March 19, 2024

Inside The Operating Room with Heart Transplant Surgeon Dr. Brian Lima (Part 2)

Inside The Operating Room with Heart Transplant Surgeon Dr. Brian Lima (Part 2)
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Season 4

Ever wondered what it takes to pioneer a heart transplant program, or how surgeons remain both strong and loose under the crushing pressure of life-saving decisions? In Part 2 of our conversation, Dr. Lima opens up about his journey, from overcoming professional burnout to the thrill and weight of launching Long Island's first heart transplant program, against all odds. His experience offers a rare glimpse into the courage and conviction required to navigate such a high-stakes medical frontier.

Then, Dr. Lima invites us into the operating room to reveal how transplant surgery is done. Picture a procedure as tightly coordinated as a Navy SEAL mission: it requires perfect timing, seamless team coordination, and groundbreaking techniques that offer patients a new lease on life. Here, teamwork isn't just important; it's everything.

Wrapping up, Dr. Lima shares insights that reach beyond the operating room. Whether you're in the medical field, eyeing a challenging career, or just love a good underdog story, there’s inspiration here for you. It’s about the highs, the lows, and everything in between on the path to making a real impact.


To discover more episodes or connect with us:


Chapters

00:02 - The Journey of Dr. Brian Lima

12:39 - Heart Transplant Process and Team Dynamics

21:17 - Inside a Heart Surgery Or

30:01 - Life of a Heart Transplant Surgeon

41:08 - Interview With Dr. Brian Lima

44:52 - Lessons From a Cardiac Surgeon

Transcript
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00:00:02.826 --> 00:00:14.166
Hello and welcome to the Career Journey podcast no Wrong Choices, where we speak with some of the world's most interesting and accomplished people to shine a light on the many different ways we can achieve success.

00:00:14.166 --> 00:00:18.751
I'm Larry Samuels, soon to be joined by Tushar Saxena and Larry Shag.

00:00:18.751 --> 00:00:32.868
Please support our show by following no Wrong Choices on your favorite podcasting platform, connecting with us on LinkedIn, instagram, youtube, facebook X and Threads, or by visiting our website at NoWrongChoicescom.

00:00:32.868 --> 00:00:38.811
This episode is part two of our conversation with Dr Brian Lima of the Vanderbilt Medical Center.

00:00:38.811 --> 00:00:46.968
Dr Lima is a cardiac surgeon who specializes in heart transplant surgery and the author of the book Heart to Beat.

00:00:46.968 --> 00:00:49.927
Tushar Saxena, why don't you lead us into?

00:00:49.948 --> 00:00:50.289
this one.

00:00:50.289 --> 00:00:50.923
Thank you, larry.

00:00:50.923 --> 00:00:57.926
Sam, part one was all about this notion of sacrifice, which actually is an overriding theme throughout the entire episode.

00:00:57.926 --> 00:01:08.840
But this is more about when you finally have come through that sacrifice and you've dealt with that professional burnout and now you see your career really taking off, because that's really what this is about.

00:01:08.840 --> 00:01:11.493
It's about once he kind of finds himself and centers himself.

00:01:11.493 --> 00:01:26.753
Now we'll see where the career really takes off to, because this is obviously one of the top surgeons in the country and he's found that happy balance between being a heart surgeon, which is obviously all-encompassing, and then having a life outside of that.

00:01:26.753 --> 00:01:31.710
But he is not simply Brian Lima heart transplant surgeon.

00:01:31.710 --> 00:01:42.069
There is Brian Lima, the man behind that, and even though he always will be Brian Lima heart transplant surgeon, there has to be more to his existence than just the job.

00:01:42.299 --> 00:01:43.865
I'm so glad you just talked about that.

00:01:43.865 --> 00:01:51.114
In addition to that, we're about to get inside a surgeon's mind when he's performing an operation.

00:01:51.114 --> 00:01:59.031
I mean that is just amazing how he reveals about being in the OR and how he goes about a surgery.

00:01:59.031 --> 00:02:03.769
I mean, I just find it utterly fascinating and I think our fans are absolutely going to love it as well.

00:02:03.990 --> 00:02:10.292
Absolutely, and we learn a little bit more about the person and how he handles himself.

