73 Questions with a Trauma Surgeon | ND MD

okay hello hi there hello how are you andy how's it going good how are you not too bad thank you not too bad at all all right are you ready for your 73 questions absolutely so what's your starter what is your name my name is terence o'keefe and what is your specialty i'm a trauma surgeon by trade it's a kind of branch of general surgery and how many years have you been practicing oh that's a good question i graduated in from general surgery 2002 and then finished my trauma fellowship 2005 started my first faculty job january 2006. so what's that uh 15 years yeah the math sounds right yes oh where did you go to undergrad or did your undergrad university train uh so slightly different as you might tell from my accent i'm originally from britain so i started off and i did my medical school in the uk in scotland actually in edinburgh and we go straight from school to medical school so we don't do an undergrad we just have medical school and it takes slightly longer in my case i actually took six years um because i did an extra degree normally it takes five okay so what brought you to the us for your medical career uh i want to do trauma surgery and as i like to joke with people we um we don't have guns in britain and we drive a little better um so we uh don't have uh uh we don't really have trouble back in those days the the whole trauma center thing didn't actually exist now there are trauma centers in the uk um but still trauma is not a big big thing in the uk it really isn't so uh if i wanted to have this kind of career um i needed to come to areas that have trauma centers which is basically here south africa and australia pretty much okay uh interesting turn of a career so i know it's been a bit but do you remember what was your favorite part of medical school uh my favorite part of medical school that's interesting i did it intercalated honours year which was basically i got an egg i took a year and took an extra degree i spent a lot of time in the lab so i spent about six months going in pretty much every day for about that period working on a research project which i really enjoyed however it did make me realize that um pathologists are completely crazy um and i actually wanted to get back to clinical medicine and so um i enjoyed getting back into the actually looking after patient care because i had already even when i went to medical school i planned on being a pathologist so i took a severe uh turn at some point in my medical school career well i think that kind of answers my next question which was on the first day of med school what specialty did you think you were going to go into yeah that was pathology i my father growing up was a family practice doc and we used to get phone calls routed to the house and so i very clearly decided early on i didn't i wanted nothing to do with family practices or general practices as called in the uk and by extension i thought i didn't want anything to do with actual patient care for those who read the house of god you talk about the patient care specialties and non-patient care i was clearly wanted to be a non-patient care specialty but i changed my mind after spending a year doing pathology so were there any other specialties you immediately out the gate said not for me uh i'd probably say geriatrics for the same reason my father used to take me to these uh these old people's homes and christmas and i'd go around and say merry christmas to all these all these people and uh in their 80s 90s in the homes and they're wonderful nice people but they all the little old ladies kept on trying to chat me up and pinch my bum um so i realized geriatrics was definitely something i wasn't going to be going into that's enough to deter you well let's get back to where you are now so what made you first fall in love with trauma surgery uh did i fall in love with trauma surgery or did i just choose trauma surgery um i didn't know about trauma surgery i actually was in my final year of medical school and i was trying to make up my mind i was rolling out various things and i was kind of coming down to anesthesia pediatrics er i hadn't really even actually considered surgery but i met someone who had worked at medstar in washington dc he was actually in the military and he told me about this thing called trauma surgery which i'd never heard of and i had no plans to come to the united states like zero this was not in my game plan at all and when i found out about that i started researching it and i realized that's kind of what i wanted to do because not only do you do surgery you also look after patients in the icu and you also have sort of pre-hospital and public health and injury prevention roles so it encompassed everything that kind of was quite exciting absolutely now for those who are interested in being in your shoes one day at least in the american system how many years of training after medical school does it take so basically you've got to do your five years of general surgery residency and then after that you can either do a one or two year fellowship i did a two-year fellowship what you really need is the surgical critical care portion which is the added certificate that's actually an extra qualification or regulated by the asu gme and the second year is is a less regulated fellowship there are various different types some people use that time to get more clinical experience some people kind of get further research degrees i actually did an mph during my two years in in miami but there's various different ways of going about it but yes you have to add a couple of years at the end of it but considering most general surgery residences about 80 or 90 percent of general surgery residents now go into some form of fellowship it's not really that big of a deal and it's actually interesting my specialty acute care surgery which is kind of what we call it now it's kind of this all-encompassing trauma surgery plus general surgery plus icu is actually seeing a rise in the number of applicants and up to up to 40 percent of of um general surgery residents are actually choosing that for fellowship and you mentioned that there are a couple sub-specialties even within trauma surgery so can you elaborate on what are the options yeah so so most people don't typically hyper specialize i mean that would be hyper specializing but surgical critical care is is uh part of my job and so it's what the way we have we work things here is basically you have times when you're on call for trauma there are times when you're doing emergency general surgery and there are times when you're doing icu there are i imagine some people out there who are just doing icu right now but most of us are doing this this whole mix and some people in various places actually have a significant elective practice as well so to a certain extent you can kind of tailor a little bit it's more tailored by where you're working and how the job is structured rather than necessarily how you control it but there are different ways of of doing that so you can and again it's the variety so for example last week i was on night shift and i was on 12-hour night shifts monday through sunday i looked after general surgical operations i looked after trauma we had a guy who came in who was who was trying to bleed to death out of his chest took him theo saved his life he did great um had a patient that came with perforated ulcer took him to the or jury's out yet he's still he's still recovering um but then this week i'm just doing academic things i'm catching up with my paperwork i'm working on research projects i'm working on performance improvement for the toronto program um and then next week i'll be doing rounding on the floor then i'll be going to the icu so it's it's all it's kind of how you're you're set up but um you have the option to have a very very varied existence as a trauma