Introduction

Listen to Dr. Matthew Roberts, an Assistant Professor in the Department of Surgery and a trauma surgeon and surgical intensivist, as well as ECMO provider, talk about his journey to and through medicine, as well as his interests and lessons learned along the way. We talk about topics like the future of his surgical interests at UAMS, as well as how he has been able to integrate his work with life outside of the hospital over the years. 

Listen to the episode

Transcript

Manasa: Welcome back to Mentor Spotlight. Today, we’re talking to Dr. Matthew Roberts, an Assistant Professor in the Department of Surgery. He’s a trauma and emergency general surgeon, as well as a surgical ICU provider at UAMS. While from Missouri, he completed his surgical training at UAMS, and has continued to practice here. He loves to teach, and is known by many from nurses to other physicians for his work ethic as well as dedication to patient care. So without further delay, let’s talk to Dr. Roberts. So can we start off with you telling us a little bit about yourself?

Dr. Roberts: Yeah, I’d be happy to. Thank you for having me. This is, I think a really cool thing that you guys are doing. And I’m excited to speak with you all. A little bit about myself. I come from very humble beginnings. And I like to think of myself as somebody who maybe wasn’t set to do surgery, but worked hard and was able to get to the point where I am today. Enjoy my career in surgery.

Manasa: Yeah. So can you tell us a little bit about your job titles, all the different positions that you hold, and what you kind of do for each of those. Like all the hats that you wear.

Dr. Roberts: Yeah, so predominantly I’m a trauma and emergency general surgeon. So majority of my clinical work is gonna be taking care of sick trauma and, and emergency general surgery patients. So that’s patients who come in with perforations – perforated bowel, incarcerated hernias, gallbladders, appys – those kind of routine things. But then we do get a little bit more complicated stuff. And then, another large part is doing our surgical ICU work as well. So seeing these patients in ICU and making sure that they’re fully resuscitated and recovering. So that’s a large part of my clinical work.

In addition to those things, I also have a pretty robust elective surgery practice, and so what that entails is predominantly, you know, basic gallbladders, hernias, things like that. Now, I also do a fair bit of peri-esophageal hernias. So patients who have been having long, long-standing issues with hiatal hernias or reflux disease. Some of the complex foregut work, I’ve been doing. And most recently, I’ve been doing robot, robotic surgery. So it’s been fairly new to our group, although not new across UAMS. But something that is becoming ever more prevalent with residency training and so a goal for me was to be able to provide that experience to our residents. And make sure that they have plenty opportunities to get those skills early on. And in all settings, not just more specialized surgical services, such as surgical oncology, or thoracic surgery, or colorectal surgery. And in addition, I’m also doing ECMO. So occasionally I’ll do ECMO support for patients who have severe lung disease and unfortunately, these patients when they don’t have a lot of options, you know one way that we can do that is by providing lung bypass support. And that’s something that is very rewarding, and a very busy aspect when we do start having those patients.. But very exciting field that I’m also able to provide some additional expertise in.

Manasa: That’s awesome. I think I’ve – I don’t know too much about ECMO, I’m trying to learn about like the different aspects of everything, but – it’s amazing the process that you go through to figure out if a person can sustain being on ECMO to get potential further treatment. But then also learning of the treatments that they would need in the future but then all the policies and kind of nuances that you don’t really think about, in terms of like what can be possible for that patient in the future. 

Dr. Roberts: Yeah, when we first started doing this, I think we were all very new to that here at UAMS. And ECMO has been around for a long period of time, but having the ability to do it here is relatively new. And it was started as, yeah, kind of the start of COVID. To be able to help support those really sick COVID patients. And so, it was very, very much a learn by doing process, you know, as we, as we took that, took that population on. And it’s been very rewarding. It is very nuanced in terms of how we select patients for ECMO support and who is a candidate and who is not a candidate, although there are some basic, basic guidelines in which we use to select those patients. But there’s a lot of little details that go into decision-making, and that’s why we have our ECMO support team. In which any of these patients who are consults for ECMO therapy, we do a conference call and we all discuss, you know, so all of the ECMO providers will all discuss the patient. And everybody kind of makes a vote on if they think that that is an appropriate candidate. So it’s a very multidisciplinary approach, just like most things in medicine, but it’s very rewarding whenever we do have those patients that we can provide that therapy for. And I feel very happy to be able to learn that technique and be able to be one of those providers as well.

Manasa: Yeah. So in terms of you being involved with that, I saw that you were part of the steering committee for that. So in terms, other than all these other hats that you wear in terms of or your clinical things. So you’re a part of that committee and you do a few others QI committee work as well, right?

Dr. Roberts: Yes.

Manasa: And then you also like enjoy teaching, and so you’re part of the medical student education side of things. So can you explain that a little bit as well. 

Dr. Roberts: Yes, so as far as my administrative duties, most of the major work I do as far as leadership roles is, is with ECMO program, although, yeah, we have our quality improvement projects throughout our trauma and, and surgical ICU. So, I’m involved with those. And then as far as educational aspects, that’s another big focus of mine and something that I very much, am going to do. So I always fine times to help students out in whatever, whatever they need. Whether that’s me as an advisor, or helping them identify, you know, another advisor recognizing, you know, where they are at in their career, and helping them get to the point that they want to be. And so ways that I’m able to provide those educational opportunities is most, most students will see me, doing surgical bullpen with all the third years, so hopefully they still enjoy doing that. And then I do a lot of mentorship for third and fourth years. And, helping them guide them through the, the difficult process of identifying residencies and matching and all that stuff. And then for residents, I, hopefully I’m able to provide some of the same mentorship. You know, helping them with deciding if trauma or emergency general surgery, general surgery is a career for them. And helping them with recognizing, you know, what they need to be able to get to those destinations. So, that’s something that I feel like is very important, to be a mentor and listen- and I think that’s a big part of it- is just listening what, what a student, what a resident needs, and what they envision and helping them get to that, that destination. 

Manasa: Yeah. So can we talk a little bit about your educational background, the training you had to get to where you are today.

Dr. Roberts: Yeah. So I started out pretty much all over the place. We moved a lot when I was a kid. We don’t need to go back that far, but ultimately I ended up at the University of Oklahoma for undergrad. I was there for a few years, and my wife was actually, she was moving to Joplin, Missouri. So I moved down there and went to finish off undergrad at Missouri Southern State University. And so that’s how I ended up in Missouri. And then I went to the University of Missouri for, for medical school in Columbia, Missouri. And then after medical school, I was fortunate to match down here for a residency. My wife was terrified of moving Arkansas, and then everything worked out. But after residency, I realized that I had a passion for trauma surgery- a lot of my mentors were here. And so I decided to take the fellowship for trauma/surgical critical care. I did a one year fellowship here and then kind of stayed on as faculty ever since. Additional training that I’ve done is some additional robotic training, yeah, over the last year. 

Manasa: I think that’s a generally known reaction whenever people hear Arkansas, just wherever I talk.

Dr. Roberts: Yeah

Manasa: So, I guess we kind of talked about this already. But, in terms of your journey here, were there any jobs held along the way, any other career paths or thoughts you had along the way that you explored a little bit, then decided to switch over?

Dr. Roberts: Yeah, I, so I recognized that I was, I wanted to do medicine pretty early on. And going through undergrad and into med school, I thought I was gonna do orthopedic surgery. And I realized that orthopedic surgery is very specific. I wasn’t going to be able to do a broad range of things. It was pretty much focused on – to me – it was focusing on a very particular subset of surgery. That just wasn’t something that I felt like was going to be the experience that I wanted. And then in my third year, I didn’t do surgery till my last rotation. And I did OBGYN my third year, I was doing a lot of gyn onc. And so I thought, oh, okay, I can do gyn onc. And so I’d, I’d set up my fourth year for doing OBGYN. And I started my fourth year, very quickly realized that OBGYN was not for me. I think I spent one day in gyn clinic, which I hadn’t done in my third year. And then I was done. And so I just decided surgery was the, was the route I wanted to go. So I was kind of a late, decision on doing surgery. I just wanted to make sure that that was gonna be the right fit for me. I was a father through med school, so I was very concerned whether or not I could balance being a family man and going through a surgery residency, which I’ll say is, is completely doable. You know, I think there are sacrifices with any, any training, but surgery, just because you’re doing surgery doesn’t mean that you can’t, you know, have a family and things like that. Which is something that is often told to students, you know, throughout their training. So. And, you know, throughout that, I took no breaks. Just kind of went, went through, you know, med school- undergrad, med school. And then, straight into, to surgery training. You know, throughout the way for me, because I was a father at a early time, I did have to work a lot. So I balanced three jobs through undergrad. You know, while having a kid, and family, and all those things.

Manasa: So if you had to describe your passions and interests within this field. You kind of talked about how you developed your interest for general surgery and being able to do broad things. But I guess what is it that drew you to trauma surgery? Some of it was the mentors that you had mentioned. But…

Dr. Roberts: The biggest thing for trauma is it’s exciting. I think, or anybody who is in surgery, and you’re doing a major trauma case. And you see the amount teamwork and effort that’s involved. And kind of the excitement that’s involved. That’s something that, that adrenaline rush is something that is hard to, to let go away. And I think if, I think early on that’s the initial trigger for trauma. Is you have an experience like that. Like, wow, that was really incredible. And then you see the results of what you’re able to do when somebody is in extremis and literally bleeding to death. And you’re able to, to control that and stop that. And, you know, return them back to, to life essentially. You know, that’s something that is very incredible. And very rewarding. I think the, so the cases for now, you know, these are very complex cases that you may get. 

You’re able to operate in different parts of the body. Very complex cases. But it’s very much a team effort. It’s not just one person who’s able to you know, get this patient through their hospital course. It’s, it’s very much relying on everybody. And so I think having that, seen everything that’s involved with those type of cases, is something that led me and drew me into wanting to trauma surgery. The culture of trauma and the providers that are in, that are in the trauma field are some of the most amazing people I’ve ever met. And everybody is very willing to support one another. I think it’s a very collegial field in most settings. And I think just the overall, kind of group atmosphere that we have, especially in this trauma department, is something that drew me in very quickly. I think just recognizing the friendships that I made early on. And the mentorship that I had early on. Just kind of sealed the deal for me that this is, this is what I wanted to do.

Manasa: Were there any things that made you question, not necessarily like deterred away from the specialty, but made you think hard about your choice? Whether that, that was like the bad outcomes that don’t always result in-

Dr. Roberts: Yeah, and its, I think you always – anytime that you’re trying to make a decision on what you’re going to be doing for the rest of your life – you do need to question everything. So regardless of what field that you choose. You know, this is something that is going to be what you do day in and day out. So you need to question, you know every little thing about it. So for trauma for me, it was, really trauma in some settings is, is not a lot of operative intervention. And so I love operating and I love being able to provide, provide, you know, my expertise with your technical ability and so. Not being able to operate routinely was something I was concerned about. So nowadays, you know, operative intervention for trauma can be as low as, you know, 20%. If not less. And so, there’s gonna be a lot of time where you’re not getting additional operative cases. And so I didn’t want to be going into a field that I not, I’m not, getting, you know, routine cases and that my operative ability maybe, you know, may decline because of that. So I had considered vascular surgery, you know, things like that, that did a lot of your routine, technical cases. But, you know, I think part of it is relying on doing general practice and emergency general surgery to where you are getting in, getting the additional cases and stuff that you need. You know, whereas trauma is not always going to be an operative experience. 

So that was part of it. The other thing I wasn’t quite sure about was- the schedule for trauma can be, you know you’ll be doing nights, you’re going to be doing some shift work, but it’s not like, you know, just doing general practice where you’re gonna have your clinic for a couple days and then you’re gonna have your set operative dates. It’s going to be a little bit more varied. So that was another thing that I, you know, had long thoughts about, but ultimately, you know, that wasn’t a big deal for me. I enjoyed the, the variety of, of things that we see for trauma and emergency general surgery, and even the variety in the schedule. I enjoy that. You know I am not- every single day is different.

Manasa: Yeah. I think that is something unique that I’ve seen within surgery- within like different specialties- in that for trauma, you can do acute care, trauma and critical care, which is not common to have that variety in your daily, every day like experience. 

Dr. Roberts: Yeah.

Manasa: So within this field, are there specific topics you’re interested in, or research specifically, or any things like that that students can learn more about?

Dr. Roberts: Yeah. Right now, I’m not doing, I’m not doing much research. Most of my, most of my roles are pretty heavy into doing educational and some administrative duties with the ECMO program. I am very passionate about our trauma department and, and specifically things that I very much enjoy are, are outcomes with major trauma intervention, such as, you know, vascular injuries, things like that. Other things that I, have a, kind of a big role, as far as not necessarily research, but as far as clinical interests- my elective practice with foregut is something that has continued to be a big focus. More at it, more as a needed, needing to fill a demand from the department. You know, we had, unfortunately when we, when Dr. Bonwich had retired, she had done a lot of foregut work and so filling in that role of providing additional foregut expertise was something that I, I developed and have continued to enjoy. And so that’s something that we have a lot of growth that we will continue to make, and we are hopefully going to be starting a foregut multidisciplinary group, with the, with the hopes of even later, you know, a Foregut, you know, Center of Excellence, which that’s a long way off. But ultimately making this a multidisciplinary, multidisciplinary field with GI and with thoracic surgery, and with myself. 

Manasa: And so, for just our listeners like me who have very little knowledge about different like anatomy aspects. So I guess foregut includes like para-esophageal hernias and like Nissen fundoplications.

Dr. Roberts: Yeah. The major area for foregut when we discuss that is going to be the lower esophagus, stomach, and the duodenum. So anything of that area. You know most foregut places are going to be managed by bariatrics, which we don’t have bariatrics here. And so some of these complex patients that don’t really have, you know have a bariatric surgeon, you know, that’s where I can help provide a little bit of, I can provide that, that surgical need that they may have. So most of the stuff that we see here is going to be largely para-esophageal hernias and, and reflex disease, which the thoracic surgery group does a lot of. Unfortunately they’re, they’re very busy dealing with esophageal cancers and, and lung cancers and stuff like that. So there’s still a lot of those patients that still need support. And so that’s where I’m able to help out with that. And then, you know, more benign causes of, you know, gastric issues and duodenal issues, and, and our group can deal with that too. You know, if it’s gonna be a, a malignant process, that’s gonna be dealt with with the hepatobiliary surgical oncology.

Manasa: Ok yeah, that’s cool. If you had to describe the coolest thing you’ve done so far in your career. Or like the most interesting or excited, exciting thing that you’ve done.

Dr. Roberts: Hmmmm. That’s, that’s a tough question. Is that as far as a case or as far as a just achievement throughout?

Manasa: Whatever you think. 

Dr. Roberts: Okay.

Manasa: And we can come back to it… To think about…

Dr. Roberts: Yeah, I’ll have to think about that one. 

Manasa: Okay. So we’ve talked a little bit about your clinical interests and everything. If you had to talk about outside the hospital, what are your passions outside the field or just outside of medicine in general?

Dr. Roberts: Yeah, outside of medicine, it is definitely my family. I was a dad very early in my life. And so I’ve been a father more than I was ever a, you know, a young 20 year old. So I, my passion is definitely my family and spending time with them. I have three kids. You know, I have a lovely wife who’s a veterinarian, and so the times that I have outside the hospital are, you know, geared at doing the family things.

Manasa: Yeah. And so I guess a question related to that, because we are, this is a surgical specialty that’s known as being hard to balance or integrate into like, between work and life. How would you describe the balance that you’ve been able to form over the years and how you try to maintain that while also being someone that works hard at the hospital and cares about their patients?

Dr. Roberts: Yeah, it definitely is difficult. But it is completely doable. I think one, you need, you can’t, you can never do things on your own. Through any residency, especially surgery. So you need to have support, no matter, you know, whether or not you have kids or no kids, you know, things like that. And so a large part of that for me was I had, you know, support from my wife and, you know, and other family that was able to, you know, come and help us out. You know, she a veterinarian, so we were both very busy, you know, early on in our careers dealing with those things. So. There was a lot to balance. I think recognizing that there’s times to make sacrifices for your career, for being in the hospital for your patients. And then there’s times to, that you have to make sacrifices for your family. And sometimes it’s kind of difficult to make that decision at the time, but, you know, as you go through that, you kinda recognize, okay, this is, these are the times that, you know, I can, I can say that, you know, somebody can do that at the hospital. I don’t need to be there to deal with that issue. And, you know, other times where, you know, this patient’s relying on you and, you know, sometimes you’re gonna have to be late for I guess, you know, dinner with the family, things like that. It’s challenging, but you know, we all go through that in life. It’s just something that you get more experience with. 

Manasa: Would you say you have any hobbies or anything that help you have stress relief for like if you’re having a really bad day?

Dr. Roberts: Yeah. Hobbies are terrific and you, we all need hobbies. Especially, you know, dealing, being in the hospital. You know, when you’re there for a long period of time, then you need something to escape to. Yeah, for me, yes, a lot of that’s spending time with my family. And then I love enjoying going for runs, and sports and do a lot of boxing. I’m not a boxer or anything, but it’s just something that I can, you know, go to the gym and hit the bag for a little bit, things like that, that can take my mind off things. And so that’s something that is definitely been able to help me escape from the stresses that we deal with in the hospital.

Manasa: I tried kickboxing for a little bit early on in med school, figured out it was not for me, but hey, to each their own for what they like.

Dr. Roberts: Yup.

Manasa: What are you currently working towards, in terms of like big long-term goals for the future? 

