Pathways by NOSMUSC

Plastic Surgery in Northern Ontario with Dr. Musgrave

• NOSM U Student Council • Season 1 • Episode 7

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Tune in to our Season Finale featuring the eloquent and inspiring Dr. Musgrave. After training in Canada and in the UK, Dr. Musgrave takes us through the life of a surgeon in Northern Ontario and contrasts it with her previous work in an urban center. Gain some important advice on how to navigate medical training, how to accept your authentic self, and how to know you are meant to be a surgeon. Thank you to Dr. Musgrave for a wonderful episode full of great stories and advice. 

If you enjoyed our inaugural season of Pathways, please reach out and suggest who we should interview next!

SPEAKER_02

Hello everyone and welcome back to the Pathways Podcast produced by Nossam U Student Council. In this series, we sit down with physicians in northern Ontario and learn about their journey to medicine, their careers, and their lifestyle. My name is McKenzie, a third-year medical student at Nossam University.

SPEAKER_00

And I'm Megan, also a third-year medical student at Nossum University.

SPEAKER_02

We're really excited for today's episode since we have the chance to chat with Dr. Musgrave, a plastic surgeon now working in Sudbury. So without further ado, thank you, Dr. Musgrave, for being here today.

SPEAKER_01

My pleasure.

SPEAKER_02

So before we begin, can we get you to introduce yourself to our listeners and just give a brief overview of what you do for work?

SPEAKER_01

Sure. I'm a plastic and reconstructive surgeon. I've been in the profession for over 20 years now. My daily practice includes almost all of the things you can think about in general plastic surgery, hands, burns, reconstruction. What else can I say? We just cover everything, basically. And uh I focus a lot of my elective practice on breast reconstruction because that's my first love. But I think it's good to have a good, solid basis in all of the plastic surgery sub-specialties, craniofacial surgery, trauma surgery, sort of the whole gamut. And I think that that uh makes you a really well-rounded individual and gives you lots of options for your practice. And so one of the things that I think a lot of plastic surgeons like about plastic surgery is the variety, and they can pick and choose things that they really love to do, but still have a good basis on general principles in plastic surgery.

SPEAKER_02

That's awesome. Thank you so much for sharing that. And if we had to start all the way from the beginning, when did you realize you wanted to be a doctor?

SPEAKER_01

Um, it's really strange because I tell people the same thing. I didn't grow up in a very rich environment. Um, you know, I had hardworking parents and we lived in a a small, a small city, but not a very uh affluent city, I guess is the best way to say it. And all I ever remembered was I wanted to have a job where I wouldn't be unemployed, where I'd always be able to work. Um, and for whatever reason, from the time I was probably, I'm gonna say 13 years old, I started to think that I wanted to be a pediatrician. And I think part of that is uh where I grew up, our family doctors were cradle to grave. They delivered us to our parents, they took care of us when we were kids, they took care of us as we got older. So that person was someone who in our community we knew was always around for us and would always help us. And I like the idea of the fact that I could help people and still have a job. And so I think that that's kind of um uh my way of kind of trying to figure out why I ever sort of um leaned in towards plastic surgery, I guess is the best thing, or to medicine in general. Uh I think it was just seeing that um you could do a lot for a lot of different people, and someone would keep you keep you employed for that. And so those two concepts kind of grew uh out of my own personal experiences um where I grew up.

SPEAKER_02

That's great. I uh I appreciate how you uh kind of tied those two things together and that kind of led you down that path. So once you realized you wanted to be a doc, what steps did you have to take to uh to make that happen?

SPEAKER_01

So um, you know, when I was going through um high school, um, we didn't have some of the things that kids have today where they can go and visit a university and learn about some things about it. Um I learned a lot about what I need to do just by asking people who were further along in their training um and had wanted to have the same kind of a a career. They wanted to do something in medicine. So I knew I had to go to university, and I knew that most places needed a four-year degree, and you had to do very well in university uh to even get uh close to being uh put forward for any kind of interviews for medicine. You also had to have um really good um scores on your MCAT, and you had to have some kind of an other life that uh showed that you were interested, involved, and engaged in either um work within your community, uh athletics, any kind of things that would make you stand out not only as a good candidate for medicine, but a generally well-balanced person, I think. I think a lot of that's changed over time, but I think those core values that people look for in their medical students are still the same. They want someone who has a little bit of knowledge about what medicine is. They want someone who is a hard worker, because it is a hard thing to get through medical school, but they also wanted people to try to figure out work-life balance. Um, and by having hobbies, activities, groups that you worked with outside of your school life, I think that's what people looked for. So all of those things I tried to search out almost organically. I've always been very sporty. Um, and I played soccer until I was about 35. I played on men's teams and women's teams. I played volleyball. I rode, you name it, if it was a sport, I would try it. And and I loved it. And so I had a whole circle of friends uh from that, and I had a lot of experiences from that. So I think for me, that was one of the things that kind of helped me uh open the door to uh getting a potential opportunity in uh uh the time of interviews and that sort of thing. But ultimately, you still had to work really hard and you still had to have really good grades for anyone to look at your application seriously.

SPEAKER_02

Absolutely. It takes uh takes a lot to apply to medical school, especially now. And uh can you just let us know what uh program you took, where you took that, and uh what medical school you went to?

SPEAKER_01

Yeah, so I took um a really long course to medical school. I did a um bachelor's degree in science with a focus on biochemistry. I then did a bachelor's degree in psychology. I followed that up with a master's in pharmacology and a PhD in pharmacology all before I went to medical school. And part of that is related to life and where life took me. And part of that was related to making my application stronger and better. And I think the third thing was having myself on a trajectory that if medicine didn't work out for me, I still had things related to medicine that I liked and I would be willing to do for a career.

SPEAKER_02

Well, with a background in biochemistry and then pharmaceuticals, um, I think it would be uh a very good uh way to transition into medicine and have uh an upper hand when it comes to the pharmacology uh throughout medical school. So I think that's a great pathway. And thank you for highlighting that you know, not everyone has the same pathway to medicine.

SPEAKER_01

No, I think I think everybody has their own unique pathway. You'll always meet people in your class who are the hardcore medicine keeners, for lack of a better word, who know how to get there and they study hard and they're very good and they're very focused. And then there's other people who kind of sort of uh want to kind of be part of of medicine and do medicine, but they're not really sure how to get there. But they know that uh all medical schools want diversity in their students, and whether that's uh related to age or experience or gender or whatever, um, you just want to show that you're a more well-rounded person. So I think that was the really unique thing I found about medical school, being in a class with people who had masters and PhDs, people who were like 18 years old and um knew from the beginning that they wanted to be physicians, people who had changed careers to become uh medical students. It was really eye-opening because I felt I was going to be like the old grandmother in the class, because all these younger people were clearly getting in after a couple of years of university. And I mean, I really did a lot before I went to medical school in terms of academics. And so I think that that was a that was an eye-opener for me and a refreshing eye opener for me because I would like to think that anybody who really wants to do this can find a way.

