Ep. 13: Crazy ER Surgeon Stories. [Gun Shots & More…]

James Boron, MD, a close friend of mine, joined me today to share incredible stories of life inside the busiest trauma centers in America. 25 beds, 1 surgeon and gun shot wounds along with non-stop life threatening emergencies all night long. 

These people are real heroes. They save lives all day and night long and often times go unrecognized. Today you get to embark on a very special journey hearing what it's really like "behind the curtain" of life or death tragedies that need instant triaging and every second counts. 

Transcript

SPEAKER_00 0:00

most gunshots the majority of them didn't hit anything so they went in and out of a leg and out of an arm and you had to do all this work up to fit to make sure they didn't hit anything but then you would just go you're you're fine you can go home and the question always is like can you take out the bullet everybody wants the bullet taken out i mean i get not like not wanting to have a bullet in like the mental aspect of that but like the answer to that is always no There was only one case I can ever remember having to go fish for a bullet. Folks, welcome to another episode of Interesting Humans. Stories are just so inspiring, and today I have a great one with a good friend of mine. He's a trauma and burn surgeon, one of only 260 in the country. So if I meet somebody and they tell me they're growing skin and they're a burn surgeon, they've got my attention, and I think they're going to have yours today, too. So we're going to get in to an incredible story here from James. James Boron, thanks so much for coming on today. My pleasure. My pleasure. I always love talking to you. talking with Jeff. Good. I appreciate that. Well, we're going

SPEAKER_02 1:11

to, we're going to just sort of go into your entire, just the whole story, uh, where it all started,

SPEAKER_00 1:17

where it began, go into the twists, the turns, your education mentors, you know, all the stuff that shaped who you are today.

SPEAKER_02 1:24

So why don't you start off? Um, where are you, where are you from?

SPEAKER_00 1:28

So, um, I grew up for the most part in Northern New Jersey, kind of right on the shadows of New York city.

SPEAKER_01 1:36

Okay.

SPEAKER_00 1:37

Um, My parents have an interesting story kind of in themselves. My dad is a West Pointer and was a 20-year Army veteran, taught leadership in England and worked at the Pentagon for a while. And my mom, he met in college, was an Army nurse.

SPEAKER_01 2:00

Oh, wow.

SPEAKER_00 2:01

And so they traveled around together. They were international a while. My sister was born in D.C., Um, but by time I came along, I was born in Virginia, but by time I remember anything, we were in New Jersey and my dad was, uh, marketing pharmaceuticals at that time. So we retired from the military. Yeah. So he retired from the military, actually born on legend goes, whoever, how true this is, I guess I'll never know. But the, um, the story is I had a bunch of health problems when I was a kid. Okay. Asthma, allergies, and they felt like within the military, I wasn't getting the care that I needed. And so he left the military to basically facilitate a better life.

UNKNOWN 2:52

Wow.

SPEAKER_00 2:53

And if you talk to my dad, my dad would have never retired from the military. Like he wanted to be career military. I think given his drivers, even how his life turned out. he still would have liked to have been a general in the military. Like that was his life goal. So the Boron story is that they did that for me, for kind of my health and to, to get the kind of care I needed. Yeah. That's an incredible story in and of itself. I mean, what a sacrifice from your, from your father and mother. Yeah. I mean,

SPEAKER_02 3:24

to make that move. So that's incredible. All right. You mentioned one sibling,

SPEAKER_00 3:27

one sibling. So I have an older sister who's three years older than me. Okay. Um, homemaker in Boston, uh, Um, accomplished under herself was, uh, worked for Deloitte for a while and, uh, was an Olympic hopeful in crew, uh, in college. So very cool. So what was,

SPEAKER_02 3:46

let's go to grade school. Some memories. What were you like? What was young James like?

SPEAKER_00 3:52

So, you know, it's interesting when I look back at like my young childhood, I had a great family life. Like my parents, like my immediate family life was awesome. I have, literally no bad memories of like great like my parents or my sister or like our life or like i don't remember super struggling for things like but i was we moved when i went from kindergarten to first grade okay and i think emotionally it really took a toll on me and i think from that point on kind of looking back I had very tough times connecting with people just in general, making friends.

SPEAKER_02 4:36

Yeah.

SPEAKER_00 4:37

Like I was, for whatever reason, I kind of like twisted something

SPEAKER_01 4:41

and

SPEAKER_00 4:42

like I had just a very tough time connecting with people. So like when I think from like grade school to high school, what I mostly remember about like grade school and things like that is just feeling kind of like an outcast. almost and like not being it and not knowing why. Right. Like there was no, like there was no good reason why. Sure. It's just like, I didn't connect.

SPEAKER_02 5:09

Where'd you move to?

SPEAKER_00 5:11

It was just like a town over.

SPEAKER_02 5:13

Oh, just at, Oh, like it wasn't across the country.

SPEAKER_00 5:15

It was just like, we moved to a nicer town with a better school system. Got it. And whatever friends and social network I had in kindergarten. Right. Which seems ridiculous, but like, I don't, and again, like it's, is it a recall bias? But like in, like my memories of kindergarten don't have that same, like, oh, I have problems connecting with people as all of a sudden in first grade that popped up. So what do you think looking back now, knowing what you know? Was it the move? Was it the insecurity? Were you afraid of moving again? Or what do you think? I think it just, looking back, I probably in kindergarten had, Some of that defect, some of that like, oh, I can't relate, but like I had known people for a while. It's just like anything, like people know you and like you already have a system established. Yeah. It's easy to continue the system. Got it. Moving to someplace new where I had to then like try to insert myself. Right. I didn't have that ability. Big difference. Yeah. Okay. So as we continue on, so that's, that's sort of moving into grade school, any pivotal moments times in grade school that you can recall? Sports you were into? Yeah, so I started playing football in seventh grade. Okay. And that was a story in and of itself. My dad played football and played at West Point and was very successful. What position? I think he was defensive line. Cool. He's a big guy, you know, he's, he's bigger than I am. So like, you know, he was at West point running four miles and boots and weighing 285 pounds. Um,

SPEAKER_01 7:03

okay.

SPEAKER_00 7:09

But like part of my parents, like my mom, my dad got injured playing football at West point and had like major knee surgery and couldn't play again. And one of them, like when they were like talking about having kids, one of my mom's point was he's never playing football.

SPEAKER_01 7:27

Okay.

SPEAKER_00 7:27

Yeah. And, uh, obvious reasons. Yeah. Like she had hard evidence of why that was detrimental. And that was always just kind of like peppered into my upbringing. It was like, your dad got injured playing football. There's no reason for you to play football. Right. And then I started growing and I started to get bigger than everybody else. And then it became one of these things of like, I hadn't found a sport that I was really good at. I was and still am the worst basketball player of all time. Anytime anybody's like, oh, do you want to just like play horse? No, no. Like there was a time in like fifth grade basketball that I shot the basket at the ball at the wrong basket.

SPEAKER_01 8:15

Yeah.

SPEAKER_00 8:15

I looked at my parents and both my parents had like their heads down, like pretending they didn't know what kid that was.

SPEAKER_01 8:22

Right. Um,

SPEAKER_00 8:25

like I played soccer, I played baseball. Baseball was an interesting story. Somebody who worked for my dad was like a minor league player for a while. And I guess to get on my dad's good graces or I don't know if my dad paid him or what, but like mentored me for like a summer in like hitting and catching and stuff. Wow. And like, I got really good. The first game I played. I hit like four home runs was having the gate, like, and I was like, man, I figured this out. And I was playing catcher and then get hit in the face with a bat. And it literally knocked all the baseball out of me. And then like, I sucked for the rest of the season. I couldn't like,

SPEAKER_01 9:07

wow.