Dr. Roberts: Yeah, long term goals are. Robotic surgery has kind of been the biggest thing. It’s not something that I see being the sole part of my career, but recognizing what application I can use it for for my patients. And most of those patients are going to be my elective general surgery patients, but some of it may be applicable to my emergency general surgery patients. And so that’s kind of one of the big things. And then clinically, as far as, you know, through administrative goals, I’m hopeful that, you know, through, we can continue to expand our ECMO department and continue to build up our trauma program department. It’s already grown so much and I think we have a good group of, of faculty members that, you know, I learn so much from every single day. And so I think that, just the group that we have, I, excited to be a part of this division and see it, see it continue to expand.

Manasa: Yeah. If you had to say, oh I wish this was different in health care or patient care, just like your thoughts about the system or things like that.

Dr. Roberts: Yeah, I mean biggest thing is, you know, just ease of access for some of our patients. You know there’s a lot of our patients that unfortunately, they, they have a hard time getting to the hospital, or being able to get things provided, and being able to provide, you know… You know, they need, they need a hernia done and they can’t get it approved so they’re out of pocket. You know, those things are the biggest frustrations that you know, this patient needs something done and unfortunately we have to go through all the, all the hoops and rigmarole, rigmarole to try to get that taken care of. So that’s frustrating and that’s something that I would love to see, you know, improve. 

Manasa: If you could give one piece of advice to students today, what would it be?

Dr. Roberts: Biggest thing is, you know, if you ask me, five years ago, going through, you know when I was in residency or at the, towards the end of my residency. It would have been, you know, just keep working hard and continue to- you know sometimes you have to make sacrifices for your patients and just dedicate yourself to them. You know, I think, you know, I would still say that with the caveat that you need to take care of yourself. And so learning that balance, you know, for yourself. Everybody’s different, you know, so what they need for recovery from, you know, being in the hospital, things like that, can be different. So recognizing those things in yourself, you know, just make sure you take care of yourself too. And there’s, there’s a lot of people that will, will help you. And so reaching out and finding people that can help you and guide you is something that I think is very important. It’s only gonna make it easier as you, you know, work your way through your career.

Manasa: And then, the reverse of that I guess, is what is the best piece of advice? 

Dr. Roberts: Yeah, one of the, probably the best piece of advice for me was, was actually from Dr. Steliga. And I think I was through my, when I was a third year or fourth year in residency, and I was just spending a lot of time in the hospital and… He just came to me and said that, you know, just, just always remember to, to just take care of yourself. You know, it’s, it’s very important that, you know, what we do is demanding and hard work and that is crucial. However, you just have to recognize that there’s other people in the hospital that can help out with things too. And that was very helpful for me kind of recognizing that, okay, there’s, there’s a balance that I need to find a little bit better.

Manasa: It’s always hard to find that. Hopefully you can reach it at some point. Did you get a chance to think about the most exciting thing?

Dr. Roberts: Oh, yeah. I mean, there’s been a lot of things, you know. I think it’s always exciting when you have a very sick trauma patient, you have, you know, daily rewarding events. And so those are ones I enjoy. I think the most exciting thing was whenever we first started ECMO and we had our first several patients that had really good outcomes. And it was a very difficult time with COVID. It was one of the most unusual times I ever experienced in the ICU where we had literally so many, so many nurses, you know, working hard every single day to take care of these patients. And we had probably seven ECMO patients, you know, all running at once, but I just, you know, looked down the hall and saw how many people were dedicated to taking care of these patients and what they were willing to do. You know, they were able to make sacrifices and, and really everybody did a great job and, you know, we saved a lot of lives that I think wouldn’t have been able to be saved without that support. So I think that was one of the most exciting times, very challenging times, very difficult, and long hours and things like that. But it was something that was exciting that we are able to accomplish as a group.

Manasa: That’s awesome. Well, hopefully we won’t have to ever face something like COVID again, but who knows. 

Dr. Roberts: Yeah, yeah.

Manasa: Well, it was great to talk to you, and I guess if students wanna reach out to you to shadow you or talk to you or have you as a mentor. Can they email you or? 

Dr. Roberts: Yeah anytime! Yeah, yeah my door is always okay.

Manasa: Sounds good, well thank you so much!

Dr. Roberts: Thank you.

Introduction

Dr. Marino is an Assistant Professor in the Department of Surgery and a thoracic surgeon at UAMS. Listen to learn more about how she narrowed down her interests to decide in pursuing a career in medicine, as well as how she approaches mentoring and what she calls “sponsoring” a student. Other topics mentioned include being a female in this field, her lifestyle, what changes she would love to see within health care, as well as her advice for students. 

Listen to the episode

Transcript

Weijia: Welcome to the next episode of Mentor Spotlight, your very own UAMS-led podcast to help connect students to faculty mentors. We are Weijia, 

Jasmine: Jasmine

Hannah: and Hannah

Weijia: …your hosts for this episode. Today we have Dr. Katy Marino, a thoracic surgeon in the Surgical Oncology department of the UAMS Cancer Institute. 

Hannah: Dr. Marino completed medical school at Louisiana State University Health in Shreveport, completed residency at the University of Tennessee Health Science Center in Memphis, and completed a fellowship at the University of Louisville School of Medicine. 

Jasmine: Dr. Marino is currently my mentor, Jasmine, for a summer along NIH-funded cancer research program called the Partnership in Cancer Research Program. So I’ve been looking forward to having Dr. Marino on this podcast throughout this entire summer. She has shown me the ropes of clinical research and has served to be such an amazing and supporting mentor to me as I work through my first clinical research project. So I thought it would be perfect to have her on this podcast. 

So without further ado, let’s welcome Dr. Marino! Hi, Dr. Marino. 

Dr. Marino: Hi! Thank you all. That was a great introduction. 

Weijia: Haha. Thank you. Well, so we’ve talked a little bit about your educational background, but would you mind telling us a little bit more about yourself and what made you decide to pursue in this career path? 

Dr. Marino: Absolutely. I think I became interested in medicine in my high school years, and I was trying to decide which path I was more interested in- policy and politics, or medicine. And I got the opportunity to go to two different leadership camps, one in D.C. on policy and one on healthcare in Boston. 

And you probably have come to realize that things can happen at two different paces in those two different fields. So I knew from those two experiences, I liked the immediate gratification and change that you could get in healthcare. And I think that early recognition is what really led me to want to do surgery as well. So many of us love the immediate change and improvement that we can see in our patients’ lives from surgical procedure. And then in medical school, when I was in your shoes, I really was able to figure that out, exactly what field of surgery I wanted to do – that I wanted to do general surgery for the breadth that it carries. It has a lot of different pathologies that we can see, whether it’s benign, whether it’s malignant, vascular, trauma, and that really kind of potpourri approach to healthcare is what really attracted me to the field of surgery. 

Hannah: Very cool. So as a young, well, rising M2, but I still feel like a little baby M1, a lot of students come in not knowing anything about any of the specialties. Or the only things they hear about are those stereotypes or what they hear on TV. And as we all know, TV medicine is very different from in real life medicine. So how would you pitch your specialty to a student, or what are the big points that you would say, these are the highlights? Maybe these are the not so great highlights, not so great, like the not so sugar coated version of your specialty? Just a quick rundown. 

Dr. Marino: Sounds great. Let’s do the non-highlight reels and reality, we will call it of surgery, specifically thoracic surgery. As you know from your introduction, I went a lot of places and trained for a long time. And I think that’s one of the potential drawbacks depending on how you view your training, is that it requires many years. It often requires years in addition for things like research to build your CV and make yourself more competitive and to stand out in the field. 

And then the potential that you might move, especially with it being a more competitive match, you’re not always in control of where you’re going to be. So those are things that just getting into the field might be an obstacle or a deterrent for some applicants. I think you have to balance that with what the benefits of pursuing a field like this. And for me, they’re very numerable. 

I love the complexity of my patients that I see. And that’s what I would pitch to somebody interested. Is that I have a very broad field that covers a lot of complex patient disease. I do everything from cancer operations to what you might consider orthopedic operations. I do benign problems like reflux and achalasia. And I like that I can see outpatients who are healthy. I can see inpatients who are the sickest of the sick come in with emergencies like esophageal perforation. 

So as Jasmine and I were talking about with research, it tickles a lot of the different parts of my brain. The other thing that’s great about thoracic surgery, and compared to other surgical fields, is the amount of technology we have at our disposal. And if you’re a tech geek, I don’t think there’s a better field for you. We have advanced software for three-dimensional planning. We have robotics. We have other minimally invasive platforms like VATS, which is a lot like laparoscopic surgery. We do endoscopic work with EGD scopes and bronchoscopes. We use everything from lasers to staplers, cryoablation. And we also just do bread and butter really big operations and make big holes sometimes. And that’s really attractive to some people too. Is just we have a whole platform of tools, and probably one of the specialties most dedicated to furthering those technological advancements. We actually have our own shark tank at one of our national meetings where people pitch ideas for new medical devices. Ans so I think that’s one thing that really stands out about thoracic surgery. 

Jasmine: That’s amazing. Very innovative. Very innovative. 

Weijia: Good for tech geeks. 

Dr. Marino: Yeah. 

Jasmine: So, you’ve talked a bit about all the different types of procedures and machines that you use. And you’ve also talked about how much you love research and policy. So how do you balance all these responsibilities? What is your typical day to day, or typical work-week look like? 

Dr. Marino: That’s a great question and I think it can vary depending on where you are at- whether you’re in private practice or an academic institution like this, and what stage in your career. I’m very early in my career. I’ve only been out three years, and so I’m really trying to use my youth and energy while I have it to tackle as many problems out there. I’d say probably 80 percent of my time is devoted directly to patient care, whether I’m in the clinic or seeing them in the hospital or the operating room. Or the flip side of patient care is the charting, and billing, and recording notes that has to go on. That other 20 percent of time I split between education with students and residents, whether it’s a simulation experience or a lecture. And then, time devoted to research with folks like Jasmine, probably a couple hours a week. And it can be hard to fit all that in. Obviously I’m going to have weeks where like today, for example, I’m not operating. I’ve seen my patients in the hospital. I got to get to work at eight this morning, which is sleeping in for me, and I have had four meetings on my docket for today that are everything from administrative to quality improvement research, and this time that I’m spending with you guys. The flip side of that is some days, I get here at 6:30 to see the patient in pre-op before surgery and if I leave and I call my mom, because I call my mom every day, okay, she goes, “wow, it’s 6:30,” that’s a good day. So I’ve spent 12 hours here already. So, it’s a give and take, it’s a balance, and that’s kind of how I look at it. I take advantage of the time that I’m not operating to do things like this. 

Jasmine: Awesome. I think this is, I think work-life balance is one of the main challenges that a lot of like healthcare providers have to go through. So I think it’s really important that the listeners to this podcast kind of like realize that, and especially its always changes with each specialty. So that’s why we try to ask this question a lot. 

Hannah: We like the non-sugar-coated version because typically that’s the only, we only get the sugar-coated version. And we’re like, what’s it really like? 

Weijia: And that’s only after you completed your training with residency and fellowship. So I was wondering what does residency and fellowship look like for you? How many years is it? What do you do? What’s the schedule like? 

Dr. Marino: So the shortest track that you can take from a traditional training standpoint, which is what I did, is five years of general surgery and two years of thoracic training. There are also three-year thoracic fellowships. So now we’re looking at eight years. And there are many people who stop to do research along the way, so that can bump your total sometimes up to 10. There’s a joke for the folks that train at one of the East Coast cardiothoracic programs that we won’t name on the podcast. But it’s a joke that you spend a decade with Dan, and we’re going to change Dan’s name, obviously, because that’s how long the training is. 

Hannah: That is quite the commitment… Okay, so shifting a little bit from medicine and what has led you here today with education and current life, but more to dreams and beliefs. So what are your current frustrations that you have within the field of thoracic surgery or just with medicine, health care in general? And how do you think, like what, what would be your dream, like either solution or like outcome? 

Jasmine: Especially since like you’re so passionate, I think about policy, healthcare policy. This is amazing- we would love to hear that. 

Dr. Marino: Yeah, this is a great topic. So, I think from a, if we look at patient problems, and to me, patient problems are my problems. Those are the ones that I should and do care the most about. From kind of a day-to-day standpoint, what they see is, gosh, I had to go to this doctor to get this record and this doctor to get this record, and nobody’s electronic health system actually talks to each other. You have things that are getting fax, things that are pushing through the cloud. So I think, if we had more resources to streamline that for patients, that it would probably expedite their care, but just in general, improve their impression of our care, and how fragmented it can be sometimes. I think from a policy standpoint, continuing to look at patient outcomes, specifically for lung cancer and the work, for example, that Jasmine is doing with LOTO screening and how do we distribute that to populations in an equitable way, focusing on disadvantaged populations, we have so many opportunities for that. So I think in a dream world, patients are able to get their LOTO CT easily, and then I’m able to get those records and work up and evaluate that patient for surgery, with fewer steps.

Jasmine: It’s all about, I think the logistical standpoint of medicine can get very complicating. Especially working, you know, in a rural population state, having that, I mean, lots of places don’t even have internet access. So much less, how are they going to know how to use these programs? How are they going to know how to get these certain records from all these different hospitals that they’re being seen at, and get a complete medical history of your patient, you know? Because you have to grab this record from this small family clinic in this part of Arkansas, and yeah. I could definitely see how that’s really, really complicating. 

Hannah: Communication is a skill. 

Dr. Marino: Absolutely. 

Jasmine: Yes. Something more specific, I think, to our state. I mean there’s lots of other rural states but I feel like that’s like a specific challenge with Arkansas, especially since this podcast is, you know, for UAMS. 

So being young in the medical field, you hear a lot about the different types of specialties, and it’s hard to differentiate between what’s true- I think we kind of talked about this right? 

Hannah: Yeah. 

Jasmine: What to take with a grain of salt. Would you mind telling us a little bit about your lifestyle as a surgeon, and what your working environment is like?

Dr. Marino: Sure. So lifestyle wise, I think I have a good lifestyle. I think I have a good work-life balance. There was periods before COVID when I was, you know, going to the same gym class, making the same friends all the time. Of course that kind of tapered off with the pandemic and all. But I’m able to engage in things like the Arkansas Museum of Fine Arts that’s coming, I like to go see the ballet, I like to travel to the lake and whatnot. So from a lifestyle standpoint, I make time and find time to do things that I love. Things that are difficult about my lifestyle that I’ve had to troubleshoot for example, dog care, right? Do I do the majority of the grocery shopping for my household? No. So if you’re, you know, have needs for household care, dog care, child care, those can become challenges and it’s important to have your community around you, or other ways to get those things done. And you do feel guilty sometimes. I have a dog, and I feel guilty about it, I can only imagine how, how moms in my shoes feel, but they’re friends and colleagues of mine that do it and excel at it.

Jasmine: So like transitioning to that – of how moms, female surgeon moms may feel, what is it like to be a female surgeon in a traditionally male dominated field? Would you say it has its own specific set of challenges? 

Dr. Marino: Certainly. I think one of my favorite stories to tell about this topic is I was interviewing for thoracic fellowship and I was with two interviewers, a male and a female. And I got asked when did I think there were going to be enough women in thoracic surgery? And I said, “Well, when I stopped getting asked that question.” And I really do believe, and hope that every woman who’s able and interested in thoracic surgery has the potential to have a career in thoracic surgery. I think part of the biggest part of that is we have to be each other’s own cheerleaders. So when you see opportunities, invite another woman to it. When you have somebody like Jasmine, who’s my student, to make sure that I’ve done every opportunity to kind of advance her career, I think that’s the difference between a mentor and a sponsor. A mentor is willing to give you advice, the sponsor’s willing to go out on a limb and give you an opportunity.

Weijia: So on that note, do you have any advice for women wanting to become a cardiothoracic surgeon, or just surgeon in general? 

Dr. Marino: Yes, I think especially now that you guys are hopefully having fewer and fewer Zoom opportunities, and more real-life opportunities to…not be afraid and reach out. I think when I was a medical student, the culture was a little bit different. I was probably terrified to reach out to any female surgeons, and at the time I knew one cardiothoracic surgeon. She was, I think, the Associate Dean of my college. So I definitely was not going to email her and say “hey, can I come hang out.” I think nowadays, it’s much more accepted, and welcomed, when students reach out and say “hey, can I come and shadow you and spend some time.” And what I try to do is find opportunities for you all to meet with me in clinic so that I can give you a little bit more one-on-one intention. While it’s cool to come watch what I do in the OR, I can’t really have this conversation about lifestyle, or my pathway, or you know, even what kind of places I like to go shopping or traveling to, right. Things that kind of help you get to know that person, when I’m in the operating room and think of a procedure. So, reach out, don’t be afraid. 

Jasmine: Persistence. Cause I mean, I think we’ve all experienced that at every level, like pre-med, medical student, of just getting, of cold calling people, cold emailing people-

Hannha: -making connections-

Jasmine: -and like, it was a really a challenge for me, like when I didn’t get like a response, or if I’m like being persistent, I’m just like “oh.” I tend to like internalize, that but I think it’s very important to just like, brush it off, and just keep persisting. 

Dr. Marino: Right. Surgeons are busy. We are all guilty of mentally responding to your text message or your email, and then forgetting to hit the actual send button. 

Hannha: I do that all the time in my own personal life, so I definitely don’t take it personally cause I have been the one accidentally ignoring others.. but anyways, so staying on the topic of advice, what is one piece of advice you would just give to medical students in general, overall. It doesn’t have to be, maybe necessarily about like medicine, but just one piece of advice that either you wish you got, or was like the best advice that you were given as a medical student. 