SPEAKER_02

That's a really good point. And there's something to be said about the diversity of a med school class that really helps us all get through the whole process together and relying on each other's strengths and things like that to get through it is is great. So on day one of medical school, did you uh always know you wanted to be a plastic surgeon?

SPEAKER_01

No. Oh my God, no. That was the least thing in my mind, surgery. Probably because I didn't know a lot about surgery, but again, I was I was older and uh I just wanted to get out there and start practicing medicine and um, you know, um living what I believe would be my best life. Um and I just wanted to see people and and treat them, and so I had no intention of doing anything but family medicine. That was what I wanted to do. I I just thought, because my family doctor was so amazing and he took such good care of us, he was kind of my unofficial, unknown-to-me role model. I liked how he treated all of his patients. I remember being in his clinic at seven and eight o'clock at night, waiting to be seen, because he would not leave until everybody in his clinic was seen. And I experienced some of that in my own life now. But at that time, we just thought it was really amazing that your doctor would see you later in the evening if you were sick. And so for me, I just wanted to get out and start that career.

SPEAKER_02

It's great that you had such a strong role model in your own family doctor. Were there any uh specialties that you had considered throughout your medical school uh career?

SPEAKER_01

Yeah, um, family medicine was always a thing I thought I wanted to do. Um, and then as I got into internal medicine, I really started to like medical oncology. And I spent some summers uh working in uh some of the the clinics and doing some research um around topics in uh medical oncology. And so, you know, I kind of at that point had two things that I thought I could do or would like to do. Um, and it wasn't until I actually went through a rotation in internal medicine that plastic surgery was even anything I I had had heard of, like because, like most people, um we associate uh plastic surgery with cosmetic surgery. And cosmetic surgery is just one of the many branches. Like plastic surgery is burn surgery, it's hand surgery, it's trauma surgery, it's reconstructive surgery, it's it's craniofacial surgery, it's so many things. But again, I I wasn't um that well versed in plastic surgery. So I knew that on medicine we would have patients who had pressure injuries uh on their buttocks, and we would call the plastic surgeons to come and see them, and I kind of didn't know what that meant. Um and then a lot of times they they didn't do the things that I thought they could do for for those patients. And then I did an elective in plastic surgery, and I my eyes were kind of wide opened um with plastic surgery. I'd always liked my surgical rotations. I have to be honest about that. I liked the way um uh patients were approached. I loved being in the operating room. I could stand in the operating room for days just watching people operate. And I remember one particular day of the doctor in medical school where I stood and watched a spinal surgeon do a three-level fusion on this patient. And he must have said to me three times, you know, Melinda, you don't have to stay, you can go. And I'm like, I'm not staying because in my head I'm thinking, I'm not staying because I think you want me to stay. I'm staying because I really think this is very interesting. Um, and so I kind of, I guess, had some um aptitude or some inherent curiosity about surgery, but again, uh, it wasn't something that I thought I would ever really do.

SPEAKER_02

That's really interesting. I like how you uh touched on a lot of the different aspects that uh medical students will experience throughout their clerkship years and you know, different rotations and things like that. And was there a point in time during those rotations that you realized, you know, it has to be surgery? Like when did you decide? Not so much family medicine, but down that surgery pathway?

SPEAKER_01

I think it was when I did my family medicine rotation as a medical student. It wasn't exactly what I thought it was. I think I was in a unique situation with some very challenging patients. Um, and I don't think it met my expectations, particularly after coming off internal medicine, where you know, you have this big group of people, you see all these very exciting things, and you think that that, you know, somehow will bridge the the world of family medicine. But I I just thought that I didn't feel I was doing enough in family medicine, and I didn't think that the patients I was seeing or the way that um the days were set or structured. Uh, I just didn't feel that that was me. And I would reflect back on that plastic surgery um uh issue with the with uh the medicine team. And I thought, you know, I gotta learn a little bit more about this plastic surgery stuff because now I don't think I want to be a family doctor. I think I want to be a general internal medicine doctor, and I want to find a way to take care of these pressure ulcer patients. And so I did an elective in plastic surgery, and that's where everything fell into place. I remember working with a very, very senior plastic surgeon who was very close to being professor emeritus at the time. His two residents were both on holiday, and it was just me. Um, and so I saw every consult in the emergency room, I saw every consult on the floor. I was first assist in the operating room, and I was on call with him. And every time he was with me, he taught me something. I remember my first day in the operating room with him, and he said, Melinda, how do you categorize sutures? And I'm like, in the back of my mind, I didn't really think there was a category. I thought sutures are sutures. And so I said to him, quite honestly, I said, I haven't really thought about that. He goes, Let me tell you what my classification is. And within three minutes, he had given me something that I still carry with me about classification sutures. So not only was his teaching meaningful, but it was impactful. And it was something that I hadn't really experienced a whole lot of before in terms of being involved in something while you're actively learning about it. Like you're getting ready to close a wound and you're getting a little tutorial on which sutures you use and why you use them. For me, I'm a very visual learner and I'm a very active learner. So I will learn a lot more by doing things than reading about it. And sometimes the reading about it would just confuse me more. But being active in it, I was learning more. And I think that's when I kind of thought, hey, this is something pretty good. Um, I might want to do a little bit more about this.

SPEAKER_02

Sounds like that elective and plastic surgery really had you immersed in the field and really uh got you in contact with a great mentor. And we'll definitely touch on mentors a little bit later. Um can you take us through now realizing that you wanted to be a plastic surgeon and the matching process?