surgeon which is good and you mentioned you actually got a mph i did i got a master's actually my msph a masters of science in public health when i was in miami i think that's one of the real areas that we we horrendously neglect here in the united states is injury prevention and part of that's just because everything is is very fragmented we have multiple hospital systems we have multiple hospitals but we don't have an encompassing healthcare system and so between driving driving regulations um and again these things are very alien for me for example the idea you can ride around on a motorcycle no helmet on i still struggle to get and get around that i understand the personal freedoms but um there's there's just common sense to me you should wear helmet protective equipment lack of seat belts um there's one state in the union um that doesn't have any seatbelt laws um that's it my mind can't get around that growing up um where i grew up but i know personal freedom's very important to people and it's a struggle sometimes to to kind of balance that um comment what you where are you going with that sorry no you answered my question exactly it would be how did that extra degree impact the way you view patient care and so well part of our role here as trauma surgeons is actually to have an injury prevention uh focus um here it's primarily working on uh elderly people in falls when i used to live in arizona we did work with um swimming pools obviously near drownings we did work on texting and driving i mean i didn't do it to you the other day but when we have our talks about the students i always get people to put their hands up and say if they text and drive and the people who don't put their hands up are just lying because we all do it so there are things that we can do that can significantly impact one of the challenges i always have with talking our residents as they talk about oh this person was in an accident if you use the word accident it implies that there's no modifiable risk factors which i could see if a meteorite falls down smashes the road in front of you and you end up in a big crater but most the rest of time we're either picking envy motor vehicle crashes rather distracted we're on our phones we're driving too fast we're not wearing a seat belt we're driving impaired there's very few times where where it's truly an accident and that's kind of part of the the the lens through which you see things when you when you do sort of injury prevention work very well said now what would you say is the most unique part of your specialty uh the most unique part i wouldn't say it's necessary this is a unique part in a in a bad way um if i can if i can good on that one the unique things that that we that i sometimes struggle with is that we can be very busy and we can take a patient to the operating room for example or we can have a patient emergency fund who's doing very poorly and say for example we don't save them unfortunately then we have to turn around and pivot and in the next 15 minutes we may be talking to a patient about doing a an app index me on them or doing another operation on them and i think one of the things that that is a unique but not in a good way i'm sorry because i couldn't think of a good good example on the spot there unique in a good way is that we we have to be fairly resilient to be able to go from what is a very high pressure high stress and sad situation and then immediately be able to pivot and move into something that's a completely different pace and still be able to provide good and compassionate patient care that is difficult the the having to get right back on the horse after you've been thrown off again um as it were can be can be challenging yeah and you mentioned some key characteristics of your field there i always allow physicians to kind of sell their specialty like a car salesman so next question would be why should someone choose trauma surgery i think it's incredibly rewarding i really think it is um there's i bless their hearts i don't i would struggle being a surgical oncologist because you're fighting cancer and at the end of the day cancer usually wins with me i can have patients who come in who are really badly injured and i can think they're going to do horribly and they can turn around and surprise me i remember very many years ago not here i had a patient who was going down hard on christmas day you know having they were really sick they gone into renal failure they had a terrible terrible brain injury and i really wasn't sure they were going to survive however they eventually started pulling through and then in march or april that year i happened to be just wandering past our clinic and the mother of this patient pulled me inside and said hey i don't you remember me but this is this is john and this patient was who had been at death store basically three months earlier was there walking talking they still have residual defects but they were clearly doing much better and so i think that the the we do have a significant ability to pull patients back from the brink it doesn't take much sometimes with patients who are uh significantly bleeding or you we have the ability to control that we can take out their spleen we can put our finger we can ligate the the blood vessel and we get that that gamut from young healthy patients all the way up to to older patients who are much more fragile but we can do the whole thing okay now turn it around why should someone not choose your specialty um so i'm gonna again answer that backwards um one of the things that people always think about is lifestyle so i don't want to be a trauma surgeon because i think it has a bad lifestyle my wife says that to me all the time i can't imagine why any woman would want to be a trauma surgeon um i i don't think that's entirely fair um to be honest i think that now particularly the way we work we're actually able to have a much more controllable lifestyle it's certainly possible speaking to the to any woman who wants to go into this field to have children have a career in trauma surgery i really think it is i think you have to getting back to what i said before you have to be willing to be knocked off the horse and get back on you have to bear in mind that there are going to be patients who are going to have very poor outcomes and you're going to be able to have to be resilient enough to move on from that and take care of the next patient that doesn't mean that you're not going to be compassionate or providing compassionate care but the you do have to have that inner resilience um to be able to work like that it's also it's a team sport so if you like working with a team if you like having a team or depending on other people it's good if you want to be the lone wolf it's probably not the great specialty for you um because you're although we think of ourselves as the captain of the ship really we're the captain of a ship only if everyone else is is doing their job and that we are very much dependent on on everyone else you also have to be able to be very self-reflective we spend an awful lot of time on performance improvement and peer review and looking at outcomes and evaluating how we can do things better so if you don't like that sort of self-criticism or even outside criticism then it's probably not um the right thing for you but you can have you can end up doing elective surgery you can do icu you can do emergency surgery you can do trauma you can do injury prevention work you can do research you can do all these things you just have to accept that your your work day may go from something as crazy as cutting out a tiny lipoma on someone's arm to that night cracking someone's chest when they've been shot in the chest it's it's this huge huge variety some fantastic advice now a fun question next okay are there any stereotypes about your field um i think there probably are most of