive or negative test. I don't think that's well appreciated by a lot of docs, I think, overlook that. And I don't think that's well appreciated with patients either. They just want to answer now and we give it to them and say, but and then they do with it what they may.

SPEAKER_00 1:04:38

Of course. No, and uh that is so well said, and I mean I think you covered a lot of really high yield topics right there. Um you know, I I will often say to patients, look, I can find something wrong with you. I can look hard enough and find something. Maybe it's never going to affect you. I don't know, but we've got to be careful about the questions that we ask, because we might get answers that we don't know what to do with there. And you said it exactly right. Now we've got this positive test. Well, what do we do about it? Well, I don't know. I mean, there's certain things that you can say, you know, if you have a major uh uh macroscopic tumor, well, yeah, you've got cancer. That's easy enough for us to go, you know, that algorithm's pretty, pretty tried and true. Um, but once you get to the microscopic level, what do we even know what we're treating? How are we going to measure that we're actually treating something? How many cycles of chemotherapy do you give somebody that's just got a positive test?

SPEAKER_01 1:05:27

Targeted treatments don't come without potential life-threatening toxicities. I mean, our immune therapies, I mean, patients die from immune therapy complications. I mean, it happens.

SPEAKER_02 1:05:36

Yes.

SPEAKER_01 1:05:36

Um, so I mean, these aren't these aren't harmless drugs. I mean, people think I give them an oral therapy, they think, oh great, I don't have to get Ivy chemo. It's like, wait, wait, the side effects are different. Most are well tolerated, but here's the other potential problems, and uh educating uh patients is is can be quite a hurdle sometimes. And we do the best we can, give them handouts that are in you know lay terms as as as Best can be done.

SPEAKER_00 1:06:01

Sure. Well, you know, I I I have patients oftentimes that, you know, are taking some sort of um hormone treatment of some type and say, I'm having this chemotherapy, and you know, uh where does that fall into the line? Do it's not worth it for me to try and correct this kind of thing. You know, it's it's you're getting treatment for your your cancer, hopefully. And whether that's preventative or active, uh it's hard to say. And you know, it's it's also gonna be hard to get patients to get up for another treatment. You know, you have to lay out for them look, these are the things that we can do. There are some things that we should do, but everything's on the table here for you. You can ultimately decide. I will certainly guide you towards certain things. I mean, you know, same thing with heart failure and other issues. Um, uh one one popular treatment that that crosses over in our side is Dr. Rubison. Dr. Rubison induced cardiomyopathy, which is a specific type of chemotherapy that is utilized that is pretty cardiotoxic. Uh, and so we have to kind of um it turns out if you cause your heart to not function very well, that can oftentimes kill you before the cancer will kill you. And so we have to be cautious is an is an interaction between a kind of burgeoning field called cardio oncology, which takes into account these kind of things. And so it's a it's a neat crossover in our worlds, I guess.

SPEAKER_01 1:07:15

Yeah, we've had we've definitely shared patients in common uh with this, and I bet you get the same too, is I think one of the most challenging things with patients right now is the misinformation on the internet about non-alternative or yeah, non-alternative therapies. I mean, the biggest one I hear about until I'm I'm I'm almost to the point where I don't even want to answer the question is you know, ivermectin and phabendazole. I mean, these are antiparasitics, and people are saying, I'm not gonna take this potential therapy that has been tried and true. We know it works 90 plus percent of the time. I'm gonna take this holistic approach and uh true try ivermectin, which I give to my dog for heartworm prevention, and they and it's good at that. Yeah, yeah, uh, but we hear it all the time. It's these alternative options that people are doing that just aren't standard of care. And then they want to get they get hostile towards you when you tell them that's not reasonable, I don't think. I mean, have have you researched this? And you know, they pull some study from 1965 that they read about on an AI bot, and it's like, yeah, well, why don't you pull one from like 2025?

SPEAKER_00 1:08:24

Of course. And you know, this is leaving all politics aside here. That's that's not at all. Yeah, we'll we're here to help people. That's that's what we really want more than anything. But this is, you know, I'll have patients that that come to me. Typically it's about statin-related stuff, and they'll say, like, did you know about this blank about statin? And I try in as diplomatically as possible and say, Yeah, I mean this is I've had 20 years of doing this kind of like yes, I I have to know this kind of stuff. I I know I know the good and the bad, I I know the formative trials. I would almost guarantee you to a man if they come to you, they have not seen the formative trials for statins because then you would see significant positive data that that comes out of that. And I'm not saying they're a panacea of that, but and it's it's the same thing with, you know, I'm I'm trying to let you. I don't want to say that ivermectin is not going to work. I don't know that it's not going to work. But I have proof that these other things can help you. I can prove to you that this can happen with formative trials that have shown this kind of thing. And that's the barrier to entry that we have in the allopathic side.