Dr. Marino: I think, attach a patient to every learning point that you can. And take every opportunity to learn as much as you can from a patient. You will carry that with you. And that’s whether it’s a learning point you read in a book, or something you learned the hard way because something didn’t go well for the patient. And looking at those problems from a patient standpoint, you will take that with you, you will remember it the next time, and you’ll learn from it and grow more than you would if you just read it in a book chapter. 

Jasmine: I think that’s why clinical experience and volunteering is like really important too. Because like when we see patients at Harmony, it’s like, oh, you’re able to finally attach-

Hannah: – always remebered those patients more.

Jasmine: Yeah. 

Hannah: Yes.

Weijia: Yeah. I feel like medical education, some of the concepts you learn are not that complicated, but they’re just abstract. You know, without seeing someone, you can’t imagine-

Jasmine: -like conceptualize it. 

Weijia: Right you can’t conceptualize it properly. Yeah. 

Hannah: All right. So what is your most memorable experience, from either med school, residency, or like, as an attending? Just in your medical journey. Either the one that you have enjoyed the most, or it was just the coolest experience for you, or maybe, you know, it wasn’t a cool experience- but just your most memorable experience.

Dr. Marino: I think one of the first and most formative experiences I had was traveling for an organ donation. 

Jasmine: Wow. 

Dr. Marino: And I was a medical student. I went with my attendings. There weren’t any residents, so I really had a close view of the surgery. And I remember thinking, well, this is such great anatomy. I can see everything. And the case progresses. And of course, at the conclusion of the case, it’s time to take the donor off of the ventilator. And at that moment, it kind of hit me. And I think it’s a piece that not everyone will experience. Not everyone will get to go on a procurement, but exactly how final and how tough of a decision that had to be for the family to make. For their loved one to come to that operating room, and leave with a completely different scenario than they went in with. I think was one that made me really appreciate transplant, and really enjoy being a part of every donor and every transplant recipient that I was a part of for the, you know, five years of residency and two years of fellowship that I still did transplant. So I have a big appreciation for what the OPOs, the organ procurement groups, do, for what families do, and for what surgeons do, for donation. 

Jasmine: Wow. I think that’s one of the coolest stories I’ve heard-

Hannah: Yes.

Jasmine: Actually, honestly. Okay, so I think, how can a student contact you if they wish to ask you a question, shadow you, or want to have you as a mentor, or a sponsor as you say. So the best thing to do is to send me an email, kamarino@uams.edu. What I typically will do is give you my cell phone number, say my clinic is on Tuesday afternoons. You come to clinic on Tuesday afternoon. We see patients together, you shadow right behind me, and we spend some time one-on-one looking at CT scans, and talking about the patient’s diagnosis and their treatment. And ideally, I like to find the date that that patient is going to have surgery and have you come on that day so you get some continuity of care and you get to actually see that patient’s operation. 

Hannah: That’s really cool. As someone who appreciates continuity, I think that is the best way to do it. 

Jasmine: Right, I think-

Hannah: It drives home the experience more. 

Jasmine: That’s my number one pet peeve. Or not pet peeve, but like, when I shadow, I always wonder, like-

Hannah: Where are they now?

Jasmine: I hope they’re doing okay. Sometimes randomly at home, I’m like washing dishes, I’m like, hmm, I wonder if they’re doing okay. Just a random thought. 

So, is there anything that we have not covered that you want to make sure our students/listeners know?

Weijia: I guess, I have, sorry-

Jasmine: Yes, yes go ahead.

Weijia: I have one more question, and this is more for people interested in cardiothoracic surgery. Because it’s a pretty competitive field, what do you think resident programs look for in a student? Like what things should a student work towards? 

Dr. Marino: Right, so I think every competitive field comes with the, you need to have good grades. I think your grades come first in your, in your medical school training. Other things that I think you can do to make yourself stand out are participating in research, if you can make time too. I think that’s becoming more and more looked upon, and those are kind of the compulsory, get you through the door. I think the type of mentality that people are looking for, is somebody who is willing to be a life-long learner. I think earlier, we talked a lot about the technology in thoracic surgery, how it’s continuing to evolve. And that willingness to be a lifelong learner, whether it’s both education and skill set, is important for the field of thoracic surgery. So really being eager to learn and improve your skill set, be in the operating room as much as possible, read things of interest to you in thoracic surgery. For example, my partner, Dr. Steliga, when he finished training, there wasn’t a whole lot of VATS, or minimally invasive lobectomies, being done. And he’s a perfect example of what it takes to be a lifelong learner in thoracic surgery. He acquired that skill set later in his practice, and brought that to Arkansas, and instituted that here and has become a leader in the field. 

Jasmine: And I think, I guess during residency interviews or when they have their, your application open, they can like see if you have, like, extensive research. They, I guess they see that you’re always willing to like learn and commit to a project, especially since like one project- bringing it from like abstract to manuscript and all the way to like publication- that takes so much commitment. 

Dr. Marino: Right.

Jasmine: So I think, you know if you show that you have all those research projects, it shows that you have that willingness and commitment, and that you can carry it over to like a career. 

Dr. Marino: Agreed. Everybody in medical school, we’re always trying to just get from one test to the next and one test to the next. And we don’t really look at that ten thousand foot view of what’s going to happen with my career ten years from now, twenty years from now. Well, as a medical student, ten years from now, did I think, “Gosh, I’m going to be studying every night that I come home from work to take my American Board of Thoracic Surgery exam”? No I didn’t, but that’s the reality. So you never stop learning, and never stop improving. 

Weijia: That’s good advice in general, I feel like for any field of medicine. 

Dr. Marino: Yeah, it’s what you would want your doctor to do for you or your loved one.

Weijia: For sure. For sure. All right, well thank you so much for being available for this podcast Dr. Marino. And is there anything else that you would like to share with us? 

Dr. Marino: Well, it was a pleasure, good luck to all of you and I look forward to seeing what your class is going to do. 

[all laughing]

Weijia: Us too. 

Hannha: Us too. Yes, yes. And listeners, as always reach out to us and let us know your thoughts, concerns, questions, and we’ll see you in the next episode!

Introduction

Meet Dr. Johnathan Goree, an Associate Professor in Anesthesiology, as well as the Division Director and Fellowship Program Director for Chronic Pain at UAMS. He considers his clinical title to be a “Quality of Life Specialist,” and in this episode, learn more about what his clinical and research interests are, as well as about his interests outside the hospital, from mixology and cooking to traveling!

Listen to the episode

Transcript

Hannah: Welcome to Mentor Spotlight, a podcast designed to help connect UAMS students to faculty mentors. We’re Hannah-

Weijia: And Weijia

Hannah: -Your hosts for this episode. Today we have Dr. Johnathan Goree, an Associate Professor of Anesthesiology at the, at UAMS.

Dr. Goree: Thanks for having me. I appreciate it. 

Weijia: Thank you for joining us! Dr. Goree is also the Director of the Chronic Pain Division, Program Director of the Chronic Pain Medicine fellowship. And the Chief of Staff Elect for the UAMS Health Hospital System. Dr. Goree completed medical school and residency at Cornell Medical School. And Chronic Pain Medicine fellowship at Emory University Hospital. In 2014, he joined the faculty at the UAMS. His research interests include racial disparities in chronic pain care, implementation science, complex regional pain syndrome, and efficacy of novel opioid-sparing technologies like neuromodulation.

Hannah: Welcome! So I know we talked a little bit about your educational background in our intro, but would you mind just telling us more about yourself and what made you decide to pursue medicine in like this specific career path.

Dr. Goree: Yeah sure. I will try not to be long winded because I could probably -that’s a 30 min question- but, I am, I grew up in Memphis, but I moved to Arkansas when I was 13. So I went to high school here in Little Rock, like right around the corner at Catholic High.

Hannah: Ok!

Dr. Goree: So I consider Little Rock my home. Left for a while, and we talked about all the places I did training, but. At some point, I decided I wanted to be an anesthesiologist. And honestly, my decision to do that centered around, really with my mental definition of a doctor was. And that was someone who had the ability to respond to emergency situations. So. I always thought about if someone were to drop dead right in front of me, who would be best, you know, best equipped to save that person’s life. And I’ve always enjoyed high pressure situations, whether that be sports, whether that be in academics. And I didn’t really know what that was when I went to medical school. So, I didn’t know whether that was a surgeon or an ER doctor, but then as I began to do my third year rotations, I really realized that, you know, the people who run codes in the operating room are anesthesiologists, and the people who really understand complex physiology are anesthesiologists. And so that’s what I decided I wanted to do. I had a little bit of a crisis of identity while I was in anaesthesia residency. Because, I realized that I really missed patients. So when you’re an anesthesiologist, or an OR anesthesiologist, most of your patients are asleep. And you’re standing behind a curtain and you’re monitoring them and you’re trying to prevent emergencies from happening. I realized that I wanted to see patients every day, and I wanted to follow them longitudinally, and have them tell me about their kids and learn about my wife. And so I started exploring this world of pain medicine. And I think the thing that sealed it for me is that I have a wisdom tooth removed. And I had to be put to sleep for it. And when I woke up, I had a lot of pain. And they gave me some fentanyl. And I actually went apneic. So I, for lack of a better term, and I’m using air quotes because you can’t see me, I overdosed on fentanyl. And it was iatrogenic. And I was given naloxone to reverse me. And that was the most. It was one of the worst moments of my life. I had 10 out of 10 mind numbing pain for about 30 minutes. I would have done anything to get rid of that pain. And I realized two things kind of shortly after that. One was that there are patients who live that way every single day of their life. And I wanted to help them. And then the second kind of informed a lot of my research interests is that a lot of the people who experience that or don’t have the resources that are being treated are underrepresented minorities. Are people who are in rural communities. And so that really informed my decision to come back to UAMS and to kind of ensure that pain care is not only done well and that we are working on preventing opioid overdoses, but to make sure that it’s equitable.

Hannah: Well, thank you for sharing. I know like, that must have been a very, very frightening situation.

Dr. Goree: Yeah, it wasn’t wasn’t fun. 

Hannah: Definitely, definitely would shape one’s career path and I can see how.

Dr. Goree: Yeah, and I will say that I have not ever given, and even as an – and I’ve worked as an anesthesiologist before I really 100% concentrated on pain- I’ve never given anyone a full dose of naloxone. And most of the time, because anesthesiologists have the, you know, when someone overdoses on opioids, it means that they’re basically too high to remember to breathe. And so if you breathe for them, then they don’t have to have it reversed. You just breathe for them until the drug wears off. So. I have bag-masked people or intubated people in that situation for 15 or 20 mins and gotten them through it. But I think it’s definitely influenced how I practice.

Weijia: So what is your typical work day look like now – now that you’re doing chronic pain management anesthesia? 

Dr. Goree: Yeah, so very different than kind of what most medical students would probably think about anesthesiologists. So my time is split between clinic and procedure time. So about half my time is spent in an office seeing patients in a clinic. And the majority of the patients I see, because of kind of my niche, my clinical niche within chronic pain, is patients who have really severe post-surgical pain, whether that be knee replacements, hip replacements, spine surgeries, abdominal surgeries that just don’t go well. If you look at the literature about 30% of patients who have any type of surgery have chronic pain after. Surgery just, you know, and that’s why a lot of times surgeons are very cautious about who they operate on, because a lot of patients just don’t do well. And sometimes it’s really hard to predict who those people are. And so I see about 20 patients a day and have conversations with them about what I can do to improve their quality of life. Like one of the things that’s kind of interesting about our specialty that makes us unique is I think we are the only specialty, or one of the only specialties, that doesn’t treat a pathology. So almost every doctor, you know, what you learn to do in medical school is pattern recognition. You identify disease. And then you learn what the treatments are based on evidence and you provide those treatments. I see patients when medicine fails them. And so when doctors try to treat them. It doesn’t go well. And then it’s like, we don’t have a treatment for which you have. We can’t fix your pathology. So we’re gonna send you to someone who is going to try to palliate your quality of life. And that’s what I do. And so I talk to patients about how to get them moving more, how to get them sleeping more. And, and actually our intake form is something that’s called a Promise 29 which actually measures patients risk of, risk of depression, the risk of lack of movement. Their risk of lack of sleeping, etc. And we talk about all those parts of them holistically. And a big part of that is pain. And then the second half of my day, and I treat pain with both procedures, sometimes medicine, sometimes opioids. The second half of my, half of my clinical time is spent doing procedural interventions. And that’s anything from injecting something with steroids, to decrease inflammation, all the way to implanting kind of complex devices, like spinal cord stimulators, which for lack of a better explanation, are pacemakers of the spine for patients with complex chronic pain.

Hannah: Very cool!

Weijia: Very cool for sure. For our listeners, I worked with Dr. Goree, and I’ve shadowed him in the clinic before, and it is, it is nothing like the anesthesia we think of. 

[Laughs]

Weijia: Yes, it’s some, I, one, something that I thought was really cool, was, one patient came in with like back pain, and all you do is you just go in with a little needle and then you just burn off the nerve, apparently, and then that gets rid of all the pain. That’s chronic pain anesthesia. 

Dr. Goree: Yeah. A lot of, a lot of what we do is kind of thinking outside the box to how can we help this patient live with this condition. And if you think about it, nerves are really just highways from, from areas of our body to the brain. And if we can interrupt that highway, we can make patients better without curing their disease. So if somebody has a disease process and there’s a sensory nerve that goes to the spinal cord, then we can get rid of that sensory nerve so that they just don’t feel that area. And for patients who, unfortunately most of our nerves are mixed motor sensory and that’s where neuromodulation comes in where we use electricity to kind of change the signal so that, so that they don’t have as much pain. So we use a lot of really out of the box things and a lot of physicians don’t really know what we do. They kind of just like send patients to us, and we’re kind of the figure it out ground for patients that I often call myself, and this is probably a dated reference so I don’t expect either of you to get it. But there was a movie back in the 90s called Pulp Fiction, and there was a gentleman who they called when they had a, what I would call a snafu. And they called him basically the eraser. And that’s a little bit about what I do, when patients don’t do well, they often end up with me and we try to help them get their life back.

Hannah: Very cool! So I know Weijia was like, that was very cool to me. What is, in like, if you can talk about it, one of your most memorable, fascinating cases that you’re like, at the same time, you know, this is really cool or interesting. Keeping in mind that, you know, chronic pain in these patients’ lives, like it is very sad, but as a physician and a scientist, [yeah], this was interesting or this was something that is a very unique experience. 

Dr. Goree: Yeah. I’ll try to not get overly technical. But I have.. One of the things that I specifically specialize in is the placement of dorsal root ganglion simulation. And that is the placement of an electrical lead on a nerve root as it leaves the spinal canal. And, they just aren’t a lot of physicians who learn that technique because doing it minimally invasively is relatively challenging. And opening up the spine to place it can cause other problems. So. Doing it through a needle is probably the best way to do it, but it’s a very small target. And I had a patient who unfortunately, had an injury due to a gunshot wound. And, he had severe, what we call complex regional pain syndrome, which is a disease that I have published a few times about, but… It’s a disease where you have nerve damage and your sympathetic nervous system takes over a single limb. And patients have swelling, color change, they have severe pain and there’s something called the McGill Pain Scale that McGill University in Canada actually published. And they ranked the expected amount of pain from all sorts of disease processes. And complex regional pain syndrome was actually at the top, above a childbirth without anesthesia, a traumatic amputation, all these other things that are thought of as super painful. So incredibly painful disease and this gentleman had basically stopped working, lost his job, couldn’t support his family. And we were able to do simulation for him and now, I actually see him at his job regularly, cause he works somewhere that I frequently, I frequently visit. And so it’s always rewarding to see someone who comes to you and says like my livelihood and my quality of life is gone. And then be able to see them a year later and see them happy, working. You know, is he without pain- no- but I think just the ability to be able to support his family has been my changing for him and why I do what I do. Is because, you wanna, I like the challenge of having to think outside the box because there’s really no protocol for what I do. It’s like I sit down and I’m like, what can I do to fix this person? Or make their life better. But the second is that patients are so appreciative because most times when they make it to me, they’ve been given up on by everyone else.

 Weijia: That is pretty cool. It’s wow…

Hannah: It’s also really cool that you got to see that change. Like you get to follow long term because in certain specialties you don’t get that and so you just have to be like, well, I hope they’re doing well.

 Dr. Goree: Yeah. We see, we see the good and the bad. Which, you’ve seen some of the good and the bad, kind of working with us. Is that, you know, we, do our best and because we’re kind of the last resort. You know, we’re not able to help everyone. But we try our best.

Weijia: So we talked a lot about, you know, the good aspect of, the fulfilling aspect of chronic pain anesthesia. What would you say is something that you don’t like as much about this field?