SPEAKER_01

Yeah, that was incredible, incredibly stressful. Um, you know, uh plastic surgery is one of those specialties where there's not many, very many people taken each year. Um, and everybody who wants to do it, uh, you know, in year for us, it was in year three, would have filled all their electives with all their rotations that they had with plastic surgery. So we used to have eight weeks of uh general surgery and then eight weeks of a couple of subspecialties. And so that's where most people who knew they wanted to um do plastic surgery would take that opportunity to, you know, either do a couple of um rotations with different plastic surgeons at their uh university, or maybe go away for a couple of weeks to another plastic surgeon in a different university and learn a little bit about them so they could get themselves kind of uh noticed when it came time to sort of pick people for interviews. I had very little time because it was September of my match year when I realized I wanted to do plastic surgery. And the interesting thing was when I had left that plastic surgeon who had taught me so much as a medical student, when he debriefed me, he said, What are you going to do for your career? And I said, Well, I think I'm gonna be, you know, uh internal medicine. I said, I really like medical oncology. And he said, Oh, that's too bad. And I thought he meant, that's too bad because you're too dumb to actually be able to do that. But what he said to me was, I just kind of looked in him and I said, What do you mean? And he said, Because you're a surgeon, but you don't know that you're a surgeon. He goes, and when you know you're a surgeon, come back to me and we'll talk more about, you know, plastic surgery and things that you need to do. And so it was in that September that I thought, okay, I'm gonna go back and see him. And his first things were, I was wondering how long it would take you to come back. And so then he agreed to write a letter for me for the Karms match. He gave me some good advice about other people that I should work with. And so I went on and did one other, a plastic surgery rotation before the match. And I did two after the match because I knew um that by the time the Karms match went in, you still had time to make an impression on people before they chose people for the interview. So um I think I got a good amount of FaceTime with people, both just before Kerms and just in between the time that you put in your application and they pick people for the interviews. And uh at that point in time, I thought I've given it my best shot because, you know, I didn't know until very late that's what I wanted to do. And I have to live with the decisions and have a backup. And that's kind of what I did.

SPEAKER_02

That's a really exciting and must have been stressful journey realizing in September that you wanted to do plastics and then trying to mobilize everything and and get references all in all in time for CARMS. So I really appreciate you sharing that story. And I think uh a lot of our listeners will appreciate how you know you might not have known that you were a surgeon at the time, but that you had mentors that uh that kind of believed in you and kind of saw you for what you were to be in the future. So I think that's that's really cool to hear.

SPEAKER_01

And I think the the the take-home message for me is that kind of adage you miss a uh 100% of the shots you don't take, right? Um so I felt that if this was meant to be and I was a good candidate for it, I felt it would happen. Um, but I had to be realistic about the fact that I really didn't know how people got picked. Into programs. And I really didn't know, you know, what I had to do other than just show people I worked hard and put in an application. And I think if you think that there's something that you want to do, I don't think you will ever regret not trying. You always have to have a backup and you always have to make sure that that backup is going to make you happy. But I don't think it's ever too late to kind of decide that, you know, all these things I thought I wanted to do, I don't want to do, and I want to do this something that's completely different. All you can do is give it your best effort. But you shouldn't give up just because you haven't been on that track for several years. And I've seen that work both ways, right? I've seen people who've put all their eggs in one basket convinced that that's what they were going to do. And then when the time came, they realized they really didn't want to do it. And then there was people who kind of knew sort of what they wanted, but they hadn't really experienced enough to really solidify that. And so those last-minute people always felt like there's not a chance in the world that they would get in. Um, and I think that's not not true. I think sometimes the chance in the world is a chance, and you have to take it.

SPEAKER_02

That's some really thoughtful advice, especially for our fourth-year medical students that uh are, I guess, applying this week, I believe, uh as of time of recording this. So I really appreciate that. Um how would you uh knowing that residency can be quite the uh trying time and also a time of lots of learning, how would you describe your residency experience?

SPEAKER_01

Um I loved my residency and I think I loved it because I had a really great group of people who were my senior residents who made junior residence learning a priority, and you don't always get that. And I think uh I we uh we were part of a small class. There was only two of us in plastic surgery taken into the program I was in that year. And now that's a program that takes five and six people. But at the time that was pretty standard across Canada. There weren't very many plastics positions, but you had, you know, PGYs two, three, four, and five who were ahead of you and would be on a rotation with you as your senior residents. And I can say that uh every single one of them gave me a ton of opportunity to do things. Um, they didn't just see me as the person who was doing all the scut on the floor or, you know, suturing every little thing that came into the eMERGE, although I was always grateful to have an opportunity to suture anything. Um they taught you constantly. Um, they were just a good bunch of people, is the best way I can say it. And I extend that to the fellows. I worked with some significantly impactful fellows who were very kind to me, who gave me tons of opportunity, not just on my plastic surgery rotations, but my off-service rotations as well. Uh the ENT group that I worked with, one of the fellows, always made sure I was able to do the trach for all the patients I came in for after-hours operations. We would take the time, I would do the trach with her up to the point where I was doing the trach myself. And it was so much confidence, a backup, encouragement. You felt like people really wanted you to succeed and they want to give you every opportunity to be the best surgeon you could be. And that's one of the things about my training that I'm absolutely grateful for. I'm grateful for the colleagues that worked with me. I'm absolutely grateful for the staff that trained me, who did the same things. They gave me tons of opportunity uh to do things and to hone my skills. Um, and so for me, residency was um, even though it can be very um stressful, and there are always people who aren't very kind to you. Um, the people who were kind to me and gave me opportunities far outweighed those one or two people who really didn't give me a hand up but kind of pushed my head down a little bit. But if you don't have the people pushing you down, you don't know how you can rise.

SPEAKER_02

Wow, that sounds like you had really had a great uh environment that you could really thrive in at the time.

SPEAKER_01

Yeah, I think it was. I it was the days where we operated at night all the time. So, you know, now it's it there's restricted working hours in some countries, and there's um uh so much pressure on the operating rooms to get cases done at night. You can't let your junior residents just go in and spend two hours doing a K wire. You know, we operate a lot. We operate a lot with each other as residents, seniors and juniors, and we also operate a lot with the staff. And when you went in at night with the staff, the staff really let you do the operation, guided you through it. And so, you know, the number of hours that we put in in those days, I think is a lot more than uh residents and fellows get the opportunity to do nowadays. Uh, I just think that there's just so much pressure on the healthcare system that every minute is precious. And so sometimes I think residents learning often takes a second seat to trying to get the cases done for the day. And the night cases that we do now, depending on the specialty, uh, tend to be a lot less frequent.

SPEAKER_02

Awesome. Thank you for sharing that. And for our listeners who may not be aware of some of the um fellowship opportunities for plastic surgery, could you maybe shed some light on what options are out there and if you considered any or if you completed any?