00:02:10.292 --> 00:02:18.669
He is definitely a comfortable, calm, cool and collected individual, and that will very much come across in this conversation.

00:02:18.669 --> 00:02:20.766
So here is Dr Brian Lima.

00:02:20.766 --> 00:02:33.045
So now you've been nurtured, you've rested, your confidence is back and you're ready to run and fast forward 12 to 15 years.

00:02:33.045 --> 00:02:41.193
We know that you're a heart transplant surgeon, so I imagine the path forward from there was pretty exciting.

00:02:41.193 --> 00:02:43.225
So where did you go?

00:02:43.225 --> 00:02:47.588
Where did you head and how did you really dig into what you're doing now?

00:02:48.199 --> 00:03:05.612
I had always had this passion for this area of heart surgery Because I think it also translates into what I do outside of being a physician and that's kind of trying to impact public policy and kind of our system of care to improve care for these patients.

00:03:05.612 --> 00:03:12.920
But it's such an under recognized disease and I really felt like I could make an impact in it.

00:03:12.920 --> 00:03:24.449
So I transitioned back to Baylor Dallas, which was a high volume center doing a lot of this, so I got a lot of repetition and exposure to it.

00:03:24.449 --> 00:03:32.907
But then I also was able to get back into writing about outcomes and so I created databases.

00:03:32.907 --> 00:03:41.548
I was able to write about the stuff that we were doing, which was then allowed me to be at these conferences and presenting at the podium etc.

00:03:41.548 --> 00:03:57.240
And then that actually led to being recruited by Northwell, which is kind of how we got to meet yeah where I was basically asked, hey, how would you like to start the first heart transplant program on Long Island?

00:03:57.300 --> 00:04:03.044
And I was like, wow, wow, that's incredible, that's an incredible opportunity.

00:04:03.159 --> 00:04:06.270
And how long had you been doing transplants prior to that moment?

00:04:06.599 --> 00:04:11.572
So this was like five years into my career, five years, five years in practice.

00:04:11.572 --> 00:04:35.129
So this was a ultimate high risk, high reward venture, because the who's, who you know, murderers or whatever you want to call it in the world of medicine and in heart transplant are in Manhattan, right, and you know, you have the Mount Sinai's and the Colombias of the world all these, and they were all in opposition of Long Island getting a heart transplant program.

00:04:35.129 --> 00:04:44.870
Interesting, they actually wrote a letter of opposite, co-signed a letter of opposition to the Department of Health saying we do not believe a heart transplant program should be started on Long Island.

00:04:44.870 --> 00:04:48.303
And so I immediately was like, okay, great, now all these heavy hitters.

00:04:49.086 --> 00:04:52.908
Wow, I feel like the Godfather music just started playing again in the background.

00:04:52.968 --> 00:04:53.209
Exactly.

00:04:54.961 --> 00:04:56.365
It sounds like a bunch of gangsters.

00:04:56.365 --> 00:04:59.065
They were all rooting for us to fail.

00:04:59.065 --> 00:05:02.009
So I was like I had to really say you know what I can do this.

00:05:02.009 --> 00:05:03.524
We're going to build a great team.

00:05:03.524 --> 00:05:04.788
It's going to be great.

00:05:04.788 --> 00:05:06.706
The whole health system was behind it.

00:05:06.706 --> 00:05:12.093
I had to write a letter of rebuttal to this letter that they wrote.

00:05:12.093 --> 00:05:16.406
They wrote I had to testify in the Department of Health and justify why we had how long was your letter?

00:05:16.427 --> 00:05:18.750
Like two words, like F and U Sounds about right.

00:05:18.750 --> 00:05:19.492
It was so crazy.

00:05:23.225 --> 00:05:26.372
But it finally came February of 2018.

00:05:26.372 --> 00:05:34.346
We finally, the day, the night, came when we did the first one and it was magical, I mean it was incredible.

00:05:34.346 --> 00:05:43.603
It was definitely, and still is, like the proudest, you know, moment of my career because of the magnitude of that moment.

00:05:43.603 --> 00:05:56.148
You know so much had led up to it and knowing what was at stake Obviously, first and foremost, the patient, but I mean she put her trust in us too, like, I mean, that's also a big leap of faith.

