WEBVTT 00:09.980 --> 00:14.800 Before there were hospitals, prescriptions, or medicine as a science, 00:15.080 --> 00:20.400 it was a calling, a promise to heal, to question, and to understand the human 00:20.400 --> 00:25.800 body. Every discovery began with curiosity, and every breakthrough began 00:25.800 --> 00:00:29.096 with someone asking why. From ancient remedies 00:00:29.096 --> 00:31.460 to artificial intelligence, this 00:31.460 --> 00:00:34.716 is where science meets compassion. Welcome 00:00:34.716 --> 00:37.740 to the Aesculapian Society. Today, I'm 00:37.740 --> 00:42.100 honored to welcome Dr. Perel Baral, a cardiothoracic surgeon with St. Clair 00:42.100 --> 00:00:45.510 Medical Group Cardiac Surgery. Dr. Baral completed 00:00:45.510 --> 00:47.760 her general surgery residency at 00:47.760 --> 00:00:50.258 the University of Kansas Medical Center and 00:00:50.258 --> 00:52.640 her cardiothoracic surgery fellowship at 00:52.640 --> 00:00:55.185 Baylor College of Medicine. We're excited to 00:00:55.185 --> 00:57.440 hear about her path into medicine, her 00:57.440 --> 00:01:00.130 experiences in cardiac surgery, and her perspective 00:01:00.130 --> 01:01.660 on the future of heart care, 01:01.900 --> 01:06.420 including artificial intelligence and robotic surgery. Welcome, and thanks for 01:06.420 --> 01:13.000 being on the show. Thanks for having me. So, let's move on to your personal 01:13.000 --> 00:01:15.674 motivation and background. What are your earliest 00:01:15.674 --> 01:17.420 memories of wanting to become a 01:17.420 --> 00:01:20.918 doctor? So, I've wanted to be a doctor since 00:01:20.918 --> 01:23.860 I was very, very young. My mother is 01:23.860 --> 00:01:28.746 a physician. She's an internal medicine doctor, 00:01:28.746 --> 01:32.280 and I was exposed to medicine and 01:32.280 --> 00:01:34.605 being a doctor from a very young age. So, 00:01:34.605 --> 01:36.760 my earliest memory of wanting to be a 01:36.760 --> 01:41.280 doctor is probably when I was like two or three years old. Like, as soon as I 01:41.280 --> 00:01:43.350 understood, like, what a doctor was and, 00:01:43.350 --> 01:45.420 like, could say the word, that's what I 01:45.420 --> 01:49.820 always said I wanted to be. So, how did watching her career influence your 01:49.820 --> 00:01:55.015 interest in medicine? Um, I think I just 00:01:55.015 --> 02:00.080 really, um, was fascinated by her, um, 02:00.800 --> 00:02:03.614 talking about her patients and how she cared 00:02:03.614 --> 02:05.980 for them and the kind of interesting 02:05.980 --> 00:02:09.355 cases she saw. And, um, she was always like 00:02:09.355 --> 02:12.180 a very, she just, I mean, she still 02:12.180 --> 02:17.080 is, but she was always very interested in, you know, being a very astute 02:17.080 --> 00:02:19.921 diagnostician and really getting at the core 00:02:19.921 --> 02:22.180 of, like, what was, what a patient 02:22.180 --> 00:02:25.495 was going through. Um, and also she would reiterate 00:02:25.495 --> 02:27.640 a lot that being a doctor is not 02:27.640 --> 02:30.560 even so much about being the smartest person in the room, but it's a lot about 02:30.560 --> 02:35.480 using common sense and being compassionate. Um, and so, I think that 02:35.480 --> 02:38.940 really influenced me a lot. So, you mentioned wanting to be a doctor from 02:38.940 --> 02:42.740 about two or three years old. When did that interest changed into surgery? 02:44.520 --> 02:49.200 Probably around high school. Um, I, up until that point, had always been 02:49.200 --> 00:02:51.844 interested in being a pediatrician only because 00:02:51.844 --> 02:53.700 I am the oldest of a lot of kids 02:53.700 --> 00:02:55.910 and I've always really enjoyed working with 00:02:55.910 --> 02:57.760 kids and being around children. And 02:57.760 --> 03:01.340 so, that just seemed like the natural progression of being a doctor and liking 03:01.340 --> 00:03:03.835 kids. And so, I was like, oh, I'll be a pediatrician. 00:03:03.835 --> 03:05.200 Um, but I didn't really know 03:05.200 --> 00:03:07.406 what a surgeon was probably until I was in 00:03:07.406 --> 03:09.560 high school. Um, and then when I started 03:09.560 --> 00:03:11.841 to learn about what a surgeon was and did, 00:03:11.841 --> 03:13.960 I was like, oh, that's, that's for me. 03:14.100 --> 03:19.940 That was much more my speed and was fascinating to me. Um, some of my earliest 03:19.940 --> 00:03:22.033 exposure to the field of surgery was just about 00:03:22.033 --> 03:23.680 learning about actually what a heart 03:23.680 --> 00:03:25.796 surgeon was and what a heart surgeon did, 00:03:25.796 --> 03:27.860 especially in the congenital world. Um, 03:27.900 --> 03:32.120 and I just thought that was the most amazing thing, being able to change 03:32.120 --> 00:03:35.168 patient's anatomy. Um, and I just thought that 00:03:35.168 --> 03:37.620 was like the coolest thing ever. And 03:37.620 --> 00:03:41.177 on that very, very basic level is how I became 00:03:41.177 --> 03:43.960 interested in surgery. Um, and so I 03:43.960 --> 00:03:46.597 went into general surgery residency, um, because 00:03:46.597 --> 03:48.520 at the time that I was applying to 03:48.520 --> 00:03:50.880 residency, there actually were a lot less, um, 00:03:50.880 --> 03:52.880 integrated programs. And to be honest, 03:52.960 --> 00:03:54.640 I don't know if I actually would have even 00:03:54.640 --> 03:56.160 wanted to do an integrated program. I 03:56.160 --> 03:58.620 don't know if, if you do know what that is, integrated residency versus 03:58.620 --> 04:03.800 traditional. No. So, there's two pathways to becoming a cardiac surgeon, 04:04.100 --> 00:04:05.927 essentially. One is by doing a general out 00:04:05.927 --> 04:07.580 of medical school. So, you do medical 04:07.580 --> 00:04:09.683 school like everybody does. And then you can 00:04:09.683 --> 04:11.500 either do a general surgery residency 04:11.500 --> 00:04:14.553 and then do a cardiothoracic fellowship after 00:04:14.553 --> 04:16.860 that, which is what I did. Or you 04:16.860 --> 00:04:19.850 can go straight from medical school into 00:04:19.850 --> 04:22.840 an integrated cardiothoracic residency. 04:23.260 --> 04:26.940 Um, and that takes you straight into cardiothoracic surgery. You cannot do any 04:26.940 --> 04:32.380 other type of surgery. Um, so there are a lot more of those programs now that 04:32.380 --> 00:04:36.936 pathway has, um, ballooned a lot in the last, 00:04:36.936 --> 04:40.580 I would say maybe like seven years. 04:41.100 --> 04:46.060 Um, and it didn't, but it didn't really exist so much. There was a couple of 04:46.060 --> 04:50.620 programs, but much, much less. Um, but I really am so glad that I did general 04:50.620 --> 00:04:53.244 surgery residency because it exposed me to 00:04:53.244 --> 04:55.680 a lot of different surgical fields. It 04:55.680 --> 00:04:59.277 gave me a lot broader, uh, experience in surgery, 00:04:59.277 --> 05:01.700 a lot of, uh, more exposure with 05:01.700 --> 05:07.340 trauma and vascular and GI issues, which are things that you deal with as a CT 05:07.340 --> 00:05:09.846 surgeon as well. A lot of, I got a lot of critical 00:05:09.846 --> 05:11.500 care experience. And so, um, I'm 05:11.500 --> 00:05:13.216 really, really grateful for that. So, I have 00:05:13.216 --> 05:14.620 no regrets about the pathway I took 05:14.620 --> 05:19.420 and I, I loved my residency. I had an amazing, amazing residency. Well, thanks 05:19.420 --> 05:23.140 for sharing about your residency, but what's the process you take before 05:23.140 --> 00:05:26.350 residency about your undergrad and medical 00:05:26.350 --> 05:29.560 school? Um, pretty typical, you know, you 05:29.560 --> 05:32.960 can do undergrad, you know, four years of undergrad. Are you asking what I did 05:32.960 --> 00:05:35.633 specifically or what a person should do? 00:05:35.633 --> 05:38.240 Oh, so what I did was, you know, I did 05:38.240 --> 00:05:41.156 four years of undergrad, you know, I, my, 00:05:41.156 --> 05:44.000 um, major was in biology, which is like 05:44.000 --> 00:05:46.389 pretty boring, you know, in terms of like 00:05:46.389 --> 05:48.720 standard, I guess, not boring, but, um, 05:48.840 --> 00:05:50.696 you can major in anything as long as you have 00:05:50.696 --> 05:52.180 all the prerequisites that you need 05:52.180 --> 00:05:55.860 in order to apply to medical school. But, 00:05:55.860 --> 05:59.540 um, I majored in biology and then I went 05:59.540 --> 00:06:02.218 