them come from from me i i always like to think of er um certainly the original couple a couple of um uh series where you had uh george clooney in there and uh and the guy who uh eric um oh what's his name i come with the name of the act the african-american gentleman who played the trauma surgeon in that uh and i just i remember all sorts of crazy things like um they would do an edi thoracotomy and clamp cross clamp the aorta then they immediately kind of go okay the patient's stable let's move them so what are you talking about that patient's not stable you can't do anything crazy like that so we there is a certain i think a a thought of of a cowboys um b i think that's a is a stereotype uh b were we're we're thought of a little shouty frankly a little um a little uh hyper a little high maintenance um and i i think that's probably fairly fairly reasonable we do expect we expect a lot um where we're in critical situations and so if people aren't doing their jobs and there could be very significant uh consequences um but it really depends on on your personality i think there are there are nice and calm trauma surgeons and there are unpleasant and unhappy uh trauma surgeons that's pretty much i think probably true of a lot of specialties okay now you do work in academic institutions i do what is your go-to question to ask your residents my go-to question to ask about what in particular about um or just a a pimping question yes oh oh i've got so many no i can't i haven't got i haven't got one i've got so many it just depends on what the situation is um but i'm i will admit to people i worship at the church of evidence-based medicine okay so evidence-based medicine is my thing so i have i was in awe when i was a student or resident of all these faculty who could remember oh you know this paper published back in 1999 showed this and these are the authors i have become that that faculty member i have a very good memory of of uh of papers and academics and scientific studies so usually my question will revolt my pimping question will revolve around do you think there's any data that supports what we're saying here and then the residents all will have to go if you're asking that question probably yes doctor and then they they don't know it so we use that as an educational thing so i i am a traditional socratic questioner and uh i do like that whole pimping thing yeah why don't we um why don't we kind of uh i've got a nice chair there if you don't mind i'll go sit down then i can you can't even stay you can look at you look at the pictures of my of my uh home region in the uk on the uh in the background there check and make sure you're so still working yes that's good what does an average day look like for you which i know is a loaded question it was not so much a loaded question but it really it depends a little bit on what i'm doing so um if i'm in the icu my average day will involve spending the first two to four hours of the day rounding branding with the residents i tend to do education as i round so if we have a dozen patients i'll be talking about all sorts of things in the icu event management nutrition or all sorts of other things and then come back to the to my office here work on charts and then as procedures need to be done i would go back over there to help with procedures excuse me and any new admits and then we'll do afternoon rounds so that would be an icu week if i'm on call um what that then revolves around is waiting to see what new things happen but usually we have at least one or two or three or more cases booked for the or so an on-call day during the week would involve going to the operating room going to see trauma as they come in going to see consults um etc and then we actually split floor rounds up completely so if i want to on a week when i'm landing on the floor it would be going out and running floor rounds typically take the longest that's usually three or four hours um and then we have clinic uh two or three times a week but we compartmentalize things into into different uh different roles um so that we can make sure that no one else no one's overwhelmed at any point teamwork yes exactly now we got some kind of rapid fire quick questions um on the lifestyle and maybe some of the or niche things to do so first off what is the most amount of patience you've ever seen in a day uh 55 i think that's that's me it can be higher than that but that's i think that's what i've done how many patients do you see on an average day if you're talking about admits or trauma patients coming in and again it depends whether we're talking 12 or 24 hours but 24 hours i think the most i've done is 30 30 new consults and admits i'm talking about floor rounds again it's it's going to be like 30 to 50. what is the most difficult procedure you do i don't like working down in the pelvis so if i'm putting if i'm working on bowels down the pelvis i would actually that's not true i've um i would say probably for me vascular surgery my eyes are starting to get a little older i don't have loops anymore so i don't enjoy vascular surgery anymore so for me i'm usually looking to try and get some help if i have a patient with a vascular surgery injury or vascular injury what's the most common procedure you do the most common procedure we do is probably unfortunately debridement um cutting off dead tissue there are an awful lot of patients in this part of the world who are not cared for well either at home or in nursing facilities we see an inordinate number of pressure wounds like sacral decubitus and patients who come in with other kinds of wounds so probably that's the most common thing we see the common procedure i do unfortunately what is the most memorable case you've encountered so far oh i still have memories of case when i was a resident it was a guy we did a pneumonectomy on and so he came and had been shot in the chest and we rushed him straight to the operating room and we ended up taking out his entire lung on the right hand side the reason it was memorable because that in general carries about a 50 mortality rate um but the guy survived and was went home another memorable case from here recently was a guy who came in who's impaled on a fence post and had a fence post um going all the way through his his left shoulder was held on my skin basically destroyed his clavicle and missed his subclavian artery in vain by a millimeter so we had to actually get the uh the saw from facilities to to shorten the the uh the fence post off before we took him to the operating room oh my gosh uh what is the toughest part of your job uh the toughest part of my job i think is telling people that their loved one hasn't made it particularly if they haven't been given any kind of uh any kind of inkling any kind of information about what's going on so we'll have family members who just know that their loved ones being brought to the to the hospital and they turn up and they don't know what's going on what the injury what's happened and then you have to go out from the operating room to to tell them that they're you weren't able to save their their child their mother their brother whoever it was um that is is always the hardest part and that's never going to get better unfortunately for me that's that's that's terrible well let's kind of move to a more positive note what is the most rewarding part of your job i think seeing people get better and go home i mean that's what we're here for we're all here to help patients and help them get better from a from a clinical standpoint it's absolutely seeing the patients recover get better make it out of the hospital hopefully to go home or even if it's going to rehab and then sometimes seeing them back in excuse me when they've recovered um i am at work an academic institution so i'm also pleased when i see things go well from an academic standpoint whether it's our residents getting