Dr. Goree: Yeah, that’s a good question. Cause I would say I can’t imagine being in any other field. I would say the couple of challenges, and if you ask most physicians, they would say the patient population. They would say that treating patients who have chronic pain is challenging because it’s depressing. Because you’re seeing patients who are really at their low point of life. There is a perception that there is a lot of secondary gain. So the perception that you have a lot of patients who are coming in to get opioids or coming in because they want drugs. I have found that most people honestly want help. And most patients don’t know what that help is. And most patients think that the treatment is gonna be medicine because they don’t know what the options are. And so a lot of times I end up spending time educating patients. Talking about like Well, how active are you? Like, maybe we need to get you, you know, in with a psychiatrist because you do have depression that’s untreated that’s contributing to your pain. So it’s a lot of very challenging conversations. Actually love that part of my job, cause I love talking to people. I love seeing people improve. But I think for a lot of physicians, they don’t wanna sit and talk to people for 45 min about, kind of like, what’s going on in their life and how, you know, they just got a divorce and that’s probably contributing to their situation. Or, you know, they don’t have these resources and they need a psychiatrist. Or that, you know, they’re not sleeping well because of x, y, z or talking to them about, you know, yesterday I had a patient that I basically did an intervention for because he was, you know, over doing some unsafe things with opioids. And so I would say that most people would see that as the downside. I don’t necessarily see it as that because I think that, that’s the side of medicine where I think the most work gets done. Is actually really listening to people because I think the perception of medicine is that we don’t listen. That we come in with an agenda and we try to get things done. But, it’s amazing what you can find out, and honestly you could find out that the reason that patients say that they’re there may not be the real reason that they’re there. And sometimes it just takes time to get to know them and listen to find that out.

Hannah: I think that is a reoccurring theme from some of the specialties that have a lot of patient interaction. Especially, I can’t remember who it was, but they said that eventually if you talk to your patient long enough, they will tell you what their problem is. 

Dr. Goree: Mmhmm. Mmhmm. Mmhmm.

Hannah: Which seems…You’re like, oh, well, they of course they will tell you what their problem is. They’re gonna tell you that first, but we mean like they’ll actually tell you what is wrong, and you’re like, oh they know what is wrong with them, they just need someone to help. Anyways, sorry side note haha.

Weijia: So as a minority in the field of medicine, and especially I think anesthesia, what are some specific challenges that you have encountered?

Dr. Goree: Yeah, no, that’s a really good question. I think the, the main challenge is really being on the front lines and seeing the lack of equity in care. And some of that is due to location. You know, I trained in Manhattan. And so seeing the difference in access to care that patients in Manhattan have compared to patients in Arkansas is one. There, in my field, there’s probably less than 30 interventional trained chronic paid physicians in the entire state. Whereas in Manhattan, there’s probably 30 within a five block radius of where I trained. Cause there’s three large practices and then three academic practices all within this like little area. So. The access is a huge issue. But then also when you think about costs. To patients who are underinsured. And then there’s also this piece, of kind of assumptions that are made about patients. And sometimes, when patients look a certain way, we’re like, oh, they have chronic pain, we need to make sure that they get, you know, high quality chronic pain care. Whereas some patients who look a different way, we’ll say that, oh, they’re drug seeking. Or they’re just trying to get opioids. Or oh they’re just trying to like get a paper signed so they don’t have to work anymore. And seeing my referral patterns and seeing who gets referred to me. And then kind of now being on the policy side of both this hospital system and also the state. I’ve been fortunate enough that, you know, I was, for the past three years, I’ve been chair of the Opioid Stewardship Committee, which kind of drives decisions in pain management for the hospital system. Now, I’m in a different role as Chief of Staff Elect and I’ve also been an advisor to kind of the drug task force in Arkansas and to the governor when it comes to opioid policy. I’ve been able to kind of influence some of those decisions and that’s been super rewarding. One of the other challenges is that there’s, you know, we talk about diversity, equity and inclusion. Those are all three different but very important aspects of the problem. Not having a diverse room that makes these decisions. You don’t have people who necessarily can identify and see the problem. But we have to make sure that, and the problem is lack of equity of care. But the fix is that you don’t just, you need to have more than just people in the room. It has to be an inclusive room and those people have to be, other voices have to be heard and they have to be a part of the conversation. And so I’ve been very fortunate to help diversify pain medicine in Arkansas. But then also kind of be included to kind of move kind of that agenda forward and hopefully make things more equitable.

Hannah: So if we can take a little shift. So I know we’ve mentioned a couple of your research topics and your publications, but if you would tell us a little bit about some of, hmm sorry, your current research projects and if you have more than one.

Dr. Goree: Yeah.

Hannah: What you have going on, your favorite, just a couple of like, what you have going on right now.

Dr. Goree: Very hard to pick your favorite kid. I would, I would say. My research really fits into three different categories. And so first, as we discussed, I do a lot of neuromodulation. Which is the implantation of electrical devices to treat chronic pain. And a lot of the neuromodulation we do is on the cutting edge. So we are, we at UAMS, and I’m proud to say it, are one of the lead centers in your neuromodulation research nationally, if not internationally. The biggest study in neuromodulation, which is the use of spinal electrical implants to treat diabetic peripheral neuropathy. We were the lead center on that study. It was a 20 center study across the country. Places like Mayo Clinic, Cleveland Clinic, you know, Yale, Harvard, Stanford, all the big centers, Duke, the, we were the core of that research. And now that is an FDA approved treatment because of that research. 

Hannah: That’s really cool.

Dr. Goree: So, a lot of the work that we’re doing is actually pushing the field forward and pushing forward new indications for, kind of this cutting edge technology. And it’s based on the idea that the heart sends signals through electricity and so we use pacemakers to treat that and that’s common standard of care now. Nerves send signals to the brain through electricity. And so if we’re able to figure out how to harness that same technology, we should be able to do the same thing. And so every year, we’re getting better at it. You know, I will say, Student Doctor Shi and I are doing a project to understand how successful we’ve been in doing that over the past six years. And calling patients who’ve had various treatments and seeing how they’re doing. But we are, a lot of our kind of our bigger studies are using it for new indications. So that’s one. The second is kind of what we talked about, kind of my passion to make sure that pain care is equitable. So understanding what happens to patients when they have chronic pain. And you know, looking at whether patients are prescribed opioids after surgery, and whether there’s a difference on, based on race class and gender is something that I’ve published a fair amount on. The last is, I did a two-year fellowship in implementation science, which is the science of taking something that’s evidence-based and making it standard of care. And it’s been shown, it takes about once we prove that something’s effective, it takes about 12 years before it becomes kind of the thing that we teach in medical school. Just takes time. It takes insurance coverage has to happen. Everyone has to learn about it. Has to get written in textbooks. And then it’s like, how do we improve that process? You know, this is kind of a controversial topic, but I’ll use it because it’s very front of mind for everyone. But I think at one point it was established in medicine that COVID vaccines would prevent death. And even though that was established, we have a large percentage of the population who is unvaccinated. And there are a ton of reasons for that. It could be due to lack of access. It could be due to misinformation. It could be due to fear, distrust of the medical system, a number of things. And so implementation science is the study of how do we bridge those gaps. I have done a fair amount of work in implementation science, especially looking at the opioid epidemic because there’s a lot of things in chronic pain that we know are evidence-based. That we don’t necessarily do in practice. So how can we bring those, kind of to bear to improve patient care. So those are kind of my three buckets of things and, more than willing for anyone to work with us on any of those three topics because we always have something going.

Hannah: I would like to insert, you will be told multiple times as a medical student throughout many of your courses. That they will teach you something for the test and then they will say right after “but in practice this is probably changing in the next year, but your test won’t have this on it. So this is what you need to do for your step exam.” We’ve been told that countless times. 

Dr. Goree: Yeah. And I would even say that one of the challenges of practicing medicine, and this is kind of a completely off topic, but one of the things that makes you a great doctor, that takes you from being a good doctor to a great doctor, is you do medical school and residency. And it’s very easy to go out and practice and hang a shingle somewhere and do that thing for 30 years. The great doctors are the ones who become lifelong learners. And I’ve only been out of fellowship for eight years. But there are things that I was taught in 2014 when I graduated fellowship that are completely outdated and I would never do. And I would say 30% of my practice is things that I’ve learned over the few, over the past few years where I am.. I probably do more DRG implants than anyone in the state. DRG didn’t exist until 2017 and so I had to go and travel and go to other doctors who invented the technique and learn how to do it from them so I could bring it back to Arkansas. So. Continuing to improve past medical school is I think what makes you excellent.

Weijia: I actually heard this from Dr. Mhyre and she said anesthesiologist, the –ologist is the study of something. So as anesthesiologist, your goal is to have a lifelong study, or else you’re just doing manual labor. So-

Dr. Goree: Mmhmm. It’s so true. 

Hannah: So kind of taking a shift from work, what are some of your interests outside of medicine? Because as we all know, you need a healthy work-life balance. You can’t devote all of yourself to your practice or it can’t go that well… So we like to know, who our mentors are outside of the hospital.

Dr. Goree: Yeah, no, that’s-

Hannah: Helps humanize our–

Dr. Goree: Take me out of being like a robot. 

Hannah and Weijia: Yes

Dr. Goree: So we’re sitting in my office right now. I have a lot of pictures of my family all around. And so I have two boys. They are eight and six. They are bundles of energy, and any day that they do not end up in the Arkansas Children’s Hospital Emergency Room, I feel like I won a prize. But I love spending time with them. And so I would say my family is definitely number one. A few other things that I randomly enjoy. I am a mixologist, so I have-

Hannah: Very cool

Dr. Goree: -like done bartending training, and I love traveling. I’m a foodie and so I love, I’m the person in the department that it’s like, I’m going to X Random City. What two restaurants should I go to? And I, I actually keep a journal of everywhere that I go and eat. And keep like a rating of what I ate there, and how good it was. That’s super nerdy-

Hannah: No, that’s sounds-

Dr. Goree: But, it comes in handy. And so I have, I travel a fair amount because of, I do a lot of speaking. I do a lot of research, etc. I actually have six trips over the next two months, but I actually have-

Hannah: Very busy!

Dr. Goree: I pretty much have a reservation at every single night at all those places I’m going. And then I would say the last thing is I’m also really interested on in the, the kind of the business side of, I would say personal finance. I actually hosted a webinar of, last night, for a international organization on how to handle finances as a physician. And so, investing, and I have an investment group of 12 friends from college, and we actually, I was just texting with them as I was coming to do this podcast, but. Doing some fun things together. But also making sure that we, we tend to invest in things that are, one, a lot of young minority investors who don’t have access to capital, but also things that we think will improve the community. So I would say those are kind of three things that I find interesting, and there are probably just sounded much more nerdy than I am. You’re probably like, wow this dude is a loser. But that’s kind of–

Hannah: No, I was like, oh my gosh, he sounds so coooool haha

Dr. Goree: Those are kind of the things I’m into. Also, love to cook. And so I am like a, I have every single cooking tool that like, my kitchen looks like Williams Sonoma.

Hannah: Every new gadget that comes out.

Dr. Goree: All of it. 

Hannah: Every family member is like, “Oh, that will make a great Christmas.”

Dr. Goree: Yeah, the problem is that I normally buy it by the time you give it to me for Christmas. I just kind of come home with stuff.

Hannah: Like what you buy the person who has it all. 

Dr. Goree: Like I’m gonna buy him a sous vide – hmm I bought one yesterday.

Hannah: I feel like I have that already.

Dr. Goree: Yeah, so, but a lot of these, my staff and a lot of the doctors I work with will often buy me random kitchen gadgets or random bar gadgets for Christmas and birthdays. 

Hannah: They’re good, they’re good gifts.

Dr. Goree: Good gifts. They always work.

Weijia: Okay, as we’re getting to wrap up, just one final quick question. What are some advice that you would give to either med students, or students interested in anesthesia. And then for people who don’t know, chronic pain anesthesia is fairly competitive. So what are some of advice you would give to students. 

Dr. Goree: Yeah, you know, I always say that, you know, the one piece of advice and, you know, a lot of this podcast is about mentors, but I would say… Networking is one of the most crucial pieces of medicine that I don’t think that we stress enough, especially in medical school. But I understand why. Because to get to the point where you’re a medical student. Normally it’s all on like stuff that you have to do. It’s like getting good grades in college, killing the MCAT. You know, doing well and it’s like improving yourself. And then eventually like this becomes a job. And I think other careers get this a little bit earlier. Because you know, if you join a multinational corporation in your, when you’re 21, like your test scores no longer matter once you get that job. Like then it becomes about like performing well. Doing your job well and then getting to know people and really showing yourself, showing your talent. And so I would say for medical students really take advantage of the fact that you’re at a hospital system where there are, you know, state, statewide known nationally known, internationally known physicians. And a lot of them are really willing to talk about their interests and they’re often excited when there’s a medical student who’s like jazzed about like some weird thing that they like, whether it be like restaurants or neuromodulation, which are two things that I get jazzed about. And so I can talk for hours about those things. And love it when students are excited about those things. To give a a tangible example of that. When I was, I would say this was, trying to count the dates back. So I guess it would be like six years ago. There was a young medical student, a UAMS medical student who was an M3. Who came to my office exactly where we’re sitting right now. And wanted to like hear more about chronic pain. And then he decided to go into anesthesiology and I became his subspecialty advisor. And wrote his recommendation for residency, and then he ended up leaving Arkansas, and he did an anesthesiology residency at Ochsner, and then he was a chief resident at Ochsner. And then now, he is my chronic pain fellow. And so I literally just did 12 procedures with him yesterday. And he was on this international webinar with me talking about, you know what he was thinking, as a resident about personal finance. And so I say all that to say that the world is just so small, especially when you get into these subspecialties. And just getting to know people can really kind of potentially change your trajectory, and you can also learn whether you like a specialty or not. Because you kind of, we all in medical school through rotations have a rough idea what a specialty looks like. But I don’t think you really understand it till you talk to people about what their job is, shadow them. And honestly, see how happy they are. Because I crossed a lot of things off my list by hanging out with doctors and being like, you don’t look happy. And this since- tends to be a trend of all of you don’t look happy. And that kind of helped me to understand what I wanted to do. And so anesthesiologists to me looked happy, and I enjoyed being around them. But then, like the people who are the most happy of the anesthesiologists were the pain people. It’s probably why all the anesthesiologists hate on the pain people, because we’re all so happy and we’re like running around in our suits and we like look so pretty. We’re always called the “pretty boys of anesthesiology” or the “pretty ladies of anesthesia.” But, I just think it’s a field that I love and my mentors from Cornell, where I went to medical school and did residency, are some of my best friends now. And I see them at meetings, I’m on panels with them and stuff like that. So you never know how this stuff comes full circle. And that. In the same way that me getting to know Trevor, Trevor Johnson, who’s our fellow who’s a UAMS alum. You know, I got to know, you know, Amit Gulati, and Neel Mehta, who are the Directors of Pain at Cornell, and I got to know them when I was a M2 and M3. And now, you know, they’re calling me like, hey, we gotta go to New York or we have to go to San Francisco and like give a talk together. So. It just all comes full circle. Those relationships really matter.

Hannah: So if a student wishes to contact you, either to be their mentor, for shadowing, research, whatever it may be. What is the best way, or your preferred way of contact:

Dr. Goree: Yeah, just reach out to me my email. I’m in, I’m in the Outlook system, JHGoree, Johnathan Goree. JHGoree is my email- @uams.edu. If you’re interested in kind of seeing what my life is like or hearing more about a lot of the things I ripped about, I am pretty active on Twitter. So, DrJGoree is my Twitter handle. And so I often talk about chronic pain and equity issues and chronic pain. A lot of my research and a lot of things I’m working on. And the chronic pain Twitter world is like a buzz all the time. Like it’s, for whatever reason, our specialty, we’re all on Twitter and we all tweet like crazy. So if you’re interested in chronic pain, jump on Twitter and start like liking some people and, you, some of the biggest names in the history of pain will follow you because we’re a really young specialty. So just, a random thought. But those are the two ways to get in contact with me. 

Hannah: Very cool. 

Weijia: Email and Twitter.

Dr. Goree: Email and twitter!

Hannah: Listeners, if you have any questions, thoughts, concerns, hopes, dreams that you would like us to know about, you can contact us. And we would love to hear it. 

Weijia: And that’s the end. 

Introduction

In this episode, we have a conversation with Dr. Matthew Spond, an anesthesiologist here at UAMS. We discuss his journey to and through medicine to date, his advice for students, the field of anesthesiology, etc. Dr. Spond is a great advisor for students and always cheers them on – we cannot wait for you to learn more about him!

Listen to Episode Three

Transcript

Jasmin: Welcome to the next episode of Mentor Spotlight, your very own student led podcast to help connect students to faculty mentors. I’m Jasmin Cotoco, and I’m Weijia Shi, your hosts for this episode. Today we have Dr. Matthew Spond, an associate professor in the department of anesthesiology. Dr. Spond completed his medical training right here at UAMS for both medical school and residency. He’s a diplomat of the American Board of Anesthesiology, which means that he has met the highest standards first practice in anesthesiology.

Weijia: He coordinates the M3 selective for anesthesiology as well as the M4 elective course. In addition, he is a faculty advisor for the Anesthesiology Interest Group, and he is a house advisor. He loves to help students truly cares for them and is always available to help us in any possible way. You will hear him say, “always hearing for you” whenever you become his mentee, and he truly means it. So without further delay, let’s get started. Hi Doctor Spond!

Dr. Spond: Hi, how are y’all? Thank you for having me.

Jasmin: Thank you for joining us today.

Weijia: Yes, can we start off with you telling us a little bit about yourself?

Dr. Spond: Absolutely. So, native of Arkansas, I was born and raised in North Little Rock. I went to high school here in Little Rock Catholic High School for boys. I went to college at the University of Arkansas at Fayetteville. I got a degree in civil engineering. I did not have medicine on my horizons whatsoever, thankfully, took more pressure off. And then I worked as an engineer for about four and a half years, and in 2004 I began medical school here at UAMS. I’ve been here ever since.

Jasmin: Awesome. So we know that you’re in anesthesiologist, of course. But how else would you describe your job title? What other positions do you hold?

Dr. Spond: I guess technically, and I’m not real big on job titles. But technically I am an associate professor, and tentatively, as of July one of this year, I’ll be the vice Chair for education for our department of anesthesiology here. And I’m a house faculty advisor for academic house Lowe.