to medical school from college, um, you know, 00:06:02.218 --> 06:04.420 did four years of medical school and 06:04.420 --> 00:06:08.757 then residency. So, how'd you prepare for the 00:06:08.757 --> 06:12.420 MCAT to apply? Oh man, let's see. How 06:12.420 --> 00:06:16.155 did I prepare for the MCAT? Um, I think I took 00:06:16.155 --> 06:19.240 a course actually, which was, yeah, I 06:19.240 --> 00:06:22.165 took a course, um, which originally I was not 00:06:22.165 --> 06:24.700 planning on taking an MCAT course. Um, 06:25.000 --> 06:27.680 because it's like, oh, I'll just like studied on my own. The MCAT that I took 06:27.680 --> 06:33.140 looks very different, I think, from the MCAT now because I took the MCAT in, I 06:33.140 --> 06:40.420 don't know, maybe like 2010, I think, which is quite a while ago. Um, but, um, 06:41.040 --> 00:06:43.125 the MCAT course really helped because the 00:06:43.125 --> 06:45.160 MCAT was not just, and I think a lot of 06:45.160 --> 06:48.540 multiple choice tests are like this. It's not necessarily as much about what 06:48.540 --> 00:06:51.099 information you know, but it's about how to 00:06:51.099 --> 06:53.480 take the exam. And the course taught me 06:53.480 --> 00:06:56.721 how, like the strategy of taking the exam, which 00:06:56.721 --> 06:59.220 helped immensely. Um, so I would say 06:59.220 --> 00:07:01.413 that if you're someone who's thinking about 00:07:01.413 --> 07:03.300 taking the MCAT, uh, definitely look 07:03.300 --> 00:07:06.168 into MCAT courses. I think I took a Kaplan 00:07:06.168 --> 07:08.900 course. So it's true that you left high 07:08.900 --> 00:07:11.872 school early to spend time in Panama? Yes, 00:07:11.872 --> 07:14.560 that is true. I am technically a high 07:14.560 --> 00:07:18.002 school dropout. Um, I never graduated high 00:07:18.002 --> 07:21.280 school and I never got a GED. Um, I was 07:21.280 --> 00:07:23.096 basically encouraged to leave high school 00:07:23.096 --> 07:24.780 early by my mother, who's always done 07:24.780 --> 07:29.760 things a little nontraditionally. Um, and she just thought it would be a good 07:29.760 --> 00:07:32.144 opportunity for me to do something a little 00:07:32.144 --> 07:34.140 different and learn a new language. 07:34.440 --> 00:07:37.039 And I was also kind of, I felt like I'd gotten 00:07:37.039 --> 07:38.960 out of high school, what I needed 07:38.960 --> 00:07:40.870 to get out of it. By that point, I'd kind 00:07:40.870 --> 07:42.780 of gotten all the prerequisites I needed 07:42.780 --> 00:07:45.750 in order to apply to college. Um, and so, 00:07:45.750 --> 07:48.720 and I really wanted to learn Spanish. So 07:48.720 --> 00:07:50.733 the best way to learn a language is to immerse 00:07:50.733 --> 07:52.220 yourself in it, which is to go to 07:52.220 --> 00:07:54.309 a country where they speak that language. So 00:07:54.309 --> 07:56.160 that's what I did. And I did that for, 07:56.160 --> 00:07:58.530 I spent about four months in Panama. Um, I 00:07:58.530 --> 08:00.900 went to a Panamanian high school. I lived 08:00.900 --> 00:08:03.505 with a host family. It was an amazing experience, 00:08:03.505 --> 08:05.100 probably the, one of the most 08:05.100 --> 00:08:06.928 useful things I ever did in my entire life, 00:08:06.928 --> 08:08.500 because now I speak Spanish fluently 08:08.500 --> 00:08:11.424 and I use it to communicate with patients. 00:08:11.424 --> 08:14.000 And it's just generally like, I love 08:14.000 --> 00:08:16.560 learning new languages. So it was a really 00:08:16.560 --> 08:19.060 great thing to do. And it did not affect 08:19.060 --> 00:08:21.689 my ability to get into college or med school 00:08:21.689 --> 08:23.780 at all. So. Did you ever learn any 08:23.780 --> 00:08:27.233 other languages that helped you with patient 00:08:27.233 --> 08:29.980 care? Um, so my mother is Russian. 08:30.200 --> 00:08:32.767 My mother was born in Russia. And so she, we 00:08:32.767 --> 08:35.100 grew up speaking Russian. Um, I've used 08:35.100 --> 08:41.040 Russian in patient care as well. Um, I learned Arabic, um, which I don't speak 08:41.040 --> 00:08:43.159 really anymore, unfortunately, because, you 00:08:43.159 --> 08:45.080 know, if you don't use a language, you 08:45.080 --> 00:08:47.870 lose it. Um, and so I've forgotten most of 00:08:47.870 --> 08:50.660 it since I learned it. Um, I never really 08:50.660 --> 08:55.880 used that much in the U S. Um, I speak Hebrew fluently as well. Um, but that's 08:55.880 --> 00:08:58.986 not that much of a need for that in patient 00:08:58.986 --> 09:02.020 care in the U S either. Okay. So what was 09:02.020 --> 09:05.640 more difficult for you being accepted into medical school or passing it? 09:08.600 --> 00:09:11.440 Oh, being accepted to medical school for sure. 00:09:11.440 --> 09:13.600 Once I was into medical school, it 09:13.600 --> 00:09:15.928 was, I mean, it was hard, but, um, I would 00:09:15.928 --> 09:18.200 say it's much harder to get into medical 09:18.200 --> 00:09:20.764 school than it is to get through medical school. 00:09:20.764 --> 09:22.580 Um, for me, medical school was an 09:22.580 --> 00:09:27.125 environment where I really felt like it kind 00:09:27.125 --> 09:30.740 of played to my strengths a little 09:30.740 --> 00:09:33.670 bit. Like, you know, like you really medical 00:09:33.670 --> 09:36.000 school is just a lot of reading, a 09:36.000 --> 00:09:39.235 lot of studying, um, a lot of like group studying 00:09:39.235 --> 09:41.480 and practice and stuff like that. 09:41.680 --> 00:09:43.825 Um, and then patient interactions, which is 00:09:43.825 --> 09:45.820 like really what I was there for. Um, I 09:45.820 --> 00:09:47.790 loved my rotations like third and fourth 00:09:47.790 --> 09:49.760 year. I just, I was in the hospital all 09:49.760 --> 09:53.360 the time. It was very easy for me back then because I was not married and I 09:53.360 --> 09:57.940 didn't have kids. So I was just able to focus fully a hundred percent on my 09:57.940 --> 00:10:00.840 education. And, um, it probably would have 00:10:00.840 --> 10:03.740 been a lot harder if, and I know a lot of 10:03.740 --> 00:10:05.687 people who have done it with families and kids. 00:10:05.687 --> 10:07.220 It's very hard. There were people in 10:07.220 --> 10:13.240 my class who had, um, you know, who were married and had kids. Uh, but yeah, I 10:13.240 --> 00:10:14.824 mean, I would say it's definitely harder to 00:10:14.824 --> 10:16.260 get in for, for me, it was much harder 10:16.260 --> 10:19.800 to get in and to get through. Looking back, is there anything you wish you had 10:19.800 --> 00:10:23.820 done differently during your pre-med years 00:10:23.820 --> 10:27.840 to help your chances? Um, probably I just 10:27.840 --> 00:10:29.890 didn't know what I didn't know, uh, to get 00:10:29.890 --> 10:31.940 into medical school. I didn't really know 10:31.940 --> 00:10:34.444 like what medical schools were looking for. 00:10:34.444 --> 10:36.540 I didn't really have like a pre-med 10:36.540 --> 00:10:39.314 advisor. I didn't have anyone that was like 00:10:39.314 --> 10:41.700 coaching me through what the process 10:41.700 --> 10:46.420 would be or what medical schools were looking for. Um, if I'd had someone like 10:46.420 --> 00:10:49.493 that kind of earlier on, then I think that 00:10:49.493 --> 10:52.420 definitely would have helped. Um, but I 10:52.420 --> 00:10:55.170 kind of just stumbled through it on my own 00:10:55.170 --> 10:57.920 and thankfully it worked out. But I think 10:57.920 --> 11:01.240 having a little bit more, especially now, I mean, like my understanding now of 11:01.240 --> 00:11:03.944 getting into medical schools, it's just like 00:11:03.944 --> 11:06.280 so cutthroat. Um, and you need like a 11:06.280 --> 00:11:09.646 thousand extracurriculars and all this research. 