Emerald Coast Medical Mastery
Get to know the physician members of the Emerald Coast Medical Association. Empowering Physicians to Promote the Highest Quality Patient Care.
Emerald Coast Medical Mastery
Episode 20: Dr. Eric Sandwith
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He grew up the son of an engineering professor, worked a clean room job at IBM, and never planned on medicine. Nineteen years later, Dr. Eric Sandwith runs one of the region's only three-star cardiac surgery programs, and still explains hearts to patients the way an engineer explains a house.
Well, hello, and welcome again to the Medical Mastery Podcast, the podcast of the Emerald Coast Medical Association. I am your Amaranthine host, Don Davis, and I am more than happy to be here with a friend, a colleague, and a hero to many patients' lives, I will say. Dr. Eric Sandwith, who is a cardiothoracic surgeon. At least that's what my notes say as cardiothoracic surgeon. I'm not even certain what that means, really. Hopefully, you'll elucidate some of that while we talk here.
SPEAKER_03I have some insight.
SPEAKER_01Perhaps I'm willing to share with you. So Eric, thank you very much for being on the podcast here today. And we're going to take some time to kind of uh find out all the amazing things that you do. Can we squeeze that into about an hour plus? We'll see.
SPEAKER_03Yeah, well, why don't we give it a shot?
SPEAKER_01Let's let's wing it, okay? Um so um despite all the titles and all the things that you are doing for us uh daily and for our patients, let me start off by asking about you. Um tell me where you're from.
SPEAKER_03Yeah. Um, well, Don, thanks for first introducing me as a friend because that's the part that I appreciate the most. And I'm um I am I've been here in the the Panhandle for almost uh to the day, almost 19 years working in Fort Walton Beach. Um I'm originally from um place called Corvallis, Oregon, where I was born. Okay, raised in Seattle. My family history is from a small community-based um area of Washington off the coast called the San Juan Islands. And um grew up in Seattle. Um and uh I guess I've had a couple experiences and a couple of adventures in life, but uh I started out as an engineer.
SPEAKER_01Yeah, okay.
SPEAKER_03And uh I grew up in a family of engineers. Um my father was a professor at the University of Washington as an engineering professor. Okay, a couple older brothers.
SPEAKER_01What kind of engineer was your father?
SPEAKER_03He was a mechanical engineer.
SPEAKER_01Okay, mechanical engineer, good.
SPEAKER_03Yeah, also referred to as the Commodore of Corrosion. Okay. So he could tell you about oxidative reduction act uh reactions, you know.
SPEAKER_01Um forever.
SPEAKER_03Yeah. Who doesn't enjoy that?
SPEAKER_01I mean, you know, it's a pretty common table side uh conversation we have in our family, I can I can assure you.
SPEAKER_03I can't tell you. I I've actually was at a dinner the other night, it was a social event, and certainly all the conversations seemed to go oxidation. Oxidation reaction reactions. As they did. Um cathodic and anodic protection.
SPEAKER_01D did you remember in terms of growing up, was there some sort of sense of what your dad was doing? In other words, um, did you have some feel for engineering and what that would um what what being a professor of that is like? Or was it more he was just at work and you were out doing your own thing?
SPEAKER_03Yeah, I want to thank you for asking that question, Don, because it's always on my mind constantly. Um never. Um no, I would tell you this. I would answer it this way, is that in my family, um, we were pretty much the average family. And and uh um two older brothers, my dad being an engineer, in our family, for some reason, sort of the unspoken truth became um that um uh I I can I would describe it as whether it was power or uh success was measured in knowledge. You know, if you knew the answer and how to fix something in an environment like that, it was it was um it was very appealing um something to pursue. Um my dad was incredibly well educated and very versed in what he did, and he was gifted at what he did. Um he taught many thousands of uh students um what he did. And but at the same time, in a home environment, uh I understand this now because I have children, um, is that the sense of uh of um identity and self is something different than that. My mom was high school educated when I was a kid, and my dad had a PhD. He had a great um academic um uh leg up on everything, but I truly think that my mom was the smarter of the two. She was uh emotionally and um um spiritually gifted as a person. I using that term kind of as a as a um all-encompassing sort of statement that she spent life trying to get the big picture, trying to get to understand understand things outside herself. Yeah. So while many of us, and myself included, on frequent uh binges will simply just try to um find the answer to things that help validate me.
SPEAKER_01Yeah, no, and I I think there's really um there's actually a lot of sage wisdom there is that um there's something about achieving high water marks in whatever field that you're in that becomes more ego-driven, and you tend to find those things that give positive feedback towards the ego, yeah, as opposed to necessarily answering big questions. And so sometimes getting out of our own shoes and getting out of our own way, or um put it another way, one of the most important questions I talk to the medical students about is always ask why. Why is a very important question. Not that I'll always have that answer, but that's the real fundamental thing that we're looking for, is to see if we can get some bigger, broader answers, not just hey, look at me, I'm so smart.
SPEAKER_03I think I understand that. And I think that um as you just described, the process of asking why doesn't necessarily uh doesn't make it imperative that you can answer it. It's simply that you do partake in that, and that's part of the whole um uh learning from your experiences um sort of brings it all together. So, anyway, that's the area I grew up in that in um in in Seattle, between there and the islands, and grandparents on the farm, and got a good, you know, rural versus urban uh growing up experience, played a lot of sports, um uh found that in my life experience that my sport sports experience taught me a lot about that. You gotta there is no um you can't do anything um without a I don't see as much validation in the things I do unless I'm determined to win. Um and I think there's a great deal of uh uh comfort in that for me. Uh it's identity.
SPEAKER_00Yeah.
SPEAKER_03Um and I see it in a lot of the people I admire. Um at the end of the day, I think at work I try to we try to build a team as opposed to build my success. We build our team's success. That's right. Um boy, that's a big one, isn't it? You can take that one and you just expand into it for days. But the point being is that um, you know, in the terms of what I do here, um it is about a successful team.
SPEAKER_01You know, I I love that because it's I grew up playing team sports. I was playing soccer for the most part of my life, and um, and there was so much value that was inculcated to me from my parents, first of all, is that you've got people depending on you, you need to be dependable.
SPEAKER_02Yeah.
SPEAKER_01And also you you taught that the the sum is greater than the the individual parts. Yeah, so so so you together can can make uh insurmountable tasks that you could not do on your own. And so um, so I find that incredibly valuable that I think I had to learn that in hindsight, honestly, and looking backwards in my retrospectoscope as opposed to actually living through it. But at the time I was just plain sport.
SPEAKER_03Yeah, I think um I think that people that don't have to learn that in hindsight are uh would be considered either gifted or angelic or something of God, you know. But uh but I think yeah, there's there's a whole great deal of uh things in life that we learn as maybe a tincture of wisdom as opposed to um inherent knowledge. That's a tough thing. I didn't even recognize while I mean I got I played a lot of baseball and football um and uh into college and just a Division II school and don't never say just a well I'm just saying incredible, yeah. Is that the the participation on a team was part of my life from the time I was seven until I was in my twenties. Um and who could ask for better, who could ask for more? I've had so many remarkable coaches that my my recollection of them resonates with me um and the things they said um to a good extent of the people that have gone on and that have been in my life. I still hear their voices and I hear.
SPEAKER_01They're always watching you. They are always watching over your shoulder.
SPEAKER_03They got a good message because they all cared.
SPEAKER_01Yeah.
SPEAKER_03Um so yeah, pretty lucky.
SPEAKER_01Well, well, you also uh learn how to deal with different personality types and kind of um again, you you have a common purpose, and so let's find our commonalities in order to be able to achieve this purpose.
SPEAKER_03So I think also, Don, if uh if we can talk about that is uh the different personality types. Wherever I go, I'll find those same personality types. Yes. And um, I know you.
SPEAKER_01You're a Douglas. Yeah.
SPEAKER_03I met you the last three places. I missed you a couple of times ago, but but I got you again. Exactly.
SPEAKER_01That's good to see you again.
SPEAKER_03Um because we do put those people around us that um you know familiar situations tend to.
SPEAKER_01Yeah, and and and we you know, again, can hearken back to some experiences that we've had in order to kind of I I I I have some insight into how to work on this. So um well now, so you matriculated uh at some point to college. Where did you go?