Jasmin: Go Lowe. Yeah, we’re both part of Lowe.

Weijia: yes we are.

Jasmin: So you mentioned that you made that transition from engineering to medicine. I’ve heard like some people make that transition. And whenever I hear it, I’m like, wow, that’s really drastic. So could you talk about more of what made you transition to medicine?

Dr. Spond: Absolutely. I like technical topics of all sorts. And I thought I was gonna get a Ph.D. in structural engineering. I thought that was going to be the rest of my life and then sort of life happened and I ended up in medical school. So how does that happen? Well, I found when I was working most productively as an engineer, I wasn’t really interacting with many people. I was interacting with the computer and calculator and pencil and paper. And I like to talk. And so did my mind sort of searched around what I wanted to do. I thought about law school, and then I, you know, for better or worse, I thought, you know what, I’ve always heard medical schools hard. I like technical topics. I like to help people. I like to interact with people. Let me give it a shot. And I looked into it, and I didn’t have that many prerequisites that I hadn’t already had. And so I took the four prerequisites that I didn’t have over the course of about a year and a half. And I applied, and I got in, and it’s been one of the best thing that’s ever happened to me, to say the least.

Jasmin: Awesome. I’ve heard a lot of stories of, like, people transitioning from computer science or like engineering from, like, a more technical, less people oriented field, to like computers or like to medicine, and I think it’s just crazy how you’re willing to go back to school again and go through all of that to get to where you are today. So yeah.

Dr. Spond: I was very fortunate. I wasn’t attached to anybody. I had no dependents. I had no debt. And sort of the world was my oyster, and I was willing to put in the time and energy and effort. And I’m very thankful that I did.

Weijia: Okay. And anesthesia is not a field that’s on a lot of people’s radar, especially at the beginning. So we were curious how did you decide on anesthesia?

Dr. Spond: Absolutely. So, it’s interesting cause the very first week of my M1 year I always sat in the back. Everybody came to class, and we had a lot of classes. And I sat next to a classmate of mine whose mother was an anesthesiologist, and I explained to her that, you know, I was an engineer by training already. She said, “oh, you’re gonna go in to anesthesiology”. So that was the first time I’ve ever heard. That was in M1 year, and then a couple times as the as the years progressed, I heard a few more times. And back then, way back in the Dark Ages when I was a med student here, every M3 had to do one week with what was called the surgical subspecialties, which was one week with Anesthesiology, one week with ENT, Urology, and Orthopedics. So we all were exposed for at least one week to anesthesiology, and it was Monday morning at about 9:00 o’clock on my one week of anesthesiology that it finally clicked in my head, that epiphany, Eureka moment. I know what those people were talking about; this is what I want to do. And it’s heart, lung, CNS physiology, and pharmacology. It’s all the real time, good ideas, bad ideas, you’re gonna find out. I have problems and make mistakes all the time. Fortunately, they’re dealt with almost exclusively in real time, so I go home with very, very few problems. And that’s one of the things I really like about it. One of many things I would like.

Weijia: Can you describe what a typical day looks like?

Dr. Spond: Sure! So a typical day, the operating rooms here, the main OR, main operating rooms here at UAMS. We start our cases typically on Mondays, Wednesdays, Thursdays or Fridays at 7:00. On Tuesdays, we started a little bit later at 8:00 because we have didactics. And so on a generic weekday, I get here at about 6:15, plus or minus. It seems really early, and it would have kind of blown me away if I have been told that. laughs I didn’t it’s gonna be getting up at 4:30 for the rest of my life, but you get used to it. I get here and I go see patients in the preoperative holding area for surgical cases that had been pretty well delineated the day before, unless I’m assigned to the add on room, and those are cases that have been added overnight. And you get to meet those patients in real time. And like I said, I really enjoy talking with people and people say, “well, if you like talking with people, why did you go into a field where patients are all asleep?” And that’s a good question too. But I get to deal with patients and talk with patients and interact with patients when they’re at their most vulnerable. They have a major operation ahead of them. There’s no such thing as a minor operation. They’re worried about the diagnosis: is this cancer, is it not? Is it curable? Is it not? What’s gonna happen to me? They’ve had to rearrange their life, arrange for childcare, elder care, pet care, arrange with their work, with your school, etc, etc, etc. So they have a whole bunch of unknowns in the back of their head, just kind of swirling around, and they’re really at their most vulnerable. And you know, I get extreme pleasure of telling them, “you know, we’re gonna work hard to have a boring day for you, unless you’re gonna have a baby here, excitement in the operating room is usually not a good thing. So we’re gonna work hard to have a boring day.”

Jasmin: I hear a lot of surgeons I’ve shadowed in the past say that, and I think that brings extreme comfort to a lot of patients. They laugh at it. It’s a good laugh. And then they’re like, that’s very comforting to hear.

Dr. Spond: Exactly, exactly.

Weijia: Boring day’s our goal.

Jasmin: Yeah and I think a lot of people have that stereotype about. I know we definitely interested in anesthesiology; she’s doing the preceptorship. But anesthesiology isn’t on my radar, but I always poke at Weijia and say, “they just put patients to sleep”. But now that you’re telling me this, like, how much is actually involved with comforting the patient, you know, it’s at their most vulnerable point, I guess I can stop poking at Weijia for that.

Dr. Spond: I have a favorite little Venn diagram. I’ve come to realize like Venn diagrams. Weijia has seen it, where I draw in the middle. I draw small circle, and I say this is anesthesia. This is how much propofol to give a patient, how to put a breathing tube in, and that takes some amount of time, a couple of years. And then I draw much larger circle all the way around, and I said this is anesthesiology. This is a bottomless pit of learning. There’s not many things in all of medicine that I can legitimately say I don’t need to know that. Yes, the answer is I do need to know that because you could have the patient, the procedure, and the time. It could be a healthy patient and normal hours going for routine procedure, or it could be a very sick patient in off hours going for very, you know, high complex, high morbidity procedure. So I need to know everything I possibly can.

Weijia: I’ve heard that a good four or five times now. Can you describe but one of your most memorable experiences, either from Med school or residency or attending?
Dr. Spond: Most memorable experiences. I’ve had some moments; I’ll try to keep these non-scary moments. Probably most memorable experience in medicine was probably, frankly, the birth of our third child, which was here. So it was at work, and it was about six years ago, a little over six years ago. And so it was in an operating room on the fifth floor, labor and delivery where I trained as a resident. I had been a medical student, I trained as a resident. I’ve been attending in this room and now I’m the patient’s significant other, and it is different, even though you’re at your place of work. It’s different to be in sort of this role of the patient. You understand that it’s a big deal.
Jasmin: And I think at that point, since you’re experiencing what a patient might feel like, you realize how much they feel like they don’t have control over the situation they’re in; versus where you’re an actual doctor for a patient, you have all the control.

Dr. Spond: Absolutely, absolutely. That’s one of the silver linings of going into medicine. Unfortunately, I haven’t had to do it much. But when you have a loved one or a family friend who’s in the hospital and is sick, you can go to their physician and say, “tell me what’s going on.” You don’t have to ask for a watered down version. You just say, “just speak to me, and I’ll listen. And I’ll understand what you’re talking about.” You don’t have to get the water down version, so.

Jasmin: So speaking of family, what are just some other things that you like to do outside of your job with your family or just, you know, hobbies that you have?

Dr. Spond: For sure. I’m married. I have three kids. One just turned 15 a week ago. She’s a fantastic ballet dancer. We did that whole last week. I have a 13, almost 13 year old son, and then our youngest is six. My wife’s a nurse, but she’s been staying at home for the past eight or ten years. She’s thinking about going back into the workforce now that our youngest is starting kindergarten. Um, I would like to say I like to do some amount of exercise. I know it doesn’t look like it, but I like some amount of physical exercise. And I love to read so.. and cook.. and eat.

Jasmin: I think we can all relate to that very well. laughs Yeah. So what kind of things do you like to read?

Dr. Spond: Anything that’s nonfiction. I like history. I like biographies. Anything that’s nonfiction: current events, recent history, so on and so forth.

Weijia: What’s your favorite dish?

Dr. Spond: Favorite? Oh my Gosh.

Jasmin: Or something that you can cook with conviction.

Dr. Spond: With conviction that I know I’m gonna do a really good job is steak, brisket. If it was my final meal, it would probably be catfish, coleslaw, and hot sauce. Yeah, so those are some of my favorites.

Jasmin: If you ever retire, just open up the kitchen. Southern cooking kitchen. I feel like there’s not enough of those around here. So yeah, I’d definitely go.

Weijia: So a little shift from personal life into your dreams and beliefs. So are there any goals that you’re currently working towards?

Dr. Spond: Yes. It’s my ongoing goal, which is very nebulous, which is to improve in all directions. I’ve never been very big on setting a grand course and following it. I kind of get distracted too easily. So if my transition from engineering to medicine happened out of luck and chance as opposed to grand plan. So I would say my goal is to continue in all directions wherever that leads me.

Weijia: OK, interesting. In terms of healthcare, is there anything that you would like to see?

Dr. Spond: Oh my gosh. OK, let’s see here. I wish that patients would, and I would probably be just as guilty if I hadn’t gone into medicine, would be a little bit more attuned to their own medical health or overall health. Sometimes it’s puzzling why, I ask patients if they ever had surgery, and they said no. And then they have to think and like, “Oh yeah, I had this” If I ever had surgery, I think I would remember, so from the top of my head, that would be the first thing I would say.

Jasmin: I think that kind of plays into just like health literacy. You know, they don’t know that this is something that’s concerning and should be given attention to their healthcare provider, so they don’t mention it. But yeah. Another question I have, this is actually not necessarily on our script, but I’ve always read about how you know people can or medical students for example considering going into anesthesiology. There’s always this saying or a lot of news going around about “oh CRNAs will eventually replace it”. That’s a hot topic now. So I would like to hear your opinion.

Dr. Spond: Sure, sure. They’re very important part of a team, just like Nurse practitioners are very important, important part of a team and primary care. And so it’s no different. You know, they’re valuable components of a team, but yeah I’m not worried about that, no more than than someone going into family practice, Pediatrics, internal medicine, psychiatry, dermatology, list goes on and on.

Jasmin: For me who doesn’t know a lot about anesthesia, anesthesiology. Can you delineate what are the responsibilities of an anesthesiologist versus the CRNA, the daily works,

Dr. Spond: Yeah, absolutely. So CRNA is advanced practice nursing and other states, it would be the PA version and anesthesiology assistant. They’re gonna be the ones in the room who are monitoring the patient; monitoring, reporting during an anesthetic. The physician’s job is to diagnose and treat. The physician job is at the top of the helm, if you will. Often times, it seems like we’re the only physician that looks at the entire patient when they come to the hospital. And again, that kind of goes back to where, I can’t legitimately say, really anything in medicine, I don’t need to know that. I need to know everything. I need to be the absolute best physician for the patient, for my team members, whether it’s nursing anesthetist, whether its residents, whether it’s in another state, anesthesiology assistants. I need to be the absolute best physician I possibly could be.

Weijia: Awesome. That’s cool. And for people like me who are interested in anesthesia, where do you see the field in the next 10, 20, 30 years?

Dr. Spond: I think it’s only going to expand. Basically, at any hospital anywhere in the country, sort of the economic engine of any given hospital is the procedural arena, whether it’s operating room, interventional procedures, whether GI or cardiac, etc. That’s the economic engine of a hospital, and that was really, kind of brought to light with the COVID Pandemic. A lot of hospital functions shut down; people were sent home; etc etc. But the operating suite just kind of has to keep going, for number reasons, to take care of patients. But it it’s also economic generator, and so anesthesiology services are always going to be required in that interventional arena, whether it’s operating room, what we call off size interventional GI, interventional cardiology, etc, etc.

Jasmin: That makes sense because when COVID was hitting, the question always being asked within healthcare was like, “OK, what preoperative or what preoperative testing must a patient go through before they’re like qualified to get their surgery?” It just seemed like hospitals always emphasized on the pre-OP testing because like you said surgeries are such a huge honestly, like revenue generator, for big hospital systems such as UAMS.

Dr. Spond: Exactly. They are. You know, it has to keep moving. And patients with cancer, they need to have an operation, right. So at some point, you know it’s gonna be too late for surgery. So the whole system has to keep moving, even though the COVID pandemic kind of showed that that we kind of slowed a lot, but we kept moving.

Jasmin: So Family Med and internal, I feel like can move to Tele health, but I feel like what you do, can not move to tell telehealth.

Dr. Spond: Exactly. You know, interventional procedures can’t be outsourced. You can’t let a robot do it.

Jasmin: Sounds like some good job security. Now you’re making me think “that’s some really good job.”

Dr. Spond: probably so. I can’t see the future, but probably so.

Jasmin: A good outlook. It would be a good answer to that question.

Weijia: Yeah, that’s good to know. ’cause I’ve heard it being replaced by CRNA; also like modern technology.

Dr. Spond: I had heard that we’re replaced by CRNAs 15 years ago when I was in your seat. And the person I heard on campus, who I have great respect for, he’s 20 years beyond me, and he said he had the same question 35 years ago. Question’s been around forever.

Weijia: Good to know.

Dr. Spond: Yeah. You know, the AI thing. That is probably, frankly, in all of medicine whether it’s certainly about radiology all the time. If you look into radiology, it’s gonna be dominated by AI, I have no idea if that’s true. I got to do a mock interview with an M4 student this past year, and I made-up a question about whether this person was concerned about going into dermatology, whether AI would play a role. And I completely made this up. I didn’t realize that’s a real thing. Google has some sort of app that can diagnose melanomas with great accuracy. So, in all of medicine, I can’t tell you where the future is going to go. It might be. It does take over: AI. That’s something to be aware of, and I don’t think anybody would be sheltered.

Jasmin: It is definitely a thing for pathology. For a bit, I was kind of interested in pathology, and that subject was always brought up. I actually have an app on my phone called Diagnose Us, and it uses AI technology. So medical students or residents or even doctors can join the app, and it will have like pictures of chest X-rays or skin biopsies, and there’s a little practice question or practice session where they’re like train you to look at different diagnosis. So the point of this app is to develop AI to work smarter. You’re not necessarily diagnosing these actual pictures that they’re showing you, but you’re just teaching AI. It’s the manpower of teaching AI, so I definitely think that’s a new forefront, but I think there’s just so many parts of medicine where you just need a pure brain.

Dr. Spond: Yeah, I think you’re right. I mean it’s like there’s been so many things over the last hundred years where we’ve just adapted, from invention of cars, to airplanes, and so on and so forth. We’ve incorporated those things: smartphones, computers, calculators, etc. We’ve benefited. There’s a net benefit. Has it displaced some people from work? Yes, you don’t make horse and buggy carts anymore ‘cause we have cars. But it’s been a huge net benefit to society.

Jasmin: The only thing is, can AI comfort you before surgery? I don’t think so. I think there’s personal aspects that a doctor provides to patients that I don’t think AI can ever really replace so.

Weijia: No AI is gonna tell you “we’re gonna make your day as boring as possible.”

Dr. Spond: I tell patients, you know, I my crystal ball is broken. I try to be a little funny. I said my crystal ball is broken; I can’t see the future. And my magic wand is broken. I can’t metaphorically pull us out of the ditch. So it’s better to stay out of trouble than to get out of trouble. But we’re going to work hard to stay out of trouble.

Jasmin: Um, veering back, I guess, to anesthesia. We went a little tangent about AI. But what advice do you have for medical students, whether they’re pursuing anesthesiology or not pursuing anesthesiology? Like these four years are pretty tough. I know residency gets tougher, but what I advised do you have to set us up for success?

Dr. Spond: Work hard, be bold. Don’t be afraid to make mistakes. Get exposed to as much as you possibly can. Will it all stick the first time you see something? No, but important common stuff. I think Weijia heard me say this morning. If common stuff comes up again and again. And the sooner you can get water, in my mind everything is Cartesian coordinates, right? So on the Y axis we have exposure experience; and the X axis is time. You wanna high arching curve with with as much area under the curve as you possibly can. Will you instantaneously memorize and remember and incorporate everything you hear? No. But will it come up again and again? Then you could scaffold onto what you’ve already heard, yes. So get your hands dirty. Don’t be afraid to make mistakes, safely. Don’t be a wallflower. Read, read, read, read, read. You’re gonna read the rest of your life. I mean, I brought an article that I’m half done with. So I try to read two articles per week. It’s probably grossly under what I need to, but it’s better than nothing.

Jasmin: So I heard that advice from another. I think he was a general surgeon. He reads one article a day before you know, bedtime reading. OK. I feel like I’m backtracking, but I think this popped up. But what made you choose this area of anesthesiology, like academic medicine?

Dr. Spond: You know, I really am, you know, at the root of it all, a big nerd, and I like to learn. And the academic setting really lends itself well to that as you can interact with other learners, and I’m gonna be learning the rest of my life. I say I’m a M18 now I guess, so that just goes to signify that I still consider myself learning. And it’s a environment where I want to be encouraging. Nobody in my family is in medicine. I had an aunt who’s a nurse, but no one in my family is in medicine. And so I just wanted to show other people that if I could do it, they can do it too. Especially coming from a 90 degree turn from engineering.

Weijia: And I just want to say that you packed a lot of good advice all at once. Like with not being a wallflower, and also not being afraid to make mistakes. I think that’s a big thing, especially for us M1. I don’t know how Jasmin feels, but I feel like, for us, we feel like we don’t really know much, I don’t know if I can do that. But really, it’s important to get yourself out there and just start doing things.