00:11:09.646 --> 11:11.960 And like, it seems I probably, I 11:11.960 --> 00:11:14.199 don't know, maybe I wouldn't get into medical 00:11:14.199 --> 11:15.940 school now if I applied, you know, 11:16.060 --> 11:22.660 in 2026. But, um, now I think you just need like a lot, you know, like the 11:22.660 --> 00:11:24.940 competition is really fierce, but I think 00:11:24.940 --> 11:27.220 if I'd had a little bit more mentorship, 11:27.220 --> 00:11:29.696 probably that, that would have helped. I think 00:11:29.696 --> 11:31.580 it helps to have that. Okay. Well, 11:31.700 --> 00:11:34.374 thanks for sharing your experience and now 00:11:34.374 --> 11:36.920 moving on to your day-to-day life. As a 11:36.920 --> 00:11:39.198 cardiothoracic surgeon, do you still practice 00:11:39.198 --> 11:40.920 on both the heart or the chest or 11:40.920 --> 00:11:44.550 do you specialize in one area? I primarily 00:11:44.550 --> 11:47.920 operate on the heart. Um, I do all the 11:47.920 --> 11:52.020 kind of what we call bread and butter cardiac surgeries. So coronary bypasses, 11:52.120 --> 11:57.340 valve replacements, aorta replacements. Um, I don't do lung cancer surgery or 11:57.340 --> 00:12:00.475 esophageal cancer surgery, um, or any esophageal 00:12:00.475 --> 12:02.500 or really lung surgery at this 12:02.500 --> 00:12:04.543 point. Um, for that matter, I just, I love 00:12:04.543 --> 12:06.440 the heart and I'm able to focus on the 12:06.440 --> 00:12:08.732 heart, the position that I currently hold. 00:12:08.732 --> 12:10.860 I'm very fortunate that I'm able to do 12:10.860 --> 00:12:14.428 that. Um, and I do, that's what I do. Did you 00:12:14.428 --> 12:17.520 study on both the heart and the chest? 12:19.120 --> 00:12:22.989 Yes, of course. And, and cardiothoracic fellowship, 00:12:22.989 --> 12:25.340 everybody in order to graduate 12:25.340 --> 00:12:28.750 has to operate on both the heart and what 00:12:28.750 --> 12:32.160 we call like thoracic structure. So long 12:32.160 --> 00:12:34.616 esophagus, medius dynum. So what's the reason 00:12:34.616 --> 12:36.580 most doctors either like specialize 12:36.580 --> 12:37.060 in one area? 12:40.260 --> 00:12:42.455 Because it's easier to specialize in one thing 00:12:42.455 --> 12:44.220 than to do everything at this point, 12:44.380 --> 00:12:47.010 you know, like 50, 60, 70, a hundred years 00:12:47.010 --> 12:49.640 ago, a lot of doctors did everything, but 12:49.640 --> 00:12:52.024 now there's just so much specialization and 00:12:52.024 --> 12:54.020 there's just so much more knowledge 12:54.020 --> 00:12:58.499 and things are a little bit more intricate now. 00:12:58.499 --> 13:02.120 So most surgeons will specialize, um, 13:02.760 --> 00:13:06.530 in one area or the other. Most fellowships 00:13:06.530 --> 13:09.940 and training programs are tracked. So 13:09.940 --> 13:15.280 meaning where I was, there were four fellows. It was a very big program. There 13:15.280 --> 00:13:18.870 were four fellows per year. And three of those 00:13:18.870 --> 13:21.680 spots were for cardiac focused, um, 13:22.100 --> 00:13:23.840 trainees. So those who were already knew 00:13:23.840 --> 13:25.580 that they really wanted to focus on the 13:25.580 --> 00:13:29.009 heart. Um, and one spot was for thoracic. Um, 00:13:29.009 --> 13:31.980 and so that's pretty typical. Um, it's 13:31.980 --> 00:13:35.157 not usually that many per program. Most usually 00:13:35.157 --> 13:37.320 it's like one or two fellows in 13:37.320 --> 00:13:40.775 each program, but, um, that is pretty standard. 00:13:40.775 --> 13:43.200 Okay. So what does a typical day 13:43.200 --> 13:49.040 in your life look like from arriving to the hospital and going home? Oh man, 13:49.220 --> 00:13:52.290 there's not really a typical day. Um, but 00:13:52.290 --> 13:55.360 I would say, let's say if I, if I take a 13:55.360 --> 00:14:00.082 day that I'm, um, that I'm operating, um, most 00:14:00.082 --> 14:03.880 days that you operate here, the case 14:03.880 --> 14:08.480 starts at 630. So meaning the patient rolls back to the operating room at 630. 14:08.640 --> 00:14:11.000 And so I try to be in the hospital by six 00:14:11.000 --> 14:13.360 o'clock so that I can go see the patient 14:13.360 --> 14:17.900 before they go to the OR, make sure everything is all good, make sure I can 14:17.900 --> 00:14:20.810 answer any last minute questions. I try to 00:14:20.810 --> 14:23.720 say hello to the patient's family. Um, if 14:23.720 --> 00:14:25.741 they have family that came to accompany them 00:14:25.741 --> 14:27.440 to the hospital, just reassure them, 14:27.520 --> 00:14:29.768 say I'm here. I, if you have any other questions 00:14:29.768 --> 14:31.220 like last minute, I'm happy to 14:31.220 --> 00:14:33.627 answer them. You know, here's where I'll find 00:14:33.627 --> 14:35.660 you after the case. And just kind of, 14:35.840 --> 14:41.420 um, I think that it's nice to like reassure patients that, you know, you're 14:41.420 --> 00:14:43.670 there and to give them the opportunity to 00:14:43.670 --> 14:45.920 ask any last minute questions and to see 14:45.920 --> 00:14:48.770 you. Um, and then usually when a patient rolls 00:14:48.770 --> 14:51.000 back at 630, it takes about an hour 14:51.000 --> 00:14:53.462 to get them set up for the procedure itself. 00:14:53.462 --> 14:55.420 It takes a lot of prep work to get 14:55.420 --> 00:14:57.780 a patient ready for a cardiac operation. 00:14:57.780 --> 15:00.140 So usually after about an hour, they're 15:00.140 --> 00:15:02.838 ready, um, for incision. So I usually start 00:15:02.838 --> 15:05.160 the case at around 730. Um, and then 15:05.160 --> 00:15:07.359 it just depends on what I'm doing. So, you 00:15:07.359 --> 15:09.400 know, if I'm doing like a three vessel 15:09.400 --> 00:15:11.980 bypass, um, that takes a little bit longer 00:15:11.980 --> 15:14.560 than just an aortic, like a simple aortic 15:14.560 --> 00:15:16.878 valve replacement, for example. So, you know, 00:15:16.878 --> 15:18.680 then you're operating for the next 15:18.680 --> 00:15:21.031 few hours and then, um, you know, maybe I'm 00:15:21.031 --> 15:23.000 done with the case anywhere between 15:23.000 --> 00:15:26.470 like 1230, 1 PM, 3 PM. It just depends on 00:15:26.470 --> 15:29.940 what's going on. Um, you know, finish up 15:29.940 --> 00:15:32.842 with the operation. Usually I go straight from 00:15:32.842 --> 15:35.240 the OR to the waiting room to talk to 15:35.240 --> 15:40.000 the family and tell them how things went. Um, and then I go to my office and 15:40.000 --> 00:15:43.828 usually, you know, chart the op report, check 00:15:43.828 --> 15:46.720 up on other patients, things that 15:46.720 --> 00:15:49.939 are going on. Um, and then I go to make sure 00:15:49.939 --> 15:52.500 the patient gets settled nicely in 15:52.500 --> 00:15:55.392 the ICU. Um, check on my other patients, usually 00:15:55.392 --> 15:57.440 in that hour between 630 and 730, 15:57.460 --> 00:15:59.583 I go around that my other patients also, if 00:15:59.583 --> 16:01.460 I have other patients in the ICU. Um, 16:02.000 --> 00:16:04.810 and then, yeah, if I'm on call, you know, 00:16:04.810 --> 16:07.620 deal with any other stuff that comes up. 16:07.780 --> 00:16:10.563 If I'm not on call, then usually I'll just 00:16:10.563 --> 16:13.280 make sure everyone's settled and then go 16:13.280 --> 00:16:15.647 home. Just, and what time I go home just really 00:16:15.647 --> 16:17.360 depends on what's going on in the 16:17.360 --> 16:22.500 hospital. Um, that can be anywhere from 430, 16:22.720 --> 00:16:24.873 five o'clock, six o'clock, seven o'clock. 00:16:24.873 --> 16:26.920 It just really depends. Um, if I'm not 16:26.920 --> 16:32.180 operating, then I can come in, you know, see my patients. Usually I have some 16:32.180 --> 16:36.580 clinic patients to see if it's a clinic day or, um, some days I have patients 16:36.580 --> 00:16:39.243 added on if it's not a clinic day. Um, and 00:16:39.243 --> 16:41.780 then I'm just available. We're all, you 16:41.780 --> 00:16:44.751 know, all of us in the group are available 00:16:44.751 --> 16:47.580 to help each other for, for cases or to 16:47.580 --> 00:16:50.628 cover each other as needed. So, um, you just 00:16:50.628 --> 16:53.260 kind of have to go with the flow. And 16:53.260 --> 00:16:55.949 then when I go home, you know, then I'm, then 00:16:55.949 --> 16:58.100 I'm the mom and the wife and I help 16:58.100 --> 17:02.260 my husband out with the kids and, you know, get everyone fed and put them to 17:02.260 --> 00:17:05.418 sleep and, and all that. And then I, you know, 00:17:05.418 --> 17:07.820 spend some time, try to spend some 17:07.820 --> 00:17:10.300 time with my husband. So could you walk me 00:17:10.300 --> 17:12.720 through like a common surgical procedure 17:12.720 --> 17:20.480 that you do in language that I could understand? Sure. Um, so I would say 17:20.480 --> 00:17:22.211 coronary bypass is one of the operations I 00:17:22.211 --> 17:23.860 probably do the most and I really enjoy 17:23.860 --> 17:31.380 doing it. Um, essentially what that involves is the first part of the 17:31.380 --> 17:40.160 operation is