SPEAKER_01 1:09:23

That I uh Yeah, there's some distrust out in the uh out in the lay, lay community. You have small fortunately it's a small percentage of patients, but there is some distrust with traditional medicine. And I mean, we've seen the infomercials 20 plus years ago that uh there's things doctors are doing that they're not telling. We know how to cure everything and we're just keeping it to ourselves financial. Exactly. It's it's like, no, you don't understand. That's I don't know. I don't I don't know. It comes up periodically. Usually I don't usually see those patients back for a second time. I don't that doesn't use they'll find somebody else that can do that. Well usually.

SPEAKER_00 1:10:00

So uh let me ask you about um what are your recommendations to young health professionals that are going into your field now?

SPEAKER_01 1:10:09

Oh I thought you were gonna ask me what do I tell somebody young in high school or getting ready to go into college about doing medicine?

SPEAKER_00 1:10:16

I already have No, they've already crossed the Rubicon here and they're going into the.

SPEAKER_01 1:10:24

Going to plumbing, H V A C or electricity. All the guys my age that I grew up with, they've all retired and sold their company and uh are all fishing somewhere.

SPEAKER_00 1:10:32

They've got a big boat, too, all of them.

SPEAKER_01 1:10:34

Yeah, no, I see that a lot. I'm sorry, I asked the question again. That was a smart aleck answer.

SPEAKER_00 1:10:38

No, no, no. That's uh uh look, you can take that wherever you want to, but but but for young oncologists that are coming out, yeah. What uh do you have any advice for them?

SPEAKER_01 1:10:47

Oh, absolutely. I mean, I think all senior docs to a certain degree, especially in private practice, are academics. I mean, we all have experiences, pluses and minus, going each whatever route we chose. I mean, the first question is do you want to work for a hospital or do you want to go in private practice? Um, hospitals will offer you the world to join with them, but what they don't understand is contracts are always renegotiated.

SPEAKER_00 1:11:10

Constantly.

SPEAKER_01 1:11:11

Yes. And it may be you have a three-year contract, maybe you have a two-year contract, but it's like being a sports star. You know, I've got a three-year contract, I'm getting this out of my three-year contract. Well, at the end of my three years, they're gonna many times renegotiate and say, Well, you haven't met this metric.

SPEAKER_00 1:11:27

You know, you're supposed to really see 20 patients a day. You've been at 17. Now we haven't brought you those patients, but either way, that was the contract. So we're gonna pull you back a little bit. It's a constant discussion.

SPEAKER_01 1:11:38

Yes. So that's and and they don't understand that coming out of fellowship. They they see the all they look at is the dollar differences. They they look at it as financially, which I'm don't I'm not saying I disagree with that. I understand because you haven't had made a living yet because you've been in school your whole life. Uh and then they choose the academic route or the or the employed route, I should say. Not academic, but employed route. Yes. And they just don't have the knowledge. They're promised the world by a non-physician CEO. Correct. And, you know, they sign on the dotted line, they get their they have kids by a house, now they're ingrained in the community, and the hospitals or employers know all that because it's hard to move your kids, they don't want to leave, because my best friend Johnny over here, or whomever, you know, we have our best friends on our street, we're ingrained in the neighborhood, and now I've got to move. Uh, that's not gonna go well. And then, like I said, you got to start over again. So then you gotta start and build a practice, which there are some lean years when you're in private practice because you're building a practice. So then the private practice options are different. Is it partnership track? Is it not a partnership track? So that's that's that's advice for a new oncologist. You know, geography, big cities, you know, you may like the amenities of big city, but there's also things you're not gonna like. And competition is a real thing in a big city because everybody wants to stay because we in big cities, because that's where we train. We're comfortable staying where we train. We know we don't like change. Most people don't. I mean, we're not military given every three years.

SPEAKER_03 1:13:04

That's right.

SPEAKER_01 1:13:05

So it's that's that's the big advice. Is you you know, and you gotta interview them as much as they have to interview you. The problem is you usually only interview them for about a day, and you make a life decision in a day based on interviewing a group with six docs with all different personalities. They might one doc might be conveniently on vacation that week intentionally. You don't know that, you're interviewing. So there's all kinds of interview advice that they need to get from mentors, uh, you know, business advice from mentors. I mean, there's just the it's a wealth of information that none of us get in fellowship.