00:05:56.148 --> 00:06:05.367
You know she could have just driven you know 15 miles into Manhattan and had one of these perennial kind of yeah, Babe Ruth type of thing Right.

00:06:06.720 --> 00:06:29.668
So and it went great and it was just cameras everywhere and one of the things that came from that night was and would help kind of bring everything full circle for me when I was thinking about a book down the road or whatever, like the theme was that during that transplant again because of the magnitude of it there was video and everyone was recording and all this stuff.

00:06:29.668 --> 00:06:37.464
So things that I was doing, that I did, second nature all of a sudden became magnified and took out the old heart.

00:06:37.464 --> 00:06:39.898
You know, getting ready to sew in the new one.

00:06:39.898 --> 00:06:43.627
As I'm taking out the old heart, it's still beating in my hands.

00:06:43.769 --> 00:06:56.565
You know, wow, and it's on video because and everyone's like whoa, the heart's still beating and I'm like, and I pause for a moment and it's like, yeah, it's kind of like the heart saying wait, wait, wait.

00:06:56.565 --> 00:06:58.654
You know, you know I can still do this.

00:06:58.654 --> 00:06:59.680
Come on, give me another shot.

00:06:59.680 --> 00:07:05.846
I was like, you know, and it's still beating a few times spontaneously and you know, typically new one sewed it in whatever.

00:07:05.846 --> 00:07:22.305
But that whole idea of, even in its last moments, the heart still trying to go and beat became kind of the foundational theme for how I tied every, all these random thoughts I had for this book and tied it all together with.

00:07:22.305 --> 00:07:31.288
You know heart to beat and all of that, so, but it was crazy, a magical, magical night and a really proud moment for me.

00:07:32.511 --> 00:07:33.312
That's so powerful.

00:07:33.312 --> 00:07:37.788
I can't wait to dig into all of the OR stuff and the surgeries.

00:07:37.788 --> 00:07:38.449
We're going to get to that.

00:07:38.449 --> 00:07:39.052
We're going to get to that.

00:07:39.052 --> 00:07:58.572
But you know, I just I can't help but think that, because you led me right into it, the egos of doctors, right Like you're talking about these, this group from Manhattan that was against you doing this you know a doctor has to be very confident, you know, like supremely confident in what they're doing.

00:07:58.572 --> 00:08:09.952
So I don't know, do you find yourself kind of riding this wave of like Uber, confidence, superman kind of feeling and humbleness to keep you grounded and make sure that you have to get that job?

00:08:09.952 --> 00:08:16.533
I just can't imagine balancing like the power that you have when somebody's in front of you on the table.

00:08:16.533 --> 00:08:18.387
I mean that's really amazing.

00:08:18.387 --> 00:08:23.692
But then to hear these other doctors like no, they should come here, we're better than that guy, who's that guy?

00:08:23.692 --> 00:08:25.927
You know like there's a really ego involved there.

00:08:26.560 --> 00:08:40.073
No, I mean, one of the ways I've dealt with this is that and it's because it's life sometimes has a way of reminding you just how not great you are right in this field.

00:08:40.073 --> 00:08:49.988
So every time, whenever I felt really good about myself, like oh boy, I'm, look at that, I mean, I'm on a roll, this is so good.

00:08:49.988 --> 00:09:05.873
Wham, you know, just when you think you got it all figured out, the body, you know, life, whatever will remind you you do not have everything under control and sometimes things will not go your way, even though you did everything in your mind perfect.

00:09:05.873 --> 00:09:12.788
So I've adapted to or evolved to you don't get too high with the highs, too low with the lows.

00:09:12.788 --> 00:09:14.812
You just stay even keel.

00:09:14.812 --> 00:09:17.350
If something's going well, you're just cautiously optimistic.

00:09:17.350 --> 00:09:19.452
You're like all right, I'm not gonna good mouth it.

00:09:19.452 --> 00:09:22.634
You know, I'm just gonna, I'm just gonna ride.

00:09:22.905 --> 00:09:24.873
And we almost it's crazy in our field.