actually, uh, harvesting conduit, um, for the bypass itself. So 17:40.160 --> 00:17:42.878 what a bypass is, is when a patient's heart, 00:17:42.878 --> 17:45.040 which has arteries that supply the 17:45.040 --> 00:17:47.420 heart muscle itself, um, sometimes those 00:17:47.420 --> 17:49.800 little arteries get blocked. And so the 17:49.800 --> 00:17:52.740 heart muscle is not able to receive the nutrients 00:17:52.740 --> 17:54.660 and oxygen it needs. And so the 17:54.660 --> 00:17:56.805 heart can become weak and that, you know, patients 00:17:56.805 --> 17:58.220 can get heart attacks from that. 17:58.820 --> 00:18:01.380 Um, and so what I do is I don't remove the 00:18:01.380 --> 18:03.880 blockages, the blockages stay where they 18:03.880 --> 00:18:07.228 are. So, um, what I do is actually create a 00:18:07.228 --> 18:10.420 new pathway around the blockage. Um, and 18:10.420 --> 00:18:13.456 in order to do that, you need some sort of 00:18:13.456 --> 18:16.420 tube, right? That can bring blood from a 18:16.420 --> 18:24.740 source of blood, which is usually the aorta, um, or, uh, a vein, sorry, the 18:24.740 --> 18:26.860 source of blood, which is the aorta. So you need some kind of like either an 18:26.860 --> 18:33.740 artery or a vein. Um, and so we most typically use veins from the patient's 18:33.740 --> 18:39.400 leg. Um, and then an artery from, uh, underneath the sternum or the breastbone 18:39.400 --> 18:44.560 called the internal thoracic artery or the internal mammary artery. Um, and so 18:44.560 --> 00:18:47.183 usually I have a physician's assistant that 00:18:47.183 --> 18:49.440 will be harvesting the vein from the 18:49.440 --> 00:18:51.596 leg while I am harvesting the artery from 00:18:51.596 --> 18:53.700 underneath the breastbone. So the first 18:53.700 --> 00:18:56.565 part of the operation is just obtaining that 00:18:56.565 --> 18:59.040 conduit. Um, and then once that's all 18:59.040 --> 19:04.460 done, um, the patient's ready to actually be put on bypass. So most cardiac 19:04.460 --> 19:10.220 operations are done what we call on pump. Um, and what the pump is, is it's a 19:10.220 --> 19:16.320 machine that takes over the function of the heart and lungs. Um, and why do we 19:16.320 --> 00:19:18.791 need that? Well, a lot of times during a 00:19:18.791 --> 19:21.200 cardiac operation, the heart has to be 19:21.200 --> 00:19:23.750 stopped in order to be able to work on it. 00:19:23.750 --> 19:26.300 Um, and so we need to be able to keep the 19:26.300 --> 19:30.500 patient alive while the heart is not pumping blood. So what we do is, is we 19:30.500 --> 00:19:33.290 hook the patient up to this heart-lung bypass 00:19:33.290 --> 19:35.460 machine, which does the job of the 19:35.460 --> 19:39.060 heart and the lungs. And it allows the heart and the lungs essentially to be 19:39.060 --> 00:19:40.906 turned off. We turn the heart and lungs off. 00:19:40.906 --> 19:42.500 The patient's heart and lungs are not 19:42.500 --> 19:47.300 functioning while I do the operation. Um, and the machine is pumping the blood 19:47.300 --> 19:52.080 through their body. So we hook the patient up to that machine. Once we put the 19:52.080 --> 00:19:54.538 patient up to that machine, um, we stopped 00:19:54.538 --> 19:56.820 the heart. Um, and then I make all the 19:56.820 --> 20:02.120 little connections I make, I sew, um, the connections between that vein or the 20:02.120 --> 00:20:04.852 artery that I harvested in the heart. Um, and 00:20:04.852 --> 20:07.220 then once all the connections are, are 20:07.220 --> 20:13.640 done, then I restart the heart, heart starts beating again. Um, you know, I'm 20:13.640 --> 20:18.020 working very, very closely with the anesthesiologist. We have specialized 20:18.020 --> 00:20:22.524 cardiac anesthesiologists, um, who are, uh, 00:20:22.524 --> 20:26.400 specialized in working with patients 20:26.400 --> 00:20:29.051 who are undergoing cardiac surgery. They can 00:20:29.051 --> 20:31.400 do other things, but we only work with 20:31.400 --> 00:20:34.460 anesthesiologists who specifically do cardiac 00:20:34.460 --> 20:36.840 operations because they need to be 20:36.840 --> 00:20:39.857 experienced in, uh, working with patients 00:20:39.857 --> 20:42.800 who have heart disease and whose hearts 20:42.800 --> 20:45.920 are stopped. And while the hearts are stopped, we work, you know, and while 20:45.920 --> 20:48.740 they're on bypass, we work very closely with the perfusionist. And the 20:48.740 --> 00:20:51.505 perfusionist is the specialist that runs 00:20:51.505 --> 20:54.200 that heart-lung bypass machine. Um, so 20:54.200 --> 00:20:56.167 there are a lot of people in a cardiac surgery 00:20:56.167 --> 20:57.620 operating room. It's not just you 20:57.620 --> 21:01.840 and the anesthesiologist. It's the surgeon, anesthesiologist. Usually there's 21:01.840 --> 21:07.860 a, uh, like a CRNA, which is a nurse anesthetist. Um, that's there for most of 21:07.860 --> 21:13.220 the case and the perfusionist. Um, of course the scrub tech is the one that 21:13.220 --> 00:21:14.860 hands me the instruments during the case. 00:21:14.860 --> 21:16.420 And they're really, I was going to say 21:16.420 --> 00:21:19.083 instrumental and I didn't want that to be a 00:21:19.083 --> 21:21.560 pun, but they are instrumental. Um, and 21:21.560 --> 00:21:24.100 then there's usually a nurse or two, what 00:21:24.100 --> 21:26.640 we call the circulator, um, whose job it 21:26.640 --> 21:29.660 is to basically keep the room running because, you know, everyone that's 21:29.660 --> 00:21:32.575 scrubbed in is sterile and we can't go and 00:21:32.575 --> 21:35.420 like grab an instrument or grab a suture 21:35.420 --> 21:39.600 or grab a, um, any other kind of, um, material that we need during the 21:39.600 --> 00:21:41.707 procedure. So their job is to be able to keep 00:21:41.707 --> 21:43.440 us is to allow us to be able to stay 21:43.440 --> 21:47.740 sterile during the operation. So the nurses are really, um, really, really 21:47.740 --> 00:21:51.116 important part, um, of any cardiac or any operating 00:21:51.116 --> 21:53.300 room in general. Um, but I think 21:53.300 --> 21:57.480 one of the new things about cardiac surgery is just really how closely the 21:57.480 --> 00:21:59.739 whole team works together. It's really, really 00:21:59.739 --> 22:01.360 important to, for everyone to be 22:01.360 --> 00:22:03.695 able to communicate clearly. Um, and the surgeon 00:22:03.695 --> 22:05.300 is kind of like the conductor of 22:05.300 --> 00:22:07.940 that whole orchestra. So, um, but to go back 00:22:07.940 --> 22:10.100 to what I was saying, so, you know, 22:10.160 --> 22:13.440 we restart the heart, the heart starts beating again. I'm talking to the 22:13.440 --> 22:16.240 anesthesiologist, making sure everything looks good. I'm talking to the 22:16.240 --> 00:22:19.191 perfusionist, making sure on their end, things 00:22:19.191 --> 22:21.500 look good. Um, and then once I feel 22:21.500 --> 22:24.640 the patient's ready to be disconnected from the bypass machine, you know, the 22:24.640 --> 00:22:26.842 heart's beating, the lungs are turned back on 00:22:26.842 --> 22:28.800 again. So the patient's lungs are being 22:28.800 --> 00:22:31.408 ventilated through the ventilator machine. Um, 00:22:31.408 --> 22:33.620 then I disconnect the patient from the 22:33.620 --> 00:22:36.059 heart-lung bypass machine. Um, and as long 00:22:36.059 --> 22:38.440 as everything looks good, then you close 22:38.440 --> 22:43.560 the patient up. We use typically wires, stainless steel wires to close the 22:43.560 --> 00:22:47.501 patient's bone to put it back together. Um, 00:22:47.501 --> 22:50.800 and then, you know, suture the skin 22:50.800 --> 00:22:53.178 back up and that's it. And we get them off 00:22:53.178 --> 22:55.500 the operating table and taking them back 22:55.500 --> 22:59.860 to the ICU where they recover. So after the surgery is done, there's like two 22:59.860 --> 23:04.180 outcomes, either the, either it's successful or unsuccessful. How do you 23:04.180 --> 00:23:06.402 handle the emotional side of medicine that 00:23:06.402 --> 23:08.360 includes complications and difficult 23:08.360 --> 00:23:12.713 outcomes? Well, I think first of all, you 00:23:12.713 --> 23:16.960 have to kind of, uh, maybe clarify what 23:16.960 --> 23:22.500 you mean by unsuccessful. Um, I guess maybe that term applies differently in 23:22.500 --> 23:28.840 different situations, but you know, if I'm doing a heart-lung bypass, sorry, 23:29.000 --> 23:35.080 doing a coronary bypass procedure. Um, I guess success is measured by how well 23:35.080 --> 00:23:38.598 those bypasses stay open. Um, and how well the 00:23:38.598 --> 23:41.580 patient is able to avoid heart attacks 23:41.580 --> 00:23:44.617 in the future and heart failure. Um, and so 00:23:44.617 --> 23:47.300 by that measure, the vast majority of 23:47.300 --> 00:23:50.180 coronary bypass procedures are successful. 