SPEAKER_00 9:07

And so that was the end of baseball. I played soccer that I was never, I never had the tank for soccer to be running that long. So yeah. I went to my, like, I saw the size I was. I knew my dad played football. All my friends were playing. I went to my mom and I go, what if this is the one sport I'm good at? Oh, and a mom would, I mean. I mean, she saw the size of me too. And it was probably like, yeah, maybe. Yeah. But, um, so she let me play and I played in seventh grade and then eighth grade suffered my first knee injury. Oh, eighth grade. So one year in. One year in. And my mom was not happy with my dad.

UNKNOWN 9:52

Yeah.

SPEAKER_00 9:54

But that was the beginning of the knee injuries. Mm-hmm. Which is ironic because it's the same knee as my dad did. It is? Was it the same injury too? No one knows exactly what happened to my dad's knee. I mean, it's been replaced twice now too, so. Oh, no. Yeah. but it's the same knee. Like we have the same scar running down our right knees. That's

SPEAKER_02 10:18

incredible.

SPEAKER_00 10:19

So, you know, it's a little poetic justice in that. Yeah. So at this point in your career or in your life, did you know anything? Did you have any idea what you wanted to do? So it's very interesting. I don't ever not remember not wanting to be a doctor. Wow. And I, Kind of like we were talking about a little before, like I was a sick kid. Not, you know, I hear other kid stories about how, like, so not terrible, but like I was always in a doctor's office. Like I had bad sinus issues. I had asthma and breathing issues and I had like terrible environmental allergies. I got like allergy shots all the time. I had sinus surgery, I think when I was in like sixth grade. Um, and so like, I was always going to a doctor. and always really respected them. My dad owned a company that service doctors. That service, right. Sure. Um, and so, and then my mom was a nurse who always had, you know, much deference towards doctors. So I think looking back, part of the reason I wanted to be a doctor was just, it was like such a respected profession in my household. Yeah. And like, I looking back, like, I think that was like, this is like, it was, What's the most, what's the best, most respected thing you could do grow? Like when you go, right. Do you think people around you also knew that? Like, did you ever state I'm going to be a doctor? And then, yeah, I don't think I ever stated anything different. Okay. Like I think when I was young, maybe like firemen and stuff, but like there are pictures of me still in diapers holding like a stethoscope.

SPEAKER_02 12:01

Oh, that's awesome. That's so cool. We'll have to get our hands on one of

SPEAKER_00 12:05

those to

SPEAKER_02 12:05

post on this show.

SPEAKER_00 12:07

Okay, awesome. So you go through, was high school also in the same area that you grew up in? So high school, so I kind of had trouble socially. Not terrible trouble, like I had friends. I just wasn't totally comfortable socially. And so because of football, I had kind of the opportunity to go to a private high school. an all boys private high school in the area, which was in Georgia. It's not, it's not a big thing, but in Northeast, like all boys, there were in our area, probably four all boys, Catholic high schools, and then three all girls, Catholic high schools. Those were the private schools that people went to. And so because of football, I kind of got somewhat recruited to go to this all boys high school and they win, uh, I mean, they have this amazing football program, right? So like for like an eighth grader, like looking at this, like they have 10 people go division one each year. Oh my goodness. They won eight out of the 10 last day championships. Like this was a football factory. Right. Um, and I found out that I was really good at football. Really good. And so I, and I thought, maybe a change socially would be helpful.

SPEAKER_02 13:28

Sure.

SPEAKER_00 13:28

Even though that apparently that didn't work out well in kindergarten. Maybe I thought it was going to help out again in high school. Um, so I ended up going to, um, an all boys Catholic high school named burden Catholic. Um, and it was a football factory. Um, I didn't bring a book home once in four years, um, Sounds like me, but for different reasons. I had like a 4.65 grade point average.

UNKNOWN 14:00

Wow.

SPEAKER_00 14:01

I just, but I never learned how to study.

SPEAKER_02 14:05

Sure.

SPEAKER_00 14:05

I never learned how to critically read. Yeah. Like, it was basically like, you need to stay in this building until football practice starts. Right. And that's kind of what it was. And, you know, the football program was very... aggressive and very competitive. And I kind of struggled to even like find a foothold within the program. Eventually between my sophomore and junior year, I grew, I gained like 60 pounds. And at the beginning of my senior year of college, I was six to 320 pounds. Oh my goodness. Where'd you go to college? Where was college? So I went to Wake Forest. Okay. On football? So this is where the story getting, you need to back up the story a little bit. Um, so through college, I had another two knee injuries that were minor. Okay. But like knocking me out for the last game of the season and stuff.

UNKNOWN 15:04

Yeah. Yeah.

SPEAKER_00 15:05

And my knee was starting to become a problem. Um, I remember walking out one day just on like our patio and my knee gave out. I wasn't doing anything. I wasn't making a turn. Like my knee just literally just. And like my mom had to like pop it back in place. And so like something was wrong. Um, and then during my senior year, it was kind of like the final injury and I had surgeries prior to this. I've been seeing a local orthopedic surgeon and like nothing was getting better. Right. Um, and so being in the shadow of New York, We decided to kind of go see somebody who knew more, some big sports medicine guy. So there's a hospital in New York called the Hospital for Special Surgery, which is an affiliate of Columbia. Okay. And they only do orthopedic surgery, the entire hospital. Perfect. And so we went there and the orthopedic surgeon looked at it and goes, I know exactly what this is because your patella is too long.

UNKNOWN 16:20

Wow.

SPEAKER_00 16:21

He goes, your patella is probably two centimeters too long and your kneecap is just floating all over the place. And so when any stress is put on this knee, your kneecap pops out and then all this other damage that you've had is going on. And like, we were very confused because like, how did nobody? How can that, right. And no, like we saw other orthopedic surgeons. Right. And he goes, in my practice, this kind of elite sports medicine practice, he goes up. Probably see three of these a year. But he goes, if you're not, you don't know you're looking at this.

UNKNOWN 16:57

Right.

SPEAKER_00 16:57

It's very easy to miss. Easy to miss. Oh, my goodness. And so it's kind of like, okay, well, now that we know what the problem is, what's the solution? And he goes, solution is to cut off your patella or cut your patella tendon, shorten it, and then re-screw it back to the bone. Okay, great. And during that meeting he goes, you'll never play football again. Oh, it goes to the risk of a hit to one of those screws that we're going to put in, in this tendon popping off. It'd just be too great. What was that? And what did that, what was that news like? It was devastating because like at that point in my career, I've been like talking to schools for scholarships and I had been taking official visits and I've, and they were all like, I had no aspirations. I was going to play for Michigan. But like Princeton, Harvard, Cornell, Bucknell, like all these schools, like we were talking to. And that was my next step in life was to play college football in college. And it was just like, oh, you're not going to do that. Um, so I kind of had to regroup and it was like the summer of my senior year, had the surgery and then, I'd gone on a few college visits with my dad, like earlier that year, like North Carolina. We went to like Vanderbilt, Wake Forest, Duke, kind of like the big schools in the Southeast. And I went to Wake Forest and I really liked it. It was what I was looking for. And so when I got the news that I wasn't going to be playing football and I had to call all those football coaches that were recruiting me and say like, hey, we're... And they were all very confused too. Like, well, you can always like walk on, like we can help you get in and then you can walk on. I was like, no, the surgeon was like, don't play football again. And I was like, okay. So I applied like super early to Wake Forest. It was like before even like applications. Anybody had like thought about an application. I already sent one to Wake Forest and was like, it's basically like, if you accept me, I'll go. Because I haven't even applied to another college yet. And so I was sitting in our basement and I remember it. And, uh, after surgery and I was on this machine that was just kind of moving my legs slowly on its own because like the big thing with the recovery was like, you need to keep this moving else your knees going to get really stiff and the tendon is going to shorten even more. So I'm just on this machine hours a day in the basement watching TV and I get the letter from wake. being like, yeah, you're accepted. And so when all this bad that was going on, like, oh, okay, at least there's a step forward now. Because like, I didn't, I don't know. Like my extracurriculars in high school consisted of football. That's it. That's all you need. I played golf for two years too, but yeah. You aren't getting into Wake on golf. No, I wasn't. And like, I had talked to the coach at the time from Wake once before. I don't know how interested he was in me, but he was a really amazing guy. Yeah. Um, Jim Grobe was his name. Yeah. And like, I remember seeking him out when I finally got to wake. I was like, Hey, I know. He goes, I know exactly who you are. That's great. And he goes, what are you doing here? He's like, he hadn't, like, I didn't, he didn't give me a scholarship. So he was kind of like, what, why are you here? And I told him what happened. And he was just kind of like, If you need anything while you're here, he's like, I'm part of the reason you're here. You're one of my guys. Let me know. I never took him up on it. I wish I would have in