00:09:24.873 --> 00:09:28.792
You would again counterintuitive, but it's almost.

00:09:28.792 --> 00:09:32.393
We don't like it when people say, oh, he's that guy, he's doing great.

00:09:32.393 --> 00:09:33.470
I'm like whoa, easy, easy.

00:09:33.470 --> 00:09:39.013
You know, he's so far, so good, doing pretty well, you know, pleased with how things are going so far.

00:09:39.013 --> 00:09:40.791
But he's not out of the hospital yet, right.

00:09:40.791 --> 00:09:49.091
So it's superstitious maybe, but we I think it's when you get arrogant that you get dangerous.

00:09:49.091 --> 00:09:56.591
You gotta be confident but not arrogant, and I've learned that the hard way, or whatever the hard way you wanna call it.

00:09:56.610 --> 00:09:59.191
So Are transplant surgeons.

00:09:59.191 --> 00:10:10.692
Whether are transplant surgeons, the elite of the elite of the profession, and then our heart surgeons, you know, let's say the Navy SEALs of that profession.

00:10:10.692 --> 00:10:11.927
Are you elite?

00:10:11.927 --> 00:10:14.207
Would you consider yourselves elite athletes in that sense?

00:10:14.865 --> 00:10:15.727
Well, I'm biased.

00:10:15.727 --> 00:10:16.751
He's trying to stay humble.

00:10:16.751 --> 00:10:17.232
I'm biased.

00:10:18.048 --> 00:10:19.344
We were just talking about humble too, Sean.

00:10:19.344 --> 00:10:21.653
I believe the whole thing out.

00:10:22.710 --> 00:10:23.553
I don't believe in humble.

00:10:23.553 --> 00:10:27.071
This man knows something that we we gotta get this out Well no, but actually the Navy SEAL thing.

00:10:27.184 --> 00:10:29.994
I've used this analogy because that's what drew me to it too.

00:10:29.994 --> 00:10:53.807
You know, when you're a little med student and you're, I remember vividly, you know, on my surgery, rotations or whatever, and being with a 10th year resident or 10th year person, this person that has seen it all, done it all, you know, at midnight you're doing rounds with that person in the hospital and there's nothing that can come through the doors of that hospital that this person would not know how to handle.

00:10:53.807 --> 00:11:06.413
Right, it's just that I was like I want he's like a Navy SEAL I want to be able to feel that comfort level because I've seen it all, I've practiced, I've trained in all these different things.

00:11:06.413 --> 00:11:13.591
So, yeah, the Navy SEAL thing I think applies because outside of the brain there's really no organ in the body.

00:11:13.591 --> 00:11:19.988
We, by the time those 10 years are up, right that we've not operated on all the blood supply to everything.

00:11:21.024 --> 00:11:27.389
And I joke also about the whole saying you know, oh, this ain't brain surgery, I think it should be, this ain't heart surgery.

00:11:27.389 --> 00:11:29.812
Heart surgery, you know the heart is a moving target.

00:11:29.812 --> 00:11:31.931
You know the brain doesn't move.

00:11:31.931 --> 00:11:37.791
You know, and at all 100 steps of a heart surgery you can kill somebody literally.

00:11:37.791 --> 00:11:40.354
I mean step one, opening the chest.

00:11:40.354 --> 00:11:43.330
If you're a little too deep, you slice the heart bleed out, you're dead.

00:11:43.330 --> 00:11:46.033
Right, I mean so all the 100-.

00:11:46.065 --> 00:11:53.128
The way you say that so nonchalantly is chillingly Wow but it's so, you know, and nothing not to take.

00:11:53.148 --> 00:11:57.193
Brain surgeons are brilliant, right, but I, in my mind, I feel, yes, that this is.

00:11:57.193 --> 00:12:06.216
It takes a long time because there's so much at stake and it's technically so difficult and challenging.

00:12:06.216 --> 00:12:08.732
So, yeah, I think, I like to think at least that.

00:12:09.485 --> 00:12:14.892
Which leads me to the question that I've wanted to ask, which is the process.

00:12:14.892 --> 00:12:17.091
We're all curious to know.