00:23:50.180 --> 23:53.060 It's very, very, very, very rare, um, for 23:53.060 --> 00:23:55.590 none of the bypasses to be open or for the 00:23:55.590 --> 23:58.120 patient to get a heart attack right after 23:58.120 --> 24:01.680 the procedure or very soon after the procedure. It's very uncommon. It does 24:01.680 --> 00:24:04.780 happen. It's very uncommon. Um, but there 00:24:04.780 --> 24:07.880 are other complications that can happen. 24:08.060 --> 00:24:11.250 Um, and I tell patients that before every 00:24:11.250 --> 24:14.440 surgery, because every surgery has risks 24:14.440 --> 00:24:17.240 and you, I only operate when I feel that 00:24:17.240 --> 24:20.040 the benefits outweigh the risks. Um, so 24:20.040 --> 00:24:22.952 every surgery involves complications such as 00:24:22.952 --> 24:25.600 infection, bleeding. Um, if someone has 24:25.600 --> 00:24:26.990 enough bleeding, sometimes they have to go 00:24:26.990 --> 24:28.280 back to the operating room for another 24:28.280 --> 00:24:32.720 operation to stop the bleeding and to wash, 00:24:32.720 --> 24:36.540 wash them out. Um, you can have lung 24:36.540 --> 00:24:39.143 complications. Patients can get pneumonia. 00:24:39.143 --> 24:41.560 Um, patients can require oxygen for an 24:41.560 --> 24:44.940 extended period of time after surgery. Patients can have kidney complications, 24:44.940 --> 00:24:47.000 um, meaning they might have some degree of 00:24:47.000 --> 24:49.060 kidney failure afterwards to have that be 24:49.060 --> 00:24:52.981 a very serious thing is very rare, but it does 00:24:52.981 --> 24:56.220 happen. Um, and stroke, um, is one of 24:56.220 --> 25:02.180 the other things that can happen after a cardiac surgery as well. All of these 25:02.180 --> 00:25:05.469 complications on an individual level are very 00:25:05.469 --> 25:08.100 rare. Um, all of them together also 25:08.100 --> 25:15.440 are not as common, but they are things that definitely happen. Um, and it can 25:15.440 --> 00:25:18.503 definitely be frustrating when they happen 00:25:18.503 --> 25:21.420 because you only want the best for your 25:21.420 --> 00:25:24.350 patient and you're operating on them because 00:25:24.350 --> 25:26.680 you want them to have a longer and 25:26.680 --> 00:25:29.941 or better quality of life than they had before. 00:25:29.941 --> 25:32.300 Um, and so you don't want that to 25:32.300 --> 00:25:36.240 be complicated by having to deal with, you 00:25:36.240 --> 25:40.180 know, prolonged ICU stay, infections, um, 25:40.720 --> 25:43.580 you know, stroke complications, things like that, but it does happen. And the 25:43.580 --> 25:48.780 main way that I tried to deal with complications like that is just by 25:48.780 --> 25:53.720 treating the patient, you know, you can't get frustrated about something that 25:53.720 --> 00:25:55.703 happens with the patient, you know, that starts 00:25:55.703 --> 25:57.180 to become evident that the patient 25:57.180 --> 26:02.780 is having, um, you know, a need for dialysis or something like that. You can't 26:02.780 --> 26:05.120 just be like annoyed about it. You have to be like, okay, we got to treat the 26:05.120 --> 00:26:06.586 patient. We're going to get nephrology on 00:26:06.586 --> 26:07.980 board. We're going to get them access. 26:08.280 --> 26:11.680 We're going to do what we need to do in order to get them treated and get them 26:11.680 --> 00:26:13.910 better. And the vast majority of time, the 00:26:13.910 --> 26:16.140 patients recover from these complications 26:16.140 --> 00:26:18.927 as well, which is great. Um, but you know, even 00:26:18.927 --> 26:21.180 small things, for example, like let's 26:21.180 --> 00:26:23.092 say a patient comes back to clinic and it's, 00:26:23.092 --> 26:24.700 I can see on their x-ray, their kind 26:24.700 --> 00:26:26.877 of post-op, their two-week post-op x-ray 00:26:26.877 --> 26:29.000 that they have, um, a fluid collection 26:29.000 --> 00:26:30.790 around their lungs, which happens, doesn't 00:26:30.790 --> 26:32.580 happen all the time, but it happens. It's 26:32.580 --> 00:26:34.480 frustrating. Like, I don't want them to have 00:26:34.480 --> 26:36.120 another little procedure to have that 26:36.120 --> 00:26:37.586 fluid removed, but like, you just have to treat 00:26:37.586 --> 26:38.740 the patient, you know, just be like, 26:38.820 --> 00:26:40.587 okay, we're going to get this drained. You're 00:26:40.587 --> 26:42.000 going to get better. And it's going 26:42.000 --> 00:26:43.913 to be done. Like, we can't just be like upset 00:26:43.913 --> 26:45.400 about it. You know, there's no use 26:45.400 --> 00:26:46.738 crying about it. You just got to treat the 00:26:46.738 --> 26:47.980 patient and get them better. You know, 26:48.040 --> 00:26:50.941 that's why you're their doctor. So that's 00:26:50.941 --> 26:53.700 how I try to try to think about it. So 26:53.700 --> 00:26:57.195 during surgery, do you use AI and robotics 00:26:57.195 --> 27:00.440 to help you? Not during the operation. 27:00.760 --> 00:27:03.289 During the operation, things are still relatively 00:27:03.289 --> 27:04.940 old school. You know, it's just 27:04.940 --> 00:27:08.567 you and your hands and the instruments and your 00:27:08.567 --> 27:11.500 brain, um, you know, doing things the 27:11.500 --> 27:17.040 way that we've been doing them more or less for the last, I don't know, 20, 30 27:17.040 --> 27:20.020 something years. I mean, with updates, you know, obviously there's like new 27:20.020 --> 00:27:23.481 techniques and new instruments and new materials. 00:27:23.481 --> 27:25.600 Um, but right now in the open 27:25.600 --> 27:31.440 heart space, we don't use a lot of, um, like AI or some people do robotics. I 27:31.440 --> 00:27:34.041 mean, where I trained in fellowship, we did 00:27:34.041 --> 27:36.340 robotic heart surgery. Um, I don't do 27:36.340 --> 00:27:38.173 that here, but, um, there are places that do 00:27:38.173 --> 27:39.840 it. That's still like a little bit more 27:39.840 --> 27:47.300 niche. Um, one way that I do use AI sometimes is just in, um, doing research, 27:47.640 --> 00:27:50.303 prepping for a case. You know, if I have a 00:27:50.303 --> 27:52.840 patient that, excuse me, I encounter in 27:52.840 --> 00:27:55.590 consult, um, who, you know, every patient 00:27:55.590 --> 27:58.340 is different. So sometimes you'll have a 27:58.340 --> 00:28:00.730 patient who, um, presents a challenge in terms 00:28:00.730 --> 28:02.600 of trying to figure out like what's 28:02.600 --> 00:28:05.895 the best option for them, surgical or non -surgical, 00:28:05.895 --> 28:07.860 or what's the best surgical in 28:07.860 --> 28:11.800 terms of a few different types of operations. And so I do use AI, um, to 28:11.800 --> 00:28:15.030 help me gather data. Um, and then I can make 00:28:15.030 --> 28:17.820 a better decision by, you know, being 28:17.820 --> 00:28:19.399 up to date on guidelines and things like that, 00:28:19.399 --> 28:20.600 because things are changing a lot. 28:20.720 --> 00:28:22.160 And sometimes I'm like, you know, I don't really 00:28:22.160 --> 28:23.240 know. I don't remember exactly like 28:23.240 --> 28:27.440 what was the guideline on this particular issue or, um, have there been other 28:27.440 --> 00:28:29.120 instances or other cases of this and where 00:28:29.120 --> 28:30.600 it used to be that I would do like a 28:30.600 --> 00:28:32.290 PubMed search on that. And it would take a 00:28:32.290 --> 28:33.980 long time because you're sifting yourself 28:33.980 --> 00:28:37.667 through all these different papers. Um, but 00:28:37.667 --> 28:40.840 now there's different AI models that 28:40.840 --> 28:45.800 will help you gather and synthesize that data. So that can help a lot. Heart 28:45.800 --> 00:28:48.290 surgery is often viewed as one of the most technically 00:28:48.290 --> 28:49.720 difficult careers in medicine. 