SPEAKER_01 20:56

hindsight,

SPEAKER_00 20:57

but, uh, just like a great guy, just like, I know, I know exactly who you are. Um, so, but that was the end of high school was kind of like the, this, it was going to be this big, like, Oh, we're going to win state champions. And we did win state championship here just without me. Um, you know, I'm going to get a scholarship to an Ivy league and like, yeah, things, things have a way. Yeah. Things have a way of working out. So you go into wake. Yeah. You, you, you start off pre pre-med, I guess. Yeah. I went in the, um, the first day and they had like a pre-med meeting and it was funny. They had once a semester, they had this like pre-med meeting. Hey, this is what you need to be doing. Cause pre-med wasn't a major awake. You had to do something else, but like, okay. pre-med kind of like steered you to the requirements of things that you would need to accomplish as well. Cause wake is a liberal arts school. Yeah. Um, I remember before the first semester in my freshman year, there was 120 kids in that room that were pre-med out of a thousand kids in the class. So 120 were pre-med by time, the end of the beginning of my junior year, that meeting. Oh, 30. Oh, Wow. 120 down to 30. How do they, how do you fall out? People just quit. Yeah. I mean, there was no official like weed out process, but they would do requirements or like see what needs to be done or they're just like, I don't, I don't want to be a doctor that much. What were you interested at the time? What kind of, so I'd always thought that I was, was going to do sports med. Like I, I had the injury. It made sense. Yeah, it made sense. And so that kind of was like my goal at that point was to do orthopedics, like sports medicine. Like I'm a big guy. And if you're a big guy in medicine, everybody assumes you're an orthopedic surgeon anyway. And so like former athlete, big guy. Yeah. Had a sports injury. Makes perfect, perfect sense that I would become an orthopedist. Yeah. And what, then what changed for you? It really was, you know, it ended up being two things. I ended up not liking the surgeries like in med school. Yeah. That didn't deter me as much as I couldn't get into it.

SPEAKER_02 23:27

Oh,

SPEAKER_00 23:28

like it was just interesting. It was so competitive. You know, orthopedics is one of those specialties where far more people want to do it than there are training spots. And so yeah. I weeded myself out of orthopedics. And was the next logical step to go into

SPEAKER_02 23:45

what? What's

SPEAKER_00 23:46

after orthopedics? So if you don't do in the surgery world, if you don't do orthopedics or neurosurgery, you start in this bucket that's called general surgery. And everybody starts there. Okay. Everybody starts there. Some people do one year and then bounce. Some people do two years and then bounce. Some people do three years and then bounce. Or some people do what I did is the full general surgery qualification is five years. Okay. So you do the five years and then there's additional trainings you can get after that. So I ended up doing the five years and then doing something else. Yeah. Any good stories in those five? I want to stay focused on those five years. Yeah. The general surgery training five years? Yeah. Yeah. So there's always, and I think this is where kind of my career path chose the path it was. So I did my residency at the now defunct Atlanta Medical Center.

SPEAKER_02 24:50

Okay.

SPEAKER_00 24:51

Which, if you follow the news, no longer exists. No longer exists, right. And it was an interesting place because it's a level one trauma center, mostly indigent care. And so you're just kind of seeing people at their worst times. And kind of the most exciting stuff I saw was bad gunshots, these bad car accidents, these bad motorcycle accidents. And there's always people that come in with injuries that, like, you don't think are survivable. And, you know, the worst would be, like, our motorcycles. Like, the thought... I think... The joke, the running joke was if any motorcyclist ever was in a trauma center for any length of time, there's no way they would ride their motorcycle ever. Really? It's just, so there's, you know, two issues. One can be mediated is friction. Okay. And so, you know, the motorcycle, like you riding the motorcycle is not the dangerous part. It's other people hitting you while you're riding. That's it. Yeah. Out of your control.

UNKNOWN 26:00

Yeah.

SPEAKER_00 26:00

You're, you're doing fine. Some car slideswipe you and there's not a door in front of you anymore. So you take the brunt of that injury. Helmets are great. What I, what I didn't realize that you learn is that not all helmets are created equal. And so there's like a real motorcycle helmet. There's a DOT sticker on it that like acknowledges that like this meets the criteria for a helmet. Okay. But there is also a helmet law in Georgia and people who don't want to wear helmets. And so they get these novelty helmets and not when you take them off, they say, this is a novelty.

SPEAKER_01 26:43

Right.

SPEAKER_00 26:43

And everybody referred to them as brain buckets because they were just basically this plastic shell akin to less protection than like a bicycle helmet.

UNKNOWN 26:54

Yeah.

SPEAKER_00 26:54

that they would get at, you know, like bike week and they would wear these and it did nothing, did absolutely nothing, but friction. So like you get knocked off the bike going 50, you hit the concrete, you slide around the concrete until you slow down. And so that creates like a friction burn on your skin and just whittles away your skin. Like we saw people that came in that they had, they were wearing shorts and flip flops. I would never recommend wearing flip-flops on a motorcycle. It would fall off, and, like, you would get in, and the skin on, like, their knees would just be gone. And, like, their just knee would be exposed. Like, the white of the bone would be out. And, like, you can mediate that with, like, those leather suits and things like that. But, like, a Georgia summer, I don't think you want to wear that. And they don't look good. And then, like, you just get terrible spine and pelvis injuries. Like, you just... Like your body is not used to getting that injury. I wish we could take this segment right here and then give it to me

SPEAKER_02 27:59

back when I thought it was cool to have a motorcycle. Right. And I could have listened to this. Maybe it would have helped. But I just I fell in a parking lot and just how injured I was from falling in a parking lot hitting gravel. what it did to my hand. I mean, that was it. But like you said, you get injured, you're done. I was like, when that happened, never, ever, ever, ever, ever again touching a motorcycle. But I was, I didn't have my gloves on going through the parking lot. Nothing's going to happen. And it was on the way to work.

SPEAKER_00 28:29

And actually, the surgeon at the White House is who saw me because I was on the way to work at the White House. So I literally got presidential treatment that day because

SPEAKER_02 28:40

I had tar embedded into the palm of my hand. 12 needles. I'll never forget it. 12 needles into here, which doesn't feel great. But yeah, point is, this point of the episode, this is incredible. Yeah. Awesome. So you go through, you... You're doing your five years. You see some great stuff, great stories, motorcycles. What point then, where's the pivot that goes, ooh,

SPEAKER_00 29:06

burn and trauma is my spot, my place? So I think it's really exciting, right? And we'll go into why this ended up being the wrong decision later. Oh, okay, great. But it was very exciting. Like, The things that were the most exciting. And at the time, one of my mentors, who was the trauma chief, surgeon in chief at Grady for 25 years, had a falling out with Grady. And for his last, like, five years of his career, came to Atlanta Medical Center. So I got to work with this world-renowned, like, the trauma textbook. The textbook that's titled Trauma, that's this thick, is written by him. Oh my goodness. And so all of a sudden I had access to this world renowned trauma expert. Um, and he was doing like, we would operate with him and it was, it was magical to watch. And there, there's, um, there's a case that I remember doing with him that I'm still to this day convinced that if anybody else was doing it, they would have died. And it was a guy who got shot in his right upper quadrant of his abdomen. kind of where your liver lives.