SPEAKER_01

Yeah, so I think there's fellowships everywhere and anywhere you can imagine. I encourage people to step outside their boundaries. So where I trained, I did a couple of months of fellowship with two different hospitals, but ultimately I was on a waiting track because I was getting licensure in another country. And it took a bit more time than either the fellowship program there or I could imagine. So uh not being wanted to be idle, um, I did fellowships uh at my local university, which I think were really great opportunities for me. So I did uh my true fellowship, I guess is the best way to call it, in Oxford, England. I worked with a lovely group of people who had a very general-based practice in a hospital that um had a wheel-and-spoke relationship with a bunch of other hospitals in the region. And the hospital that I worked in only had three surgical subspecialties. There was plastic surgery, neurosurgery, and ENT. Those were the only surgical subspecialties in the whole hospital. Um, so for that reason, we had five or six surgeons, and we had about six or seven fellows. And so, again, it was a really great experience for me. I got to do a lot of different cases. I got to learn a different way of working. Um, we could work as long as we wanted in the operating rooms. Uh, people would stay late. It wasn't a problem. Sometimes we ran lists on Saturdays. Uh, we would work in the local hospitals that were part of our wheel and spoke and do things there. Um, and it's just nice to see the similarities and the differences in the way people do things because that's one of the things that if you stay in one place and you do the fellowship of the same place, you're just learning the same things you already learned and so from the same people. And so it's nice to go and see that other people do that operation the same way, or that other people do that operation a little bit differently. So I think you get to build on different ways to do the same operation and find the way that works best for you. So I think out of all the time you're in medical school and residency, fellowship is the best time of your life.

SPEAKER_02

That sounds like a really exciting time, especially being able to go overseas and and kind of learn a whole different healthcare system and and and like you said, kind of become an even more well-rounded surgeon, that sounds like.

SPEAKER_01

Yeah, I think it is because I think, again, the attendings didn't come to our operating rooms. We were given as registrars, we were given a list. And you would get your list a week in advance about what you were going to do, and you would just do it on your own. It was just you and a surgical assistant. And if there was something on your list that you didn't know or, you know, hadn't had a lot of experience with, then one of the all the registrars would come and operate with you. Because again, a lot of them were training for, they were the equivalent of our uh residents, and they were training for uh their exams, but they had a huge breadth of practice because the way that you get onto the system there is a bit different than it is in Canada. And so I had a lot of good colleagues there who uh when I had something on my list that I thought, I don't have much experience with this. I think I'm gonna, you know, get someone to give me a hand with it. Uh it was just another opportunity to build on your skill set.

SPEAKER_02

Yeah, that's that's fantastic. And thank you for sharing that through all that training and the fellowships, is there anything that uh was unique that you learned about the the specialty of plastic surgery, or anything that kind of surprised you that you weren't expecting?

SPEAKER_01

I think that I knew uh that by the time I finished my training, I was well trained. And I was surprised by that because I thought it was gonna take me a while to feel like I could go out there and do things independently. But I think the way that plastic surgeons and probably a lot of other uh surgeons uh train their residents is to make sure that they're safe at what they do. They choose their operations correctly, they give you the confidence to make decisions, they question you about why you're making decisions and you have to justify it. And I think that leads you to actually become a better surgical planner, I guess is the best way to say it, or to make sure that you have the right operation for the right patient. And I didn't know that I would get that everywhere. You know, like when you get comfortable in your training program with the people who train you, you know what they're giving you, but you, I guess you don't know what's happening everywhere else in the world. And for me, it was very reassuring to me that my training stood on par with the training in the United Kingdom, and that I had my equivalent royal college certification in the United Kingdom, as I do in Canada. So that made me feel like not only uh was the experience that I got in my uh residency very good, but that um I knew that around the world at that point in time, um, people were getting the same type of training. So that there was a real um security in knowing that what I knew, everybody else knew, and that uh as weird as this sounds, there were no real secrets that I didn't know. Like I knew, you know, a broad scope of operations, I knew the things I liked to do, I knew the things I did well, and it felt reassuring that that translated, just not from a Canadian point of view, but from a bigger point of view, because within the registrars that I had worked with, a couple of them came from Australia, a couple of them came from England, a couple of them came from Ireland. So there was a huge group of people who had all trained in different countries, but we all sort of were equal when it was all said and done. We had all learned the same things uh the same way. And so you felt like you had really joined a fellowship of of people who were like-minded and knew all the same things, I guess is the best way to say it.

SPEAKER_00

That's amazing. Thank you for sharing that. And like you mentioned, it really speaks to the quality of the training that you received. Um, so next we kind of just wanted to talk about um classic surgery as a whole. We know that it's super busy, but did you have any other roles in medicine throughout your career, like research, teaching, or anything outside of your main specialty?

SPEAKER_01

Um, yeah, we always did research as residents. We had to present uh a um paper every year in our resident research day. Um, you know, having had a PhD background, um, I didn't really want to go down the lab work uh road anymore. I figured I'd I'd done, you know, uh enough of that through my master's and PhD. And I didn't want to take time away from actually learning medicine and and training in medicine to do any more kind of research as a resident, other than the ones for the project. But I did lean in pretty heavily into education. You know, I know that I got a lot of opportunities through my residency to spend time with medical students, to teach medical students, to teach junior residents. And I got a lot of um good feedback from that, and I really enjoyed doing it. So I spent a lot of my career in the uh sort of teaching side of plastic surgery. I spent 10 years being the undergraduate coordinator for the Department of Plastic Surgery that I worked for. Uh, we had workshops for students all the time about plastic surgery. We developed an online um course to learn how to suture. Um I became involved in the evaluation of surgeons. How do we evaluate a good surgeon? How do we know that their teaching is um good? How do we know that the students enjoy their teaching and are learning from it? I sat on a ton of committees at the university level for uh different exams, including OSCI's. So I had my fingers in a lot of different educational pies. Um, and I loved every minute of it. Um I think there's something about trying to relay what you know uh to another person and them allowing you to learn from them uh uniquely is something that is really what I would say the apprenticeship part of medicine and surgery. You know, in the the olden days where you took on uh someone and they were your apprentice and they learned their craft through you. I think the educational thing is the perfect opportunity to uh not only teach people the formal curriculum of, you know, how to deal with a patient in the emergency room, how to suture, how to learn something about wound care, but also a little bit about approaching uh patients who are in uh crisis or who've had a bad experience, or who just are having a bad day, and trying to give people pointers on how to um turn those moments around so that uh you're able to deal a little bit better with uh challenging situations because not every day is fantastic, um, and not every case is fantastic. And so by being involved in education on a bunch of levels, thinking not just about the teaching itself and the ABCs of medicine and surgery, but uh teaching people about wellness and teaching people about um uh supporting each other and asking for help and um being responsive to um challenging situations that people go through. I think um those things were all part and parcel of trying to be a better educator. And that change came really, I'm gonna be honest about that. That change came really in the last, I'd say, seven years, where I saw the culture um trying to evolve and change and people trying to adapt to a whole lot of things. And, you know, the pandemic really threw uh a spanner in the works for that sort of thing, where, you know, we really had to be very cognizant about what was happening with learners and what their fears were while trying to deal with our own fears. And so I think education is a wonderful platform, whether you're having students in your clinics or in your operating rooms, or whether you're just sitting down and talking to them about, you know, how to manage the day-to-day uh stress that you get. How do you deal with a bad evaluation? How do you ask for feedback and not feel that, you know, you're a terrible person because, you know, the person who gave you feedback didn't really give you feedback in a nice way. Um, so there's a lot of other things around the educational portfolio that I see coming up, and I find those very exciting. And I think they're a wonderful opportunity for people who want to make an impact in the next generation of physicians and surgeons, not just by, you know, the ABCs of medicine and surgery, but by the softer side uh of surgery and um learning to look after yourself as well as your patients.