SPEAKER_03Yeah, uh University of Washington, of course. I've heard of it. I like to, you know, because my dad was uh professor there, but my two brothers, yes, the older guys, they had to go to Washington State, which I kind of um in in the state of Washington, which is different here, the Apple Cup will distinguish uh these two things. So I like to give them a little hard time for that. But um at the end of the day, I went to um started out in Oregon at um a place called Pacific University for two years of football, ended up breaking my jaw uh and uh could not did not have the capacity to return to the um to the sporting events, but ultimately I also knew that at some point I had to kind of grow up. I had to sort of look at my future, and engineering uh was more or less the unspoken expectation. I went through that and did that. I certainly didn't do it with um uh any superlative um excellent output. I got through it. And when I finished um at the University of Washington, I um went and worked for IBM for about a year. This is about 1988-ish. And while I was working for IBM out in Vermont, um switching coasts now, okay.
SPEAKER_01Yeah.
SPEAKER_03I had to get away. I had to go explore the world a little bit. And uh went out to Vermont and um uh worked for IBM in a place called Essex Junction, where they made um master copies copies of microchips. So anyway, it's a uh it was an energy-based um um practical developing um uh development.
SPEAKER_01Yeah, but technologically advanced, yeah, that you're doing it it was it was pretty interesting at the time.
SPEAKER_03But I went out there and s got started in that and um worked in a grade 10 clean room, and I could not recognize for the life of me the people that I worked with each day.
SPEAKER_01Um looks like they're working in the uh Willy Wonkas factory or something.
SPEAKER_03Is that not unlike it at all, just cover their face a little more, and that was it. But we would, and then outside of that work environment, I couldn't even recognize I didn't know who was who I was working with. Um and that struck me. Um I recognized that I enjoyed the inquisitive nature of what we were doing and the potential application of what we were doing. You know, it it wasn't uh earth shattering or anything else, but it was science and it was applying as engineer, as an engineer would. Um and while I was there, I got to take this um out of just curiosity, a uh life-saving course, which for to be on the uh EMS response team at the at the IBM Center, um, you had to take this course. And I took the course, and during the course of uh going to these um lectures every it was like Wednesday night for an hour and a half, we came up to the um the potential need for for delivering a baby or something like that, and uh part of that segment included a description of the fetal to adult cardiovascular system and how it changes. And I don't know uh what the big uh thing going on in my head at that time was, but it hit me between the eyes like like a sledgehammer. I just I wow.
SPEAKER_01Fascinating, right?
SPEAKER_03No, beyond, I mean more yes, fascinating is a term, but I understand that the the change that that hit me with was like, oh my god, I can't do what I'm doing. I need to uh I need to do this, I need to look at this.
SPEAKER_01What a terrifying and at the same time great moment because then you say the crystallization of purpose is one of the most important things that you can ever find in your professional career. Now, frustrating to say, well, I've got this degree and these other qualifications that have kind of led me to here. Um, however, um purpose uh seems to have uh at least sparked in you.
SPEAKER_03Yeah, that was that was a big deal. Um if you look at the way um all of the preparatory work that God has done inside of us or whoever it is, um and how that evolves and how that changes so dynamically and so intuitively once you look at the big picture, but it's just mystifying to me. It's almost as if you know, you think about um how those uh mobiles get balanced. And it's like that, but in four dimensions. And all of these things are happening inside the baby to provide life, and that it happens so repeatedly and so reliably.
SPEAKER_01It's unbelievably the precision that's uh or it's unbelievable, shall I say, the precision with which that this is reproduced. Exactly.
SPEAKER_03I mean and I think that you know, being you know, looking at the semantics, when I look at that, I don't say unbelievable, I say humbling.
SPEAKER_01Oh absolutely.
SPEAKER_03Truly, absolutely totally believable because you see it a thousand times, but it's so humbling because that's true. I can't do that. You know, I can't do that.
SPEAKER_01Um anyway, we're back when you look at that from an engineering perspective, because because you know you think that this um the human body is is perhaps engineered, or at least you could see it through those eyes at some point.
SPEAKER_03Um see see a a component of physics and chemistry and biochemistry, um, acid base, uh pressure, um fluid resistance, resistance to flow. Try to find one physical dynamic that exists in this world around us that doesn't isn't active and at play in that moment when a baby takes its first breath.
SPEAKER_00Yes.
SPEAKER_03And then you add to that the electrochemical stuff of the neurologic process that makes it happen, because it's gonna happen every time. Yes. When they say every time, it's most every time.
SPEAKER_01But but um large majority of the time, unless there's some issue.
SPEAKER_03Yeah. What?
SPEAKER_01This is this is so incredible. I love the fact that you said this because just from the cardiovascular physiologic perspective, there's a ton of things that, first of all, we get the honor of knowing. Secondly, we need to know about when the baby takes its first breath. Yeah. And the physiologic changes that change when you open up those alveolar sacs and and you get that oxygenation from the first head, and the pressure difference between the left and the right side of the heart, and how that closes up the foramenolet, and these other seemingly esoteric things from our perspective that do have downstream consequences, but then just the beauty of the whole thing is kind of awe-inspiring. Moving. Yes. And and I this is some of the stuff that I I want to get to on you with what you do in your day-to-day living, because there's a lot of things that have to cause you some reverence and some awe, just with um first of all, the humility that I've seen you interact with patients, but secondly, with some of the um quite remarkable things that you're doing day in, day out. But uh, but we'll spoiler alert that and say we'll get to it. Okay. So um, so there was this eureka moment, you find yourself, despite being a well-trained engineer and kind of an analytical thinker, something that may have uh caught your eye about maybe going into medicine. Now, did you have any other medical training other than the basic sciences in undergrad or anything else that even sparked that interest?
SPEAKER_03No.
SPEAKER_01So never thought of being a doctor.
SPEAKER_00Always thought of being an engineer. So, how did you go from there?
SPEAKER_03Uh, met people, God put uh somebody put these things, these people, in my life, and um almost pretty close to the same time, I met um a lady by the name of Kimberly O'Sullivan, who's been a dear friend ever since. She was in medical school at UVM in Vermont, um, and she had a group of friends that sort of had embraced me to uh uh get to know them. And so over time, um I talked to them about what they were doing and came to the uh real conclusion because you know you go through these many changes where you know in life if you're if you're fortunate enough to you get to question a lot of stuff that you otherwise that we take as as rote as being true because our parents told us that. So um, you know, and my family is the same. And so as I was going through all of this, um I was moved by the compelling nature of children. So I wanted to be a kid uh doctor, uh pediatrician. And uh uh so I went to medical school to do that.
SPEAKER_01You had your mindset, pediatrics is gonna be the thing. You get along well with kids. Can I take you one step back for a second and say what was the conversation like with your parents when you said, hey, this whole engineering thing's for the birds, I need to go do something else?
SPEAKER_03Could not have been more supportive. Could not have been more supportive. Um, you know, and you know, they say is that I'm not much, but I'm all I can think about. Um That's the truth, yeah. But my um my uh siblings are kind of either way on it, and uh um but my my mom and um my dad are very supportive.
SPEAKER_01Um and and I couldn't not do it. Yeah. This is this is the thing that I tell any prospective medical student is that do the thing that you can't not do. Yeah, that is the thing that is gonna drive you more than anything. Not the thing you can do, do the thing that you can't not do. It's different. So um, so where did you end up applying and going to medical school?
SPEAKER_03Um, more people. And my life experience has taught me it's the people. Um, truthfully, more people help. Um, a dear friend named Barry at the time, her name was Barry Berger. Um and she had been my friend since I was uh you know in grade school and uh still remains a friend. Um and she helped me get back then it wasn't one sort of clearinghouse application. Right. I applied um I went back to school, took the uh the preparatory classes, and this was in 90, 1989 or 90 when I took the MCAT. And I could not believe it, because this is the first time in my life that I was doing something because I had that, I was moved to do it. I wasn't doing it because I had to do it as part of my graduation and all that. It was because I was I wanted this, and it was the a new feeling for me to find something I wanted. And then I took the MCAT and I had just I think overstudied or something because I was in 99.8 percentile, and so because of that, I had some choices. I interviewed and applied to a bunch of different medical schools, um, decided that I wanted to go to Columbia in New York. Yes, went out there and interviewed, loved it, um, and was truly decided by it.
SPEAKER_01This is still culture shock, because I mean you're a Pacific Northwest kid and you moved to Vermont. Vermont is not the same as Columbia, New York, and so so um you decide to go into the city for doing medical school.
SPEAKER_03Well, I interviewed there, got accepted, yeah, and then I went home and had a conversation with my dad. And he had me sit down with uh um his uh accountant. So we had a long conversation about that, and I recognized that uh you can't couldn't support. There's no way that I'm gonna spend five hundred thousand dollars to uh get an education that would I can get for much cheaper. So I got accepted to the University of Washington, so I stayed there.
SPEAKER_01Okay.
SPEAKER_03Yeah.