UNKNOWN 30:24

Okay.

SPEAKER_00 30:24

As far as gunshots, that's like the worst. The worst. Coming in the side, coming in the front. Coming in the front, like front to back, like right side, the worst. And so trauma surgery is just plumbing. It's all plumbing. Your whole body is a bunch of tubes, tubes that carry various things. Trauma surgery is putting those tubes back together. And so your liver's, has a ton of blood running through it, and it's very complicated, and there's really no great way to fix it. This guy got shot right through his liver, which is a bad injury in and of itself. Okay, got it. As it was coming out, it nicked the portal vein, and the portal vein's the biggest blood vessel in your body. And what it does is all the blood coming out of your intestine dumps into the portal vein and then gets filtered through your liver.

UNKNOWN 31:22

Okay.

SPEAKER_00 31:23

So your liver filters all this junk that the blood picked up in your intestine. Okay. Um, but this, you know, this vein is, you know, the size of a half dollar fully inflated and the amount of blood that rushes through this thing at a given time is epic. Yeah. And there is a term that's still like, I hear it and gives me, because there's bleeding and everybody talks about bleeding. And then there's audible bleeding and audible bleeding means their blood is making a sound as it's coming out. Like so much blood is coming out that it is making a sound audible bleeding.

UNKNOWN 32:04

Oh my.

SPEAKER_00 32:05

And so this guy nicked his portal vein. If he had, it had gone through his portal vein, that's a clean kill. Done. No chance. Okay. Um, and so like, People's experience with portal vein repair outside of like liver transplant is like very minimal. Like most people have done zero. Luckily, David Feliciano was there and he has done 15 in his career. And so we opened this belly full of blood and it's audible. Like you're hearing, it's not a heartbeat, but you're hearing squirting up, just not squirting. So it's not an artery. So it's a vein. So it's like low pressure, but it's so big that literally you're just hearing like this whoosh. And so like, it's one of those things like when you get shot in the belly and you bleed in your belly, your belly holds it tight for a while. And at some point you have to cut it open and figure out what's going on. When you cut it open, all this blood falls out. You kind of just dump it all on the floor because you're trying to figure out what, like the only, goal is to figure out where that blood came from. So just dump all this blood on the floor. It can't be reused because it's full of shit anyway. And find the bleeding. And usually you can do that. Clear out the blood, put some towels in, dry it up. And then you're like, okay, it's coming from up here. Okay. We ruled that like, and you can narrow it down. We weren't able to clear out the blood. So it was just, it was coming so fast that no matter what we did, every time we tried to like look. You were back in a pool of blood. I remember to this day, he just goes, oh, I know what this is. Literally put his finger into this pool of red. He goes, okay, suck out the blood now. We were able to suck it out. And he had literally put his finger on where this hole was. Got like a vascular clamp around it. I still remember watching this and going, how is this? And then sewed it. And the guy lit. Oh my goodness. if I was on my own, even as I was five years in my career, no way that you wouldn't know anything about it. It's just, wow. And that's like, just like all the surgery, like experience means everything. And like, Oh, I've seen that before. Right. And being able to like, Oh, I've done five of these. I remember the two that didn't work. I'm going to do it the way the other three did. Like you just learned from experience. And so like stuff like that is awesome. Like you don't, You don't get that excitement. And I really, at that time, like the lifestyle. Cause like in my head growing up, doctors were like always on call.

UNKNOWN 34:58

Okay.

SPEAKER_00 34:59

Carrying a beeper around at the time. Remember beepers and like, yeah. And you always had to be like reporting into your patients. A patient can call you in the middle of the night if you were on call and you had to answer it. And I didn't like that part of being a doctor. And so trauma surgery is. shift based work. You're there for 30 hours at a clip and then you go home and you can't do trauma surgery from your bed. So no one's calling you. And so like, I was like, you know, like, it seemed like a good living. It's a surgeon salary. So it seemed like enough money. Yeah. And I was like, well, you're working seven days, you're doing like six or seven, 30 hour shifts a month. And then like, I'll be able to live my life.

SPEAKER_02 35:42

Pretty

SPEAKER_00 35:43

awesome. Seemed like, like in hindsight, yeah. not what I would have wanted in life at all, but like at the time, like this is going to be great. I'm going to, you know, I'm going to make 400 grand. I'm going to work six days a week, six days a month. And then everybody's going to leave me alone after that. Little did you know, little did I know what happens next? So I got really into like, okay, I'm going to do, I'm going to take care of the injured patient. And so to do that, you need to do. at least critical care. So you need to get trained in critical care because injured patients get very sick. Okay. So you need to be able to manage an ICU. So that's one fellowship. And then my other thought was I want the experience that David had and Dr. Feliciano had. Yeah. So there's trauma fellowships you can do too at like really high volume trauma centers. Yeah.

UNKNOWN 36:42

Um,

SPEAKER_00 36:43

build up 10 years of experience kind of in one year. I was like, I should do that too. And so I ended up matching to Cook County in Chicago for these fellowships. And matching is what? So matching is a process and it happens in med school and residency and in fellowship where basically you go, you interview at all these places, you create a list of your rank list. And then the hospital creates, uh, these are how we rank it and it gets put into a computer and then your assignment basically gets printed out at the end of it. Got it. And so you do this at every step you do it, you know, med school, you do it in residency, you do in fellowship, like, okay, I'm going here. Right. Um, and so you matched to Chicago, Chicago. Uh, so there, there's a couple, there's, you know, A few really large trauma centers in America. You know, there's Jackson in Miami. There's Grady in Atlanta. There's Houston, LA County, and then in Chicago. And then it drops off. You would think New York and Boston would have big trauma centers, but there's too many hospitals within the city. So the trauma gets spread out. And so what makes us a trauma center, like super high volume is that you're able to do it. There's not many trauma centers around you. And so at the time, that was what Cook County was in Chicago. It was just had this huge catchment area of a very violent and Cook County is actually the first trauma center in America.

SPEAKER_02 38:33

Oh, it is. Yeah. Very cool.

SPEAKER_00 38:35

So they have this kind of extensive history and I was excited to go. I think. I was married at the time and our preference would have been to stay in Atlanta at Grady, but that envelope came and Atlanta wasn't on it. So do you have to

SPEAKER_02 38:50

take the match?

SPEAKER_00 38:52

Yeah. Like you can't say no.

UNKNOWN 38:54

No.

SPEAKER_00 38:54

Okay. So like you sign something where like the decision for this is binding. So if you don't list the program on your list, there's not a chance that you match there. So there's a chance that at the end of it, you don't get a match. Got it. Which. isn't a problem of itself. I guess I could have just gone and been general surgeon in Atlanta at that point. Yeah, sure. Um, but if you list it and they pick you, you're going, you're going, um, pack your bags. So we were off to Chicago and Chicago was nuts. And specifically Cook County was just a level above, just a level above what I thought was going on. Really? Um, Just the volume that they saw at the time. Nowhere near Atlanta. Way above. You're saying way above Atlanta. So I never worked at Grady. And so I've never, like, it's probably, especially with Atlanta Medical Center that's gone now. Yeah. And University of Chicago opened up in Chicago. So that took some of Cook County's volume. Okay. So I would expect Grady to be very similar at this point because there's no other big trauma centers

SPEAKER_01 40:04

around. Got it.

SPEAKER_00 40:06

But also Chicago is a much more dangerous city than. Um, and so it was crazy from the day one and it's, you know, a county hospital underfunded under resourced and then it's unionized. Even the doctors are unionized. Oh, so it's, it's very strange. So like no one can get fired. Like I'm sure if you did something terrible, but like you couldn't, you couldn't get fired. And also they couldn't sue you for malpractice because you're a government employee. So you're indemnified by the government for any wrongdoing.