SPEAKER_00

That's so great. And we love that you love teaching. Um, I don't want to speak for other medical students, but um, I know that it's great when your preceptor is passionate about teaching and sharing their knowledge. And obviously, as someone who spent a little bit of time with you, I think it's pretty clear that you're passionate about this. And so that's something that's really appreciated.

SPEAKER_01

I think that's the side. When I was asked before about things that, you know, surprised me. That surprised me. What surprised me was that you could spend time with someone and have such a profound impact on them in very short bursts. Do you know what I mean? Like you take someone to your operating room, you show them a few things, and you know, they feel great about that experience. And that translates into them thinking more about that specialty where maybe before they never did. And I never ever thought that teaching could be so influential in a positive way. Um, and that was certainly a surprise to me that uh, you know, I was very grateful to have a lot of learners come and say that, you know, even just one or two things I said or did had really helped them to, you know, navigate a little bit better. Um, so uh that was very surprising. And it's a very impactful on me as a teacher to get feedback, both positive and not so positive, because again, feedback isn't either, it's just someone telling you what their experience was. And we have to appreciate the uniqueness and the authenticity of everybody's experience. But that was very uh surprising to me.

SPEAKER_00

Absolutely. And when you have someone that likes teaching, it's so much easier to create that mentorship and that role model that you kind of look up to. And on that note, you touched on this a little bit earlier, but did you have any specific mentors throughout your education that helped kind of guide you and keep you motivated to where you are at your career now?

SPEAKER_01

Yeah, I've always had the people who have always supported me. It didn't matter what the situation was or um what the issue was. I would always have a circle of people who uh were there to listen, who were there to ground me, who were there to support me. Um, they weren't there just to tell me everything's gonna be okay, because sometimes everything is not okay. Uh, but they were there to give me true, honest, and heartfelt feedback. And uh amongst them, I had people who uh would walk into a fire for me, and I knew that. And I think those people will always be in my life. Um, so uh my program director was a phenomenal source of support for me, um, both through residency and through my career. I had a senior resident who's a plastic surgeon. We have a lifelong friendship, um, and she is one of my biggest supporters and my voice of reason when the world around you is going crazy. And I have a trainee who is potentially one of the most impactful and influential women in my life. She's a brilliant surgeon. She's a brilliant thinker. And she just knows how to give you the experience that she has with so much wisdom that sometimes I wonder who was the teacher and who was the learner. So I will I will always carry with me a group of people who have uh been influential and who would who would tell me basically, you know, this is this is important or this isn't important at all, and this is what you need to worry about, and this is what you should do. And, you know, I'm here if you need me. And when they said that, they really meant it. And so I think it's important that you find those people on your path, and some of them will come to you organically, and some of them will not be who you thought they were, and they have nothing to do with your specialty, but they're in another specialty. Um, and they can see sometimes more clearly than you can. And I think people can't choose your mentor for you. I know that there's a lot of programs out there when you become a resident, they match you with someone to be your mentor. I don't think that works. I think you have to figure out who that person is, um, uh, spend some time with them so you both can be your authentic selves. And then that grows on its own. You don't have to force it, you don't have to do anything to encourage it. You just feel the fit automatically, right? Um, it's like putting on a good pair of shoes. They just feel right and they should feel comfortable. Um, and so sometimes when you're just paired up with someone because that's a person who's doing the same type of surgery that you want to do, or that's a person who says they're really interested in education, but it's not your cup of tea, I think that can be more stressful than helpful. Uh, but I think mentors are very important and they always have to be a step away from the people who evaluate you. And that's important to remember. Um, yeah, if you go to a mentor and you ask for their confidentiality, you have to know that what you say to them is gonna be confidential. Um, and that's what builds relationships, right? Being able to share tough things with other people and knowing that no matter what, they're gonna give you their best advice and what you've told them is between you and them. Um, they're also gonna put you on the path towards other people to help you in your career. Let's say you don't know, you know, you don't know where to go for a fellowship, but you know you want to do craniofacial surgery. Well, your mentor should be someone who can say, listen, I know a couple of people. Let me set up some some time to talk to them. Or, you know, when you come to the meeting this year, uh, I'll introduce you to some people. So it's good for networking. It's good for you for your uh clinical well-being, it's good for you for your mental well-being. I think that's what makes a mentor. I just don't think it's a senior person who you get assigned to who says, you go go do X, Y, and Z and you'll be great. I think it's someone that you meet who says, What's going on? Let's talk about this stuff and how can I help you? So putting a hand down and having someone reach it and help you up is far better than someone pulling you up and telling you where to go.

SPEAKER_02

That's absolutely true. And as current clerks, we definitely appreciate uh having mentors. And as you kind of said, it can be a kind of a dynamic relationship and can't always be forced, and you just kind of connect with certain people, and then somehow you always end up a little bit more interested in whatever specialty they're interested in as well. So it's great.

SPEAKER_01

That's absolutely true.

SPEAKER_02

Yeah. And knowing that yeah, typical day, especially uh for plastic surgery in more the northern Ontario setting can kind of vary. Can you kind of take us through what a typical week might look like for yourself?