28:50.060 --> 00:28:52.715 How much of succeeding in the profession depends 00:28:52.715 --> 28:54.540 on academic ability and how much 28:54.540 --> 00:28:57.969 depends on communication? Um, well, I think 00:28:57.969 --> 29:00.920 you mentioned three different things 29:00.920 --> 00:29:04.570 because you mentioned, uh, technically challenging 00:29:04.570 --> 29:06.760 or technically demanding, um, 29:07.060 --> 00:29:08.963 academics and communication. I think those 00:29:08.963 --> 29:10.640 are three very different things. Um, 29:10.940 --> 00:29:15.352 because, uh, academics, meaning like how well 00:29:15.352 --> 29:18.980 you can answer a question on a test, 29:19.120 --> 29:24.280 um, that can be taught. Um, and some patients—some people are 29:24.280 --> 00:29:26.637 not very inherently good at that. Um, and it 00:29:26.637 --> 29:28.780 doesn't mean that they're not smart. It 29:28.780 --> 00:29:30.985 just means that their brain is just not wired 00:29:30.985 --> 29:32.700 as well for multiple choice tests. 29:33.000 --> 29:37.540 Um, and those same people can be very, very good at interacting with patients, 29:37.780 --> 00:29:39.520 have excellent bedside manner, have a lot 00:29:39.520 --> 29:41.260 of common sense, have excellent clinical 29:41.260 --> 00:29:44.190 judgment. Um, and with that also goes like 00:29:44.190 --> 29:46.980 really good communication. Um, and then 29:46.980 --> 00:29:49.896 there's the skill aspect, which just has to 00:29:49.896 --> 29:52.540 do with like how dexterous you are and 29:52.540 --> 00:29:55.218 how well you are able to like execute all 00:29:55.218 --> 29:57.700 the fine movements that are needed in 29:57.700 --> 30:01.400 order to do a cardiac operation, which, yeah, I would say, I would agree that 30:01.400 --> 30:05.200 cardiac surgery is probably one of the more technically demanding surgical 30:05.200 --> 30:14.680 specialties. Um, and I think that skill can be improved upon. I think it 30:14.680 --> 30:20.120 definitely helps to have some innate ability and some innate dexterity. Um, 30:20.980 --> 00:30:26.819 and, but having common sense, compassion, um, 00:30:26.819 --> 30:31.880 good clinical judgment, I think all of 30:31.880 --> 00:30:33.697 those things are really hard to teach. And 00:30:33.697 --> 30:35.340 those are some of the things that are 30:35.340 --> 30:40.960 actually the most important in being a good cardiac surgeon, because I have 30:40.960 --> 00:30:44.384 worked with surgeons in the past who are technically 00:30:44.384 --> 30:46.360 very good. They can do a very 30:46.360 --> 00:30:49.408 technically beautiful operation, but they have 00:30:49.408 --> 30:51.860 very poor clinical judgment, meaning 30:51.860 --> 30:56.320 that they will operate on people who really should not have surgery and they 30:56.320 --> 00:30:58.915 can do a lot of harm in that way. Um, and 00:30:58.915 --> 31:01.320 so I think a really important part of 31:01.320 --> 00:31:03.060 being a heart surgeon, a really important 00:31:03.060 --> 31:04.800 part of being any type of surgeon or any 31:04.800 --> 00:31:07.781 type of doctor is knowing when to do something 00:31:07.781 --> 31:09.920 and when not to do something and 31:09.920 --> 00:31:14.517 allowing yourself to execute that, uh, sort 00:31:14.517 --> 31:18.580 of judgment. Um, and communication of 31:18.580 --> 00:31:20.602 course is always like a huge part of it. I 00:31:20.602 --> 31:22.480 would say in CT surgery, probably even 31:22.480 --> 00:31:24.858 more than in other specialties, because we work 00:31:24.858 --> 31:26.780 so closely with other specialties as, 31:26.980 --> 31:34.460 uh, a general surgeon, perhaps I would say we work a lot less with medicine 31:34.460 --> 00:31:36.638 specialties. Um, and it's, it doesn't make 00:31:36.638 --> 31:38.660 as much of a difference to have like a 31:38.660 --> 31:42.780 really close relationship with the anesthesiology, but, um, CT surgeons work 31:42.780 --> 00:31:45.983 very closely with cardiology, work very closely 00:31:45.983 --> 31:48.300 with anesthesia, um, very closely 31:48.300 --> 00:31:51.199 with critical care. Um, and so I think that 00:31:51.199 --> 31:53.760 being able to communicate and be part 31:53.760 --> 00:31:56.513 of that bigger multidisciplinary team is really, 00:31:56.513 --> 31:58.520 really, really important. It makes 31:58.520 --> 00:32:00.899 a huge difference for your patients. So, um, 00:32:00.899 --> 32:02.900 I think recognizing that you're part 32:02.900 --> 00:32:05.867 of a bigger team is, is really important. Okay. 00:32:05.867 --> 32:08.140 So are there any sacrifices of this 32:08.140 --> 32:13.760 career that students do not hear about often enough? Um, 32:17.100 --> 00:32:19.436 there are huge sacrifices. Uh, I don't know 00:32:19.436 --> 32:21.500 if students hear about them or not. I 32:21.500 --> 00:32:24.213 would say that I, I probably did not understand 00:32:24.213 --> 32:26.060 the magnitude of the sacrifices 32:26.060 --> 32:28.800 that I would have to make in order to do this job. You know, like I made the 32:28.800 --> 00:32:31.210 decision to be a heart surgeon when I was very 00:32:31.210 --> 32:33.200 young and I just kind of pursued that 32:33.200 --> 32:40.240 very persistently, um, without really understanding what exactly it involved. 32:41.100 --> 00:32:44.952 Um, I think that there are really big sacrifices 00:32:44.952 --> 32:47.520 in terms of your personal life, 32:47.700 --> 00:32:51.220 your social life, your family life, um, that 00:32:51.220 --> 32:54.100 have to be made. I think as a woman 32:54.100 --> 32:58.360 in surgery, there's no avoiding the fact that you're going to make really big 32:58.360 --> 00:33:01.279 sacrifices in terms of family. Um, I think 00:33:01.279 --> 33:03.920 that I don't feel that I've ever been 33:03.920 --> 33:08.360 discriminated against, um, as a woman surgeon. I never felt that I was ever 33:08.360 --> 33:12.720 discriminated against as a resident or as a fellow. I feel, again, this is my 33:12.720 --> 00:33:16.309 personal experience that I was always treated 00:33:16.309 --> 33:19.100 with a lot of respect, um, and was 33:19.100 --> 33:24.920 treated by my attendings and my co -residents, um, no differently because I 33:24.920 --> 33:30.440 was a woman. However, um, I think that people don't appreciate or understand 33:30.440 --> 33:34.760 really like, it's just very, it's very, very difficult if you want to have a 33:34.760 --> 00:33:37.166 family, if you want to have kids being pregnant, 00:33:37.166 --> 33:38.820 doing this job, having a newborn 33:38.820 --> 00:33:42.354 doing this job is extremely difficult. Um, 00:33:42.354 --> 33:45.720 and I'm doing it. I'm, I'm currently, I 33:45.720 --> 00:33:49.212 have two young children and I'm expecting a 00:33:49.212 --> 33:52.460 third in about five weeks. Um, and it's 33:52.460 --> 33:57.960 very hard, but it's definitely doable. Um, if you, it's helps to have a very 33:57.960 --> 34:04.200 supportive and involved partner. Um, my husband's amazing. Um, but it's very, 34:04.360 --> 00:34:07.820 very, very, very, very hard. And I am not, 00:34:07.820 --> 34:11.280 I would encourage anyone that wants to go 34:11.280 --> 00:34:14.681 into the specialty to, you know, pursue it 00:34:14.681 --> 34:17.920 and talk to as many people as possible. 34:18.560 --> 00:34:21.082 Um, but you know, so that you can get a sense 00:34:21.082 --> 34:23.100 of if this is really something that 34:23.100 --> 00:34:26.290 you want to do. Um, but you know, I love 00:34:26.290 --> 34:29.480 my job. I'm very, very fortunate that I 34:29.480 --> 00:34:33.030 get to help people in this way every day. 00:34:33.030 --> 34:36.580 And I really value being able to be part 34:36.580 --> 00:34:39.286 of the people's lives that I helped in the way 00:34:39.286 --> 34:41.580 that I am. Um, and it can be extremely 34:41.580 --> 00:34:44.887 gratifying. Um, but yeah, it's very hard. You 00:34:44.887 --> 34:47.680 make a lot of sacrifices. I spent the 34:47.680 --> 34:53.400 entirety of my twenties, you know, studying and in the library, I was 34:53.400 --> 00:34:55.353 probably not at all as good at having like 00:34:55.353 --> 34:57.120 more of a social life as I could have 34:57.120 --> 00:34:58.564 been. There's definitely people who are in 00:34:58.564 --> 34:59.940 med school who are not studying all the 34:59.940 --> 00:35:01.788 time. Like people are in med school and have 00:35:01.788 --> 35:03.300 lives outside of med school and you 35:03.300 --> 00:35:06.388 can 100% do that. Um, I just like, didn't really 00:35:06.388 --> 35:08.640 know how to do that. I didn't know 35:08.640 --> 35:13.560 that that was like an option. So I sacrificed like, you know, a decade or 35:13.560 --> 00:35:15.417 more. I mean that, you know, my entire twenties 00:35:15.417 --> 35:16.760 I spent like in school, you know, 35:16.860 --> 00:35:20.900 so, and as a resident. So, um, you know, but 00:35:20.900 --> 35:24.480 I don't have any regrets and I just, I 35:24.480 --> 00:35:26.680 think that it's good for people to know what 00:35:26.680 --> 35:28.580 the options are and like what they're 35:28.580 --> 35:33.720 getting themselves into. Well, first, congratulations. And, uh, Thank you. 35:33.720 --> 00:35:36.006 Second, you mentioned you had a family and 00:35:36.006 --> 35:38.020 you need to support that. So for you 35:38.020 --> 00:35:40.140 personally, what percent of being a doctor 00:35:40.140 --> 35:42.260 is about the money versus helping people? 