SPEAKER_01Um and and that's um, you know, University of Washington, by the way, not a bad medical school, just in case we're uh sober clear here.
SPEAKER_03No, I was good with it.
SPEAKER_01Yeah, exactly. So um so tell me what medical school was like for you. New kind of training, and perhaps you're surrounding yourself with um some pretty intelligent folks.
SPEAKER_03Very intelligent people all around me. Um and it was really the um I mean, here's the thing, um, smart people can be from everywhere. Um happy people, um engaged people. Um I don't think it's not that I don't think that I had happy and engaged people around me before then, but I think that it was the first time I was able to recognize it. Um I think um when I started as a uh determined to be a pediatrician, um I had no idea w what it was about being a pediatrician that I wanted, but I did find out in medical school that um that's not the same thing. That it wasn't what I wanted. That's true. I did a rotation at the children's hospital in Seattle, and um which is amazing uh in their um in their care and their their approach to cystic fibrosis and a lot of gene uh viral vectoring of gene therapy. And that is what they are good at. And but the patients that I met there, the children, um I was not equipped uh emotionally or spiritually to be able to deal with kids that were sick and or dying.
SPEAKER_01One of the hardest things ever to see somebody who didn't deserve this to be suffering through it. Um that is a place where, you know, I'm I wanted the best for the kiddos, but I felt the same thing. That emotional range is, you know, you talk to pediatric oncologists and you're like, I don't I don't understand how you are able to function because that would be difficult for me.
SPEAKER_03Yeah, I really don't. I've never understood that. Uh I do think that many people that say that they they manage it well, I think they probably manage it okay. Yeah.
SPEAKER_01They put on a good face.
SPEAKER_03Yeah, I yeah, I don't I don't have that. It's not in my wheelhouse.
SPEAKER_01Yeah, well, and I mean, good on you for funnest because uh, you know, as I've elucidated several times to to perhaps the lay audience here, that you know, the first two years of medical school are more of a didactic time where you're learning more stuff than perhaps you've ever learned before in your entire life and an impossible amount, but you and it's also kind of newer material too. I mean, you know, for me, I'd never done anatomy or anything like that. I had done some biochemistry for sure, but but you have to learn a lot of it and it comes at you fast. Yeah. And then your third and fourth year are clinical rotations where you're actually learning how to be a doctor a little bit more. Um, so you've kind of had this mindset, you've probably done pretty well throughout the didactic uh series, I would imagine. Umce you get to the clinical rotations and you find that maybe pediatrics is not going to be your thing, where do you go from there?
SPEAKER_03Well, then you engage the ego and allow people to kind of stroke that and encourage it. Um I knew that general internal medicine would not work for me. Would not work for me. I could not do that job. I couldn't do that job today. I couldn't do it, but I could not do it with green eggs and ham. So I think it ain't happening. Um but um I did I did find things in the surgical field to be much more appealing. Not like I not like I landed on it and I had solid footing and I knew this is where I was gonna go. But eventually, and I'm being honest about this, it would it appealed to my ego, and um I liked it.
SPEAKER_01I think that is actually if you're gonna get really honest with the vast majority of surgeons around here, and many of our membership that will admit to that, there is a portion of that. When you all of a sudden say, This is one of the most difficult things that you could ever do, not just in terms of the brain power, but of the hours, of the diligence, of the willingness to be able to sacrifice, all of those things, it's you get a higher um seeving echelon of people that can actually do that. So once you are able to make it through that gauntlet, that is certainly a badge of honor. And you know, if you were in the British medical system, you could earn the title of Mr. at that point. Um, but but to be able to say, no, no, no, I can do this is um that's a pretty big badge of honor.
SPEAKER_03Yeah. And I don't know if people, when they describe their life experience or their interests and and successes and stuff, I don't know if they really um try to describe it as though you know they were the the in the protagonist in in all situations. Let me just tell you is that I wasn't. Um I wasn't I struggled with a lot of things. Um I think during that time it became very clear to me that I needed to not drink. Yeah. So it's been in place for more than two decades, and um good on you. And that's important. That's a very personal part of it because the truth is that I had so many, uh just like everybody else, I had a a hundred different challenges, and the thing was is that I didn't always do the right thing in the right moment. But somehow I was able to reflect back on it and find maybe what I could have done, what I should have done, and try to try to emulate that in the future. Um I recognized um um mm as many shortfalls in myself as as um as as gifting. Um I recognized many shortfalls in others as gifting. I recognize the value of not being um I don't know to be to be honest, just not to be a big deal.
SPEAKER_01Um this is also you starting or at least continuing on a pathway of we will all make mistakes. Yeah, the cardinal sin is not learning from those mistakes, yes, and um and that is writ large um and very high profile cases in the medical field, but in your personal life day to day, there's nothing better that you can do. Of course, you will stumble. It's getting back up and and being better and learning from that.
SPEAKER_03Oh yeah, I absolutely and and it it's so easy to talk about. I'm glad. Yeah, this is an intervention, by the way. When are people coming into the room? Um But no, it's so easy to talk about. It is such a challenge to try to keep your to stay mindful about that.
SPEAKER_01Yeah, and in mindfulness, I think, is really the journey in life. It's it's coming back to those points. This is what I've heard about um meditation. You know, meditation, we sometimes think that that is breathing and being in touch with our breathing. The truth is that you are going to have intrusive thoughts, you're gonna have invasive thoughts. The meditation is going from those thoughts back to the breathing, back to the here and now.
SPEAKER_03And so that's that's your be present in the moment and not just as a um as a saying that we use, but actual as a as a process or a way that we be. Live in the way that we live. That's right. Um and uh yeah, I of course I'm I'm I'm uh grateful for that, and I I strive to um be able to be grateful to make sure I'm in a place where I can grab on to that. Um and you know, uh the whole process of um of all of these things in life and the last, you know, as I got a little bit older here, has been um to try to stay in that place and be grateful and kind and and stuff. I think uh I think that matters. And at the end of the day, is as much as I can, even though we're spending this hour as you uh continue to ask me questions about my favorite topic, um it's uh it is about it's about others. Yeah. Best day is about other people. Yeah.
SPEAKER_01Um, you know, I found that um um mindfulness was very difficult for me, even though I really enjoyed my intern year to soak it all up because sometimes we're really, really difficult. So you move on from here to your intern year as a surgery intern, which is some of the hardest that you'll perhaps have ever worked up until that point. Um where did you go for your residency?
SPEAKER_03Um, I ended up having wanted to go to the East Coast and the South. Um, even looked at that during medical medical school. Um, but as a resident, I could go pretty much anywhere, get the same nothing pay and work. And so I found a uh I wanted to be at this point in time, I had evolved into the uh small town general surgeon that said that sent the tough stuff away. And all that at the end was important.
SPEAKER_01Just all shucks wearing suspenders and you know, just a small town country surgeon. Okay, all right.
SPEAKER_03Um so I went to Virginia in a place um the place called Roman Oak, Virginia, in the Karelian healthcare system, spent four years there and about a year in Charlottesville doing general surgery. And um yes, worked a great deal. I worked a great deal. Um I lived in this by this time, and you probably have a similar um experience, but by this time you have simply worked hard to get somewhere, and each day it wasn't like, okay, I'm just gonna take it easy today. No, it's like every day you're back at it for something that you hope is in the future in terms of your your education. But the thing is, is that during that time and it crept into my experience was that I met people that were compelling. These people were wait, these people were more interested than me. I mean, no way.
SPEAKER_01I know. Who would have thought?
SPEAKER_03That doesn't happen. But I'm me, sorry. Have to get some more therapy for that. But no, um uh I went to uh Virginia in Roanoke and I loved it. Um I I met someone there that was before we really knew each other, we had gotten ahead of ourselves. And uh we had a daughter who is my my oh my god, she's the mini me. She is. She's now 28 years old. Wow, um beautiful um cardiac surgical PA up in Fairfax, Virginia. And you know what? I I I see her going through things similar to what I did. Um and I see her struggle and just as we can talk about kids forever, but my other kids, but uh especially because she's in a s in a similar field to me, and um, and I'm so proud of her. I mean, emotionally she's far out outpaced me, that's for sure.
SPEAKER_01This is what I think back to me at 28, who's not a very emotionally uh stable person, but um you know, and this is uh this is a totally separate point, but but I I like this jumping off point for one second is that um it's a hard place to be to want your kids to face adversity because overcoming that is going to be the most important thing that they could ever do. And it's not just hey, you're gonna face adversity, it's wanting them to face adversity. It's a hard place as a parent to be.