SPEAKER_01

I'm afraid to scare off people by telling them what my typical week looks like, but but I'll tell you. So um, all of us at Health Science North have a similar schedule. We have a full day of clinic, we have a full day of minors, and we have a full day of OR. And then we have two other days. Most of us will work one of those days in an office, and the other day is usually an academic day. Now, theoretically, on a calendar, that's what it looks like, but um, it never really works out that way. Um, our call is really heavy. Uh, we do a week of call at a time. We're thinking about modifying that, but we haven't been able to come to a mutually acceptable arrangement where we all feel comfortable with uh taking it uh a different way. So for the time being, we do a week call. For call, um, I'm on call this week. And as of yesterday, I had 37 referrals, uh, 20 of whom I'm gonna see on Friday in a new half clinic day. I all of us now have a what I call the pre-call clinic, which really isn't a pre-call clinic. It's a mini post-call clinic where you try to take care of the people that you've seen at the beginning of the week so that your clinic the following Monday, which is really the post-call clinic, isn't busting at the seams. And so um, on average, uh most of us have been seeing between 50 and 80 patients on call in two clinics. Um, and that's uh that's a large number of people to see. Um, and that's due to the shortage of physicians we have in northern Ontario. So we get calls from everywhere uh north here. Like I've had calls from um, you know, Capus Casing, Timmins, Thunder Bay, um, everywhere you can think of, we get calls from. And sometimes it's just for advice. I think this is this, and what do you think, and how how should I treat it? And other times it's I don't know how to treat this, and can you see the patient? And that's unique experience when some tr someone travels eight hours to see you and then sits another three hours in your clinic because the volumes are so big. But I don't think any of us turn people away very easily. I know I don't, I get in a lot of trouble. Um, but I can't I can't say no to people who I think uh need some help and I think I can provide it. So call is the most onerous thing that we do. Um the operating room is like every other operating room. Uh, you know, we probably uh with turnover time and getting in and out and getting patients organized, but most of us can get somewhere between three to four cases done a day. If they're moderate size cases, you get a few more if they're short cases. We have excellent um nursing staff, we have excellent anesthesiologists, we have a really nice group of people who work in the operating room at HSN. I feel very lucky to have really been blessed twice. In my last job, I had a phenomenal group of people I worked with in the operating room. My plastic surgery team was awesome, and my plastic surgery team here at HSN is awesome. So we operate for a day. And if you ask any surgeon what's the happiest time of their life, it's when they're in the operating room. It's what we love. It's why we do what we do. We love operating. Um, and then there's the minor procedure room. I usually run a day every two weeks because I try to run an office on the other uh day. Um minor procedure rooms, again, are a great way to do um some very basic cases. I've transitioned most of my hand surgery over the past eight years into the minor procedure room. So I do a lot of wide-awake hand surgery. Um tendon repairs, nerve repairs, uh K-wiring, all those things I used to do in the main OR. I do them in the minor procedure room now. And that's uh thanks to a very great Canadian plastic surgeon from New Brunswick named Donald Lalonde, who uh really has pushed the boundaries of wide-awake hand surgery, and we're all grateful for that. But allows us to get more patients through and it doesn't tie off the OR time. So we tend to do our bigger cases in the main OR and our smaller cases in the minor. And then uh the academic burden becomes the fourth day in the untold uh day that you have that you love and hate. You love it when it's done, but you hate it when you have to start with it. You know, we have to keep our records up to date. We have to make sure all our notes are done on time. Um, it takes a long time sometimes, depending on your EMR, to get things done. So that's a day that you need to make sure that you've taken care of all of your paper for the work for the week. You've done all the forms that the patient needs, you've sent out all the referrals that are required to give them help for things that you can't do. Um, and make sure that um you're ticking off all the boxes for the hospital in terms of having all your documentation in place. And so that's a typical week for us. Uh, the office time is to see patients who need a little more time with you because the conversations are a little bit longer. So for me, that focuses around my breast reconstructive practice. I see those patients for about an hour. There's a lot to tell them, there's a lot for me to um uh share with them and for them to share with me to make good decisions about uh what type of reconstruction, if they want reconstruction, what reconstruction really is. And uh skin cancer is the other thing I see in my uh office, because again, a lot of those patients are a little older. They don't want to sit for two hours in a clinic waiting to see you. So if I can see them in the office and get them in quicker, because I know I have their biopsy, I know that there's not trustings I need to do. I know that I just have to talk to them about the procedure. We'll do that. Um, so that's pretty much my week.

SPEAKER_02

Well, definitely sounds busy enough.

SPEAKER_01

Um I tell people I worked in a very big hospital um uh for the first half of my practice, and I've never been busier than I am here. And I love it. I love it and I hate it. I love it because I um am working with a really nice bunch of people. I am doing a lot of cases that I did as a resident, that I'm now re-enjoying doing as a full-fledged plastic surgeon. Uh, but I feel a real sense of purpose here that sometimes I didn't always feel. Like I guess it's knowing that people are willing to travel so far for healthcare and that we're able to provide it. I think all of us who can go into medicine get something out of it. And we'd all be lying to say uh that we didn't feel really quite special when we do something to help someone. I think that's why people go into medicine. I I like to think that the core of all of us are just a bunch of people who want to help people. Um and I think there's a great satisfaction for that. I did get it a lot in my other practice, but I see it a lot here now. Um, and even though I'm busier and more tired, I love it. I um I'm really grateful. I'm really grateful for Northern Ontario.

SPEAKER_02

And with how busy we are, I'm sure Northern Ontario is very grateful to have you as well. I think it goes both ways. And just another way to scare away a few people from plastic surgery. How many hours are you working a week on average, just as a quick follow-up?

SPEAKER_01

Um, you know, I think my clinic days, I'm usually late. Um, I'm trying to be better on time, but I'm usually late because I talk too much. But I would say average week. Um average week in the hospital would be probably 35 to 40. But average week to get everything done, you probably have to add another 20 hours to that. I take work home with me. I make sure that my notes are at least partially dictated in the clinic, but then I spend a lot of time editing them and making sure the grammar is correct, and that's just because I'm very idiosyncratic and um I want the letters to read perfectly. And so um I spend a lot of time rereading my notes and re-checking my notes when I get home. So it is a very busy week, but when the weekend comes and you're not on call, it's very nice not to have anything to do and have a beautiful place to live where you know nature's just outside your door or down the road. And so I think it is a very, very busy life, but I don't think our lives are different than anybody else. I really don't. I think every surgeon's career is a very busy career. I think the time they spend in the hospital and outside of the hospital is you know shifted towards doing things for patients. And I think no matter what type of surgeon you want to be or what type of medical practitioner you want to be, it's trying to carve out your life so that you are able to do all the things you need to do, but still are able to have time for yourself and take time away from your job because you have good colleagues who can support your patients while you're away. And I think that work-life balance is something that I never had. And I doubt I'll ever really have it because uh when we grew up and we trained, it was just about doing the job. Uh, if you ask someone about work-life balance, they just look at you as if you, you know, like, what is that? You're a surgeon, of course you're gonna be working hard. But I don't wish that on the next generation of surgeons. And I think that your generation is a lot better at saying no than our generation was. You know, we always used to say, well, I'm gonna say no to that person the next time they come. And then they come and go, Yeah, of course I can do that. Yes, of course I can add that extra hour in. So I think we have what I call um very soft boundaries with taking on more work, where I think today's generation has a much healthier vision of the job and are able to really detach themselves at the end of the day or the end of the week and know where their guidelines are and I think, or where their barriers are. And I think that's incredibly important. So I don't want anyone to work as as hard as all us olts did. I want them to work hard when they're at their work and love what they do, but have time for their family and friends and hobbies and everything else outside that. And we're only gonna get that if we get more physicians.