SPEAKER_01 40:55

Oh,

SPEAKER_00 40:55

is there anywhere in America like this? So I don't know. I never

SPEAKER_01 40:59

heard of that.

SPEAKER_00 41:00

So, and it's very strange because as you like go through your medical career, they ask for like, where'd you work? You need to provide your medical insurance for that period. Because all medical insurances cover tail coverage, which means the patients that could sue you three years down the road, that medical insurance while you're there covers them if they sue you three days. They're covering the patients that you see at that time. So the hospital that you're signing up with wants to know that you have tail insurance. Got it. And every time I would say Cook County, you have to provide this insurance. placard or whatever of your medical insurance. And they would always just send me, it's like a Chicago statute that outlines that physicians working at Cook County are indemnified up to$10 million by the government and held harmless. Like, and like, it was always a question, like from all the people I got hired from and be like, what is this? And I was like, well, there's no malpractice, but I was a government employee. So like, I guess we couldn't be sued. So like you couldn't be fired. You couldn't be sued. So like, just try your best. Just try your

SPEAKER_02 42:08

best. Oh my goodness.

SPEAKER_00 42:12

And I remember my first night on call was July 4th. What year? So this year, this, I can track the year. So let's see. Roughly. So this is going to be 2016. Okay. First night on call. First night on call. As a trauma and burn surgeon. So I was a fellow, a fellow at the time. So there's, there's still somebody looking out for me to make sure, but I'm a board certified general surgeon at this point. Okay. So like I could, I have a board certification. I can do most of the operations, but like I'm in fellowship. So there's still people looking over me, giving me advice, things like that. Okay. Um, so July 4th. And so July 4th on Chicago is a very violent holiday and it's violent. for a reason. And that reason is that Chicago uses Shot Tracer. Shot Tracer. Okay. So Shot Tracer lives on all the telephone poles in certain neighborhoods of Chicago. So when a gunshot is fired, these sensors are able to pinpoint a block where this gunfire happened so they can dispatch police to it. Else, you hear gunshots and where did that come from? Who knows? You know. Wow. And so... Shot tracer gets cops to locations of gunfire very quickly in Chicago. What happens on July 4th? Oh, fireworks. Fireworks. Render shot tracer ineffective. Oh, they don't know how to. So the shot tracer doesn't work.

UNKNOWN 43:49

Oh boy.

SPEAKER_00 43:50

And people doing bad things have realized that. Yeah. And it's a holiday and any holiday in Chicago. It's elevated. Yeah. Yeah. Sure. Um, and so it's a bet. And I got warned like, Hey, this is like one of the worst nights of the year. Like just be ready. And I was like, I got this. Yeah. I did my residency at a trauma center. I'm like, what are you going to? And so just to kind of elaborate on the difference of Cook County compared to like an Atlanta medical center. So Atlanta medical center and most, most places there's, when you go in the ER, there's, two, three, or four beds in their own separate area with lots of resources around it that are dedicated to the trauma beds. Okay. So if a trauma activation comes in, they get put in one of those beds and that's where, like, so the trauma surgeon's not in the general ER. At Cook County, the trauma bay was its own ER. So like when you came in, there was an ER door and a trauma door. The trauma door opened up and instead of four beds, there's 25. 25 beds.

UNKNOWN 45:09

Oh my.

SPEAKER_00 45:11

And so, you know, at Atlanta Medical Center, the trauma, trauma bay was three beds, really two, but you can never really take care of more than four patients at a time. One doctor. One doc. Well, there's a ton of people helping. There are residents, there's a doc, there's the ER doctor, there's nurses. So it's not like I have to do all this myself. Like, so huge trauma teams are huge, but you're never during my residency, which was very trauma heavy. Never, never was I asked to take care of more than four patients at one time. And it's like tough to keep, you know, if they're badly injured, it's tough. So yeah. About 11 PM on July 4th, all 25 beds were full with people who were shot and they just started wheeling people in and putting them in the hallway. Like there's nowhere else for them to go. And so you're just, and so it was just, it was the first time in like medicine that I was like, I am absolutely overwhelmed. Yeah. Helpless. It was just, you know, like during my residency, like if someone came in and got shot in the belly, take them right to the OR. Yeah. And that's like good dictum. And direct care. They pretty much got like. Yeah. Yeah. Right. But, but when there's 25 people, they all can't go to the OR.

SPEAKER_02 46:45

How many docs for 25?

SPEAKER_00 46:47

One. So it was.

UNKNOWN 46:51

Wow.

SPEAKER_00 46:52

So I was a fellow. There was an attending who's like my overseer. And then there's probably a team of 10 residents, three of who are surgical residents. So like can help out in the operation. The other are like ER and other type of residents. That's not enough. And I think there were six nurses. And so like under-resourced, underutilized. But I learned very quickly that there are, Very different types of gunshots. And I think you need to see a ton to realize that. There is the gunshot that kills you instantly. Okay. They don't even make it in. They're just brought in dead. Just brought in dead. Okay. Brought in with a sheet on them. What does that? Brain shots do that. Heart shots do that. And sometimes liver shots do that. Okay. It's really the only place like with good, like if you're in a metropolitan area and there's quick access. Yeah. You'll make it. You'll, you'll at least make it to the trauma center. Okay. Um, and then there's the people and there's the gunshots that are like, they get to the trauma center at the 10 minute mark after their shot. Right. And they have another four minutes in. That's it. And so you need to do something right then else that patient's dead. And sometimes it's a very simple thing. I remember one guy was shot in the heart and like, so you end up opening the patient's chest right there when they walk in the door. Like literally you take a knife and just start hacking away at it and break, you know, you break their sternum and then you take this you know, like jaws of life type thing, just kind of spread the rib cage open like a clam and the heart sitting there. And this guy had on his left atrial appendage. So the top of your heart left side, the bullet had just kind of like nicked it, but it's the heart. So it has a lot of blood going through it. And so he had lost probably 90% of his blood volume by then, like into his chest.

UNKNOWN 49:14

Whoa.

SPEAKER_00 49:15

But once you saw it, you put a clamp on it. It gave him a shit ton of blood. Took him the OR. Took like two stitches to fix. Actually, like fixing the damage from like ripping open his rib cage took like the most amount of time. But literally two stitches saved that guy's life. In the heart. In the heart.

SPEAKER_01 49:35

Did you do that? Did you do that?

SPEAKER_00 49:37

Okay. But given two more minutes, that guy would have just bled out. But like, so, so a lot, some, sometimes these like super bad injuries are super easy repairs.

SPEAKER_01 49:48

Yeah.

SPEAKER_00 49:49

It's just like, you need to get blood back in them and stop the blood from coming out. Triage. Yeah. Straight triage. Exactly. Exactly. And then there's these ones that like that golden hour. I don't know if you've heard of that. No, I can't wait though. So, um, Dr. Crowley, who, um, is, um, the like big trauma surgeon that started shock trauma in Maryland, um, came up with this term, the golden hour. And it's been disproven since then, but like, it's the holds up most of the time is that you need to get patients that are severely injured to definitive care within one hour for them to survive. Definitive care being a hospital. Definitive care being a trauma center. Does it matter what level? Aren't there different levels? There are. So, um, Like in America, it needs to be a level two or a level one. Okay, two or higher. Level three and four are just basically feeders for two and one. Two and one, okay. And the only real difference between two and one is education and research. So a level two trauma center, most of the time, the difference is they don't have like residents and students and they don't produce trauma research and like sometimes they don't have like super specialized. Like if you have any like complex, complex face reconstruction or something like that. Um, two or one, two or one, because there is a trauma center or trauma surgeon in house at level twos and level ones. And you need that trauma surgeon. Cause sometimes like we just talked about, it's a really easy fix. You just need somebody that can get in that chest. And the only person that can do that as a surgeon. Yep. Um, so Crowley came up with this like golden hour. Like get to definitive care, get to the OR within one hour. And like, you know, as trauma surgeons, you tried to hold to that most of the time. And so there are patients and I would say the majority of patients actually fall into a third category, but like patients, most patients who are still alive when they come in, but are sick, you got an hour. You start giving them blood right when they walk in the door. Yeah. And then you start trying to figure it out.