SPEAKER_03It is, and I think it's a I think it's again, just like most things, it's different for different people. I think it's different for different children. Yeah, that's um I can tell you that I do strongly believe that you know, total selfish approach to this, but my children will learn the most from their failures. Yes. My children will not learn those important qualities in life, um, the kindness and the service and the gratitude from always winning. That's those things it would surprise me if someone was able to do that. That's right. Um I'm not saying it's impossible, but for me, I think it would surprise me. Um my I say that with my children, and um I see them with some things they s seem to struggle with, and there's different levels, you know. One of them might be an academic whiz and then struggle in the inner human interaction uh world and with you know having friends and doing the right things. Yes, yes, yes. At the end of the day, my favorite thing I like with my kids is to ask them not how how's school. Um, so what is one thing you did for someone else today? And hopefully, while they're going through this process of winning and losing, and hopefully, mostly winning, um, that uh they do gain that sense of uh of the value of others. Yeah.
SPEAKER_01Service. Yeah, no, I I think that that's a really um great and sage way to handle that. Um I'm here for your parenting TED talk, by the way. Um so I'll take that.
SPEAKER_02Okay.
SPEAKER_01Um, um heading back uh to your training, so you finished five years of surgery residency. Now, um, did you know immediately that your curiosity was piqued by um some further calling towards fellowship from there? Yeah. Uh what were your thoughts?
SPEAKER_03Yeah, again, uh my my ego is continuing to grow um almost at the rate of a uh banana tree in spring. Um because that just that'll grow six feet in a day.
SPEAKER_01But uh no, I well be and and rightfully so, you're successful. Yeah. You're you're doing things, you're getting the feedback from attendings and patients and others that say, hey, what you're doing seems to be resonating and and you're you're going on the right track and people are getting better and you're servicing others.
SPEAKER_03Yes. And just like you, Don, I mean, if you look back at this time, um, or if I look back at this time, I recognize that you know, there's certain people that came into my life that made sense. So uh I big deal about growing up in my when I meet somebody that I I really resonate with, um and they can they can be a mentor. Go figure that word mentorship. Oh my god. Um greatest gifts you get in life, right? So um I found um a guy named Brian Strain at um in in Roanoke um who worked there as a cardiac surgeon, and um and the other um oh god, Joe, I can't remember Joe's last name, and and uh um Paul Thomas France. Um these people were people that I looked at up to. I admired them to some extent, almost too much, but I admired them so much. And they were actually kind. They had kindness. Um Brian was a mentor to me. Um when someone in my life has been willing to invest in me, it humbles me. Um it I there's very few things I'm more grateful for. And I wish I was better at demonstrating that to my wife.
SPEAKER_01Yes. Look, if we're gonna talk about wife complaints about husbands, we've got several hours here. Chris could come pull up a chair, we could all join here, but um we certainly don't have time for all of that.
SPEAKER_03No. But I'm just telling you, is that honestly in in your experience too, is that there are those people, and they are sentinels in in your life, in my life experience that um that uh that allowed me to become who I am.
SPEAKER_01There are standard candles in my life that I can look back towards that say, hey, you're on the right path. You're emulating someone that you respect, and somebody that you respect thinks that you're good enough to continue on this path. Yeah. And that that kind of guideposts you and says, hey, maybe I should keep going in this direction.
SPEAKER_03Yeah, I agree with that.
SPEAKER_01So um, so you chose to go do fellowship after that. Um now at the time that you had these mentors, could you see yourself being a cardiac surgeon? Is that someplace that you ever let your brain go?
SPEAKER_03Um I could see myself wanting to be a cardiac surgeon with them. That's what I wanted. When I'm honest with myself, that's what I wanted. I wanted that to go on because um that felt good. Yeah. Um but I don't think that as I got further and further into the process again, I recognized the elements of what I was compelled by. And this time instead of it like in the pediatrics area, this time it added up. I was like, yeah, I want to do this. Um and so I carried on. Okay. Went to Kansas City, the Mid-America Heart and Lungs Center Institute, and um was there for two years.
SPEAKER_01Okay. So now you're doing um what I'm gonna call big boy surgery. Okay. Um, so so um that's not to dismiss or deride any of our uh general surgical colleagues at all because they do absolutely wondrous things, but we're taking a step up here. In terms of complexity, in terms of the severity of the patients that are coming to you. Now, one of the things that I've commented on in this FAIR podcast is that when I got into cardiology fellowship, I felt big. The ego had driven me quite away, and I realized very quickly that I didn't know the first thing about cardiology. Did you have some similar experience about getting into it where all of a sudden there's some expectations of you that, oh, I was going to have to pick up uh the bowl and start running very quickly if I wanted anything?
SPEAKER_03I don't know how you keep doing this, Don, but okay. Can you give me the grace to let me go back to medical school? Take your time. Um so as you talked about the initial part of medical school being uh didactic and in a classroom and stuff, we had during at the University of Washington, we had a another program during that first two years where we began, it was introduction to clinical medicine. And so groups of us would break up, uh, four or six of us in a group, and we'd have one of the uh esteemed retired colleagues from the University of Washington or from the medical school would have us go and interview a patient in the hospital and come back and give our report to the group and the uh and the physician. Anyway, um so probably my first time uh participating in that exercise, um I was sent to go interview uh a lady who had had lung surgery for um non-small cell lung cancer, and they had to take out her entire lung. And of course, um that the reference to that is a pneumonectomy. Um, so I went, interviewed her, talked to her about it, did not demonstrate the normal curiosity you would expect for someone to do to pay attention to. And so got the interview, went back to the little meeting room, and the uh emerettis uh fellow that was asking us about our interviews said, um, so of course, European accent. So doctors said this. We knew a patient, and you talk about uh they had this surgery in the operation. Can you tell me about this? What sort of surgery did they have? And um and I had not even looked at the patient's uh physical exam. We weren't we were asked not to do that because it's a little creepy at that point in time. But um no, um I said, well, um how'd it go? I said, well, she had a pneumone acty um and now she's just recovered and she feels better, and I think she's gonna go home in a couple days. And he goes, and he's looking at me the whole time, Dr. Sandra, what is the newman? Um no, what it was it isn't. He said, Dr. Sandro, what is um what is a pneumanectomy? I said, Well, um I I think, sir, that that is the surgical removal of the Newman. And that was my honest of God best answer at the time. And everybody else was laughing at it. And and so he explained to me what the Newman was, yes, which was so important to me in learning Latin and all the things that you get to learn further down the path. But right at the beginning, I got punched right in the nose with just how ridiculously um without the training, it is me. It's just me. And me is not a powerful, as powerful a um a provider as me educated. But it was funny because pneumonectomy and now I do them. My dad had a full circle. Yeah. Um my dad had the similar uh thing about his engineering um uh oh about this he said I used to not know how to spell engineer and now I are one. Um, which was for my dad's sense of humor was really funny.
SPEAKER_01Yeah, at large. Um look, those humbling experiences are absolutely incredible and informative to us. I mean, what you learn from these is you don't ever want to be caught with your pants down again. No, you are gonna be prepared. That feeling will stick with you. Um perhaps it's stuck here still today, and um, so I will um try and keep my Newman's intact just in case. Okay, so um no, um, so you do two years of cardiothoracic surgery or cardiac surgery at uh Kansas City, is that right?
SPEAKER_03In Kansas City, yeah, two years.
SPEAKER_01Um Did you feel at all that 24 months was not going to be near enough to be able to get the breadth and depth of the surgical experience you would need in order to perform this?
SPEAKER_03For me, it was not enough. Yeah. No, for me, I needed more. I wanted more. Um, and uh, you know, I had again looked at the pediatric side of these of cardiac surgery, and oh god, no. That was far too too uh but I did want to know more about what I did and how I do it. Um today's uh you know, we've been everybody's been down this path about uh today's experience and yeah, not uh I don't think um residents going through their training these days in the current rules that exist, um, that you they get enough. Yes. Even in the rules as they didn't exist before, I needed more. It was difficult, yes. I wanted to be confident and comfortable in at the this is at that time. I wanted to be challenged to as much as I could.
SPEAKER_01You know, this is is and this testifies to something, which is that, you know, these rules hours, um you're not uh a SATA store a maschist. Um you don't want people to suffer that go through training. Of course you want them to be well rested, of course you want them to feel great and to get good sleep and hang out with their family and everything. The problem is biology and pathology don't care about how rested you are. It's going to be complicated. And if you're gonna come out and serve, you have to know certain amounts of things and you have to have experience with them. And it's not just C one case, you have to be able to really understand the pathology, the pathophysiology, and therefore what the intervention should be: when to operate, when not to operate. There's just a very finite amount of time for you to be able to get this that is very difficult to squeeze in, especially once you add on hours limitations. So so we totally um, you know, I'm I'm copacetic with with uh the rules hours or the hours rules, shall I say, and um, and kind of how difficult it is to train. However, your patients are going to need you to know a lot of stuff. So can you get all of that stuff with those rules hours in place? I don't know.