SPEAKER_00 1:13:38

But you don't have time for it. And then all of a sudden, I mean, I got zero business classes. I don't know what a profit and loss sheet is. I tried to figure that out all the time. Oh, absolutely horrendous. But um, and so uh, you know, that's really sage advice. I think uh what you really kind of glean down to is like, uh, what is your purpose? What do you really want to do? Where do you really want to be? Start thinking about these things. These are really important to you overall because uh ultimately um most of us uh you know we're not avaricious. Uh money is not the answer to everything. You're gonna get paid. You're not gonna starve. You're gonna be able to go out to eat dinner. Those things um will will be there. Um so find out the kind of lifestyle that you that you want. Do you want to be able to golf cart to your kids' school? That's a good thing. Um tell me about what you do for fun. What are your hobbies?

SPEAKER_01 1:14:27

Uh yeah, it's tough. It's tough right now as we're actively. Is work a hobby? Yeah, unfortunately, it seems like it at times. But I mean, unfortunately, you know, I like what I do, I have a great staff. Uh, you know, we have providers, P A N Ps, that always makes it uh helpful for us. They are they support us tremendously, and it's uh, you know, the practice can't survive without everybody that's in it. You know, hobbies for fun. I do like to fish, I just don't get a chance to do it as much. Uh I must get asked every time I'm on vacation if I how how the golf game was. I don't play golf, don't care for it. I don't like it. And patients always go, Oh, they're shocked by that. I know. Are you even a real doctor? I mean, it's uh yeah, certainly like the beach and stuff. So I like the water grew up on the water, so I've always been around it. So the that aspect of it is what I like to do.

SPEAKER_00 1:15:12

Yeah, when when you do get that that free chance. And again, uh, you know, you've got a busy practice, but also um seeing your family occasionally is nice. Yeah, yeah.

SPEAKER_01 1:15:23

Go back to Savannah. My parents are still living, so uh we go back pretty regularly, go catch up with old friends. Because I mean I grew up there, I see old buddies from high school, et cetera.

SPEAKER_00 1:15:32

Yeah, it's nice that that's drivable from here.

SPEAKER_01 1:15:34

So definitely.

SPEAKER_00 1:15:35

Yeah, okay. Um I th I'm I'm conscientious of your time and really appreciate your uh don't don't look over there. Okay, then uh I guess I'll have to let me let me tell you this. Here we can. Um, but I am gonna end up with some rapid fire questions here for you. Okay. I can't wait. This is everybody's favorite. Um let me start off by saying um who is the smartest person in history? Einstein. Hey, great answer. We love that here.

SPEAKER_01 1:16:03

It's a popular answer here, and we agree with it. Um you start thinking about like mentors and training and all that. I mean, you know, you get touched by so many different docs and training that are they're geniuses and they they seem to know everything, especially when you're at that part of your career you're learning. And you know, you think about all the the attendings I've been exposed to in my career, and I was like, well, half of them were probably geniuses, but I mean I threw that one out there just because nobody can argue with Einstein.

SPEAKER_00 1:16:28

No, nobody can argue with that. And it reminds me of when uh we were doing history and physicals in our third year of medical school, and uh one of my attendings, uh Dr. Levine, who is an endocrinologist, um I started off my not this one. No, no, no, different one. Um and I started off with my patient presentation. I said, this is a such-and-such year old who's got bilateral nephrogenic, and he goes, Oh no, bilateral? I was like, Yes, sir, and he goes, That sounds like retroperitoneal fibrosis. And I was like, okay. Anyway, so I'm still amazed by that to this day. Uh so smart guy. Um If we can live to a thousand, should we do it?

SPEAKER_01 1:17:10

Uh no. Okay. We'll be overpopulated before we know it. So I guess we'll have to move to Mars.

SPEAKER_00 1:17:17

Go to Mars, yeah, exactly. Uh, you know, I'm my kids might be able to get off the planet. We'll see. Um That's a tough question. I mean, who who asked that question?

SPEAKER_01 1:17:25

Me. This is who asked this question, okay? You're Amber Antonino. If you say no, then people are gonna be like, well, he's a nihilist. He doesn't he wants to. It's like, no, I don't I don't know the answer to that, but no, my gut instinct is no.

unknown 1:17:36

Okay.

SPEAKER_01 1:17:36

Because I I guess the the the question would be what's my quality of life gonna be from years 100 to 1,000? I don't know. I mean if I'm sucking on a straw and you know, not not enjoying, you know, being I'm not functional, that's right, then maybe not. So that's why I said no. You don't ask for explanations, but I don't, I don't know.