Dr. Spond: yeah, exactly

Jasmin: I feel like a lot of times we’re too afraid to be wrong, and that’s the culture that’s cultivated. I wouldn’t even say just with our class. I feel like with a lot of people, a lot of medical students. We’re group of very intelligent people, so we all go through impostor syndrome. But I don’t think we all realize that. And so we’re always so scared to be wrong, And so you think that like, “oh that guy says smartest person in the room,” but really that guys just too afraid to say something that makes his wrong.

Dr. Spond: Exactly, impostor syndrome is very real. I mean, I still have impostor syndrome and maybe I should, I don’t know. But you wanna make mistakes early. What you don’t want to be is a silent wallflower. And then the next thing you know, you’re in M3, and M1 and M2 are looking up to you for the answers, but you just don’t have the answers. You remain quiet. And then you’re a M4 and then more people expect more of you, and you still can kind of keep it hidden. And then you’re an intern. Then you got people above you and below you expecting stuff from me. Then you’re upper level, and people below you and and above you have more have more expectations of you. Rather, stumble and fall and pick yourself up early on. That’s the best thing, so work hard and don’t get a wallflower. Get your hands, metaphorically dirty.

Weijia: And something kind of random, but because I’m on the preceptorship, I was told by one of your residents to ask you about your car. What kind of car do you drive and does it have a seat?

Dr. Spond: I had a car like 20 years ago that did not have air condition and yes my car has air conditioning. I have a 2007 Toyota Camry. And a leopard can’t change his spots. I love my car. And they probably asked you about this because about a month ago and I fixed it, I went forward over a parking bumper in a parking lot, and then I came back over. And it kind of popped this piece of plastic down, so it was kind of dragging for a little bit. I put some tape and the tape fell. So I don’t care. You know, you ever Uncle Buck, the movie? To the to the listeners, if you’ve ever seen Uncle Buck, it’s not quite that bad, but my kids called the Uncle Buck. And I ya’ll should look up Uncle Buck.

Jasmin: My dad has a Toyota Corolla, and something about the plastic… Oh wait, this is not sponsored. laughs No, actually, I remember it kind of came unhinged. And it feels like plastic, and you just got to pop it back in. And my mom drives a 2002 Honda CRV, and she travels for her job. So if it ain’t broke, don’t mean to fix it, don’t replace it.

Dr. Spond: I drive my 2007 Camry and I got it when I was beginning of the M3 and I love my car.

Jasmin: So next one is gonna be a Tesla is what you’re saying.
laughs

Dr. Spond: My wife actually has two nice cars,

Jasmin: OooK

Dr. Spond: One of them is a hand me down the moment I want it, but I don’t want it. So then it’s becoming our 15 year olds; she’s like, “well, I’ll take it.” That’s not gonna happen; you’re gonna get my Camry.

Jasmin: You have a backup?

Dr. Spond: what else did they tell you to ask?

Weijia: That’s the only one. The AC thing was the big one.

Dr. Spond: I’ve got air conditioning. Yeah, I’ve got air conditioning in my car, thankfully. I did in back in 2002. I had two engineering buddies, and we shared a house over in West Little Rock. And we went two full years with no air conditioning in this house. We rented it. It’s a long story, and there’s a lot of hard headedness and stupidity. everyone laughs And who’s gonna crack first? Who’s gonna complain first? And we went to full summers with no air conditioned house.

Jasmin: In Arkansas

Dr. Spond: And we had good jobs, and we could have bought a new air conditioner. We could have bought the house. But who’s gonna flinch? Not me. That might have been what they were talking about my air conditioner.

Weijia: I think she said your old car before you got your new car did not have air conditioning.

Dr. Spond: Oh yeah, my old car didn’t have air conditioning. So my now wife when we were dating, she lived up in Conway. And I would like take off my undershirt, and just wear a shirt that I wasn’t even going to wear to see her. I’d park at her parking lot of her apartment complex. I’d wipe down with some paper towels and go in. So yeah, my old car didn’t. I’m too proud.

Weijia: Alright, as we’re getting near the end, I wanna make sure we hit all these questions just very quickly. How can a student contact you if they have more questions? If they wanna shadow you?

Dr. Spond: I’m the only Spond at UAMS. So Spond Matthew at UAMS.edu.

Weijia: And is there anything else that we have not covered that you would like our listeners slash students to know?

Dr. Spond: Yeah, absolutely. Just have confidence in yourself. It’s a long, hard slug. You hear sometimes, I hear in people when I was in medical school saying “oh med school’s easy.” And so my two questions to them would be: number 1, did you go? Don’t tell me it’s easy if you haven’t been. And what were your grades? Were you AOA or not? And if you weren’t, then don’t tell me it was easy ‘cause it’s tough, it’s hard. Be proud of yourselves. It’s a long, hard slug. It feels like a sprint at times, but it’s really a marathon, and it is hard, it is difficult. But it’s your long term, durable competitive advantages. It’s what sets you apart from physician assistants, nurses, nurse practitioners, and everything else. There’s only one way to do it, and it’s to go through it. And if I can do it, anybody can do it. I only had two Biology classes where I started in M1 year, freshmen level biology, which some of it included: plants have cell walls. Totally worthless when you get to med school. And then I had a pretty good microbiology class, and that’s all I had. And was I studying scared for most of medical school? Yes. But does that work? Yes. So if I can do it, anybody can do it. And like I said, I’m cheering for you. I think that’s what I try to usually tell people who are in my academic house: I’m cheering for you. It’s tough. It is hard. I didn’t know what I was getting into. Nobody in my family has been through med school. It was kind of the great unknown. The fea of the unknown is the biggest fear there is. So yeah, be proud of yourselves. Keep your chin up, keep working, and you’ll get there. Four years goes by really quick. What your real goal is: someday to be board certified in whatever specialty you enjoy. That’s five, 10 years down the road for most folks who are in med school. But you want to be board certified, active and productive physician in whatever specialty you like. Because we need good family practice doctors. We need good psychiatrists. We need good general surgeons. We need good OBGYNs. We need all you folks.. Whatever somebody is has a passion for, go for it.

Jasmin: I’m so happy this is recorded ’cause then I can just listen back when I’m at my low point. laughs On that note, thank you so much for having this interview with us. And he dropped his e-mail earlier, so everyone feel free to contact him.

Dr. Spond: Yeah. Thank you both. This has been fantastic.

Weijia: Thank you. And listeners, as always, please reach out if you to let us know about your thoughts, concerns, or questions. We’ll see you in the next episode!

Introduction

Our second episode highlights Dr. Joseph Margolick, a general and trauma surgeon as well as Assistant Professor within the Division of Trauma and Surgical Critical Care in the Department of Surgery. In this podcast, we cover topics related to his career pathway and his interests, including research, global health, differences between healthcare systems, etc. Listen to learn about his passions both inside and outside the hospital!  

Listen to Episode Two.

Information about the article mentioned regarding the six pillars that indicate sustainability of global surgery partnerships:

Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986.

Episode Transcript

Hannah: Welcome to the second episode of mentor spotlight, a podcast designed to help connect UAMS medical students to faculty mentors. We are Hannah, Manasa and Weijia, your host for this episode. Today we have Dr. Margolick, a general and trauma surgeon as well as a surgical critical care specialist in the surgery department at UAMS and he is excited to be a mentor for students.

Manasa: Dr. Margolick is originally from Canada, he first moved to Texas where he completed his fellowship in trauma and critical care surgery then he came to Arkansas. His past experiences include working with the Canadian Red Cross global emergency response unit as well as working as a research assistant and Tel Aviv Israel. He has done research on numerous topics from trauma care to global surgery initiatives he has helped to develop institutional guidelines within UAMS here.

Weijia: If you ever work with him during rotations you will see that he is very passionate about teaching students and is an advocate for student involvement. He is the epitome of Canadian kindness we can not wait for you to meet him so without further ado let’s get started! Alright Mr. Margolick…

Everyone: *laughing*

Dr. Margolick: That’s alright, yeah it’s MarGoLick, yeah and it’s just it’s kilogram backwards if you ever forget.

Weijia: kilogram 

Dr. Margolick: Yeah, not that it makes it that much easier to remember.

Weijia: OK OK hi Dr. Margolick

Dr. Margolick: Hi

Weijia: Can we start off with you telling us a little bit about yourself?

Dr. Margolick: Yeah sure so first of all I think this is a great podcast and I really commend you all on this initiative. It’s great to see medical students taking interest in mentorship and helping other medical students find mentors so… so good on you all. Yeah so as you mentioned, I’m from Canada. I was born and raised in Vancouver BC. I did my undergrad near Toronto and I did my med school near Toronto and took a couple years off kind of in between. and you know I… I came down to… to Dallas to do a residency or sorry fellowship in trauma and… and actually haven’t been back to Canada since, which is odd. It’s been like almost three years since I’ve stepped foot on Canadian soil and you know I… I really like it here and my passions are really just trauma care, critical care, emergency surgery and just making sick and dying people people better.

Hannah: Nice, alrightly, so for us and M1s who’re new to everything, could you just tell us a little bit about what your job entails, what you do kind of on a daily basis.

Dr. Margolick: Absolutely! I mean I… I really… one of the things I love about working here is that my… my job is quite varied. You know I…I mainly do clinical work and that’s divided between trauma surgery so take trauma call, an emergency general surgery, and those are both pretty full on and then I also do surgical critical care, so that usually is like a week or so of critical care every six weeks and then on top of that I have a you know a modest elective practice that I try to squeeze in and I do endoscopies, colonoscopies, and EGD and then when I’m not you know doing clinical things I… I try to get some research done, so I’ve got a few projects on the go with medical students like yourselves and I’m interested in divisional initiatives like trauma guidelines and then we’ve recently started doing trauma simulations, which has been a lot of fun. We’ve partnered up with the metropolitan EMS service and they had these really cool mannequins that are that are like these, I think they’re called, trauma FX mannequins and they’re extremely lifelike and you can pump them up full of blood and create pulsatile bleeding and have them mimic lots of trauma physiology like tension pneumothorax or airway emergencies, so just like a airliner might simulate various cockpit emergencies we’ve been simulating trauma situations with the residents, so that’s been that’s been a lot of fun. So yeah every day is different and… and then on top of all that you know teaching medical students and residents.

Manasa:  It’s really cool you get a wide variety of like differences in day-to-day I guess too.

Dr. Margolick: Yeah absolutely and I mean for someone like me I knew that that was going to be important and that’s one of the reasons why I like trauma. You know we get to operate in different body cavities. You never really know what to expect when one is coming through the door.

Manasa: So we know a little bit about where you trained for medical education, but can you tell us a little bit more about your background in education as far as the undergrad or like even what you wanted to do when you were growing up versus how that changed with time.

Dr. Margolick: Oh yeah, well you know I… I don’t have a formal background in education, you know I haven’t actually done any university training. I don’t have a masters in education or anything like that. I… I got my undergrad degree in… in psychology and biology and I originally wanted to be a clinical psychologist and I actually was gearing up to do a Ph.D. program in psychology, but I don’t know. You know sometimes you don’t even necessarily make decisions or make plans things just kind of happen and I kind of just had a change of heart and a bit of an awakening that I thought medicine was gonna be the right career choice and so kind of near the end of my fourth year of university or sorry college, I pivoted to to medicine and haven’t looked back since. As far as my educational interest, I guess I don’t really have any formal training I think a lot of it is, at least in my opinion, kind of intuitive and a lot of it is based on trying to emulate what my mentors and what my educators helped me with and how they were most effective. So that’s sort of what I try to do. I… I would say that I don’t have any, like I said, formal background or… or formulaic approach to… to teaching or education. It’s just sort of you know what interests me and hopefully my passion kind of seeps through.

Weijia: I see and you said that you changed your interest in undergrad. I was wondering what made you change your interest, made you become interested in *implied trauma surgery and critical care*

Dr. Margolick: You know there was really no defining, I would say no defining moment. It was just sort of a set of various circumstances and you know when you go into something, you know with a preconceived idea of what you think is going to be the end result, it can sometimes take a long time to… to change directions. It’s kind of like turning a big ship and so I think there was just a bunch of different experiences and… and circumstances that just caused me to… to change my mind you know. I realize that I didn’t want, you know, for one thing I wanted to be active. You know psychology is really interesting but I kind of thought I might be a bit bored sitting, you know in an office all day or I just kind of wanted to explore other options and so it’s… it’s really hard to say. There was no defining moment. 

Hannah: Was there any defining moment for like, this is I want to do, surgery, trauma surgery, critical care? Or was it like the same, I kinda just ended up here?

Dr. Margolick: Yeah, I mean I’ve never been one to really make a whole lot of plans. You know, I’m not a 20, I’m not someone who, *pager beep*  scuse me, I’m not someone who thinks you know twenty steps ahead you know. But it is funny because, you know, psychology is… is very different than trauma surgery. But I think there are some kind of parallels, you know, there’s a real exploratory element of both fields and… and as soon as I started general surgery residency, I just knew that that trauma was gonna be it was gonna be where I… I ended up and… and… and as a Med student I knew that general surgery was where I wanted to be, to end up and I mean I… I enjoyed being in the operating room but I just, I enjoyed the idea of being able to be that doctor that could identify a problem and then fix it. You know I didn’t like handing things off necessarily, and so yeah. It’s funny because as soon as I entered Med school, I mean within like two months, I was like yeah I wanna be a general surgeon and then as soon as I, *pager beep* excuse me and as soon as I started general surgery resident, I was like yeah trauma emergency general surgery that that’s the field for me and I think it just has a lot to do with my with my personality and just yeah I… I like kind of like the unknown and the excitement of not knowing what you’re going to find.

Hannah: Something new everyday. 

Dr. Margolick: Yeah!

Manasa: So I guess along with that, do you have, I know we kind of talked a little bit about your research interests but a little bit more about your passions within the field like any specific things that you haven’t already mentioned and I know you mentioned that you do trauma guidelines and trauma simulations and anything else that students could potentially get involved with working with you with or anything like that.

Dr. Margolick: Oh yeah, absolutely! I mean I have quite a few research projects on the go. You know at the research is hard because as a Med student, you know, which you don’t have a lot of is time and you also don’t have a lot of money and research requires a lot of time for no money. So you know it’s tough but it you know I would say that I am really interested in getting Med students involved in… in research not because I feel like I’m the greatest mentor for… for research I’m… I’m not the world’s greatest researcher, but I do think that it is important to be invested in in the future of ones field and it and it just shows a commitment to growth and… and learning within the field of medicine and so I… I think getting involved in research for medical students is… is a really good investment in… in one future and it’s also just something too that, you know, you get to know people and department or the division of the field that you’re interested in. You know for example just like the three… three of you I mean,  you know, I know that you’re interested in surgery *indicating Manasa*. I’m not sure about you all yet. If you’re still deciding but now you know me and you know now you’re getting to my other colleagues like that kind of stuff is important for building connections in the future so yeah I think just getting getting those students involved in research I think is… is a good interest.

Weijia: And is there, what are your passions outside of medicine?

Manasa: We are taking a big shift. Yeah like you’re inside the outside *the hospital*

Hannah: Like a complete 180

Dr. Margolick: I think that’s about tapped out on research stuff but you know I… I would say probably like a lot of you have a lot of interest and some of some of them had to take a backseat to training you know. So you know I used to do a lot of hiking. I used to work as a hiking guide and used to run quite a bit. My… my wife, whenever I got too chunky would just sign me up for marathons and I’d participate. 

Hannah: That’s something I think my mother would do.

Everyone: *laughing*

Dr. Margolick: Yeah… yeah like you gotta be kidding me. But you know I just like being outside you know fishing or hiking is probably my favorite thing to do now but I haven’t… I have a baby at home and so she’s been taking up just about every ounce of my free time.

Hannah: As kids do. So I know you said that you don’t really plan 20 steps ahead, but are you… do you have any current goals that you’re working towards in the future whether they be long term, short term, inside medicine, outside medicine?

Dr. Margolick: Yeah, you know I… I think at this point you know I’m… I’m still early in my career as a faculty so my short term goal is just continue to progress and continue to get better continue to improve as a surgeon as a clinician and as an educator and there’s really just no substitute for… for experience you know and so that… that’s sort of my… my short term objective is just to kind of come in as someone who’s open to new experiences and willing to take on new tasks to help the department, help the division and… and help myself grow, just kind of like how you are all doing that today. You know my long term goals, you know, I… I… I love UAMS. I think this is such a great institution. I think you know I… I never planned to be in Arkansas, you know but I came here and I immediately fell in love with this place and I think that we have a phenomenal department and a phenomenal division and so, you know my long term goal’s just help continue to grow and develop this department and… and… and turn it into and well continue to… to help it grow and really turn into one of the premier trauma centers in… in the country, which I think it is.

Manasa: So I guess this is more of like your ideals of goals of what you see in healthcare but like what changes would you wanna see in healthcare and what are the main concerns you have with it right now?