SPEAKER_03The answer in cardiac surgery I can tell you is absolutely no. No, it's a negative, yeah. It's not, it's not possible. Um, and as we talked before, I have uh new partner who's relatively young and and is a an excellent example of excuse me, he has made up for all of those um um uh not having the reps, not getting to see it um as much to the best of his ability. And now he's really putting together all of these things now. Um not to say that he didn't have most all of them before he did. Um and he's he's really growing into that person he's supposed to be. Um it's it's um it's amazing to see somebody work so hard and again he's so empathetic and kind with uh with his patients. So he continues to push himself hard. Um because I'm sorry, like you said, um nobody wants someone else to suffer unless you read the the House of God.
SPEAKER_01House of God, yes, indeed. Formative reading for any medical training, yes.
SPEAKER_03And it wasn't wrong. Um I'm sorry. It's all a little bit crazy, it's all a little bit over the top, but it's and I I I hate to say this because when I went through my residency, I I would I kept saying, you know what, go ahead, you can do it to me, I'm not gonna do it to the next guy. And I I don't think I did. I don't think I was cruel and punishing to the next uh um resident. I had high expectations. Absolutely. These are people that make this decision to give us the opportunity to take care of them. They're not here for you. It's the other way around. That's right. And when I see that um the uh opposite of that in a physician who is perhaps making a very good income because they're they're some of the mode that they take care of folks, I think it's mixing up the the uh value of this. And we talked about this a couple of weeks ago on the phone, actually, it was the that one thing that was was put in place all of those thousands of years ago, but uh a person going to another person, or you can call them a patient going to a physician and and the power of that relationship where one person helps another. Um my god, that is it's it's not uh unbelievable, but it's powerful. Yes. Um and now everyone is trying to get a piece of it.
SPEAKER_01That's right. It's it's a humbling experience for sure, because you take somebody that is, you know, in many cases, um desperate. Yeah. They want to feel well, and you have the ability to per perhaps make them feel better. And what what a great position to be in, not to take advantage of, but to help somebody. I mean, that's to do the next right thing. And and yeah, and it's like we get to make a living out of this. This is incredible.
SPEAKER_03When your patients, when your patients want to say thank you to you, and you are sitting there looking at them saying, Look, you know, you this is the same way you feel like when you help somebody out across the road, perfect, you get ten times back. I mean, you you have no need to thank me. I it's been my experience. And I can just tell you is that when I talk to patients about heart surgery or and all of the the details, I can't make them a heart surgeon that day. I try to instill in them um something that they can start building themselves on because their selves have to get through it. Um and so you need to work on that strength part. I let them know, um, I think to the best of my ability that I can't control the outcome. I can con I can influence it, sure, and I will always be accountable for it. But I can't control it. That's a god thing, yeah, in my opinion. Yes.
SPEAKER_01Um and so of which I am not.
SPEAKER_03Yeah. But no, absolutely um uh and I think all of us, as long as, you know, when we take this um, you know, the Hippocratic oath, I there are so many good examples of how that's not followed today. Right. There's so many good examples. And all of us look at the people who don't follow it as great because they're rich. Um I'm not sure that's the right way to measure it. Yeah. Um I think that our I think sometimes we're a little bit koofed up about that.
SPEAKER_01I would agree. I would agree. And uh, you know, I wish that we could the things that we want to prioritize, we could incentivize more. And we don't necessarily do a great job of that, at least um from a financial perspective, but that's uh different conversation here.
SPEAKER_03So it's it's just an amplif amplification of the imperfections that are me. Yes, you know, and I can see them all around me. Those are the things that resonate with me the most. Um but you know, every time you get the opportunity, and I am present and trying to be present with the gift and burden of the shortcomings that I have and throughout my whole story. Um you know, if I can show up and and try to make some day buddy, somebody else's day better. It's a good day. It's a good day indeed. It is, and it's not taking for granted the complexity of what we do. Right.
SPEAKER_01Um, you know, uh my my experience with you is that that that is not false humility. That is not all shucks, you know, I'm just a guy. It is a truly lived-in, breathed-in experience of you happen to have a set of talents that can help, but you are a member of a team that is all racing towards one end, which is trying to help people.
SPEAKER_03So we're a team. We are definitely a team. Um I am a leader, it's what I do. Um people don't want to come in and see that their heart surgeon lacks confidence. I have confidence in what we do. I've done it for a long time now. Um, and for me, I gotta tell you, part of the thing after I finished my training and I finished in Kansas City, and then I went to the Mayo clinic for another year just doing complex cases.
SPEAKER_01Can I take one second there? Because I'd like to plant a flag there. Um in the cardiovascular world, um, there are even the top cardiology programs will acknowledge that the Mayo Clinic for Cardiothoracic surgery is probably the mecca of all things. In other words, um, this is not something that you would say necessarily, but um this is probably the highest echelon in terms of cardiovascular academics that we can get, probably in North America. And we could talk about some places around the world. Um, it just really is where the rubber meets the road in terms of highest complexity, in terms of where you're getting some of the best technique, where you're getting the real movers and shakers. That's not to say cardiothoracic surgery is not taught anywhere else and it's not amazingly done in other places. This is just there's a reason that it's probably the hand in hand back and forth with Cleveland Clinic, back and forth on on who's the number one program, and it's um it's perpetual that it's it's kind of stayed that way since its induction. So um this is no small feat to make it to the Mayo Clinic and doing cardiothoracic surgery. I I I think that's a high watermark, and you should be commended for that.
SPEAKER_03Yeah, well, um here's the thing about that. I mean, you know, and it's it's kind of like um it's your um I think the Mayo Clinic is as I refer to it in my time there, I called it the Church of Medicine. It really did, because it's kind of how they approach it. Um I was educated by some of the pillars of my profession, and I do think it's an amazing place, and it was a humbling experience. You know, um Hartzell Schaff, Joe Duray, let me just tell you, there's a guy in this world, his name's Joe Duray, and they didn't make any more like him.
SPEAKER_01He's a one-off snowflake, is that it's not a sort of thing.
SPEAKER_03He was um, again, so capable, so incredibly capable, beyond if I were to um throw a rock, I couldn't hit where he's at on an everyday basis. But I'm just telling you, is that he could do most anything, and he expected that of himself. And every day after one win, uh he would come back and and work even harder the next day. Um but on top of that he had kindness, and that's always been something that I've um for the most part appreciated and my mentors, um, not all of them, but most of them. Um the number of people, the thousands of people that contributed to me getting to know this stuff has been moving. But and the other part is that I went to the Mayo Clinic as a fellow. I think that they have um residents there that are off the charts. I was grateful to have the opportunity to work in that environment for a year. Um and yes, I think it's an amazing um institution. It's a it's a it's a state of mind, it's a uh it's an approach, it's a whole the whole thing because of the historical components of it that make make it what it is. There is no other. And I was grateful to get to have seen that. I think the residents that come out of there should all go and be major program directors and all that. I was a fellow and I got exactly what I needed, which was um my experience with complex reoperative um cardiac surgery, um, and some of the greater complexities that that you only see there. Um but yeah, I yeah, it was an amazing thing.
SPEAKER_01Yeah, the Mayo Clinic being a quaternary referral center. Oh, once once things have gone into absolute mayhem and third um.
SPEAKER_03When it starts to ar you know, everywhere else it started arguing, auger into the ground. I'll tell you this at the Mayo Clinic. Um yeah, again, more mentors everywhere, but um Hartzell Schaff, who is um is one of the pillars of cardiac surgery and um oh my god, it scared the hell just scared the hell out of me every day. I'm not kidding. And for good reason. Um but how you know it's kind of like what is it? Uh there was like a movie about something about being John Malkovich or something, yes, being Harsel Schaff. Oh God, I could not imagine.
SPEAKER_01Um well, there's gotta be, you know, a certain amount of excellence and pressure that they put on themselves in order to be that because I mean to fill that academic stardom, I mean, you know, most of the lay public is not gonna know these folks, but but in our world they're going to in some cases hang the moon.
SPEAKER_03I mean, you know, they should know them.
SPEAKER_01Yeah.
SPEAKER_03I think it's worth it. I think those there's a great opportunity to find uh a variance in how we pick our heroes. Yes. And um and those people should be they should be looked at. Um yeah, because um the people that endeavor to do great things every day um probably Because they are hard. Yes, because they are easy, but because they are hard. Um yeah, uh those those are are people to be um to be taken note of and to um be um uh respected for that.