UNKNOWN 52:06

Yeah.

SPEAKER_00 52:07

Look at for holes, look for bullets, try to collect the line. What could this possibly be? You know, do I open the center of the chest? Do I open their lungs? Do I open their bellies? Do I have to open a leg? Like you can't, you can't just go, you have to figure it. You have to somewhat solve the problem before you start cutting.

SPEAKER_02 52:24

Sure. Absolutely.

SPEAKER_00 52:25

Um, and that always like bugs residents and stuff like, oh yeah, this is a gunshot. Let's just go cut them open. Like, are you going to cut? You can't just start. You can't just, you can't just start doing it. And so you end up, but for the most part, if they come in alive, you can give them enough blood to keep them alive until you figure it out. But the majority of gunshots, and I never realized this because I never had to make the decision can sit there for a while. For hours. Incredible. And why is that? It's because they're bleeding slowly enough where you can trickle in blood and keep up with it. Once you get to a certain volume in your butt, your belly kind of tamps it down and holds pressure on it. And it's something that like, yeah, if you hit a bunch of intestine, like it's like leaking poop, but you can clean that up. They're not going to die from that. They're going to die from that. So like when people get shot, like the silver Warren died from infection.

SPEAKER_02 53:29

Yeah.

SPEAKER_00 53:30

It's because they didn't know that that was so infected and they would die three and four days later from an overwhelming infection. But we're talking two hours.

SPEAKER_02 53:40

Yeah.

SPEAKER_00 53:40

You write two hours with poop in your belly.

SPEAKER_02 53:43

Interesting.

SPEAKER_00 53:44

Natural processes. Like when people have perforated diverticulitis.

SPEAKER_01 53:48

Yeah.

SPEAKER_00 53:48

It's a hole in your large intestine. And they sometimes sit for a week with it. Like. It'll be all great. Like, yeah, neat. There's a hole in your bladder. All right. You got a belly full of piss. Yeah. All right. And so most gunshots of, and we're talking people who make it to the trauma center, most gunshots, at least in Chicago, the majority of them didn't hit anything. So they went in and out of a leg and out of an arm. And you have to do all this workup to fit, to make sure they didn't hit anything. But then you would just go. you're, you're fine. You can go home. And the question always is like, can you take out the bullet? Everybody wants the bullet taken out. They want to save it. Well, they, well, maybe not. I mean, I mean, I get like not wanting to have a bullet in like the mental aspect of that. But like the answer to that is always no. Right. Always no. Because you cause damage trying to get that bullet out. So you do leave it in. Yeah.

SPEAKER_01 54:47

That is true. Oh

SPEAKER_00 54:49

my goodness. There's only one case I can ever remember where, having to go fish for a bullet. Not aware what part of the body, or can you not say? No, no. So I remember this case so vividly because like my entire like department was looking at it and we were trying to figure it out. Couldn't like, it's not theoretically like, I guess it's possible, but like, so we're watching it and you're looking at a guy got shot in the back and this bullet is kind of like right next to his spine. And we're kind of looking at it and going, didn't hit his spine. His blood pressure is fine. So I couldn't have hit the aorta or the vena cava that live right there. Is he fine? We should, we should do some more studies. And so we ended up getting like a contrast study where we inject contrast through the big blood vessels and to see what they looked at. And when you're doing this, you're doing this under a live view. And you would see the aorta light up. And then this bullet was sitting on it. And with every heartbeat, you saw the bullet move with the patient's pulse. But it wasn't in it. It was literally just like right next to it.

SPEAKER_02 56:16

On it.

SPEAKER_00 56:17

Laying on it. And So like nothing needed to be done like right away. We all sat there and go, what's the chance that over time that this just beating against this bullet is going to erode into that blood vessel. Like with like five of my partners, we were all like, yeah, we got to go get it. And it was the hardest operation ever to try to find this thing because the patient's fine, by the way, looking at you being like, I feel fine. And we're like, He's fine. He doesn't need blood. And so you're doing an operation basically on like a healthy person. And you're like, how does insurance even see? Well, I get none of these people. I'm sure you're, you're, you're not gonna worry about that, but, but it's, wow. You're just kind of like, I know you feel great, but we're going to have to, um, we're going to have to do something big. Yeah. You're like, why? I feel great. You're like, yeah, you're doing good now. And like, we showed him the images and we're like, just like, if you rub a bullet against a balloon, um, for, you know, 20 years, eventually that balloon's going to pop, right? Yeah. Like, same type of logic here.

UNKNOWN 57:23

Oh.

SPEAKER_00 57:24

But, like, you just, but for the most part, it just kind of goes. Yeah. And, like, it's one or the other. Let's talk about, that's remarkable. Let's talk about growing skin. So, why do we, why are you growing skin? Tell us about your

SPEAKER_02 57:40

career now. Yeah. Let's, let's, let's focus there.

SPEAKER_00 57:45

So it was interesting. Um, burn surgery, I hadn't really thought about, and it was an option given. They had, um, in Chicago, they hadn't hired a new faculty in 20 years. Okay. And they came to me and were like, we would love to hire you, which I was like super honored by. But they're like, the job's not open until one year from now. I was like, well, what do I do for that one year? Like, okay. Like I've been in school now. I'm 32. Right. Like I need to start making money sometime. Like, they're like, well, you can, you know, do a burn fellowship. So I ended up doing a burn fellowship out of nowhere and like really, really like it. It's the arts and crafts of surgery. Burns. So when you get, when someone gets burned, the skin's dead. And if you don't, you don't take off the dead skin, it gets infected and then patients die. That's why patients die from burns. They get an infection because it's dead skin infection. is where infection sets up. So basically the principle with burn surgery is remove all the dead skin. And then depending on how deep it is, you have to put skin from somewhere else back on that. And so you take, like if it's a small burn and it's all the way through your skin, you take a skin graft. So you take kind of a 10 once thousands of an inch of skin off and you do that kind of with like an electronic razor almost. Okay. You mesh it out so it has holes in it and then you just staple it to the hole that you made with your knife and skin regrows and there you go. And that's burn surgery. It's not super complicated. There are intricacies to it. Um, but that fellowship ended up being kind of where, or the reason I'm where I am now. So kind of backtrack one step from growing skin. was the, I started falling out of love with my career. The seeing everybody's worst nightmares daily is, was really tough.

SPEAKER_02 59:54

Sure.

SPEAKER_00 59:55

And I have mentors and stuff that did it their entire life. And like, it didn't bug me. It didn't bug them.

SPEAKER_02 1:00:01

Yeah.

SPEAKER_00 1:00:02

It really started like eroding who I was. Um, And so I realized that I realized that as some tough things happened in my life personally. Um, but like, I just couldn't keep doing it. Like, and I ended up in, in trauma and burn surgery kind of through this path. It wasn't like this passion, but I was like, I need to get out of this. I need to do something else. And so I wanted to do like the business entrepreneurial world had always kind of interest me. And, um, I was like, I think I need to make the jump and do something that like, I feel like the most invigorated, you know, invigorated when I'm doing something business wise or leadership wise or something like that. Maybe even though I did 12 years of medical training, maybe I shouldn't be doing this. And to like, that was like a big step. And I think that's. was like one of the defining moments of my life was even though I spent my twenties training to be this person. Yeah. I don't like that person. Do I have to stay that person?

SPEAKER_02 1:01:18

What an incredible piece of advice that is right there.