into good fellowships papers getting accepted or published research projects going well and i i do still enjoy some of the academic recognition from that standpoint but primarily it's about the patients now quick fire from lifestyle questions because i know you mentioned earlier trauma surgery is kind of notorious for the lifestyle so how many hours do you work in an average week so if you average it out i still think i work around a 60 hour week so 55 to 60 a week which honestly is i remember reading a study um about what attendees work back in the uk and that's exactly the same as the attendings work back in the uk and i'm not sure be that much different to uh to various other surgical specialties it's just that we probably work more weekends frankly um and more nights than other people one of the things we've done with acute care surgery is we've taken over pretty much all the nighttime responsibilities of general surgeons in academic centers like like here so unless something goes wrong with one of the general surgeons patients um by general surgeons here i'm talking about the surgical oncology team the minimally invasive team etc unless something goes wrong with when they're inpatients they're very unlikely to be called in the middle of the night and that's been a a shift in how the model has gone um in that we are the general surgeons now um and so it's not true in every way of course in the smaller centers that's not the case but in most academic trauma centers or particularly academic level one trauma centers um we will end up doing more night call from that standpoint um but the hours i don't think are terrible the problem is the surgeons we get up early that's the i think that's my wife's biggest complaint i mean the other day i i think on tuesday um everyone in the house was still asleep apart from the dog and i and the dog woke up when i woke up and then i left the house at 6 30 and no one was awake so we do get up early because the ors start early well you almost answer my next question which is what time do you normally wake up uh i normally wake up at 5 45 um that's not ideal i luckily i don't live that far away from the hospital residents and fellows usually have to wake up a little early than that to get here but um i plan on getting to work at seven i'm slow i actually take more time getting ready to go to work in the morning my wife does um because between shower and sha shaving is the shaving the shaving takes time if you don't cut yourself but she's always able to get to work in less time than i am um but i could do it at six but as i'm one of these breakfast people okay i mean you know that that whole argument that mark wahlberg and dr oz had in like 2019 or whatever it was um i'm a mark wahlberg guy breakfast gotta have breakfast so i leave the house and if i can recommend anything to your to your viewers if you're a surgery resident have breakfast before you leave the house so i always do what time do you normally leave the hospital uh i always have so i'm a slightly different person because i'm the division chief so i always have there is always more paperwork always more emails to answer always more things to do honestly i could sit in my office for a for a month and not even leave and i'd be fine so i try to get out of here by five but i'm also trying to be better about being home when my kids get home from school so on weeks like this week when i don't have any clinical responsibilities and i've just finished night shift i try very hard to get home so i can meet my kids off the school bus so that's that i would leave here at 3 40 to be home by by four today i'm leaving even early because i'm going for a haircut um but yes on average it's about uh realistically on average it's about a 10-hour day okay how many hours of sleep are you typically working on um so we do we do shifts so that's the that's the big difference one of the things that we instituted back in 29 uh 2020 in fact was a uh a 12-hour shift um 12-hour day shift 12-hour night shift um which we're actually in the middle of publishing a paper on that about how that infected burnout and and was basically uh was a very good thing for the faculty so when i'm on night shift i come in i start the week on monday night i stay up all night and i try not to go to sleep on the subsequent nights i just sleep during the day the same one on day shift then we go home at night so we don't have 24-hour calls anymore so usually unless there's some problem at home i'm sleepy i'm i'm sleeping seven seven to eight hours seven hours i can do well on seven hours if i get eight hours of intro to sleep i'm great but i'm i'm older so unfortunately i do do that i do have the nocturia thing getting up in the middle night to go pee but um i aim for eight and usually get a little less how many hours of sleep are you working on right now uh i think i'm fine i went to what i uh our problem is getting our kids to to go to sleep so i think our kids finally went to bed at 10 past 10 last night and i was up at 5 45 so do the math whatever that is a little bit less than eight hours seven and a half and i know you kind of touched on this earlier but do you have to take call yes so we take uh the way we have it right now there's seven of us we're a little short we should be at eight and in fact we proved to go to nine and so the way we're running our schedule is that you that means that basically once every seven weeks you do a week of nights so you don't do any other night call and we do have backup though so we do have to have someone available in case there's too much work going on here and we have to call someone else in so um i think i've been called in once in the last couple of months as backup um but otherwise it's just those seven nights are called do you prefer night shift or day shift i find day shift more tiring no one likes night shift in my family we call it the dreaded night shift so my wife doesn't like it my kids don't like it um the the good thing about night shifts is usually there's more down time so i can usually get some work done during the week although never as much as i think i can i can watch the occasional movie and things like that and i don't feel guilty about watching a movie at work when i'm on nights but i don't sleep i make a deliberate point of not going to bed because i think that's much better to to flip your um your sleep wait no your sleep wake cycle so if i had to choose myself i'd actually probably say nights because i find days more stressful in a way if you pick ask my family they'd say the other way around now how long does it take you to chart at the end of your day because i get varying responses from different specialties so it depends what we're doing but usually if i'm doing something that involves charting i'm banking on about an hour a day an hour yeah an hour a day or maybe a little more but it's not what i do when i'm in the icu for example i write my notes as i'm going along so all i'm doing at the end of the day is cutting and pasting and signing um but for example i'm still my for my night shift last week i still have six charts to do my problem is i can't i'm very a little ocd in the way i write my my notes um and so that takes a little longer for the for the kind of notes we're talking about right now the history of physicals and so the lag time for that tends to be a little bit longer after my week of days or weeks of nights daily progress notes i sign without fail before midnight on that day i will not let them go to a next to the next day unless i'm literally running out of hospital to go on on vacation so i'm very ocd about my notes kind of a wholesome question who are you most thankful for on your care team who am i most thankful for my care team um i'm gonna have to probably say my trauma program manager so i mean we as a trauma medical director i work very closely with my trauma