SPEAKER_01Yeah, I think I think uh revered is probably certainly a way to to think about them. But also, it's not just that these people are doing incredible medicine, they're also formulating incredible medicine. I mean, you know, you you could tell me galore about various different cardiothoracic procedures, but coming up with those is not just like let's try a skin incision that's um two inches deep as opposed to one inch deep. I mean, these are entirely new physiologic channels that you're creating in some cases. And to and so to have the chutzpah to be able to do that, to put it on paper, to get it through an IRB, and then to implement that in place and see that it works. Yeah. Wow.
SPEAKER_03So maybe you'd agree with this, but I remember going through my residency and having my opinion of every attending or person like that. And my opinion, of course, and normally would be formatted based on my experience with them. It had nothing to do with what their all of their vast numbers of uh responsibilities. Would be because there was a lot. I mean you think about these all the different um fellowships and other things that they had to maintain and direct and guide and and educating others and how important that is. I I did not know the that I had been in an educational environment for so long I did not realize at the end that I I did what I do the best while I was teaching it.
SPEAKER_01Yes.
SPEAKER_03I can't help but have you know a medical student or a resident uh or even a nursing student in the operating room telling them about what I'm doing.
SPEAKER_00Yes.
SPEAKER_01Isn't that well it's it's it's also part and parcel with that is that you don't really know a subject until you've tried to teach it. And you will realize very quickly how um oh I was a little lax on some of these details that perhaps I should have understood a little bit more.
SPEAKER_03Absolutely. If if you can teach it, otherwise describe the process of achieving it of something, or how something works in all stages without looking at a book, then you know it.
SPEAKER_01Yeah, that's right. I also found that same kind of um uh ideal with patience. I should be able to explain this to you. And there's some pretty complex concepts that we have sometimes, but I can still get down to a piece of paper, and uh, you know, there's this this uh great um uh story that I had heard, perhaps it's apocryphal, about um Einstein's wife, who um, whenever after he had passed, he had gone to I think it was a lab in Colombia where they had created this dynamic representation of general relativity, and they had put out all this instruments, whatever. Now she's walking through and observing all of this, and there's they're giving her reverence and praise and saying, thanks to your husband, you know, that we've been able to create all these wonderful models. She goes, My husband did that at the dinner table with a piece of paper and a string or something. So it's the you know, it's if if I can be able to explain these concepts on paper in two dimensions, drawing it, I think that that's there's something that's elucidative about that that kind of doesn't necessarily pay full um service to how complicated these things are, the electrophysiologic data of patients in a three-dimensional network of how this whole works, while that is creating cardiovascular physiology, which is a physical phenomenon. I mean, these are incredibly difficult things to really think about at the fringes, but I think we can simplify them down and get some good gist to where people understand.
SPEAKER_03Similar to your experience, I can tell you, in you know, 25 years of doing this, it's uh um I'm not, as I said, going to make a patient into a cardiologist or a cardiac surgeon in a conversation, but that's not my job. My job is to communicate. And of all of the things that I can tell you, and understand this clearly is that uh working in this environment here, I don't do cutting-edge necessarily um surgery, I don't do the most complex, but I do those all those cases as good as anyone else does on a daily basis. The ones that are sort of straightforward and the ones that because I'm a small town cardiac surgeon, and when I run into a uh a case with uh with a prohibitive mortality or morbidity, risk of mortality, I will send them away to an appropriate institution because it's not about my surgery, it's about their life. Um and I have come to a place where I'm I'm pretty okay with that. Um but that being said, when I'm communicating with a with a patient just like you are, um make eye contact, learn in conversation. Not that I've demonstrated again today, but learn to be a good listener. And when I listen to people, try not to fit their narrative into my model. I have a tendency to do that because that's not what's supposed to happen. Um when I communicate with people, I now have a bunch of um things around the hospital when I go around on patients. Um my my team and I they recognize it when I give the talk, when I do the talks. And there's I don't know, 20 or 30 talks. Of course, of course. But they know them word for word and um roll their eyes every time they start because they know it's coming. But it is for me when I talk to a patient about their say their heart, um the heart, the heart's a house. It's got four rooms, two upstairs and two downstairs. Now, upstairs are called atrium, and downstairs are ventricles. It's got plumbing and it has electricity. All right, that's it. From there we start, and that's the framework because um communication for me is more about illustrative discussion. I think it's the best way to learn for me.
SPEAKER_01Same way I learned about all this stuff. Okay. Two atrium and two ventricle. I'm gonna write that down because it sounds good. I just want to make sure I know this.
SPEAKER_03So that's the physical structure of the heart, and there's a door between each of the rooms. But um there's uh there's two junction boxes. There are um, there's three different major sources of of plumbing. Um and you know, when the electricity comes in from the road, it goes to the first junction box, the SA node, which carries basically the distribution of the wiring of the top two rooms, and then there's a section junction box in the center of all four rooms, and that carries the wiring down into the bottom two rooms. Um there are specific wires. They're as real as your mind wants to make them. That's right. And so, anyway, we talk about the doors and the all that. And then when we talk, that's the function, the structural part, the functional part is that essentially what the heart is, is it's two inline pumps in series. That's all it is. That's right. It is 100%, that's what it does. It has um, based on uh the primary principles of um an inline pump, is it has two one-way valves, and in between those two valves is it is a chamber that can ch vary in volume and pressure. That's it.
SPEAKER_01That's right. Done.
SPEAKER_03You hope it's a one-way valve, and um there's when from there parts the pathology is everything that takes you away from that.
SPEAKER_01Yes. This is why I say, especially to my engineering friends, all cardiac physiology is V equals IR. You know that you've got you you've already started down the pathway. Anything we're we're gonna do is gonna manipulate that those terms somewhat. So um so um I I do want to talk to you about because you know, there's obviously a lot of different procedures that you do, and we could talk about whether that be septomyomectomies or uh a bentol procedure or valve replacements or anything. But perhaps I think our audience and maybe even other professionals would like to talk about something that's a little bit more of um a chip shot in your world, but let's talk about bypass surgery for a second, okay? Um maybe you could give us, because I think there's a mind's eye of what exactly is going on here. Maybe you could give your kind of potted description about what this procedure means to you and and perhaps what patients might experience if they're gonna have this.
SPEAKER_03Um coronary artery bypass grafting, also referred to as a cabbage, um, is probably the most performed operation in our culture. Uh the years since it was first developed, of course, with evolution and improvement, um patients that are a hundred times sicker have a lower mortality rate than when they started.
SPEAKER_01Um can I can I take one second there and say that I have talked to my patients about this quite a bit. Just about every patient is gonna get off the table. Yeah. We do a remarkably good job. And I say we, and I mean you, do a remarkably good job of getting these patients off the table, still breathing, still functioning. Okay, now there can be some untoward outcomes from there for sure, but this whole idea was that um, you know, the fear was that, I mean, if I go to a cardiothoracic surgeon, look, odds are that I might die on the table. Frankly, that's just not true. That's just not true.
SPEAKER_03It's a very correct statement. It is just not true. Um in the last 10 years, I have never had a cardiac patient that didn't get off the table. We have technology and the science of behind all of this that was kind of relatively new at the time I trained is very versatile and very applicable in in these uh situations. We can help and we can assist the heart. So, and as our previous uh conversation we had touched on before, the um the ability for us to mimic the things that keep us alive is getting better. Yes. The ability to sustain that is getting better. It's a long ways from the the, as we also tell the patients, you know, um our uh our our solution is a very distant second. Yes. The best way was the way it was done the first time. But our solution works, it is a very distant second.
SPEAKER_01Well, there were some billion years of evolution by natural selection that helped to kind of carve that out. You've been doing this over the past, I don't know, yeah, 200 years that we've kind of delved out this stuff. So so they've had a head start. But either way, we do have some sufficient way to kind of and some long-term outcomes that suggest that there is a way to help mitigate the issues.
SPEAKER_03We we can. And um remember this though, is that uh, and that's the truth of the matter, and if you you know, every day you go to work and someone can die, um, it's just over time it you you kind of learn to be a bit um to recognize those things in the fringe that might be more important than you think. Um people in general do not pass away from heart surgery because of heart surgery, they pass away for the most part is gonna be cut because of an inflammatory or infectious cause, pulmonary issues or diabetes for the most part. Yes. Um people from heart surgery generally now do not die because of renal failure. Doesn't happen. Um the inflammatory component can always be an issue. Um I do believe that um gives us a lot more latitude in terms of who we treat and how. A poorly functioning ventricle is the part that is going to be a real heavy weight for that person to swim with. Um we can compensate for that with you know the impella, the ventricular assist devices and things like that.