Dr. Margolick: Well…

Hannah: A complex question…

Dr. Margolick: Yeah, well you know, I tried a different train a different system as you know the Canadian system is you know universal health care so you know physician and hospital services are… are completely free for… for residents and citizens and so yeah that’s what I was used to you know so dealing with insurance issues and having you know patients without insurance not be able to pay for their services and you know that… that part to me took some getting used to. I don’t have to deal with that stuff on the day-to-day basis but occasionally you know we have to cross paths with the insurance companies and you know it… it… it does sort of bother me that… that access to Healthcare is a challenge for… for millions of people in this country and so I don’t know what the right answer is. You know there were there are downsides of you know universal healthcare system. I mean are… my wait time for a lap Kohli is maybe three weeks you know whereas in Canada might be six months so there is upside to… to certainly to this system I think one of the challenges I’ve seen coming to Arkansas though is that patients come in and they’re not healthy you know.. they don’t see primary care physicians necessarily very often they have untreated disease you know untreated cardiac disease and… and that impacts only my practice but you know any surgeon that comes into contact these patients will have to optimize them and so that becomes that becomes a real challenge so I guess if I could make one change it would be just better access to primary care. You know I think family doctors have such a critical role to play in patients lives and in their overall well-being and long term health so I would love to see patients engage with their family doctors more and be able to access them or more easily.

Weijia: that would be a good change for sure. You said that you’ve worked in the Canadian system too and I was just curious would you recommend students to maybe go out of the country for some medical experience?

Dr. Margolick: I think that’s beneficial yeah I… I mean I… I think so it… it… it… I mean I went to you know if you’re… if someone kind of like you know there’s… there is an adventure element to it you know I… and I think that that’s important to recognize. You know I… I don’t think that two week rotation in another country is gonna, you know you’ll learn some things but it’s not gonna make a huge difference in your medical knowledge. I don’t think, I mean it kind of depends on where you go at least that was my experience so I… I mean I went to Haiti as a Med student and I just I… I met this doctor who was an anesthesiologist at my Med school who was from Haiti and I just chatting with him one day I said you know I really like to go and he was really cool and he just hooked me up with this doc in rural Haiti you know and I just kind of went there on my own for a month and… it was really cool yeah few hiccups you know like I knew it wasn’t a particularly safe country there was a lot of kidnappings at the time and they actually forgot to pick me up at the airport which was you know.. where you are.. scary and you know I learned a lot on that rotation mainly about just healthcare disparities and how difficult it is for you know people to get the care that they need and a lot of other countries but…so from that perspective it was really beneficial and it also kind of plugged me in with a bit of the global health scene which I continue to sort of be involved into this day. So, yeah, think it’s a very I think …I think… it’s exciting and a useful opportunity if one goes into it with the knowledge that you know.. you know maybe the medical knowledge is not the prime objective is to make connections learn about another country, learn about another culture,  and… and with the idea that you know it’s best also to to take something away that’s going to be a bit of a…a long term collaboration or.. or commitment with…with…with people from other. *pager beeps* I’m so sorry.

Manasa: so for our listeners that don’t know much about global surgery since we’re on this topic now. I know coming in I didn’t know much about it but I was curious so I guess for a student that’s wanting to know more about it what are some resources or where some places or people that can talk to you about just getting like their toes dipped into the sea of it.

Dr. Margolick: yeah yeah absolutely so a lot of universities are big into the global surgery field so for example, Duke University, UCLA they have large branches and divisions dedicated to global surgery. It…it is a bit of a convoluted field because there are you know NGOs involved there are you know academic institutions there are faith-based institutions all sorts of different fields and specialties so I’ll tell you it is I think it is a difficult thing to…to even start to wrap one’s head around you know because it can just be kind of… all this overwhelming. You know, Operation Smile, Doctors Without Borders, various universities…it’s difficult I think the best way to start is to make a personal connection you know with someone who is actively engaged in the field of global surgery. So for example, here at UAMS Dr Lori is… he’s a colorectal surgeon and really great guy and he’s involved in actually doing trips to abroad. I think he goes to Liberia every few months or so and other various other trips as well that other various surgeons have taken. I personally started out through the Canadian Red Cross and my… it was just just like that was personal just like my trip to Haiti was a personal connection as a trauma surgeon at my Vancouver General Hospital who did some work for the Red Cross and I… you know… we… we were you know friends basically and so she got me involved in the Canadian Red Cross and I was able to go down to Mexico City for a month and just do a trauma rotation there. And that was really interesting because I just went down there to just to get you know to…to learn a lot about trauma surgery. Mexico City is only one trauma hospital in like a city of like 30 million people and so they don’t have a trauma system necessarily like we have here but… And I got to be at it which was really eye opening and very cool and then my last week that we actually had a 7.5 Richter scale earthquake that was you know… tumble a whole bunch of buildings and sadly hundreds of people lost their lives and thousands more injured but… I was just happened to be you know moment zero at Ground Zero of the Red Cross hospital in the middle of Mexico City when this happened so that was so that was quite a wild experience and amazing learning opportunity. So I digress though. I think just developing personal connections is the best way to do it. The field of global surgery has changed so much to where really people are focusing on professional relationship development and sustainable collaboration over many years and that’s changed from a traditional mission style trip where a group of surgeons from you know let’s say United States or Canada or Australia parachutes into a country, operates for two weeks, and then you know leaves. That still happens and…and that’s fine but really the the focus has changed you know there are you know several pillars of sustainability: ongoing funding, bilateral collaboration research, and authorship, ongoing training, and ongoing discourse and you know bilateral binational exchange of ideas and…and that I think is the most important thing for global surgery these days.

Manasa: So Doctor Margolick actually wrote a paper about these pillars as well so y’all can check that out.

Dr. Margolick: Yeah that was my shameless plug. The Margolick Pillars.

Hannah: I know you briefly mentioned the being in the Red Cross. Mexico. Ground Zero. And you had a very unique learning opportunity there. So while it wouldn’t be, I think, coolest would be the best word to describe that experience. What is the coolest surgery that you have gotten to see or do in your experience as a physician?

Dr. Margolick: oh boy!

Hannah: Or some unique cases you have seen?

Dr. Margolick: well well I’ll tell you what a case from yesterday. How about that?

Hannah: The recency effect. 

Dr. Margolick: What was that?

Hannah: The recency effect. 

Dr. Margolick: Yeah… so… a young guy was shot. Cruiser. Just happened to be cruising by. And somebody flagged down this cop and deputy just loaded this guy into the back of a cruiser and just dropped him off at UAMS ER and which was… that move saved his life which is I think is very cool in and of itself. You know had that deputy maybe stay called an ambulance then you know waited 10 minutes for the ambulance or five minutes for the ambulance and then like he was just wouldn’t have survived. So that…that decision to just load him up in the back of the truck and drive him to the UAMS was that in of itself is a cool…cool feature of the story. So yeah this gentleman showed up with the blood pressure in the 60s. Obviously bleeding from a gunshot wound and I took him immediately up to the operating room where he had bullet had gone from his abdominal wall through the left lobe of his liver and shattered that lobe. It had gone through and through his stomach, nailed his spleen, bounced off of something else, nailed the mesentery of his colon, and then went through his kidney. So yeah that was a situation where there’s almost an overwhelming number of priorities. I mean this guy is bleeding to death from numerous locations and time is really critical in these patients. The longer you operate on them, the more hypothermic, they more coagulopathic, the more acidemic. They get a lethal triad. So once i get into this state, this physiologic state of dying, they just start to circle the drain, so you really need to mobilize quickly and get all this bleeding under control. So I actually, I called my colleague Dr. Matt Roberts, who…another trauma surgeon here. So we work on him together and took out you know a lot of this left lobe of his liver, spleen, kidney, left colon, the left kidney, half of his stomach to get the bleeding under control. So yeah that was my late afternoon yesterday. 

Hannah: Sounds like a busy afternoon…

Weijia: just a typical day… for sure 

Weijia: So you’ve had a lot of you know international experience and you know you’ve been to Canada you’ve been to Texas. Now you’re here what’s one piece of advice that you give to medical students in general?

Dr. Margolick: One piece of advice?

Weijia: Mhm. 

Dr. Margolick: That’s a tough question. You know I think um what’s really important to recognize. You all have decided to become doctors. You could have taken the easy, an easier path in life but you decided to to push yourselves, challenge yourselves, and go into a field that is really important and really challenging and I think that’s really commendable you know. Med school is hard. Residency is very hard. Being a faculty is hard. And so, but the more that you invest in your future, the more that you invest in your career, the more that you invest in your education, the better it’ll be for everybody. And most importantly, the better it will be for your patient. So I would say, you don’t, you only get one Med school. You don’t get redo’s. You don’t get to do it twice. You get one. You have four years to become as good of a doctor as you possibly can be, and so I would say take advantage of every opportunity you can you know. Read 5 pages of a textbook every night you know. Try and do some research if you can. Review anatomy regularly. Get to know faculty. Do things like just as you all are doing. I mean this is a perfect example of…of the kind of things that I would advise medical students to do you know. Create your own opportunities you know. Medical school is not spoon fed to you. You have to seek out those opportunities and take advantage as much as possible because ultimately we have a contract. It’s an unwritten contract with society that you get these enormous privileges of being a doctor and prescribing medications or even doing surgery on patients but in exchange, you have a duty to be as good of a doctor as you possibly can be. So..so keep that focus in mind. Enjoy the moments of training and because if…if you’re constantly looking at the next step you know you’re not happy in university ’cause you’re too focused about getting into med school, you’re not happy in med school cause all you wanna do is get into residency. You’re not happy in residency ’cause all you care about is a prestigious fellowship and so on and it’s like, you know, it doesn’t end you know. Then there’s divisional promotions and department heads and all that kind of stuff to get to ultimately where you’re just in the retirement home of your choice. So it is important to enjoy the moment but also stay focused on the momentous task at hand. 

Hannah: On the flip side, what was the best advice you were given? Both either as a med student or just in life in general. You have some if you’re given some very sage words. 

Dr. Margolick: Oh man. I’ve had a lot of great mentors and I think I…I mean I’m kind of regurgitating that advice like what I just told you is advice that I got from mentor I really trusted and…and… and he’s a great guy. He’s a trauma surgeon in Vancouver. But you know he…he basically told me you know to be the best surgeon as possible you have to kind of pick the more challenging things. You have to seek out opportunities and challenge yourselves whenever you can you know. The easy…the easier path is… won’t make you better. If you’re always comfortable, you’re not learning and…and that’s true in surgery you know. If…if you’re a resident doing an operation and you’re too comfortable, you’re not…not really learning. You’re not pushing yourself. 

Weijia: So what’s trauma residency like? You know we always hear surgery super busy, you don’t get to have a life. How…how much of that is true?

Dr. Margolick: You mean general surgery residency? 

Weijia: Even trauma, yeah.

Dr. Margolick: Well the trauma fellowship is…is quite different. You know, it’s… it’s one year, it’s a lot of critical care. It really depends on where you do your…your…your fellowship and so I think there’s probably not a big ubiquitous lifestyle associated with trauma fellowship. It’s busy. You know and just like what’s true for residency, you need to apply yourself every moment of every day when you’re in the hospital. Yeah, I did general surgery residency and I mean I did in Canada. It’s…it’s different you know. We don’t have the 80 hour work. We shouldn’t have to log hours. It was different. I..I think it is a little bit more old school you know. It’s…it’s tough I mean it is you know. There’s…there’s going to be sacrifices. But there’s like most like everything in the human body there’s gotta be some hemostasis or homeostasis where there’s no substitute for experience. You have to recognize that. But you also if you burnout, you’re not gonna be a very effective physician, wife, mother, son, whatever. So you gotta try and find some balance and way to enjoy yourself outside of medicine. But yes, no, residency is busy and it’s hard and you should go into that knowing that it’s going to be hard. In fact, that should be a motivating factor you know. If you’re gonna be a surgeon you have to I think enjoy pushing yourselves and enjoy challenging yourselves and…and…and really feel like you want to rise to that occasion because if you’re constantly…if you’re constantly thinking of the you know the pillow or wanting to take a nap, it’s just gonna make everything so much more challenging. If you’re gonna do a night of call as a resident, if you accept the fact that you’re just gonna be up all night working all night then you know if you do get an hour or two of sleep, that’s a bonus you know. If you go into it thinking “Oh my gosh I just want to sleep!” and it’s just going to be so painful. So you have to go into it with that mindset. So yeah, I…I would say that there’s…there’s no it’s a very busy and challenging five years but the challenges are offset by the thrill of learning to do something that’s so unique. I mean there aren’t a lot of people on this planet who know how to do a surgery you know and…and as you progress in residency, you start to develop more knowledge, more…more skills, more and more confidence, and so that is really exciting.

Weijia: Mindset and passion. 

Dr. Margolick: yeah!

Weijia: ..and success.

Dr. Margolick: Yes, exactly! That…that’ll keep you going.

Manasa: Well if a student is interested in working with you, either shadowing you or having you as a mentor, has… just has a question they want to reach out to you about, how can they contact you?

Dr. Margolick: Yes! Email me. Yeah, no problem. I’m always happy to get emails from students. We’ve had. I’ve had a couple yeah actually a few M1s you know shadow me and I’m you know happy to arrange something and more than happy to have them scrub into the OR. So yeah just… just e-mail me: JMargolick@uams.edu. You know if I don’t get back to yo,  just e-mail me again. I’m not the best at responding. But yeah just get in touch with that way. I’m happy to do it. 

Hannah: Alright is there anything that we haven’t covered so far that you want the listeners, students to know about?

Dr. Margolick: *laughs*

Hannah: It’s OK if there’s not. It’s not a trick question.

Manasa: It’s probably also a lot that you would want to let us know about.

Dr. Margolick: Yeah, well, you know, I I think I’ve probably rambled enough on your podcast but I will say, I really do you know commend you all for doing this and I think like I said is if…if your med student that’s serious about being the best doctor possible and getting the most out of your educational experience then then doing stuff like this not necessarily this exact thing is…is…is the way forward. So congratulations y’all. 

Weijia: thank you.

Hannah: Well thank you so much for talking with us today. We really appreciate you taking the time to participate in this podcast and help out the student.

Dr. Margolick: Great, you’re so welcome. Thanks guys. 

Weijia: And as always, please reach out with any comments, concerns, or suggestions to let us know your thoughts.

Introduction

Our first mentor we cannot wait to introduce you to is Dr. Hakan Paydak of the Cardiology Division of the Department of Internal Medicine. He is well known to our medical students as he teaches an amazing EKG course for M4s! Listen to this first episode of Mentor Spotlight to learn more about Dr. Paydak’s journey through medicine and to UAMS, his interests, as well as his advice for students.

Listen to Episode One

Episode Transcript

Manasa: Welcome to the first episode of Mentor Spotlight, a podcast designed to help connect UAMS medical students to faculty mentors. We are Manasa, Hannah, and Weijia, your hosts for this episode. Today, we have Dr. Hakan Paydak, an Electrophysiologist in the cardiology department at UAMS.

Hannah: Originally from Turkey, Dr. Paydak was an Assistant Professor of Medicine at the Medical College of Wisconsin before he joined the UAMS COM in 2009. He started the cardiac electrophysiology program as well as Device Clinic here. He is also highly active in research, publishing over 80 pieces to date and has presented at over 105 conferences.

Weijia: He also teaches the fourth year class “ECG Reading and Arrhythmias”, highly recommended by those who take it. He has won over 10 teaching awards nominated by medical students, residents, and fellows.

Manasa: Without further delay, let’s talk to Dr. Paydak. Hi Dr. Paydak, we are excited to have you here being our first faculty mentor being spotlighted!

Dr. Paydak: Thank you

Manasa: Everyone that knows you has wonders to say about you, so it is high time everyone learns about you and how you want to get involved with students!

Dr. Paydak: Sure

Manasa: Can we start off with you telling us a little bit about yourself?

Dr. Paydak: Sure. I was born and raised in Turkey. I was born in St. Paul’s City of Tarsus and I lost my dad at five years of age so it was a hardship for me. But I think it made me stronger in life later on. At 11 years of age, I went to a boarding school in Istanbul, which is the biggest city in Turkey and had all of my classes in English and some in German by American teachers and English teachers. It was a private school designed specifically for the kids who had lost their fathers in the wars. I became a part of the school and I still keep my relationship with the school. We are actually going to be celebrating our 40th graduation anniversary this June and I’ll be staying at the school for one night. It is one of the top schools in the country and after graduating that school as the valedictorian, I had a brief stint in the United States as an exchange student before I graduated. When I was a Junior in my own high school, I came to the United States as a Senior high school student and stayed with an American family, whom I call mom and dad, Mr. and Mrs. George and Karen Marshall, who I’m gonna visit this weekend in Phoenix, Arizona. They hosted me for a year and that was one of the best years I have spent in my life because I came from a boarding school and then saw that people were coming to school by driving which was a big big change for me. I had a wonderful year and I still call my mom and my dad. They are gonna put me on their will. They said they saw my home here and they said “We are taking you off the will,” but that’s okay. My dad was a hall of famer in basketball in Indiana, so he told me he is gonna give me his trophies.

Everyone: *laughing*

Hannah: That’s a pretty good inheritance, if I do say so myself. Alright, if you wouldn’t mind, you told us about your upbringing, what made you specifically decide through your medical journey that you wanted to specialize in cardiology and then even more specifically in electrophysiology.