SPEAKER_00 1:17:53

I leave it open. Uh now um the uh you know one of our former podcast guests, Tom Mayer, had suggested uh this idea of not just lifespan or health span, but joy span. Yeah, I like that. If you can keep the joy span going, that would change. That may change that.

SPEAKER_01 1:18:10

That I do like. That's that's absolutely relevant.

SPEAKER_00 1:18:13

Yeah, yeah. Um do you like it too cold or too hot at night? Too cold. Okay, good. That's the right answer. Only one. Um what is one thing you would tell yourself if you could go right now to talk to you as you started med school?

SPEAKER_01 1:18:26

Get into electrician, H V A C or plumbing.

SPEAKER_00 1:18:30

Sage advice to you back then.

SPEAKER_01 1:18:32

Um seriously, I'd go get a I'd go get a trade. I mean, it's not to not to discount what we do. No, no. I mean, all the all the public has been piped into my entire life growing up in a doc's family is you tell somebody, oh, my dad's a doctor like, oh, it's like they take a whole different attitude with you because they go, oh, a silver spoon. It's like, I don't think you understand the sacrifices we make. None of them do. I mean, you know, we're all buried in debt from college, we're buried in debt. I went to grad school, et cetera. But besides college, med school, you don't make money in med school. Unlike all the law students that lived in my crackhouse I lived in and make in Georgia, they all had a job. They could go out and do stuff. They went out and did social things at night, you know, and these are law students, which I thought were like us, and you know, I'm not I don't want all the lawyers to call me with us, but no, no, no, we'll edit this out, Chris. So it's fine. But I mean, literally, I mean, we can't have a second job where massive amounts of money in debt, and then you go off and be a resident, you're making $2.20 an hour because you're working so many hours, and then all of a sudden, you know, you finally get to your your career where you can make a a living, and then you've got to pay back all this debt that's in these high interest loans, many of them now. I wasn't fortunately, but many of them now, because interest rates were really low. But I don't think people understand the sacrifice, because all my friends, they have kids, they got a car, a house, and I'm driving an old 20-year-old vehicle that barely starts, and they just don't understand it. So it's a it's a huge financial sacrifice. But that's why I say, you know, I think I'd I I'd do medicine again. I don't want to sound like I wouldn't go back into medicine. I think your point is what I think. If I'm in high school, I think uh the the tradesmen are gonna take over the world. I mean, these kids can't look up a YouTube and figure out how to change a light bulb, there's a problem. And that's that's the issue. The tradesmen are gonna come in and say, I'll charge you fifty bucks to do that. Yeah. And they'll do it because they can't figure it out. Of course. Of course. No, it's that's an explanation for the case. I like that same device here, okay?

SPEAKER_00 1:20:29

Uh uh let's say here, what is one current medical treatment or therapy we're gonna shudder at that we use 15 years from now?

unknown 1:20:41

Wow.

SPEAKER_01 1:20:44

I I can tell you what we're gonna shudder at in 15 or 20 years. It's not medical, it's plastic. We're gonna think we're morons for plastic over the last hundred years of what we've done to this entire world. They're gonna be digging up plastic a thousand years from now and going, those idiots in the 21st century. Right. Um So besides the point, as I drink out of my plastic bottle, notice I didn't know.

SPEAKER_00 1:21:04

We'll get a glass for this.

SPEAKER_01 1:21:05

No. Shudderat? Boy, I don't know. I hadn't even thought about that. Um I think we're gonna look at chemotherapy and say, what the hell were these guys doing? And then they're gonna say, Well, that's all we had. Um because those those toxic are horribly toxic, they're fatalities associated with chemotherapy. Um, but if you look at look at historically in medicine, if it's all you have, I mean, we've we've we give arsenic for crown outline in our office for certain leukemias. I mean, arsenic's poison. I mean, okay, everybody knows what arsenic is. They put in pressure-treated wood years ago. Um, it's just how much of the poison can we give uh and it'd be effective to treat disease. Um, but yeah, I think people look back and be critical of chemotherapy. I don't I don't know 15, 20 years from now, I think 50 to 100 years from now, they'll say, God, what the hell are these oncologists doing? They're causing secondary cancers, they're causing this. But I mean, that's that's a trade-off risk versus benefit.

SPEAKER_00 1:22:00

I I love this answer because I think something similar. Uh, you know, at some point we're gonna get some some spark moment, um, some eureka moment where we find out, uh-th this is how you treat cancer, and it's something off the wall. Maybe it's plastics. I don't know. But the point is that there's gonna be something that comes along that says, oh, we don't any longer have to utilize uh chemotherapy for that kind of thing. And that that'll be a great day whenever we get there. Um two more, okay? You ready? Um Tell me, what is the greatest song of all time? Stairway to Heaven.