SPEAKER_01Yeah, so let's let's uh let's plant a flag there for just one second. So so your left ventricle, the main workhorse, the systemic ventricle, the main pump that is pumping blood to the periphery of the body. Um that is something that you want squeezing as best as it possibly can. As it gets progressively weaker, you can get progressively sicker because it's not perfusing all the vital organs that it needs to. And there makes some intuitive sense out of that. Um we can do plenty of things to try and help that ventricle. We can also, there's there's medications that help, there's some procedures that could potentially help. Um, one of the things that I talk to my medical students about is that a poorly functioning left ventricle is a bad day. A poorly functioning right ventricle, however, now you might not make it off the table. Okay, so so if you have to choose between an LV ejection fraction of 5% or an RV ejection fraction of 5%, you choose the LV all day long, okay, going on a style. Um, and so, you know, there's and and as you had alluded to, we do have some pumps now that can provide you more than sufficient amount of pump device function that absolutely can get patients a new lease on life in terms of their functionality, their ability to interact, their ability to create meaning. We don't want to have to go to that, of course not. But we have that capability, technology has been enhanced with our brains and our surgical capabilities to be able to provide this service to patients.
SPEAKER_03Yes. I agree with with that in in with all the different points that you made. Um I think from my perspective though, is that yes, that is possible, but also remember that you're when you're walking that path, you're walking a very narrow path. And the things that can knock you off that path are many because you are so vulnerable vulnerable. Um you know um seem some in over the years seen some catastrophic things occur with that. Just even anything like a heparin allergy. Oh my goodness. That is horrible.
SPEAKER_01Well, of course.
SPEAKER_00Of course, it is terrible.
SPEAKER_01Yes.
SPEAKER_00Um these are things you have to contend with.
SPEAKER_01We have to try and find solutions around them. We we do have some tricks here and there that we can utilize, but it's not optimal. You know, once you start to take resources off the table, it's hard, and it's you you would you would said it quite well, but um I typically say you've got less bandwidth to be able to handle insults. Yeah. And that is the thing that ends up.
SPEAKER_03Yeah, and you know, you know, it's been my experience with the whether it's doing a cabbage procedure or a valve procedure or even a tavern that that um we do, or we do we also deal with the aorta and the and I do lung surgery for cancer and stuff. Um but the key part of all of that is the patient having a successful recovery. Yes. Um and whether it's the the heart surgery or lung surgery or anything else, um is trying to get that person back to where you can communicate. Because you get them back to making eye contact with you, you can help encourage them through it. I have failed, I don't know how many times I've said this to a patient, is that all, and I tell this patient before the the procedure is that you know, from my background as an engineer, you learn certain things work, and but my background as a heart surgeon has been that you learn all those same things work good, but how much are they going to work for and who are they gonna work for? The person in the spirit that comes through, it's been my experience is that the person who will do better, all other physical things being the same, is a person with a positive attitude, a con an idea of something bigger than themselves, and a place in the future that they can see themselves being with family uh or friends. Um my experience has shown me that the the greatest obstacle that I can run into after a surgery, aside from all you know the the physiologic stuff, is is to run into a person who can't get out of their own way. Very common.
SPEAKER_00Yes.
SPEAKER_03Because there's pain and discomfort, there's fear, and these are the necessary ingredients to have that self-centered fear reaction. And you can't, it's funny. I walk into patients' rooms the day after surgery, and you know, I give them my my you better do this, um, you know, um uh talk. And at the same time, then I have them, and at the end of that, after a little roughing them up, getting them motivated to have a you know, they need to win, they need to to move forward, you know. Um then I tell them that I'm gonna check on them the next day. And I said, when I do, I want to hear the answer to this question. Okay. I want you to tell me of three things that you're grateful for that have nothing to do with you. Okay. And I hope no nobody who's gonna be a future patient ever sees this. Because the the the secret of that, as you probably know, is that a person in self-centered fear can't see behind beyond themselves. That's all they can see. And if you're able to take them out of self-centered fear, they see it easily. They see the rest of the world. And their burden is not so great. I don't know how that happens, but it works. And let me see, it works a lot when it works. But the key is that I know that when I ask them that question, I'm going, oh my God, it is impossible. Everything has something to do with me. No, this there's no answer to this. It's a trick question. And then they contemplate it for a couple of days and a couple swing and misses, and and then all of a sudden and I love to see this. They get it. Oh. Oh yeah. On the sun. Yeah. Beautiful day. You know, something like that. The the sunrise is a big one, the ocean, the the world around us, and the the nature and essence of every individual that isn't me. These things have nothing to do with me. Those are the things that I can choose to um to have a good day. I can choose to recognize, you know? And this is the conversation that we have with these patients after surgery. And I don't know how, but it helps. Yeah. It helps. For sure. And um, you know, I'll you know, I'll get up there and um have a bit of a yelling match if I need to, but when you do that, when I get myself out of my own way, I have a better day. When they do it, they have a much better day. Yes. Um, and it's pretty cool because a little coaching, a little mentorship can help people get there.
SPEAKER_01And it's it's also testifies to the body wants to heal itself. The body wants to make itself better. It's really good at it. It's had a lot of practice over the eons in order to develop these kind of pathways with which it can do it. So, you know, it's the Sir William Osler quote of the job of the physician is to get out of the way and let the patient heal themselves. Um, occasionally they need a nudge with some bypass surgery or valve replacement, but still, then after that, it's you not only do we need to kind of get out of the way, you need to get out of your own way. It's a brilliant idea.
SPEAKER_03Yeah, uh no, there's no question in my experience that the biggest obstacle is from a patient who is so, and you've seen this, and we've all seen this in people who are simply overwhelmed. Yes. Of course. In a moment of overwhelm, that's a moment of powerlessness, yes, and it's despair as well. It's powerlessness and despair. So remove it, get it out of there, find a way to communicate with the spirit inside because it's still there. It is. Um, there's no question in my mind. But um, the best part of all of that is to see, like on the second day for me after heart surgery with patients, generally the second day, maybe about 10 or 11 o'clock in the morning, when I go in, there's something different about their eyes, about the way that they're engaging. And if I don't see it, I have concern.
SPEAKER_00Yes.
SPEAKER_03But um, when you see that, it's uh means things are moving in the right direction.
SPEAKER_01And and it may not be anything that you could objectively state these are the qualities. Of it, softer palpebrial fissures or something along those lines, but it's something that you can feel and you know this means the brain's going in the right direction.
SPEAKER_03When you're looking at me and talking to me, it's so much more compelling than if you weren't.
SPEAKER_01Yes.
SPEAKER_03It's the same with patients. You know that, but I agree. But I love that. Um, I love to be able to see that and to be a part of it. To participate in that process is a is a gift.
SPEAKER_01Well, and notice you didn't say anything about the surgery itself. This is all you're interacting with a human being at this point. Yeah, it's true. And and the the humility and the um objectification, honestly, that we can do whenever we're in the procedure. It doesn't take away from there are reverent times where we take a step back and say, wow, this is somebody who is incredibly vulnerable, and I am in such a blessed position to be able to don't get me wrong.
SPEAKER_03I'm not walking around like all day long. I'm not. Generally, you have to continue to work on the team. And the team, which our um our team it's in in Fort Walton is, I mean, it is pretty remarkable. They do such a fantastic job on so many hundreds of levels. Um this last I don't know if I told you, but our reporting for the STS, you know? Yes. We've been three-star. Surgical database. Surgical database. And they rate the outcomes, and we've been real fortunate that in the last couple of years we've been consistently in the three-star, which is difficult for a small program because just one will knock you out.
SPEAKER_02Yes.
SPEAKER_03But our outcomes have been amazing. And then the last reporting, we were perfect in every category, which is very rare. I mean, I mean, very rare.
SPEAKER_01That's like uh rare air. Because things happen. Like, I mean, there there's there's bad things that can happen. There is still entropy in this universe, so I mean, so we have to contend with that. So but it but again, a testament to I think leadership and your team and how well you interact with a common purpose.
SPEAKER_03Yeah, and and keeping in touch with all these different things we do. Um I think our team does a good job. I I think uh uh the interesting part of any successful practice is a continuation of change and being able to adapt to that and help people move through it. Yeah.
SPEAKER_01Being mobile, being being uh flexible. Um that is that's how you move.
SPEAKER_03We get we we get our uh resource chain kind of wrenched down uh pretty tight sometimes, but um the people and individuals that work on this team, um to a one of them, uh they are remarkable people, and they're there for the right reason, and I would have them take care of me. Even more important, my wife, yeah, kids.