00:12:17.091 --> 00:12:26.950
You know, how do you do not in great detail, because I imagine that would take about seven and a half hours of lecture or 10 years what's the process?

00:12:26.950 --> 00:12:29.374
I mean, how do you identify a candidate?

00:12:29.374 --> 00:12:30.629
How do you get the heart?

00:12:30.629 --> 00:12:33.453
How does the heart get from point A to point B?

00:12:33.453 --> 00:12:38.232
Like you know, I guess top-lining things to a certain degree, but what is the process?

00:12:39.065 --> 00:12:44.914
So on the person needing it, they've obviously gone through the gamut of everything.

00:12:44.914 --> 00:12:48.072
They've exhausted all options, all conventional medications.

00:12:48.072 --> 00:13:04.567
So and the heart is the analogy I use is like you know, you could have a perfect vehicle truck, car, whatever and you could do all the right things, get the oil changes, the 40,000 mile checkup, whatever but at some point, if you drive that car long enough, it's gonna give out.

00:13:04.567 --> 00:13:08.573
And same thing applies to the heart in some respects.

00:13:08.573 --> 00:13:14.057
So the only option left is replacing the heart.

00:13:14.057 --> 00:13:23.371
So there's a system in place where, if we as a medical team feel that that person has reached that point, we list them for a heart.

00:13:23.371 --> 00:13:39.513
And then there's a donor system, national system, and if we get a match, then we either ourselves go out and get it or sometimes there's procurement teams that go and get the heart from the donor.

00:13:39.513 --> 00:13:41.730
That's a whole other can of worms.

00:13:42.667 --> 00:13:46.852
So that's one of the questions I wanna ask, like is the heart still beating?

00:13:46.852 --> 00:13:50.355
Is it like what is the heart doing as it's traveling?

00:13:52.285 --> 00:13:54.373
So there's two kinds of donors.

00:13:54.373 --> 00:14:00.692
Historically, you know, up until three years ago, four years ago, these were brain dead donors.

00:14:00.692 --> 00:14:18.831
So, legally, you know, someone's determined to be brain dead for whatever reason car wreck, suicide, overdose, gunshot wound, et cetera they have no brain function left and a neurologist has to go and actually confirm that, yes, this person is brain dead.

00:14:18.831 --> 00:14:24.770
In those cases it's a controlled donation, it's a scheduled thing.

00:14:24.770 --> 00:14:28.070
We're gonna tomorrow at 10 am, they're gonna go to the OR.

00:14:28.070 --> 00:14:42.033
We have five teams coming in one team from New York that's gonna take the heart, another team from Pittsburgh that's gonna take the lungs, et cetera, et cetera, and we stop the heart, take everything out and then put the heart on ice and bring it back.

00:14:42.125 --> 00:14:45.549
And when you say we, you are part of the team, that's going to get the heart.

00:14:46.644 --> 00:14:54.188
Or with the recipient, because depending on and what gets complicated is the heart really the pressure is.

00:14:54.188 --> 00:14:57.370
You really only want that process to be four hours if you can.

00:14:57.370 --> 00:14:59.532
Historically that's kinda so.

00:14:59.532 --> 00:15:05.354
I mean you have to have the heart stopped in the donor, taken out, transported, sewn in the recipient.

00:15:05.354 --> 00:15:09.929
You want that ideally under four hours as a rough benchmark.

00:15:09.929 --> 00:15:17.730
Wow, so if it's if someone's not had heart surgery before, right, there's no scar.

00:15:17.730 --> 00:15:21.013
So I can get in and sew a heart in in an hour.

00:15:21.013 --> 00:15:22.826
On that Cause there's not.

00:15:22.826 --> 00:15:29.630
But if someone has had heart surgery before, maybe they have a heart pump, whatever it's like digging out a fossil.

00:15:29.630 --> 00:15:32.633
It's all encased in scar tissue.

00:15:32.633 --> 00:15:37.734
So it could take a good two hours, hour and a half, to get everything cleared up.

00:15:37.924 --> 00:15:41.068
I set it out so that you can take the heart out and put the new one in.

00:15:41.068 --> 00:15:46.052
So we have to orchestrate this dance with the donor team, our team.

00:15:46.052 --> 00:15:47.808
Okay, what time?