SPEAKER_00 1:01:21

And like, I feel a lot of doctors right now are not happy. It's not the environment it was in the nineties. Yeah. Right. Um, But you feel trapped. I was very fortunate not to have any debt associated with my education because of my parents. Um, so, but like you're encumbered with medical school debt, you put in all your twenties and now you're going to say, I'm going to go do something else. And the best advice I got was if you're not going to be happy doing this now, you're not going to be happy doing it 10 years down the road. Another great piece of advice. Wow. And so it was like, I was, it was Jeff, it was eating my soul. It was causing me to be paranoid in parking lots. It was causing me to drink too much because I would come home after these shifts and seeing all these bad people and try to do things where I wouldn't think about it. And it was anything I could do to like, it's not thinking about that. And going back to kind of like earlier in my life, I already felt like an outsider and had trouble connecting with them.

SPEAKER_02 1:02:38

Yeah.

SPEAKER_00 1:02:39

By doing this and having this career, it took me a step further away because I had this thought that no one can understand what I've seen or what I'm going through. Like, oh, you have a job in real estate.

SPEAKER_01 1:02:52

Yeah.

SPEAKER_00 1:02:52

Must be really stressful.

UNKNOWN 1:02:54

Right.

SPEAKER_00 1:02:54

Yeah, tell me about all the stress. Right, right. And not to minimize that, but like it isolated me even further for somebody who doesn't connect with people to then have this career that no one can understand. No one. No one. And I always like, I'm not, a soldier who's seen combat, I think is much worse. Like, I can't imagine getting your bloody, your buddy blown up or you lose, like, much worse. This has to be right below that. Because you're just seeing everybody at their worst moment all the time. And I couldn't handle it.

UNKNOWN 1:03:29

Right.

SPEAKER_00 1:03:30

And I figured that out. So I was like, okay, I'm going to do something in business. My dad was an entrepreneur. I'm interested in it, but I know nothing about it.

SPEAKER_02 1:03:42

I've never

SPEAKER_00 1:03:45

had to run an expense report. I never had to do a P and L. Like I've just, I've never had to like really lead a team where they're like dependent on me for their livelihood. Um, so what do I do? Right. And so I had started, I had like tailed back my career to the point where I was only doing locums and locums are where you like go to a hospital and that has like a short-term need and fill it. And so I was signing up for like week stints at like various hospitals so I could do other things. Got it. And I was going to go get my MBA. And I had applied. I had actually even started a healthcare MBA at Pepperdine. And I was like, this is going to give me the knowledge I need to then take the next step, whatever the next step is. But I know...

SPEAKER_02 1:04:40

Something in the business world.

SPEAKER_00 1:04:41

I know I can't be a trauma burn surgeon, a practicing trauma burn surgeon anymore. Like, I can't continue down this road. I know where, like, I had two colleagues kill themselves. And I wasn't there. I'm not saying I was there. But, like, I could see that I was on the start of that road. And so, like, I need to jump ship. And... I get a call from a recruiter one day and I get phone calls all the time from people asking if you want to do locums and some recruiters and stuff. And I normally don't take them really good at screening calls and people I don't know.

SPEAKER_01 1:05:17

Sure.

SPEAKER_00 1:05:18

And, uh, I ended up talking to this recruiter and was like, Hey, have you ever thought about using your burn knowledge to, you know, help patients in a corporate sense? And I went, what does that mean? How would I do that? And she kind of started describing the need of this company that makes cell-based products that they're growing. They're getting, you know, they're getting an additional burn product and they need more medical expertise in-house. Their current CMO, they have orthopedic and burn products.

UNKNOWN 1:06:03

Yeah.

SPEAKER_00 1:06:03

And their current CMO, who's the medical person, the doctor in the organization is an orthopedic surgeon and he's doing a great job with the burn side, but is getting overwhelmed and would like someone to do the burn side of the CMO position. Oh, okay. So like we talked about it and at first they offered it and it was tough. It's tough at this point in your life, I found out to make big career jumps and big career moves because you've already made money. You're, you know, if you're making a salary, you're already making a good salary. I was making a really good salary as a doctor. And then I have house payments, car payments, pay for the kids. I have two kids now. Like, and so like, and they offer me, I was like, I can't, I can't take that. Like I can't go from making this to making half of that. Like I just can't do it. Like even if like making is going to make it more is going to kill me. Like I'm going to have, I'm going to have to go, go with that. And eventually like we negotiated for a year and I eventually got it up to what I was making as a surgeon.

SPEAKER_02 1:07:18

That's awesome.

SPEAKER_00 1:07:19

And I was like, well, I guess I don't need an MBA anymore. Cause this was kind of the job I was, I guess, going to be looking for after it. And so about two years ago, I made the full-time jump, totally left clinical practice and started working for this company called Veracel based in Cambridge, Massachusetts. Um, and as far as biotech pharma goes, it's a relatively small company. Um, and so what they do, what they. did when I started is they made two products. And basically the basis of the two products is they can take a small biopsy of your own cells and then expand them to fit, fix a problem. So on the orthopedic side, if you have a big cartilage defect in your knee, it gets to take a small biopsy from the cartilage in your knee, take it back to the lab, make a cartilage patch of your own cells that the surgeon can then implant. and then heals. And then you have your own cartilage functioning because it functions and heals like normal cartilage does. What's the time frame on something like that? So the biopsy to implant, I think, is three weeks. Wow. You know, it takes a while to expand the cells.

SPEAKER_02 1:08:47

How do you mail it? I'm just curious.

SPEAKER_00 1:08:49

I actually don't know how they mail it on the orthopedic side. On the burn side, So we do the same thing. We take a biopsy of your skin and then we can grow a five by 10 sheets of your own skin to be put back on you.

SPEAKER_02 1:09:07

It's incredible.

SPEAKER_00 1:09:08

But it's an expensive technology and those are couriered. So a person, cause they, it's time sensitive, but a person gets on a plane with big boxes of these sheets of your cells, that each box gets its own seat and seatbelt and they hand courier these to hospitals.

UNKNOWN 1:09:26

Wow.

SPEAKER_00 1:09:27

Um, but so yeah, the, the burn product at that time, um, it's been out forever.

SPEAKER_02 1:09:32

Yeah.

SPEAKER_00 1:09:33

Um, the technology first came out in like the early eighties and it's just kind of evolved.

SPEAKER_01 1:09:38

Yeah.

SPEAKER_00 1:09:39

But it's basically, if you get burned so bad, you know how, how we talked about taking that thin sheet of skin to then like put on the place that you're inside. Yeah. Yeah.

UNKNOWN 1:09:51

Yeah.

SPEAKER_00 1:09:51

Okay. What happens if you don't have that skin to take? What if you're 80% burned? And so it just becomes a numbers game, right? Like there's not skin to take to then put back on. And so what this allows is that we can grow that skin in the lab to then be stapled on and you don't have to take the skin grafts from a while. So it's really life-saving technology because these, you know, are there ways to do without it? Yes, but they just take forever. They take forever. And like you said, like I said, the, infection is the biggest issue with burns yeah and so the longer you take to fully heal everybody's wounds the longer the chance or the bigger the chance that you have sure so somebody getting infection right okay a couple more questions for you

SPEAKER_02 1:10:39

yeah so at any given time right now today how many if you had to like quantified how many burn cases bigger ones not i burned my finger on the stove but bigger cases that you're talking about are going on let's say in America at a time, like a

SPEAKER_00 1:10:56

hundred. You're, you're in luck that I would just get off a call where we went over these numbers again. I can't wait. So there's 40,000 hospitalized burns a year. Okay. A year, 40,000. Got it. 40,000 of them. Um, of those 40,000 burns, approximately 1000 of them are massive burns. Great. Defined as more than 30% of your body surface area. Oh man. And about 600 of those survive to discharge. And the other ones die? Yeah. Die because of the burns and the infection of the burn or whatever it is. Those size burns create all types of problems with your body. Infection's a problem. The other one is fluid balance. And so... When your skin holds in fluid into your body, when you are burned or when you remove skin, all of a sudden you lose all this fluid. And I'm not talking like, oh, that's like a really sweaty shirt. Like I'm talking about, so a burn patient who comes in, who's like massively burned, let's say 60% was in like a house fire or something like that, will get sometimes 80 liters of of fluid via IV in the first 24 hours they're in the hospital to replace all the fluid that their body's losing.