SPEAKER_02

Well, I appreciate you being on the forefront of advocating for better work-life balance. Um, what would you say the bread and butter of your specialty is? And considering that you've come from a more urban center and now is working in northern Ontario, I wonder if you could shed light on if there's any difference uh on the bread and butter of working here in Sudbury versus uh elsewhere.

SPEAKER_01

Yeah, um, hands. Hands, hands, hands, hands, hands. Uh you know, I had I had a share of hand surgery when I was um working at the law center I worked at, but my partner was uh a hand surgeon, and so he did a lot of hand surgery. I did a lot of trauma, hand trauma. So finger fractures, tendon injuries, nerve injuries, amputation revisions, those sorts of things. And sometimes even the amputation revisions were done by the emergency room. Um, but here we see a ton of hands. So I would say my on-call distribution of patients, about 80% are hands. And so I've really had to go back and uh revisit all the hand operations I'd learned as a resident. I rely on my colleagues a lot um to run cases by them if I'm unsure about things or I want a second opinion to make sure that I'm taking the patient down the right path. But hand surgery here has been a really big um thing for me because I really didn't do a lot of it before. I spent a lot of the my other time doing uh breast and breast reconstruction as well as uh craniofacial trauma. And um I really didn't get a lot of uh hand patients. Um so um I think that's a big difference. And I think part of that is the idea that when you work in an urban center and you think about uh how far it takes you to drive to another hospital, sometimes it's a five-minute walk up the street. Um, but within the area that you work in, within a 20-mile radius, there's probably seven other hospitals. So you don't see the same volume because it's being distributed over more hospitals. But here, because uh there's so few plastic surgeons in all of Northern Ontario, you become a very big catchment for a lot of things. So that's really, really quite different for me. And uh something that I knew I had to be able to do hand surgery when I came here and I was completely prepared for that, but I didn't think uh I would see the volume that I'm seeing. And um, so that was that's certainly different from an urban center. Um the things that the things that are also a little different um is um resource time. You know, it's easy sometimes in urban centers to get extra days when you need to have an extra clinic. And I think here it is a little more challenging for exactly the same reason. You have a lot of subspecialties who only have like a limited number of spaces that they can work in. And so sometimes it's not as easy to get as many extra days as you want. But having said that, haven't had a problem getting some extra days. You know, you can't always get all that you want, but at least there's an opportunity uh to get a few um extra days, uh, not only just in the clinic, but in the operating room. You know, I think people are very conscientious about making sure the operating room time is fully utilized, and that uh does play to an advantage here. I think um people are a lot more, I don't want to say respectful because that's not really the right word. Thoughtful, I think is what it is. Thoughtful when they call you at night. So uh I got a lot more calls at night uh working in an urban center than I do here. And I'm crossing my fingers when I say that because I'm probably jinxing myself for tonight. But anyway, um, I think people are very well versed in what really is an emergency. And if you're they're calling you at night, it's because it really is an emergency. It's not because it they just want to get it off their plate and get rid of it, but it's because it really is an emergency. And so uh I'm uh I think that that for me is a really nice change because there's nothing worse than being up all night operating and then having to run a full operating room the next day or a full clinic the next day. And it does happen, but uh that's the one thing I've seen. I I think people are very, very considerate and uh probably very knowledgeable about what needs to be done as an emergency. And so whenever my phone rings at night, I know, I know it's something important. I know it's just not someone, you know, telling me something that's in the emergency room that they want me to come and see that I really don't need to see. Um and I miss residents and I don't miss them because of the work they did. I I mean I do miss them because of the work they did, but I also don't have uh such a large inpatient load as I did when I worked in an urban center. But I miss having them with me for exactly what we talked about earlier. I I love teaching, I love having people in my operating room with me. I love watching them do things. I love watching a medical student become a resident and a resident become a full-fledged plastic surgeon. And I've had a great opportunity to see many of those in my lifetime. And it gives me such pleasure to see people really rise uh during their careers. And so I miss those moments of having residents around me and watching them do their very first carpal tunnel to seeing them doing a very complex craniofacial case. Um, and um so for those reasons, that's the one of the bigger changes for me is um the the number of learners and having a lot of time with learners.

SPEAKER_02

No, that's that's amazing. And we can tell that you have a passion for teaching, and so um having no residence here, you know, maybe that's something that might change in the future as as the need for plastic surgeons continues and uh as NASA continues to grow as well. And so just given that you're uh recently practicing in Sudbury, was working in Northern Ontario Always something that you wanted to do or always piqued your interest?

SPEAKER_01

Um, it's interesting because um I'd say about 10, maybe even 15 years ago, Amanda Fortan, who's a chief of plastic surgery here, tried to encourage me to come to come to Northern Ontario. I wasn't having a great time at that point in my life, and I was looking for a change. And I guess I couldn't separate myself from what I thought were my academic goals to moving to Northern Ontario. I thought I'd be isolated, I thought I uh would miss my family and my friends, and uh that my life wouldn't be as busy, I guess is the best way to say it. And as time uh passed, every time we would see each other, she would encourage me again to think about coming up. And then ultimately um I started to come up and do locums uh here and I really, really enjoyed it. And I really need to change in my life. Um mentally, emotionally, academically, uh surgically, every way I could think of, it was time for me to change. Um, I just didn't feel I could um be my very best self uh staying where I was. And I saw lots of opportunity here uh to go back to my core values and my core principles of doing the best job that I possibly could do for people and being able to make uh an impact in people's lives by providing really good service for them and bringing something to Northern Ontario that is um not done very often, and that's press reconstruction. Um, so uh it was a great opportunity that she gave me, and again, I'm very grateful for her. And since being here, I I can't imagine going back to an academic center now. I really can't, and I I don't mean that in a bad way, but I just mean it in the way that to get to work now takes me eight minutes. And I can stop at Tim Hortons on the way. And uh during my last two years uh in the place that I worked, even though I lived about, I'd say 20 minutes away from the hospital, it would take me over an hour some mornings to get to work. And that's leaving at six o'clock in the morning to get there for seven. And uh I can just drive down the street to the grocery store and be back home like in you know, 30 minutes. To get my groceries in Toronto wasn't like an all-day event. So for all those reasons, it's just been really really, I don't want to say refreshing because it doesn't sound right, but it's just really been a really nice change. I knew it was gonna be different. I knew it was uh gonna probably be a more calm life, and I think it is, but I didn't think that I was going to fit into it as easily as I think I have. Like I thought I would miss a lot of my creature comforts and those sorts of things, but you know, the highway is there, you can drive anywhere you want on the weekends or your weeks off. But to come back to a place that's quiet and calm and uh safe and um nice, I guess, is the best thing. It's beautiful. Northern Ontario is beautiful. Um, so that that part of nature, um, that's great.