00:15:47.808 --> 00:15:50.208
How long does it take to get from the airport to the?

00:15:50.208 --> 00:15:51.072
How long is the flight?

00:15:51.072 --> 00:15:53.113
Okay, so that means you're gonna get here.

00:15:53.113 --> 00:15:54.711
We're gonna be three hours in when you get here.

00:15:54.711 --> 00:15:55.408
Okay, that's good.

00:15:55.408 --> 00:15:56.653
That means when you get in.

00:15:56.653 --> 00:16:01.706
That means I have to have everything absolutely ready so that when you walk in the room with the new heart, boom.

00:16:01.706 --> 00:16:03.231
I could take out the old heart and sew it in.

00:16:03.231 --> 00:16:05.626
We're under the four hours Now.

00:16:05.626 --> 00:16:07.594
If it's four hours and a half or five, it's not.

00:16:07.664 --> 00:16:23.049
But I mean, these are just kind of like the rough guidelines we hold ourselves to and that's kind of what it was for ever, until 2018, when we started to look at hearts from non-brained dead people.

00:16:23.049 --> 00:16:24.695
What does that mean?

00:16:24.695 --> 00:16:39.274
There's a large proportion of these unfortunate situations where they're not brain dead, but almost meaning for whatever reason.

00:16:39.274 --> 00:16:46.932
They still maybe have a couple of reflexes, but they're vegetables or in a vegetative state and the family is still gonna say look, we're gonna withdraw support.

00:16:47.745 --> 00:16:51.913
In that instance, you're saying is it okay if we take organs after they've died?

00:16:51.913 --> 00:16:56.634
So they pull the plug, withdraw, person dies.

00:16:56.634 --> 00:17:00.072
We then come in and take the organs.

00:17:00.072 --> 00:17:03.251
That's called donation after cardiac death.

00:17:03.251 --> 00:17:06.693
The problem is the heart.

00:17:06.693 --> 00:17:12.752
How do you know it's okay after all of that Is you know it's the person's been dead for a few minutes.

00:17:12.752 --> 00:17:23.128
So this whole thing now of resuscitating, bringing back to life a dead heart, is what's become a big thing in our field over the last couple of years.

00:17:23.128 --> 00:17:34.673
You can either do that in the chest, where you quickly open the chest and go on the heart lung machine and see if you can get the heart back to life, or you just take the heart out and put it on an external heart and a box.

00:17:35.005 --> 00:17:35.205
Got it.

00:17:35.205 --> 00:17:36.351
That was gonna be my question.

00:17:36.351 --> 00:17:38.712
So you keep beating while traveling?

00:17:39.806 --> 00:17:40.509
And while traveling.

00:17:40.509 --> 00:18:09.558
So I did a few pioneering centers here in the United States, got going with doing that Duke and Mass General Vanderbilt, where I am now and when I came back to Texas after being in New York I did the first five or six of those in the whole state of Texas of using these donors where the person died and we bring the heart back to life.

00:18:09.558 --> 00:18:19.682
But that's kind of the the way you can use these hearts Very, very, very big controversy right now about that in our field.

00:18:19.682 --> 00:18:23.582
It's kind of the, the hot button topic, if you will, in our field right now.

00:18:24.531 --> 00:18:30.874
So, if you're listening to this, you want this guy, you want this.

00:18:30.874 --> 00:18:31.896
This is the guy.

00:18:31.896 --> 00:18:33.260
This is the guy you want.

00:18:33.260 --> 00:18:44.676
I'm gonna steal a question that I know that my my partner here, larry Shay, was gonna ask you at some point, but it seems like the right time to ask teams and the team that you work with.

00:18:44.676 --> 00:18:48.578
You said yourself you consider yourself a Navy SEAL in some ways.

00:18:48.578 --> 00:18:52.150
Is every member of your team a member of that Navy SEAL team?

00:18:53.192 --> 00:18:55.777
This is the ultimate team sport, I have to tell you.

00:18:55.777 --> 00:19:02.673
There's so much coordination, there's so much involved, as I mentioned just briefly.