Dr. Paydak: So that’s a great question. So my uncle was an internist and my other uncle was a dentist, so they were both in the medical field. My uncle who was an internist was a great physician in my opinion and I worked with him in middle school years during summer time. I helped him register his patients and there were about 65 of them a day. And he was very caring, he didn’t even go to lunch. He started early in the morning and stayed very late. He took care of the patients. Some patients couldn’t pay him, but they would bring him some chickens or some other gifts, etc. So he was my role model. He was also very interested in cardiology but then during the second year of medical school, I went to Hacettepe University School of Medicine in Ankara, Turkey, which was a top medical school in the country and I am one of the first graduates from the English group. During my second year of medical school, I got sick during summer time. I was doing translations, I was trying to become a tourist guide to make money and I was interested in tourism and could use my english. But then I think I over worked, I was also doing some research in biochemistry and I think I overworked and I had a viral pericarditis, myocarditis involvement and I almost died. But they did a cut down and they took me emergently to the hospital and I survived, thank God. But this made me more interested in cardiology. And then after finishing medical school, I went to study internal medicine in residency, but I wasn’t always determined to go into cardiology. What happened was, I got lucky. In the middle of my residency after the second year or so they said cardiology is now going to be a different department and the ones who wish to go into cardiology can apply and if they are chosen then we are automatically going to let them finish, do three years of cardiology fellowship and that was a great opportunity for me. So I didn’t need to take any extra exams or anything like that to go into cardiology. And then I was reading a lot, I was reading a pamphlet on the wall one day during my residency and I saw that there was a scholarship from the Netherland’s government to do research in the Netherlands at one of the top centers. And I applied for it and I got chosen and I spent a year in the Netherlands and worked on cardiac electrophysiology and I didn’t know anything about cardiac electrophysiology until I went to the Netherlands. It was a virgin field in Turkey and this is happening in 1992, so this is about 30 years ago. I chose to go into clinical cardiac electrophysiology or heart rhythm disorders because mentor said this is the only virgin field in Turkey, and I know you want to stay in academic medicine, so if you chose this field, he said, then your chance of staying in academic medicine will be higher. So I did a proposal for research and it was accepted and I went to the Netherlands for a year and worked at Utrecht University Hospital for a year and was clinical cardiac electrophysiology fellow. I worked with one of the top cardiac electrophysiologist in Europe at that time. The physicist that worked in the group at the time, actually invented the mapping systems that we are using today and had 40 patents. And my boss there, he later died, Professor Robles de Medina was so kind, he told me that if they liked me they would give me the second six months of scholarship and they paid me actually three times the scholarship that I received in the first six months from the Netherland’s government and they gave me an extra 500 euros to go on vacation. So it was a great year there and that expanded my chance of coming to the United States because, had I not had one year of training in cardiac electrophysiology at one of the top centers in Europe, I don’t think that I would’ve been able to come to the United States by phone interview. So after I finished my cardiology fellowship, I was offered to stay as chief of cardiology at a smaller university hospital in Turkey, but I decided to pursue electrophysiology, because at that time electrophysiology, and still is, very expensive, so it isn’t one of the fields that is actively pursued by people in Turkey. So I thought that I should come to the United States for further training. So I applied to positions and Dr. Richard Kehoe from Illinois Masonic Medical Center in Chicago asked me for an interview and I said I don’t have enough money to come and visit you but can we do it over the phone? He said yes. Because of my prior training in the Netherlands he thought that I would be a good candidate and he offered me the job, I accepted it. When I came I told him, I have not been to the United States over the last 16 years, I was there as an exchange student but I don’t know anything about Chicago. And when I came to the airport, I might be the only fellow, who… there was a limo waiting for me, at the airport for me. He was so kind, he provided the limo, he provided a furnished apartment for me until I got my stuff and I started working as an electrophysiology fellow with him and his group. On the third day, he invited me to his home and said “look we want you to stay for another year, if you want you want to do another year” and I said “look let me apply to ten best places in the country and if I get in, I’ll do a year there, if I don’t then I’ll do another year here with you.” He wrote me very nice letters and I ended up working for his rival, University of Chicago, in Chicago. So that was that was the best training that I’ve had at one of the top schools in the country and I worked with one of the best electrophysiologists in the world, Dr. David Wilbur and I published a circulation paper in 1989 and I want to go back to Turkey and work as an electrophysiologist, but the opportunities were still not there at the time, so I decided to go to Kuwait. Because it was closer and there was an electrophysiology opportunity. But then they told me that I need to be board certified in the United States in order to work in Kuwait, so I said “I am getting board certified.” In addition, I interviewed at the University of Illinois, but I couldn’t get the job because I don’t have a license, I don’t have any board certifications, none of those things so they couldn’t offer me the job unfortunately. So I said “I am going back to training.” That was the moment difficult year of my career in the United States because I went from PGY-8 at the University of Chicago to PGY-1 at Illinois Masonic Medical Center. When I was a fellow there, the interns who worked with me became my residents, the residents became my attendings. But still, I had a great year. They made me run the EKG courses there for the morning report because of my EKG knowledge and cardiology knowledge. And I did research with Dr. Kehoe and the group. I did my clinic with him and the board gave me a year of credit because of my prior training in Turkey, so in two years I became an internist. I then decided to apply for a cardiology fellowship. I couldn’t convince Northwestern University that I would get a year of credit, but Case Western was convinced that I would get it. Case Western offered me a position out of match and I accepted it. There I worked with Dr. Waldo and the group over there. Dr. Waldo is one of the most pioneers of electrophysiology. So I have been lucky to have great mentors in my life and I think this helped me to become a good teacher, because I learned from all these wonderful mentors.

Weijia: That’s a great story, thank you Dr. Paydak. So I’m gonna take us back a little. When I first heard the word ‘electrophysiology,’ I was like ‘something fancy to do with the heart’ right. So could you explain to us maybe what you do on a daily basis.

Dr. Paydak: Sure. So electrophysiology means studying the electrical components of the heart. The heart composed of two parts, one of them the plumbing that supplies the blood supply to the heart. The other one is electrical system that helps the heart contract 72 beats per minute most of the time. Electrical problems can be due to slow rhythm problems or rapid rhythm problems. For the slow rhythm problems, we will implant pacemakers, like I did on Wednesday, to a patient who needed a pacemaker. For the rapid rhythm problems that can potentially kill you, then we can implant a defibrillator. Which can detect the rhythm problem and pace you out of it or shock you out of it and that’s what I did today at the VA medical center. We implanted a defibrillator with two leads. So there were two reasons I went into this field, one of them is: it is very rare in medicine to be able to cure things, but in electrophysiology, your heart rhythm disorders, there are chances for us to be able to cure things by procedures. One of them is ablation. Ablation is through the tip of a catheter, we can pinpoint the cause of the rhythm problem and we can burn there, without causing any damage to the patient, eliminating the rhythm problem for good. For instance, for patients with Wolff Parkinson White there is an extra connection between the upper and lower chambers and if you pinpoint that and eliminate the problem the patient will not need to be on medications for the rest of his or her life. This is the main reason why I went into this field. The second reason was to be able to prevent death in people that are prone to having rhythm problems that can potentially kill them. By implanting a defibrillator, we can save their lives and the defibrillator will get them out of abnormal rhythm problems and save them. I’ve seen many patients who have survived with the defibrillators I’ve implanted over the last 30 years.

Manasa: So you have had quite the bit of journey to where you are now. So currently, what job positions do you hold within UAMS here.

Dr. Paydak: So I’m a professor of medicine since 1995. I am the director of the electrophysiology lab and electrophysiology fellowship program since I came here 13 years ago, since 2010. And I became the associate chief of the Division of Cardiology in 2017 and I also member of the promotion and tenure committee for the university, for the College of Medicine. These are the main positions that I hold, for now.

Manasa: That’s more than enough

Hannah: That’s perfect. It sounds like you have done a lot of research in your training leading you here. Are you currently doing any research or have any particular research interests?

Dr. Paydak: Yes. We are actively doing research with our students, medical students, with our residents, and with our fellows, both cardiology fellows and EP fellows. I was just talking to one of our medicine residents who interested in going into pulmonology. One of the things we want to look at is, we use amiodarone most of the time, short term. It’s the most effective medication we have, but it does have a lot of side effects. So I was just suggesting we can look at the amiodarone related side effects over the last 13 years I’ve been here and we can especially look for the lung related side effects, since he wants to go into pulmonology, for instance. We have published recently a report on using the graphic trends for differentiating supraventricular, ventricular tachycardia and this is a special project for me because we utilized our senior medical students that rotate with me for this EKG course and arrhythmia course. They became our subjects. So what we did was, we asked them to look at the telemetry of the patients to detect whether the patient is having supraventricular tachycardia and what type is it. Is it a sinus tachycardia, meaning the normal heart beating faster and faster like when we exercise. Or is it a sudden onset, sudden offset rhythm problem. And just by looking at the telemetry they were not sure, but then when we looked at the graphic trends they showed us whether there is a sudden increase in the heart rate and it will be in the shape of a rectangle or a square versus whether there is a gradual increase in the heart rate and gradual decrease in the heart rate that will be a bell shaped curve like when we exercise. So after looking at those graphic trends, their accuracy increased to better than 95%, for fourth year medical students. This is a paper that our chief, one of our cardiology fellows right now is the first author, I’m the senior author. So I’m very proud of this paper because we got our senior medical students involved as well. And we are doing mostly clinical research and we have done some research that is dedicated to UAMS patients only and we have published them. We have also done some database driven research and we have had publications and circulations and etc. So we are currently doing both clinical research and database driven research with our fellows.

Manasa: And can medical students get involved and reach out to you if they are interested?

Dr. Paydak: Absolutely! Absolutely! So, I have to tell the story of one of our phenomenal residents who came to me as a first year medical student. She said she would like to do research with me and we did a paper together on utilization of rhythm controlling medications in pregnancy. She was the first author and I’m the senior author. She wanted to go into cardiology, but then she got married and now she is gonna work as a faculty in internal medicine at North Little Rock Baptist Hospital. I’m sorry that she’s not gonna go into cardiology but this is an example of one of our medical students, first year medical students, has published a paper with us. And one of our other medical students that did research with me is now a cardiology fellow actually, he is gonna be graduating from our program. So we get our medical students involved and also we get Dr. Mehta, Jay Mehta, who is our research guru involved with our research projects and get his input as well.

Weijia: That’s really good to hear. Personally, I have been having some trouble finding research, so I’m glad doctors are open to med students. Aside from research and your job, I was curious what are some of your passions outside of the hospital?

Dr. Paydak: Oh, I am a big sports fan. I played soccer in my youth on my high school team and also ameatur soccer in Turkey and one year in the Netherlands. When I was an electrophysiology fellow, I played soccer in the Netherlands. And then I ran cross country in the U.S. because when I came to the U.S. as an exchange student, my high school unfortunately did not have a soccer program. So they asked me to become the kicker of the football team. So the first time I am trying to kick, I am kicking and the guy that is the holder isn’t very happy and I said ‘What’s wrong’ and he said ‘Can you try and kick it a little bit higher’ because I was kicking under the bar, like soccer style. So when I started to kick it over, I became their kicker and since then I have a great passion for American Football, soccer, both my kids play soccer, and one of them is playing basketball now and the other one is at college now, at UC Berkeley, he is playing intramural soccer with some Turkish kids there, that he met over there. So sports is my biggest out of hospital hobby. The other one is playing chess, again with my kids and also I have been playing for years. It gives you an advantage of troubleshooting and analyzing, etc. so I would advise any student to learn to play chess and then to play it. And traveling, you know we go to Turkey every year to visit my family, but we have also traveled in Europe and I had a couple of clerkships during my medical school years actually, one year in the Netherlands, one year in Denmark, one year in former Yugoslavia. As a matter of fact, I saw my first pacemaker implantation when I went there for a clerkship at the end of my fourth year of medical school, in Yugoslavia.

Manasa:  That’s awesome!

Dr. Paydak: I just said ‘this is very nice, very interesting’ and now I am implanting pacemakers.

Manasa:  Full circle *laughing* So we know a little about your passions outside of the workfield, and then we wanted to ask you a little bit about your dreams, beliefs, and things you want to see in the future. So what are you currently working towards in terms of your goals for things you want to happen in the next few years or the next few times past that as well.

Dr. Paydak:  So one of the things I am really proud of is having this course for senior medical students that I started about 10 years ago. I myself had difficulty in learning how to read EKGs and even at the end of my one year of training in the Netherlands, my boss was confused that I couldn’t read EKGs as well as intracardiac electrograms. And then I made it a passion for myself to learn how to read EKGs which is still a learning process for me, even as a professor. But I also had this desire to teach the medical students, senior medical students, how to read them. And this is the only, I told our dean that this is the only program in the whole United States where we teach systematic reading of EKGs to our medical students, not all of them, the ones who choose my course. And unfortunately we have to limit the number to 10 a month because of limited space and etc. But my dream is to be able to teach every student that graduates from UAMS, how to read EKGs systematically and for that we have a plan with one of my fellows. We just applied for a grant to be able to start a podcast actually.

Everyone: *laughing*

Dr. Paydak: To be able to teach to all of our medical students how to read EKGs in a question answer manner. And also to be able to do some research related to this. Believe it or not, one of our senior medical students who is now becoming a resident of ophthalmology is gonna be the senior author but we do is we do pre and post test for the EKGs and then seeing, hoping that there is gonna be an improvement, we will be able to publish this and it’s gonna be the first. So my dream, personal dream, is to be able to teach at Harvard Medical School and I have had the opportunity a couple of years ago to be able to go there and work there, but I unfortunately couldn’t get the job because I wasn’t doing epicardial VP ablations or afibril ablations and etc. But that’s my personal dream. But I am very happy that we have this course and it’s my target, my hope, that we will be able to teach it to every student who graduates from UAMS. I wanna use the podcast idea and I wanna use also maybe lectures, maybe three lectures or so we will be able to add maybe two more sessions just for reading purposes. Maybe in 5-10 sessions we will be able to teach you guys.

Hannah: That sounds very helpful, as someone who we’re currently studying for step and all the outside resources, it sounds like the podcast is a wonderful idea and will be beneficial to more than just UAMS students as well. So going forward, what changes would you like to see in healthcare or what are some of your main concerns about healthcare as it is now.

Dr. Paydak: You see, I’ve been a little bit biased of being raised in Turkey, where the healthcare is provided to every citizen, like in England, like in Canada. So the other day I was thinking about this and I am still, again it doesn’t fit with the capitalist system of the United States as well, but I think it will be my desire that the biggest country in the world, the richest country in the world can provide healthcare to all of their citizens, whether they have insurance or not. But again, you know we need to educate our public that they have to abide with the rules of healthcare themselves early on, for instance in England I heard they wouldn’t do a bypass surgery to a smoker, for instance. So the public should also be educated to abide with the rules and then I think it will be better to prevent disease from happening rather than trying to clean up the things after the crash.

Hannah: As the old saying goes, prevention is the best medicine.

Dr. Paydak: Exactly

Weijia: Absolutely, so what’s one piece of advice you would give to med students in general, aside from playing chess?

Dr. Paydak: Okay the most important advice I give to anybody in life is: read the newspaper. Half an hour, it doesn’t matter what newspaper you read, it can be New York Times it can be Washington Post, it can be Arkansas Gazette, which I read every morning. But I start my day by reading the newspaper, it gives me a lot of knowledge about Little Rock, about the state, about the country, and about the world. So this is something that I have done since my childhood. My uncle used to send us newspaper everyday and the first thing anyone, my aunt is telling me that even before I knew how to read I would just go and try to read the newspaper before she read it herself. So that’s the most important advice because, especially with the interviews and everything, it will help you tremendously but I think it will also help you to become a more complete person and physician, if you know what’s going on in the city, in the state, in the country, and in the world.

Manasa: A better person as well as a more whole physician that can relate to patients better.

Dr. Paydak: Yes

Manasa: Okay so one question for you, is what is the best advice you have gotten over the years?

Dr. Paydak: I think my uncle whom I lost years ago gave me the best advice and it’s: if you are the best don’t worry about the rest.

Everyone: *laughing*

Dr. Paydak: So this is something that I’ve been trying to teach my kids as well so when they complain oh the coach played him more than I did, then I say ‘look if you’re the best you don’t need to worry about these things, just try your best at least, you can’t be the best at everything,’ as you know. But give me the best, give me your best, that’s what I’ve been trying to do everyday and that’s what keeps me going. And doing all these duties of clinical work, teaching, research, and administrative work.

Hannah: Alright, so our last little question for is a two parter it is: if you’re willing to be a mentor to students how should they best contact you or what is your preferred method of contact.

Dr. Paydak: I think that sending an email will be the easiest way because I am accessible to all the medical students and my email address is hpaydak@uams.edu. And I will be happy to meet with you for shadowing me in my clinics, attending/joining my procedures, or participating in our research projects, or in other activities you would like to get involved.

Hannah:  Wonderful! Thank you so much for talking with us today. We really appreciate you taking the time out of your really busy schedule to participate in our podcast and help out our students.

Manasa: And is there anything we haven’t talked about so far that you want to make sure our listeners know about today.

Dr. Paydak: Okay I have to tell you this, I learned this from Dr. Robert Robertson, who is the head of surgery. The other day i was reading a pamphlet, again my love of reading everything and there he said ‘nothing beats experience’ ‘nothing beats experience’ so again I have had four years of EP training and I have been in this specialty for 30 years, sometimes, we have to make hundreds of decisions every day but the thing I find most helpful is my experience over the years and its something that you young students are gonna accumulate each day that you work with us and work at UAMS, but that’s something your are gonna realize when you become as mature as myself or as old as myself I should say. But that’s something that I learned from Dr. Robert Robertson and I really appreciate it.

Manasa: Well you have had a tremendous journey and we are very fortunate to have you here at UAMS.

Dr. Paydak: Thank you, thank you. Good luck to you guys during your studies and again if you choose to attend my EKG reading arrhythmias course, I look forward to working with you guys.

Hannah: Well thank you so much!

Dr. Paydak: You’re welcome!

Weijia: Thank you and listeners, if you have any comments, concerns, or suggestions, please feel free to reach out to us and let us know your thoughts!