35:45.500 --> 00:35:48.481 I mean, I would say like, don't go into the, 00:35:48.481 --> 35:50.920 don't go into this if money is your 35:50.920 --> 00:35:53.340 only motivation, because it's going to be 00:35:53.340 --> 35:55.760 very disappointing. I would say, I'm not 35:55.760 --> 00:35:57.622 going to lie and say, as a CT surgeon, I don't 00:35:57.622 --> 35:59.080 make good money. I make good money. 35:59.220 --> 00:36:02.685 CT surgeons are some of the most highly paid 00:36:02.685 --> 36:05.520 physicians. Um, so I think that I'm 36:05.520 --> 00:36:09.322 very fortunate in that aspect. Um, but a lot 00:36:09.322 --> 36:12.520 of other specialties are not as well 36:12.520 --> 00:36:14.919 paid at all. Um, and it doesn't mean that 00:36:14.919 --> 36:17.260 they don't work as hard. Um, it doesn't 36:17.260 --> 00:36:19.691 mean that they don't help people as much or 00:36:19.691 --> 36:21.840 more than I do. Um, it's just the way 36:21.840 --> 00:36:24.051 the system works, unfortunately, and the way 00:36:24.051 --> 36:25.960 that, uh, healthcare reimbursement in 36:25.960 --> 00:36:30.108 this country goes. Um, so I would say that 00:36:30.108 --> 36:33.860 a very, I would say it's more helping 36:33.860 --> 00:36:36.670 people versus the money, because if it was 00:36:36.670 --> 36:39.480 just the money, then I would do something 36:39.480 --> 36:43.040 else. You know, like there's a lot of other ways to make a lot more money than 36:43.040 --> 36:49.180 to be a heart surgeon. I mean, like for the money alone, it is not worth the 36:49.180 --> 00:36:51.190 stress and the time. I mean, like being a 00:36:51.190 --> 36:53.200 heart surgeon is unbelievably stressful. 36:53.720 --> 36:59.360 Um, your patients are very, very, very, very sick. Um, and being on call as a 36:59.360 --> 00:37:01.188 heart surgeon, I mean, you have to be ready 00:37:01.188 --> 37:02.760 to just drop everything you're doing 37:02.760 --> 00:37:06.305 at the, you know, at a moment's notice. Um, 00:37:06.305 --> 37:09.520 and that is very stressful. So yeah, I 37:09.520 --> 00:37:11.925 would say if you want to do this, you have 00:37:11.925 --> 37:14.100 to be very strongly motivated to help 37:14.100 --> 00:37:16.680 people. Um, and only minimally motivated 00:37:16.680 --> 37:19.260 by the money because the money alone is 37:19.260 --> 37:24.100 not going to get you there. So if a student has the passion, do you believe 37:24.100 --> 37:27.680 medicine is still a good career if they need to borrow money to complete their 37:27.680 --> 00:37:30.585 education? Yeah, of course. I mean, I had to 00:37:30.585 --> 37:33.160 borrow money to complete my education. 37:33.160 --> 00:37:36.186 I'm still paying off my student loans and, 00:37:36.186 --> 37:39.140 you know, that's just a part of my life. 37:39.200 --> 00:37:42.672 But, um, if someone has the passion and the 00:37:42.672 --> 37:45.740 drive and the, um, the willingness to 37:45.740 --> 00:37:48.908 do the work that it takes, then I 100% think 00:37:48.908 --> 37:51.500 that medicine being a physician is, 37:51.720 --> 00:37:56.615 is a good path to take. Um, but I think it's 00:37:56.615 --> 38:00.620 the, the landscape of healthcare is 38:00.620 --> 38:03.280 changing a lot. So I'm not sure how, you know, where it's going to go over the 38:03.280 --> 00:38:07.198 next, you know, 10, 15, 20 years. Um, but I, 00:38:07.198 --> 38:10.760 you know, there's already a shortage of 38:10.760 --> 38:14.320 physicians in this country and that shortage is only going to get worse. So I 38:14.320 --> 00:38:17.803 think it's, it's still a very worthy field 00:38:17.803 --> 38:21.120 to pursue. So do you see AI and robotic 38:21.120 --> 00:38:23.744 surgery as threats to medical careers or tools 00:38:23.744 --> 38:25.740 that will change for the future of 38:25.740 --> 38:30.400 medicine? I don't think it's a threat. I think it's a tool that will change 38:30.400 --> 38:37.380 medicine and in a lot of ways can make, make it, make our ability to help 38:37.380 --> 00:38:40.610 patients. It'll expand our ability to help patients. 00:38:40.610 --> 38:42.660 So it'll make it better. Um, and 38:42.660 --> 38:46.880 I think as with all technological advances, like it's not worth fighting 38:46.880 --> 00:38:48.958 because it's going to happen whether you like 00:38:48.958 --> 38:50.620 it or not. And so you might as well 38:50.620 --> 00:38:54.186 get on board and figure out how it can benefit 00:38:54.186 --> 38:56.900 your ability to help patients, um, 38:57.180 --> 00:39:00.170 rather than just, you know, taking a stand 00:39:00.170 --> 39:03.160 and refusing to allow yourself to be, you 39:03.160 --> 00:39:07.680 know, um, helped because it's just not the 00:39:07.680 --> 39:12.200 way technology goes, you know, people who 39:12.200 --> 00:39:15.380 are, people who refuse to, you know, use 00:39:15.380 --> 39:18.560 technology or just, it just, it doesn't 39:18.560 --> 00:39:21.820 help you. So if your children someday told 00:39:21.820 --> 39:25.080 you that they want to be a cardiothoracic 39:25.080 --> 00:39:27.269 surgeon, would you encourage them, warn them 00:39:27.269 --> 39:29.060 about the sacrifices or do a bit of 39:29.060 --> 00:39:34.131 both? Well, I have two girls, um, and the baby 00:39:34.131 --> 39:38.320 I'm currently pregnant with as a boy. 39:38.700 --> 00:39:41.190 Um, I do think that makes a difference to 00:39:41.190 --> 39:43.620 be honest. Um, but regardless of who it 39:43.620 --> 00:39:46.236 is, if the boy or the girls told me they wanted 00:39:46.236 --> 39:48.240 to be a heart surgeon, I would 100% 39:48.240 --> 00:39:50.500 just, I would, I think they would see the 00:39:50.500 --> 39:52.760 sacrifices already growing up with me as 39:52.760 --> 00:39:54.492 their mother, but I would, yeah, I would 00:39:54.492 --> 39:56.180 tell them about the sacrifices I would 39:56.180 --> 00:39:58.146 tell them about. I would make sure that they 00:39:58.146 --> 39:59.800 understood like how difficult it is. 40:00.120 --> 00:40:02.594 Um, I wouldn't discourage them from it. Um, 00:40:02.594 --> 40:04.780 I think that I would try to help them 40:04.780 --> 00:40:07.330 make the best decision possible. Um, and I 00:40:07.330 --> 40:09.880 would make sure that they understood that 40:09.880 --> 00:40:12.584 you don't have to be only a heart surgeon to 00:40:12.584 --> 40:14.980 be able to help people. I think it's a 40:14.980 --> 00:40:17.496 wonderful thing to do. Um, and I think that 00:40:17.496 --> 40:19.660 women make incredible surgeons and I 40:19.660 --> 00:40:22.327 wish that we were a little bit better supported 00:40:22.327 --> 40:24.200 in this country. Um, from like a 40:24.200 --> 40:30.900 family standpoint, um, because I think that fewer women would leave, um, the 40:30.900 --> 40:36.880 workforce or, um, be discouraged from going into certain specialties if we had 40:36.880 --> 40:42.480 better support, um, as mothers essentially, because most, most women 40:42.480 --> 00:40:44.671 still want to be mothers. I mean, a lot of people 00:40:44.671 --> 40:46.280 don't, but most women still do. Um, 40:47.280 --> 00:40:49.719 but in certain specialties, that number is 00:40:49.719 --> 40:52.100 a lot lower. Um, and I'm not saying that 40:52.100 --> 00:40:54.185 everyone has to have kids at all. Like that's 00:40:54.185 --> 40:55.760 a very personal decision, but for 40:55.760 --> 40:58.700 the people that do, I think they need better support because those same people 40:58.700 --> 00:41:02.113 can still be really, really, really good doctors 00:41:02.113 --> 41:04.460 and surgeons. But, um, you know, 41:04.600 --> 41:07.840 