SPEAKER_01Exactly what I say about you and your team all the time, which is I would go to them, I would send my family to them, and that that should say a lot to you, okay? Now, um look, I am mindful of your time, but I do want to cover a couple of different uh topics here just to make sure that we we get those out while I've got your attention here. Um, first of all, um, how is AI going to integrate into your field?
SPEAKER_03The AI integration on every level. It will be every level. Um surgically, um, as I could give an example right now from in terms of lung cancer surgery, um, moving to robotic platform. I did it nine or ten years ago, and it was too cumbersome, took too long. With the AI improvements, um, I think that we have um a very good platform for a very good outcome. In terms of patient care and selection, uh, we're using um some of the ambient um uh recording devices in order to create notes and to cut down on our time for um uh documentation, which is everyone's burden. My goodness.
SPEAKER_01Yes, and that is a great uh solution for AI or or a problem for AI to help with. So so yeah.
SPEAKER_03The ambient um device has been remarkable. Excuse me. Uh in addition to that, some of the nursing and pharmaceutical issues and all the the things, you know, when you look at um healthcare today and some of the bigger stressors and problem and true problems has been um uh incidental accidents that occurred. I think it'll have a huge impact on that. Hopefully. You know, they keep talking about whether it can decrease the actual nursing burden. I think not. Um I just I I don't know. Again, I go back to the touchy-feely side of things and and it's that human interaction that makes all the difference.
SPEAKER_01That's it. That's it. You know, a a touch on the shoulder, uh, you know, just look in the eyes. That's that's gonna mean the world to patients, I think.
SPEAKER_03How are your kids? Yeah. Um the thing of, you know, when you have that patient that you've operated on before and they come back and they've lost someone or something that was important to them. You know, sorry to hear about that.
SPEAKER_01Take that time. Yeah, put your notes down, yeah. Talk with a human. Don't ever blast through that. Whenever I hear that, that is a time to let's talk about that for a little bit.
SPEAKER_03Yeah, I did a uh I got to talk to the folks out here at um at Margaritaville yesterday a couple months ago. And the essence of our conversation was be heard. Just be heard. Um you are the unicorn in the field of cardiology around here because many cardiologists are so overburdened with their timing for patient interactions that their patients never actually get to see the the lights of their eyes and they don't get heard. They don't understand why does this it I don't understand how an evaluation with a cardiologist can actually be done in 10 minutes because you know why does this human being show up to get their heart looked at? Just seems to me like you know, this is this is important stuff.
SPEAKER_01Yes, yeah, and look, it's by design, yeah, and you have to make compromises with that, and you know, um there's plenty of different compromises or different um spinning plates that we have to evaluate with, and some of that is you know, uh time with our family, other of it is financial. Um, and that's something that I find incredibly meaningful is to sit and have that time with patients. I'm uh just that's that's more for me. Okay, that that means something to me. Um so um let me ask you about what do you do for fun? What are your hobbies? I love baseball. Okay.
SPEAKER_03Um not gonna hold that against you, but still that's love baseball. I gotta admit, I'm um I'm a Boston Red Sox and a Seattle Mariner, both. Um I uh go to Fantasy Camp every January. Oh down in Fort Myers with Boston Red Sox. Um I love that. Um done that for the last two years and I plan to continue that until these old legs don't move. Um I I honestly uh in the last ten years I spend my time with my son and my wife and my daughters um whenever I can. I don't I have worked because my engineering background thing, I really wanted to build a building. I wanted to build something. I wanted to make something that I feel is important and that would benefit my community. Um so I build an office building. And I have spent the last ten years just trying to get people to live in it.
SPEAKER_01Because you're not doing anything else. You may as well.
SPEAKER_03No, yeah, but um it's it's a it's an I-beam construction. It it's incredibly strong. It's the strongest building in Fort Walton, I think. But um yeah, it's been it's been very satisfying and very painful at the same time. Um but it is it's taken some of my time up. Um I um trying to think. I've in my life I used to do a lot of things, and I don't do as much. I go out fishing every once in a while. It's not really my thing. Um trying to think, God, it's terrible. I need to have more hobbies.
SPEAKER_01Well, I mean, I I find that um there's not enough time in the day once you really start to get into it. When you come home, you cook dinner, you hang out with your family for a little bit, and then it's man, I better get some shut eye if I'm gonna do this thing again.
SPEAKER_03So thank you for giving me a second there because it allowed me to reflect on what I actually do at home to relax. I work in the yard, and um I I weed. Yes. I weed. Yes. I um take care of the yard, I I I weed a lot of it. Um and I try to get my kids to do it with me. My wife won't do it. Um and I enjoy that. I enjoy being there with my my kids. Um I watch a lot of horse horse riding. Oh, okay. I watch tennis and I watch soccer. I played football and baseball, and my son will play neither of the two. So I became a coach, a soccer coach. I didn't even know the rules, but I did know how to tie tennis shoes and I did know how to tie cleats. Okay. It gave me a roll. It gave me a roll. You know, something I did for five years.
SPEAKER_01Um catch any of the World Cup.
SPEAKER_03Um, we went down and saw a game down in Miami. Oh, yes. Um and hopefully we will get to see a World Cup game in the summer when we're on vacation. Yes. We're looking out in the Seattle area. Yes. Um but I hope to actually see hopefully see two baseball games this summer. One in Chicago, one in Seattle. Um we're gonna travel back home to visit my family and friends from when I was this big. Um right.
SPEAKER_01Well, look, I could go on and on for another few hours as we have on our own personal time uh with each other over the phone, and we will probably do that again. But um I do have some rapid fire questions for you. You ready to end this whole thing up with some rapid fires? Okay. All right. Who is the smartest person in history?
SPEAKER_03Einstein.
SPEAKER_01Love that answer. Very popular and rightfully so. Um for several reasons. Um if we can live to be a thousand, should we do it?
SPEAKER_03No.
SPEAKER_01Do you want it, would you rather have it too cold or too hot at night? Too hot. It's the wrong answer, actually, I have to tell you. Um What is one thing you would tell yourself if you could go right back to when you were starting medical school? What's a piece of advice you would give yourself?
SPEAKER_03You're good enough.
SPEAKER_01Yeah, I would agree. Um What is one current medical treatment or therapy that we are going to shudder at that we use in 15 years?
SPEAKER_03In 15 years from now, what will we shudder at that we're doing currently?
SPEAKER_01That we're doing currently, yes.
SPEAKER_00I love it. Boy, you just got to get reading the comments coming now. This is gonna be great. I got you then. Oh, fantastic.
SPEAKER_01Um I actually kind of agree, believe it or not. Um so um tell me what books you're reading right now. What one? What books are you reading right now?
SPEAKER_03Um right now I am vigorously attacking two Seduco books that are both experts. Yes. Okay, that's and um one looking at and another book that I'm not gonna say the title of, but is uh related to our political situation.
SPEAKER_01Yes, fair enough. Fair enough. Um what is the greatest song of all time?
unknownWow.
SPEAKER_03Oh man, I'm gonna tell you 100% there is no one answer to that.
SPEAKER_00This is very difficult. I know.
SPEAKER_03This is there's not a greatest song. There's not. There's just not. There are too many, too many that are truly beyond a certain threshold of amazing, uh, whether it's classical, whether it's rock and roll, or even uh I love flamenco.
SPEAKER_01Um it. Great song, classic, totally worthwhile. Go listen Stairway to Heaven. Um finally, and this is a uh this is uh one of our newest um rapid fire questions that was created by one of our members, Scott Taylor. Um, what would you do if you were not an MD?
SPEAKER_03I would find the best bridge I could find anywhere, and I'd live under it.
SPEAKER_01Spoken like a true cardiothoracic surgeon. Um Eric Sandwith, I I want to thank you personally for being so great to my patients, for b for being so avuncular and welcoming to me, uh, for interacting so well on so many patients, for affecting so many people's lives in a positive direction, uh, for being a stalwart member of your community, for being an excellent doctor, and I mean that sincerely. Um and thank you for being a member of everyone here.
SPEAKER_03So God, it's amazing you say that. It's like you don't know me.
SPEAKER_01Well, we'll we'll talk the serious talk after the cameras go off.
SPEAKER_03Don, thank you. Thank you for the opportunity.
SPEAKER_01We will have you back. There's several more questions, several more topics that we would love to get to. However, the time just gets away from us, and you've got busy patients to save, and I've got busy patients to send to you.
SPEAKER_03So you've got a lot of a lot of stuff to catch up with.
SPEAKER_01Yeah, so well, um, most importantly, thank you to the audience for helping us make medicine better together.