SPEAKER_02

Definitely seems like it was the breath of fresh air that you kind of needed, and definitely uh we can share the sentiment of, you know, enjoying not being stuck in traffic all the time. And uh a previous guest had said that uh they found living in northern Ontario to be almost like they were living a more efficient way of life, um, which I it sounds like uh you you kind of uh share that sentiment as well.

SPEAKER_01

Yeah, I think I think that's true. Although I did uh get caught in a traffic jam yesterday when eight ducks decide they were going to walk from one side of the street to the other, and I had to wait for them to get across. So I took a video of that and sent it to a few of my friends and said, uh, this is a traffic jam in Sudbury.

SPEAKER_02

That's amazing. That might uh that might get the recruitment in Sudbury uh involved for sure. Um one of the topics that we discuss at uh Nossam University often is about r rural generalism. And often we taught we discuss that in the framework of family medicine, but knowing that kind of what we discuss with the bread and butter of working in Sudbury and things like that, have you noticed that now being in a more kind of rural setting, that your scope of practice is even more expanded or more general?

SPEAKER_01

Uh I think that's true. I uh you know, I think all of the things that I'm doing in Sudbury, I did in my old job. Uh different, but different levels of them. Like I said, hand is a huge part now, where I would say it was a minor part. And you have to be a better generalist because you are treating general plastic surgery problems. Uh, people aren't coming to you just as a sub-specialist. So, you know, as I said, my my practice was really focused in breast reconstruction. And 80% of my operating rooms were related to breast reconstruction. Um, I'm working with a wonderful group of uh surgical oncologists here in HSN. And I do a lot of our we do a lot of our cases in my room because uh I'm used to that. I'm used to having um them done done in my room because it usually takes me a bit longer than it takes them. And I'm happy to try to get more patients through the system and allow them to use their law their time for lumpectomies and oncoplastic things and all of that. But the breath is much bigger. Um, definitely see a lot more skin cancers. And again, that's related to a large number of people and a small number of providers and pediatrics. I do pediatric hand. And I really hadn't done a lot of that since my residency. So again, I, you know, I had to go back and uh relearn all those things. I got a lot of support from my orthopedic and plastic surgery colleagues uh for those cases when I needed to ask a little bit more about them. But I think it's true. I think um uh the catchment is so big. And the diversity of occupations that we treat and ages that we treat and conditions that we treat require you to be a very good generalist. And so you can you can have that one thing that you love to do all day, every day, but you can't forget that you have to know the basic principles of the basic operations. And sometimes those more complicated operations come up because those simple little cancers that would have been treated uh very easily in a minor procedure room don't get treated because the patients don't have primary care access to go look at that thing that's not healing until it becomes so big it becomes a really big issue. So it's it's interesting that I think the scope is as broad as it is, with such endpoints. Again, very simple things and very complex things. Whereas I think everybody thinks if you were at a big urban center, you don't need to know much about the con the simple things because you're the sub-specialist in your specialty who does blah. And so all your cases is going to be blah. Here, that that's not true. We all have to span the scope of what we love and what we uh love to do with all of the things that we need to do. And so I think for us, uh, I look at it as the way to continue. You know, we always have to do continuing education, right? That's how we keep our licenses, that's how we keep up to date. I think it puts some things in in my frame to expand my CME. So, you know, I have more opportunities to go to workshops and conferences related to the general practice that I'm doing now. You know, I always go to my sub-specialty meetings, and a lot of that, sometimes I'll just hear the same things again, and sometimes I pick up new things. But in this, uh in this area now, um I think there's a lot more opportunity for CME to think about what you want to do and what you want to learn and go and actually learn something new. Uh, because I think that's the other important thing in every specialty. If you do the same operation every single day for the rest of your life, you may be missing out on some really other great operations that you could do and would like to do. And you may even be missing out on some opportunities in your own really great operation that could be even better. And so uh I think CME is certainly one of the things that's um that's expanding for me.

SPEAKER_02

Oh, that's awesome. And I appreciate you sharing that. And now that we've gone through your career up to this point, I'd like to just touch on my favorite question. If you could go back and see yourself, you know, day one of med school and give yourself one piece of advice, what would it be?

SPEAKER_01

That's probably the toughest question I've ever had in my life. I think the one piece of advice I would give myself is to thine own self be true. Um, you can't live lives for other people. You can't be who other people want you to be. You just have to be your authentic self. And that has to be good enough, not just for other people, but for you. You have to accept you for who you are. We're all imperfective people. We're all human beings, we all have flaws. And I think uh that once you learn that it's the quality of people that you surround yourself with and not the quantity of people that you surround yourself with, I think your life becomes better instantly. And I think those authentic relationships that you have will take you through the hard times and maybe help you avoid situations that you've gone through that you could have really um avoided. Had you trusted yourself a little more and had a little more insight into who you actually are and who you actually wanted to be, I think that's the that would have been the advice I would have given myself to thine own self be true.

SPEAKER_02

Well, I think that uh highlights a lot of what you said today, stemming from, you know, knowing, maybe not knowing at the time that you were meant to be a surgeon, but a mentor knew it, and then you finally kind of seemed to accept that at one point and and made surgery work for you. And then even reflecting on your experiences, watching your family doctor, you know, spend the extra time with their patients and seeing how you kind of enact that as well in your own practice is really helpful. And it's really good sound advice, I think, for for medical students or pre-medical students that are thinking about a career in medicine. So I really appreciate you sharing that insight.

SPEAKER_01

Thank you.

SPEAKER_02

And that wraps up our episode. So we'd want to thank you again, uh, Dr. Musgrave, for being our guest on our podcast. You're sharing your time, your stories, and your insights into being a surgeon in Northern Ontario, and we really appreciate that. So thank you.

SPEAKER_01

Uh you're very welcome. Very happy to help.