program manager she makes sure that we're on track for a site visit which i have up there on the board which is coming in 2023 make sure we're working on our pi projects making sure all the t's are uh across and the eyes are dotted um and so she's the she's the person i'm really um going to lean on the most and having said that i'm going to also say my partners i have some very good partners what you need to do need to be able to do is is you need to be able to rely on the people who are coming behind you i remember talking to a colleague of mine back in phoenix many years ago and he basically said that although he was in a group any patient of his that landed up in the icu he basically had to then manage 24 hours a day for the rest of that time they were there because none of his partners really wanted to have anything to do with his patients or they didn't have that kind of group practice so if you work in a group practice and you have reliable partners it's golden yeah oh kind of a story time and we'll try to keep it brief but what is the most complicated case you have encountered so far the most complicated case i've encountered um what i can think of a very complex case that we had in my last um before i came here to to augusta it was a lady who was a good samaritan she had pulled over the side of the road to help somebody push their car somebody didn't see her and basically rammed her from behind causing both her legs to get pretty much amputated as well as causing multiple other injuries including burns and we spent we took her to the operating room we worked on her she died a couple of times on the table we had to open her belly we had to deal with her lungs she had a brain injury she had burns she had multiple fractures and she was a survivor and it was it was quite phenomenal honestly because usually when you have a patient who dies or has cardiac arrest after blunt trauma it's very difficult to get them back and so she was one of the more complex patients i've looked after okay now what is the most common medical advice you give to your patients uh common medical advice i give my patients that's a um i think it's more about mobilizing it's more about giving them uh making sure that they're not just sitting around um so one of the the things that people don't realize about recovering from surgery is that the more time you actually get up and move the better it is it's better for your lungs it's better for your bowels it's better for for everything um and so there's a certain group of people who very much adopt the sick role and won't move or just you go in and say is there anything else i can do for you and they'll ask you to fluff their pillow or get them a coke from the from the uh the thing will cover their toes because they're cold um and i worry about those patients because they're clearly going to expect to be weighted on hand and foot whereas the secret to recovering um quickly and well is is kind of pushing yourself to a certain extent making sure you get up out of bed in your way as long as you're not thinking about patients who have fractures and they're non-wavering but getting up moving around and so try to motivate people to do that it's probably the most common piece of advice and also helping patients realize that they're not going to be pain-free unfortunately um there is pain associated with injuries um and we can't abrogate it and if we do try and completely get rid of it then we're going to end up causing even more opiate addiction than we are already seeing all right so we've talked a lot about your life inside the hospital now how about your life when you clock out so what is your favorite thing to do when you're not working i hang out with my kids um i don't really have significant hobbies right now i used to do a lot of bicycling but um i kind of vacillate between it it gets too cold here and then it gets too hot um but i do i do go out on my bicycle uh a bit i like um cycling on the augusta canal the the path there but no it's mostly hanging out with my kids i have a seven-year-old and a ten-year-old um and they are they have lots of fun uh as i mentioned before we started uh filming i have a a six-month-old puppy that i completely surprised my family with um so i've got a lot of work to do with uh on the puppy and training him but it's hanging at home i have a very nice house i have a great existence at home and that's that's been one of the things that's been a major boon in coming here to augusta is that our family life has really blossomed so good to hear now what is your favorite place in the world uh to visit uh well my wife's from brazil so brazil has a very soft spot in my uh in my mind but also i've i love if you're talking about cities i say barcelona is probably all my favorite cities um i love france i have visions of retiring in france even though my wife and i have different opinion on that matter but um probably france and and uh brazil and of course obviously i like going back home to britain when i can but um we had planned to go in december for christmas but then omicron put pay to that so does your family ever ask you for random medical advice no um well actually that's not that's that's actually not true my wife is a physician and despite the fact that she's a physician anything medical that happens in the house with our kids it's always it's always for me to to figure out and decide so um yes i have i have been asked for and i've been texted pictures of of people's cuts and said like so i had one friend in my last job who used to um when i lived in arizona she used to do a lot of mountain biking and what she would do she would text me pictures of her injuries usually a week late after she'd been neglecting them and said what should i do now i said well you should have had it taken care of when you have had the injury i don't know what to do now but yes i do get it's not so much my family but it's uh it happens on occasion uh well that kind of answers the next question what's the weirdest question a family or friend has ever asked you medical related it's usually it's usually been about wounds or things like that but uh i'm i'm very i try to be very clear for example like anything about a rash you want to ask me about i don't do rashes i'm not a dermatologist i absolutely don't do don't do rashes or anything like that and and honestly i i try and keep myself away from being the kind of person who does stuff at home there's there's a one of our neighbors is a er physician and he's always helping stitch up someone's kid or something like that it's like no that's not me if you have any problems there i can tell you where to go i'll help you go there but i'm not stitching up someone's uh uh someone's hand on on my kitchen table yeah it's always the er position and the amount of times uh people have responded with uh just weird pictures that they get sent is yes it's too funny yeah now what is your favorite animal not a dog or cat i am a herpetologist so i love snakes i had an eight foot long african rock python when i was in medical school um so i like snakes and uh we're actually going to my son is going to be trying to persuade his mother to let him get a lizard and we'll be going to one of the reptile shows that she is so yeah reptile's my thing reptiles amphibians insects love all those things not a great mammal person yeah if you could have dinner with anyone in history who would it be oh oh gosh i wasn't expecting that question uh i know i'm a scientist so probably be somebody uh scientific charles darwin or um or albert einstein uh someone like that it would probably be someone um from that side of things i'd probably have to think about that for a uh for a while to come up with a really if i only have one person it wouldn't be someone historical it wouldn't be a politician or a or a political leader or a king or a queen nothing like it would