SPEAKER_01 1:22:34

Beautiful answer. Love it. Although Bittersweet Symphony is another one. That's my one and two, so I'll go with one and two. Yes. So I've heard the so Bittersweet Symphony was a stone song and it was a sort of thing. Oh, you're talking about the stone song, it's a musical song. So they they they they took that rift and their the um they took it and put it there, their thing, and they got no royalties. They got zero royalties. Every time it's played in on TV, whatever. I think uh Keith Richards or one of them finally started giving royalties in the last five years. But uh the first 20 years they got zilch.

SPEAKER_00 1:23:14

Well, if you hear it, it's it's definitely a part of the song. You can hear the actual OG, Better Sweet Symphony, which is a very cool part, but it's not the violin part or anything that you would think is stands to your ear as as the part of the verse version of Bittersweet Symphony.

SPEAKER_01 1:23:29

So Yeah, it's it's odd that they got the head part for the case. It's really a copy of somebody's.

SPEAKER_00 1:23:38

Yeah, this is uh but but when you take that part out, it adds a little something, but unless you're really listening to it, you wouldn't hear the difference without that. So so very interesting segue there. Okay. And finally, uh tell us what books you're reading right now.

SPEAKER_01 1:23:53

Uh actually, uh uh Old Man of the Sea. Oh. Great. And then there's a doc in Savannah that is a murder mystery writer. His name's Mark Murphy. He has a new book. I've read the first couple of pages. Uh it looks like it's gonna be good. His first book wasn't as good as this one appears to be. Somebody encouraged I read it. So uh I've got a few pages in it. I don't read a lot of uh pleasure reading uh during the week if I'm on vacation or something like that. So I'll set it down and pick it back up in a couple of months or something when I'm on vacation. But I do read New York Post religiously every day. Uh I never miss that without uh well, maybe on a Saturday or something, I might overlook it if I'm out of town. But I read that every day. Uh but yeah, book. What about you? What do you got open right now?

SPEAKER_00 1:24:38

I've always got a few books that are going on. One one of them is my wife and I are both listening to the Dan Brown book. Oh, yeah. Secret of Secrets, which is kind of a page turner that we'll listen to on Audible. Um I am reading a book on uh the quantum mechanical basis for evolution by natural selection, which is a it's a heady tone that is really uh uh Maybe I need to rephrase the smartest man I know from Einstein. You shouldn't. And the last one is uh Man in the High Castle. Man in the High Castle, which is Philip K. Dick.

SPEAKER_01 1:25:10

Yeah, but that was the uh Amazon series about 10 years ago, wasn't it? Yeah, yeah. It's an interesting concept with the East and the West and then the middle.

SPEAKER_00 1:25:17

It's it's a it's a counterfactual history of if the Axis had won World War II. Father Line.

SPEAKER_01 1:25:23

It's the modern version of Fatherline.

SPEAKER_00 1:25:24

Yeah, so so uh it's it's interesting. It's it's a it's a neat take on things.

SPEAKER_01 1:25:28

So it is a neat take on things.

SPEAKER_00 1:25:30

But it'll be the same three books that I'm reading when you come back to do this podcast again in six months.

SPEAKER_01 1:25:36

So uh so I'm not exactly churning through the Hemingway thing is like my favorite place on the planet is Key West. And uh I was there not long ago, and uh I was like, you know, I hadn't read any Hemingway in a million years, and I wasn't a big fan of it in high school, so I was like, uh maybe there's something to it. Maybe I need to reread it as an adult. So that's kind of where I'm stuck.

SPEAKER_00 1:25:54

Yeah, yeah. Uh it's something about six-toed cats or something. Uh there's a lot of them. There's a lot of quite a few of them. Um well, look, uh, I can't thank you enough for being here today. I can't thank you enough for being in our community, helping all the people that you're doing day to day, um, also being a colleague and a friend and somebody that I can bounce off ideas and ask you about things like the cure for cancer and say, hey, I've never heard of this chemotherapeutic. Can you help me with this? Of course I need it. Well, it's a two-way street, so of course. Uh we really appreciate everything that you're doing for us here. Um and and thank you for being uh both erudite but also really approachable. Um so that's really just uh great for our community. So thanks for being here today. Uh thanks to Dr. Christopher Haberman for being here, uh, for teaching all of us, for talking with us today, and thank you for helping us make medicine better together.