when they're fighting against a system that doesn't support them, it becomes 41:07.840 --> 00:41:10.836 very, um, counterproductive. What made you 00:41:10.836 --> 41:13.760 feel that St. Clair would support, would 41:13.760 --> 00:41:17.035 support you as both a surgeon and mother? What 00:41:17.035 --> 41:19.740 made me feel that way? Well, from the 41:19.740 --> 00:41:22.762 very first interview I had with, um, Dr. Andy 00:41:22.762 --> 41:25.180 Kiser, I knew that he would do that 41:25.180 --> 00:41:27.123 because one of the very first questions he 00:41:27.123 --> 41:29.020 asked me was, tell me about your family, 41:29.280 --> 00:41:30.408 tell me about your personal life, tell me 00:41:30.408 --> 41:31.480 about your husband, tell me about your 41:31.480 --> 00:41:34.234 kids. Um, and I knew that he cared not just 00:41:34.234 --> 41:36.540 about me as a surgeon, but he cared 41:36.540 --> 00:41:39.279 about me as a person and supporting me, um, 00:41:39.279 --> 41:41.700 as someone who's not just part of his 41:41.700 --> 00:41:44.443 team, but part of his community, you know, 00:41:44.443 --> 41:47.120 and so he wanted to make sure that I was 41:47.120 --> 00:41:49.702 supported, um, on all those fronts. And so 00:41:49.702 --> 41:52.100 that is a huge part of why I took this 41:52.100 --> 00:41:54.407 position because that support is very rare 00:41:54.407 --> 41:56.660 to find. So how do you physically remain 41:56.660 --> 00:41:58.555 present for your husband and children when 00:41:58.555 --> 42:00.360 you might need to be at the hospital at 42:00.360 --> 42:01.320 unpredictable hours? 42:04.320 --> 00:42:07.466 Well, when I'm at the hospital, I'm not physically 00:42:07.466 --> 42:09.480 present with them at all. So, I 42:09.480 --> 00:42:13.390 mean, you know, you just have to make sure 00:42:13.390 --> 42:17.020 that your partner is aware of the fact 42:17.020 --> 42:20.200 that you're on call, that you have to leave at any moment, um, try to have 42:20.200 --> 42:24.760 backup childcare available if possible. We are definitely struggling with that 42:24.760 --> 00:42:27.842 because we don't have any family here in Pittsburgh, 00:42:27.842 --> 42:29.680 but, um, you know, so you kind 42:29.680 --> 00:42:31.920 of have to get, you know, your village and 00:42:31.920 --> 42:34.160 neighbors and babysitters and nannies and 42:34.160 --> 00:42:36.393 stuff like that. Um, but yeah, it's, I mean, 00:42:36.393 --> 42:38.220 when I'm on call and I'm at home, I 42:38.220 --> 00:42:40.725 try to be at home as much as possible. I, when 00:42:40.725 --> 42:42.740 I'm not on call, I leave my phone in 42:42.740 --> 42:45.540 a different room. I don't look at my phone. Um, when I'm on call, I have to 42:45.540 --> 00:42:47.549 have my phone, you know, nearby so that I 00:42:47.549 --> 42:49.460 can hear if someone calls or something 42:49.460 --> 00:42:51.888 like that. But, um, you know, I try to be as 00:42:51.888 --> 42:54.040 present with them as possible when I'm 42:54.040 --> 00:42:55.679 there. And then if I have to leave, I have 00:42:55.679 --> 42:57.200 to leave and that's it. And my husband 42:57.200 --> 00:43:00.624 understands and he supports me and, you know, 00:43:00.624 --> 43:03.440 you just, you figure it out. Um, and 43:03.440 --> 00:43:05.606 you just take, take it one day at a time, a 00:43:05.606 --> 43:07.620 lot of coordination, a lot of planning, 43:07.840 --> 00:43:10.200 a lot of organization. I mean, when I say 00:43:10.200 --> 43:12.560 one day at a time, I mean, like mentally 43:12.560 --> 43:17.100 you take it one day at a time, but, um, you know, my husband is very, very 43:17.100 --> 00:43:19.967 organized and on top of things. So we plan 00:43:19.967 --> 43:22.560 things out well in advance. Well, the 43:22.560 --> 43:25.800 final question, what piece of advice do you wish you had heard when you're an 43:25.800 --> 43:26.740 early teen like me? 43:33.520 --> 00:43:36.153 Um, I would say, I don't know if I would 00:43:36.153 --> 43:38.720 have followed this advice, but I would 43:38.720 --> 00:43:43.220 probably say, um, when you're in college, 00:43:43.220 --> 43:47.500 try to not just sit in the library all 43:47.500 --> 00:43:50.110 day, every day, you know, try to get out 00:43:50.110 --> 43:52.720 there, enjoy your life, spend time with 43:52.720 --> 43:57.980 friends. If you're in college in a city that you haven't lived in before, go 43:57.980 --> 00:44:02.083 explore the city, go meet new people, try to 00:44:02.083 --> 44:05.720 get out there. Um, and don't just have 44:05.720 --> 00:44:08.282 this mentality of like, I'm a pre-med student. 00:44:08.282 --> 44:10.120 The only thing I can do is study 44:10.120 --> 44:14.860 and be a pre-med, you know, student. I think it's really important to get out 44:14.860 --> 00:44:16.601 there. And that's also part of why, like, I 00:44:16.601 --> 44:18.220 went to Panama, I went to learn Arabic, 44:18.380 --> 00:44:21.170 I got to do these different things. But, um, 00:44:21.170 --> 44:23.580 I definitely was a little more single 44:23.580 --> 44:26.540 -minded than I should, but that I could have been, you know, like I could have 44:26.540 --> 00:44:29.650 probably gotten out there a lot more, but 00:44:29.650 --> 44:32.760 I just didn't know. I was, I didn't know 44:32.760 --> 44:41.800 like what, what the world was like. So, um, yeah, I mean, like, well, the main 44:41.800 --> 00:44:43.526 piece of advice I would say is like, spend as 00:44:43.526 --> 44:45.060 much time as possible outside, I guess, 44:45.240 --> 00:44:48.902 like do sports, move your body, um, be outdoors, 00:44:48.902 --> 44:51.420 throw your phone in the garbage. 44:51.860 --> 44:56.340 Like, don't be on your phone. Like, I can't stress that enough. Like, don't be 44:56.340 --> 00:44:58.539 on your phone, I guess. That wasn't so much 00:44:58.539 --> 45:00.380 of an issue when I was younger. And 45:00.380 --> 45:07.940 like, now I'm like, it's, uh, yeah, just be, be present in the real world. You 45:07.940 --> 00:45:11.648 know, I think you'll learn a lot more, um, 00:45:11.648 --> 45:15.180 from that than, you know, from a lot of 45:15.180 --> 00:45:18.235 stuff that you see on the internet. Okay. Well, 00:45:18.235 --> 45:20.640 thank you so much for agreeing to be 45:20.640 --> 45:24.340 interviewed. I am currently weighing my options on what type of doctor slash 45:24.340 --> 00:45:27.154 surgeon to become. So I really appreciate 00:45:27.154 --> 45:29.900 all the information you've given me. Of 45:29.900 --> 00:45:31.764 course. Can I just say you, what grade are 00:45:31.764 --> 45:33.540 you in? I'm in eighth grade. I'm in the 45:33.540 --> 00:45:37.041 summer transition, transitioning to ninth. Okay. 00:45:37.041 --> 45:39.740 I would say don't make any decisions 45:39.740 --> 00:45:41.585 right now. That's maybe one other piece of advice 00:45:41.585 --> 45:42.940 I would give. Like, I didn't make a 45:42.940 --> 00:45:45.164 decision to be a heart surgeon until I was halfway 00:45:45.164 --> 45:46.720 through residency. You know, like, 45:46.760 --> 00:45:49.246 it's very difficult. You can't make that decision 00:45:49.246 --> 45:50.920 right now. Um, I would say like, 45:51.060 --> 45:56.500 allow yourself to be open to different specialties. Um, you're so young and so 45:56.500 --> 00:45:59.564 inexperienced. And I don't say that to like, 00:45:59.564 --> 46:02.140 insult you. I'm saying that to allow 46:02.140 --> 00:46:04.896 you to understand that your options are limitless. 00:46:04.896 --> 46:06.660 Like you have so much potential 46:06.660 --> 46:10.260 and so much ability to do whatever you want. So don't pigeonhole yourself too 46:10.260 --> 00:46:12.730 quickly. Um, no one's forcing you to make 00:46:12.730 --> 46:15.200 that decision right now. There's no need 46:15.200 --> 00:46:17.289 for you to feel like you have to decide right 00:46:17.289 --> 46:18.960 now what kind of doctor you want to 46:18.960 --> 00:46:21.750 be, or if you even want to be a doctor. So 00:46:21.750 --> 46:24.540 I would say just try to keep your, try to 46:24.540 --> 46:29.600 keep your mind open. Um, and I think you'll be really pleasantly surprised 46:29.600 --> 00:46:33.900 about like how much that opens you to new 00:46:33.900 --> 46:38.200 experiences. Okay. I won't decide. Thank 46:38.200 --> 00:46:40.912 you. All right. You're welcome. Take care. 00:46:40.912 --> 46:43.560 Enjoy the rest of your summer. Yep. Good 46:43.560 --> 46:44.140 luck with everything.