most likely be a scientist what would you guys be eating at that dinner well i'm vegetarian so uh would probably be certainly something without meat which would probably they would find abhorrent um i don't know who is it there was some very there's some very famous vegetarians oh of course now hold on i'm thinking the world's worst famous vegetarian out of hitler which is not that's definitely not something i want to have dinner with uh i don't know salad maybe boring salad simple but safe answer yes yep what is your favorite dish to eat um my favorite dish to eat bread and cheese honestly i i grew up in an um you've heard of cheddar cheese obviously right so cheddar gorge is where cheddar cheese came from initially and that is about an hour and 45 minutes my house so there's an awful lot of good cheddar in my part of the world in back in the uk and so just a cheese and pickle sandwich would be uh that's not american style pickles that's branson pickle which is like a chutney so cheese and pickle sandwich that would be my favorite food very simple no coffee tea or soda tea absolutely tea i'm totally british in that sense i love this question because i always get something different from every doctor how much water should you be drinking every day as much as you feel thirsty this whole you have to drink this much waters like you have thirst receptors for a reason your body's probably pretty smart they've got first receptors and if you drink too much your kidneys are pretty smart too and they'll pee it out so if you're thirsty go drink some water if you're not don't worry about it forcing yourself to drink a certain regulated amount of water is just ridiculous what's the science behind that see evidence-based medicine there's no science behind that whatsoever oh well that's the answer i uh co-signed to uh favorite meal from the hospital cafeteria if you have one i suppose taco tuesday the taco ball on taco tuesday if you're gonna push me i said if you have one i've had people say abs there's nothing in there that it's either taco tuesday or it's the the um the black bean burger neither of which particularly impressive okay so are there any artistic hobbies you keep up with artistic hobbies no not really nothing um i wish i did do more on the kind of arts front um no i mean this new reason i i have i'm tone deaf i can't play an instrument um it's been a long time since i've tried to draw pain i like art as you can tell these are these are pictures of uh of the the countryside around my uh close to my where i grew up this literally i used to is like a mile and a half of my house um i used to ride up the hill to get to um that's a little further but that's the river i grew up and i used to fish on that river um when i was growing up i had a trout stream um but no i'm not artistically inclined anymore i'm afraid favorite kind of music to listen to in the or uh well i like dance electronic music so trance music i try not to force people to listen to that though because i think as it'll mean so when when p if people ask i usually will pick something fairly safe like rihanna or shakira or even hits of the 80s no you can't go wrong with hits the 80s right yeah i agree with that your favorite music album of all time uh my favorite music album of all time is probably um the album love by a band called the cult which is kind of like a gothic punk rock band from the uk in the and the 80s but that's mostly because i have a lot of um very good memories of things i was doing when i was listening to the songs no your favorite song of all time revolution from that album what's one random task you wish you could be better at one random task i wish you could better uh it's not a random task this is being a little more broad i wish i was not so much of a procrastinator so i do have that is i it's a failing of mine i know it's a failing of mine i sometimes dress it up and say no i'm not procrastinating i'm just trying to gather information before i make a decision but in reality all the time it's actually just procrastination i wish i wasn't so much a procrastinator i think i if i would do better if i was more of an action taker um still consider things and not do things um as it were rashly but um actually sometimes getting off my my tushy and doing what i need to do would be useful what is the best way that you relax after a long day um this is going to sound so stupid i like scrolling through facebook i like i like singing it's not just about scene or something i get i get a lot of news unfortunately through facebook i mean i was doing this last night i was lying on my couch i had my big ipad pro out i was scrolling through facebook and scrolling through news i like to read the equivalent i suppose of a newspaper i like to know i like to be well informed in the uk i would actually read a newspaper if when i was back there i used to read a newspaper called the guardian which was a kind of a left-wing democrat leaning um newspaper here i cannot abide the printed media i have to say and i'm not very like there's no way i could sit down and watch cnn or fox or any of those things um and so i i kind of curate my own news by going through the apple news app and facebook so are you a night in or go out on the town kind of person 19 these days i got kids indoors or outdoors depends on the weather i don't i don't like being hot and sticky in general i would say outdoors to be honest i grew up and as you can see i grew up in the countryside i like being outdoors but i um i spent just been 11 years of my life before i moved here in arizona and in june july and august you literally could not go outdoors because it was like it was 116 degrees two years in a row on my birthday in june like no i'm not going out on that um here it's not so bad it's just sticky but as long as you're it's it's not bad we're actually in the middle of redoing our patio so that we can spend more time outdoors next summer putting fans in putting shutters in so we don't get blinded by the sun but yeah in general outdoors beach or mountains mountains every time which is a problem because my for my wife is beach 100 of the time so we have to uh i'm trying to persuade her to let me take the family skiing and sugar mountain in a couple of weeks but that's uh that's a work in progress would you consider yourself would you consider yourself more of an introvert or an extrovert introvert and do you think that personality trait was a factor in you choosing your specialty no i've actually had to be more of an extrovert unfortunately i think it's hard to be an introvert and a surgeon because people are looking to you for leadership usually and you have to have a certain presence i think as a surgeon to be able to instill confidence in patients so i think it's you can be a certain introvert i just think it's harder and i think that you have to i certainly have more of a confident booming personality now than i did when i was in medical school i was much more introverted in medical school i would say all right and now we're getting close to the end only a few more questions but these will be some pretty reflective questions okay the first one being what did you think you were going to be when you grew up as a kid um so what i wanted to be was i wanted to be a zoologist discovering new species of butterflies and insects in the amazon jungle i figured after a while that was probably a not very useful um in terms of overall usefulness to humanity and b i thought that well all the all the um all the species have been uh discovered right now there's nothing left to discover i mean because you've now got how many thousands of insects etcetera so funny story i was in medical school in the second year of medical school and i went to the local botanical gardens in edinburgh very beautiful victorian botanical gardens and i noticed an exhibition of photographs on so i went to