UNKNOWN 1:12:32

Oh my goodness.

SPEAKER_00 1:12:33

And so, and when you do that, that's not without its consequences. All of a sudden your lungs take a hit because your lungs are now full of fluid. And so like these massive burns, while like the skin is the inciting event, all these other problems come up. And so like when these patients get burned and a lot of times these massive patients are in these massive burn patients are in house fires and stuff like that. So they get all this soot into their lungs to have what's called inhalation injuries. And so they're sick patients. And so like, yeah, getting the skin coverage is important, but they die from other stuff. But like the quicker you can get them to the point where there's no skin left open. Right. Is better for their outcome.

UNKNOWN 1:13:17

Okay.

SPEAKER_00 1:13:18

Like the quicker you can move them along. And basically the dictum is that you should be in the hospital one day per percent burn. So if you're 80% burned, it's expected that you're in the hospital for at least 80 days. 80

SPEAKER_02 1:13:35

days.

SPEAKER_00 1:13:37

All right. To bring it to an end, I have two questions. One's personal and one's business. What are some things that listeners can do just in their life in general to avoid whether it's a little bit safe, more safe, safety in the house or safety in a vehicle or just some things you've heard in your career. So to avoid burns or fires or explosions. Yeah. So safety. So we'll go back to trauma first. Okay. Safety devices are very effective. And the mortality that's associated, the mortality reduction that's associated with seat bag belts and airbags is amazing. Okay. You need to be seated and belted properly. Okay. And I have a four and a five-year-old. I'm constantly fighting this battle to, oh, we're traveling. Do they need a, really need a booster seat? or whatever, like what booster seat do they fall into or like seat belts only work when they're on effectively. So people like when you're sitting in a car, don't put your feet on the dashboard, sit in the car, like you're supposed to be sitting in the car with the seat belt, the way it's supposed to be. If you're a kid, you have kids make sure it's appropriate. Even that one time, even that short taxi ride, there's. this great device that I found that I'm the biggest believer on. It's called safe ride. And it is a vest that children can wear and it replaces a booster seat. And so it moves the seatbelt down on their neck, away from their neck. Um, and basically, which is what a booster set does. A booster seat moves people up. Yeah. So the seatbelt is not. On the side of, yeah, it's on the neck. What this does is it actually lowers the seatbelt by like a Velcro strap. And these are little things. And I have two kids, two of these vests fit in my backpack. And I, every time I get in a limo or a taxi, they have these on, we're getting buckled in with them. People are always like, what are those? Like, I was like, I'm not letting my kids in a car, not belted properly. If you have kids that are in booster seats or car seats, you know how annoying it is to travel with it. Once they're in a booster seat, get these vests. You can do Uber with them. You can travel with them. And it ensures that your kids have the right seatbelt, which is imperative for a child. The burn stuff is just common sense. And it's usually things that are avoidable. A lot of household burns are from coffee, cup of ramen noodles, touching a radiator. And it happens, kids burn themselves all the time grabbing a hot cup of coffee. Yeah. And just take... Bores over. Kids have very thin skin, and so they can't take as much heat in the skin. And so... cup of coffee on your chest. Yeah. You'd be pissed off. Right. And maybe it would give you like a sunburn. Yeah. But like. But damn, it's. Damn, it's serious. And so being very careful with your, have hot liquids around children, even where you put it on the counter, when you have a stove on, what is your oven on? Can you lock the door of your oven? Things like that. Like, that was the one thing that like stuck with me is that like when you have kids, like I hate kids. I love cooking. I hate cooking around my kids. Because I literally am like, you cannot be in the kitchen when the oven or the stove is on. Unless I'm standing right there. Because everybody's like, well, what's the chance of something happening? Well, I know it can happen because I've seen it. And I have to treat it. And I have to fix it. How about fireplaces? We're going through that right now. Kids love,

SPEAKER_02 1:17:51

they want to go in and roast the inside fireplace in our home. I'll put a couple logs in and they want to go in and cook marshmallows and all that stuff.

SPEAKER_00 1:18:02

So I think it's just kids should never be unintended around a fire. My kids love s'mores right now. I don't know where they even figured out what a s'more was. Maybe for my kids. But they love it, but it's... okay, we're going to do this. And if we're roasting marshmallows around a fire, I'm not having a beer. I'm not, I am, we are right there paying attention because it, because it takes one second. And I think that's like part of the reason, like, again, going back to like leaving practice was like, see all this stuff. Like, Oh, I know what that looks like. When that kid puts his hand in that fire pit. Yeah. Oh, he thought the fire was out. So he put his hand in the, in like the, like the coals or whatever of that fire pit. Cause somebody showed him that it made black on his face and it burned the hell out of his, like, so like I'm extra careful around fires, but I think with kids, seatbelts and fires, just being vigilant, right? Like don't take it for granted that your kid's not going to grab your cup of coffee. Right. Like you just have to be careful. I'm so

SPEAKER_02 1:19:13

glad we talked about this cause I'm living it now. My kids love serving us. They'll bring us coffee in bed. And I know how they do it. They're reaching up. And I could see right now, just because you explained it, they take it this way because the coffee's on the floor. So it's logical. It's spilling towards them. Now, oh my goodness, their skin can't take what ours could. All right, last question. What do you go back to young James? You had to go back and give young James advice anywhere at all. What comes to your mind? any

SPEAKER_00 1:19:48

point in your life? I think if I would go back and give myself advice is that it's up to you to make your own happiness. I think a lot of my life, I was looking for happiness to find me or things to evolve into happiness. Incredible. And what I've learned and I've had, you know, as, as, you know, very well. And we've talked about, I've had career changes, personal life changes, you know, very tumultuous, you know, three or four last years and it's making your own happiness. And if it's not making you happy, you know, you gotta move on from it. Yeah. And you did it. And I think the other thing is just keep walking. Like life is, is going to give you all kinds of hiccups and you're not going to achieve some of the stuff that you wanted to achieve, or you're not going to hit a benchmark that you thought you were going to hit. It's important. Learn from it, but just take the next step. And I think one of the things, one of my qualities that I'm most proud about myself is I can get knocked down. I can be told that I couldn't do something, but I'll just keep walking. Keep on going. Solid. Well, I'm grateful to hear your story. I knew, I knew a bunch of it, but man,

SPEAKER_02 1:21:23

some of the stuff you mentioned today is remarkable, incredible. So I get, I'm just going to show visual when I get to sit with these interesting folks here, I get to take more notes than I took in a college class. So this podcast is really changed things for me. I didn't expect, I mean, I knew it was going to be awesome, but man, to sit here and get this kind of the information, the tips, all this stuff.

SPEAKER_00 1:21:47

I love it. So thank you. No, I, I think in the last couple of years and mostly inspired by you has been telling my story, telling my authentic story to people and going back to, I have trouble connecting with people, telling my authentic story to people has allowed me to connect with people. Yeah, man. That's

SPEAKER_02 1:22:10

awesome. Thank you so much.

SPEAKER_00 1:22:13

It means the world

SPEAKER_02 1:22:13

to me. So, all right, folks, another episode of Interesting Human. James Boron was open, transparent, laid it on the table for us. Thanks for tuning into this episode. And as always, I just ask sincerely, if you've gleaned, whether it's nuggets, a tip, whatever, would you mind leaving ratings on the podcast for us? Whatever your platform is, share it with your friends, etc. So thanks again for tuning in.