the exhibition of photographs and it was an exhibition of photographs by two zoologists who was discovering new species in the amazon jungle and funnily enough they were just a couple years older than me so i went damn it i could have done what i wanted to do and then i went yeah but i'm pretty happy doing what i'm doing and i'm always going to have job security so is there a different specialty you think you could have done um yes i think that but i think that depends on so just before i came to the u.s really for good my mother got diagnosed with ovarian cancer and it was a big discussion for me because i've been accepted back into a residency program after already having come here for one year and left and it was a big discussion between her and i about whether i would come back or whether i would stay there and in the end she was very supportive and said listen i've lived my life you need to live yours you need to make your decisions you need to make your plan for your future um and i don't i don't regret that however i do sometimes wonder if i should have stayed and if i had done things differently um if i had i probably would have tried to become a laparoscopic or minimally invasive surgeon in the uk that's not so much bariatric surgery like it is here um but that would be more sort of foregut surgery and other things so i certainly think i could have done something else i'd enjoyed anesthesia part of the reason i didn't do it in the uk is an anesthesian uk it's a really tough exam and it's all about physics and i hate physics it's all about sort of linear displacement of gas and boyle's law and laplacis law and stuff like that and i would have i would have not had a good time with that exam but could i have done something else yes if you didn't do medicine what do you think you'd be doing right now well i'd like to think i was doing something on that zoological front but as i got older i i don't know i think there's all sorts of things that you um i could be doing uh i think the struggle we have now is that a lot of people get turned off by medicine because medicine is a lot more constrained than it was before i mean i i don't if you've ever read any of these books about how medicine was back in the day um even here in the in the us there's a great book called the horse and buggy doctor about a family practice doc who used to go and do his house calls and a horse and buggy and my father grew up doing house calls my the general practitioners back in these days will get called at the middle of night they'd have to go out and do house calls which is clearly has some major lifestyle limitations but i think you've got to find something that's that's rewarding what would i do outside of medicine i have become a little bit more fascinated by finance over the last 10 or 15 years so i don't know maybe i would have i would try to pick up something like that that's very different to the 25 year old me who was in medical school i'd like to point out so that this is me 27 years later the 25 year old mia medical school would have um had a very different opinion about someone who's working in the in wall street or the stock market or uh or um the city in the uk now everybody knows whatever fuel you go into in health care it's difficult so were there any times that you doubted you would make it as a position not as a physician no i never doubted i would make it as a physician i did doubt sometimes whether coming to the u.s was possible or and or going to happen i remember the first time i applied for surgical residency i got three interviews the second time i applied for surgery residency i got one interview and that's applying to literally like 170 programs around the country and there were some places that were very very close to foreign medical graduates like for example duke i i applied to duke and they basically said you're an fmg we're not even going to bother we just we don't do anything with fmgs and so when you're coming from overseas and trying to get into us that can be very difficult i always had a backup i was a pretty good medical student in the uk i always had an option to go back to the uk so my issue was just was i going to make it here um as opposed to whether now i didn't have the easiest time of getting into medical school but i did manage to overcome that and gone to medical school and again if i hadn't gone to medical school i had good grades i would have got into something um and i could have maybe uh transferred so i was i was very driven i i had the advantage of i decided at the about the age of 15 i had a vision i had a plan um and so um that worked well for me and has worked well for me up until now now i'm not sure i regard myself as being terminally differentiated to use a sort of a an evolutionary term i'm a division chief of trauma i don't plan on being a chair i don't plan on being a president i don't plan on being anything else other than this um so as far as i'm concerned i've reached my my own self-imposed glass ceiling now if you could change one thing about the medical field right now what would it be if i could change one thing about the medical field hard to know whether to to talk about the [Music] burden of documentation um and the electronic health record or whether to talk about the the back aspect of that which is the burden of um the kind of the the regulations of the placed upon us now a lot of those regulations are well-meaning but there's a lot of stuff that's being you're being forced to tick boxes and um do things that don't necessarily impact patient care unfortunately um our big i think our biggest challenge to patient care right now is is staffing whether it's physical therapy whether it's nurses whether it's having enough physicians and we're all spending increasing amounts of time you brought it up yourself about on on documentation the uh barack obama and joe biden came up with this wonderful idea many years ago about meaningful use and encouraging all these people to to um to get involved with electronic documentation and in theory it sounds like a great plan the implementation of it has been a disaster and that i have to say is probably contributing to physician burnout more than any other one single factor at least up until covered now we have other things to complain about now again there's so many people that probably want to be in your shoes i've gotten a couple comments one specifically a trauma surgeon okay so what can a medical student do right now to prepare to go into your specialty so um although it's become very difficult with kobe the one thing i would do is i would say shadow go and go and hang out on a friday night in the emergency department go go hang out at times that aren't they are a little weird so go on a saturday night go on a friday night go on a sunday afternoon hang out with with some trauma surgeons see what it looks like see if you really want to do that because sometimes you walk into emergency departments and there are people screaming blue bloody murder there are people swinging at doctors and nurses there are people who have major psychiatric disorders and those patients also get into trauma we have a not significant population of people here who come from the local prisons and jails who have ingested foreign objects or inserted foreign objects and themselves do you feel like you want to be looking after that kind of patient at two o'clock in the morning on a friday or saturday night if that's something that just completely turned you off then you've got a great opportunity to say you know what i should i could look at something else if you like the excitement of never know what's coming through the door and in this places even more never knowing because our paging system is not sophisticated enough all we know is it's blunt versus penetrating and they're sick i don't know what i'm getting until i literally walk down to the emergency bay emergency room it may be i get level one and then i'll say it'll say penetrating that could be a stab wound it could be a gunshot wound it could be a graze it could be something really significant i don't know so you'll get a flavor for that and then if you decide that's really what you want to do then there are multiple other ways to get involved find your local trauma surgeons and get going with some research with them you want to start buffing up your cv to make sure you're going to get into a good surgery residency bear in mind you're going to have to do a residency you can then start thinking about where do i want to do my residency if i do my residency in um to pick a spot of spartanburg south carolina um i'm not going to get a lot of necessary a lot of exposure to trauma if i do my residency in miami or los angeles i'm going to get a lot of exposure to trauma and so you can start sort of planning that career if you if you want to most it's an unfortunate fact of life that most academic medical centers have a significant amount of trauma we are as a whole a rather violent society and we also don't behave in the way we should we drive too fast we drive drunk we don't wear our seat belts um and so most academic medical schools will see a lot of trauma so you don't have to don't feel i'm saying you have to go work in new orleans miami or los angeles all the violent places you're going to probably get a pretty good exposure wherever you go now if you were to go back would you change any of your experiences that got you to where you are right now uh that's a bit of a loaded question because if i changed any of my experiences i wouldn't be where i am and i wouldn't know the people i know so for example if i hadn't gone to miami for my trauma fellowship i wouldn't be married to the wonderful woman i married to today if i hadn't gone to ohsu i wouldn't have uh have got necessarily had that interest in trauma so if i were the different paths i could have taken yes would they have ended me up here probably not i would have done something different but i don't think i'm gonna i think there's a lot of point to spend a lot of time regretting decisions you've you that i've made in the past um i tried to get uh my fellowship miami was second choice to the one i i wanted but it worked out very well um so no i don't i don't think i have huge regrets about where i am the path i took to get me here all right oh we finally made it question 73 last one oh what would you say to the aspiring trauma surgeon right now i would say it's a very good field to go into isn't it you're going to have great job security the only reason you would ever be to be unemployed is if you want to be yourself it's uh there's always plenty of of people around who want trauma surgeons you do have to bear in mind that you you will need a team so if you want to be a small town surgeon in a rural town it's probably not going to be you're not going to have the opportunity to make use of the skills you're going to learn going through general surgery agency and a trauma fellowship but you don't necessarily have to be that big of a town um i don't know what the size of augusta truly is but it's 250 000 plus um and we have a level one trauma center so yeah you can uh or you can end up living in someone like new york new york has multiple trauma centers um so you always have you have choice of where you want to work and how you want to work i think it's very rewarding it is tough um you're going to have to be resilient it doesn't necessarily work well with a very with a completely fixed um schedule so for example there are some when i was uh finishing up my residency i sat down and had lunch with one of the um the general surgeons in private practice and i said explain to me how your life works um and he basically said well i'm on call every tuesday and every fourth weekend so that was his like every tuesday he knew he was on call for 24 hours and every fourth weekend he was on call our lives are not like that they're not quite as regimented as that but if you have an ability to roll the punches you want to have a very varied practice and you don't mind working hard and the corollary of that is you get paid well then it's a great career well said that's all i have for you dr keith thank you so so much uh for your time i know you're very busy uh there will be plenty of students that uh are incredibly inspired by your stories thank you andy no no bro is happy to do this for you wait before you click away if you are a current student interested in pursuing a career as a surgeon i have a very very special opportunity for you the goal of the 73 question interview series has always been and still is being able to give students all around the world exposure into some of these medical fields that right now they may not be able to have access to due to covert restrictions or maybe you can't find the right mentorship for you that's where the sponsor of today's video vevo surgery comes in vivo surgery is a brand new and quickly growing service that allows students from anywhere around the world to tune in virtually during live surgical procedures yes live to be able to learn from surgeons and ask them questions in real time now i've been in a bunch of ors and sometimes even being there live it's really hard to see what's going on the amazing thing about viva surgery because i actually was invited to a vip event for them to let me try out their service is that you get a really high quality low latency point of view of what the surgeon's seeing i got to see a neurosurgical procedure there's orthopedic procedures that have been showcased and if i'm being honest i can see more on these live streams than i could when i attended some of these procedures live in person not just that but these surgeons know you're there to learn and so you can chime in and ask questions in real time they can hear you and you can see them literally explaining what they're doing what anatomy you're looking at and special considerations at each step of the procedure viva surgery was allowing students to get almost one-on-one mentorship with a surgeon that is quite honestly unparalleled to anything that has been offered before from any service out there currently on the market i know more than most people that early exposure into some of these niche specialties is the way to decide if it's right for you and there are many of you who cannot get access to witnessing surgery procedures right now due to coving so i've teamed up with vivo surgery to give you guys a chance to get into one of these vip streamings if you are a current student looking to pursue a surgical specialty or even gain some mentorship from a surgeon go to vivosurgery.com or use the links in the description to sign up for the waitlist for your chance to get into one of these vip live streams spaces are extremely limited and as you can imagine these surgeons times are very very valuable so they're looking for the best and brightest to be in these so that their time is worthwhile and you learn the most that you can again this is open to students everywhere around the world because it is virtual so if you want to be a surgeon one day and you want some one-on-one mentorship with 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Channel: ND M.D.

Views: 289,001

Keywords: 73 questions with a trauma surgeon, 73 questions with a trauma surgery resident, trauma surgery, trauma surgeon, trauma surgery residency, trauma surgery resident, mcg, nd md, the real nd md, nd md 73 questions, life as a trauma surgeon, life in trauma surgery residency, mcg trauma surgery, mcg residency, mcg students, mcg truma surgery residency, life as a trauma surgery resident, trauma surgery interview, trauma surgeon interview, trauma surgery stories

Id: nKjs88CUJ5w

Length: 64min 33sec (3873 seconds)

Published: Sun Jan 16 2022