00:19:02.673 --> 00:19:16.614
You know you have a donor team, the recipient team, and not to mention all the care leading up to that day when you know being able to take care of these people that are so sick, desperately needing a heart.

00:19:16.614 --> 00:19:18.417
They're on life support, right, they're on.

00:19:18.417 --> 00:19:21.324
So there's the team is massive.

00:19:21.324 --> 00:19:34.901
The team that decides, hey, this person is has gotten to the point where we need to do a heart transplant, doing the heart transplant itself, all of folks involved in the operating room to do that, that's it.

00:19:34.901 --> 00:19:36.443
There's so many people.

00:19:36.443 --> 00:19:38.412
So, yeah, it's.

00:19:38.613 --> 00:19:38.854
I would.

00:19:38.854 --> 00:19:41.520
I would liken it to a Navy SEAL operation.

00:19:41.520 --> 00:19:49.039
I should say a Navy SEAL operation where you have multiple members of that team, with varying roles right, but all the roles are important.

00:19:49.039 --> 00:19:52.727
It would not be possible without all those individuals contributing.

00:19:52.727 --> 00:19:59.211
Some contribute more than others, some, you know, have more kind of oversight than others, but still, at the end of the day, it's just.

00:19:59.211 --> 00:20:02.343
It's basically a massive, you know, navy SEAL operation.

00:20:02.784 --> 00:20:07.210
So every member of that team, I'm gonna assume that you're not out there walking, walking the war.

00:20:07.210 --> 00:20:10.038
It's a warm, you're called and I don't need to joke.

00:20:10.097 --> 00:20:10.499
I don't mean it.

00:20:10.499 --> 00:20:11.442
I don't mean to be flit.

00:20:11.442 --> 00:20:13.353
You're not out there.

00:20:13.353 --> 00:20:14.095
You're not out there.

00:20:14.095 --> 00:20:16.662
You know walking the wards and doing rounds like everybody else.

00:20:16.662 --> 00:20:24.840
So what about the other members of your team, like the nurses on your team, like they're obviously very highly specialized for transplant?

00:20:24.840 --> 00:20:30.583
I'm assuming they're not out there doing the same stuff that the average nurse is doing on the rounds?

00:20:30.583 --> 00:20:31.755
They're essentially called in.

00:20:31.755 --> 00:20:33.402
When you're called in, is that this?

00:20:33.402 --> 00:20:33.903
Is that the case?

00:20:34.023 --> 00:20:38.596
Yeah, I mean you have the operative team that are there to do the surgery.

00:20:38.596 --> 00:20:48.522
You know the anesthesiologists and you need I mean these are heart anesthesiologists, these, that these are top of the line, amazing, amazing anesthesiologists.

00:20:48.522 --> 00:20:58.401
You have the person running the heart-lung machine, because when we do these, when you do heart surgery, you have a heart-lung machine and you have a person that's sitting there at the heart-lung machine running it.

00:20:58.401 --> 00:21:00.594
That person's amazing.

00:21:00.594 --> 00:21:01.797
Who's helping you?

00:21:01.797 --> 00:21:04.363
The scrub, the person, the nurse that's hanging near the instruments.

00:21:04.363 --> 00:21:05.251
The nurse is getting the stuff.

00:21:05.251 --> 00:21:06.817
I mean all those things.

00:21:06.817 --> 00:21:08.221
That's just the operation part.

00:21:08.221 --> 00:21:17.013
Then afterwards you go to the ICU and you have these nurses in the ICU that are highly specialized and intensive care docs that are highly specialized.

00:21:17.013 --> 00:21:24.346
That you know, because I can't be there right, you know, 12 hours after all this, this whole thing started exactly.

00:21:24.567 --> 00:21:25.150
You got a handoff.

00:21:25.150 --> 00:21:26.273
You know what they're doing.

00:21:26.315 --> 00:21:26.856
No, they're.

00:21:26.856 --> 00:21:29.607
They're keeping track minute to minute, hour to hour.

00:21:29.607 --> 00:21:35.642
Blood loss, you know, adrenaline medicines that need to be tweaked, all these different things, it's a whole.

00:21:35.642 --> 00:21:48.432
I mean it's so when you start to kind of rattle off and and consider all the people involved, it's mind-boggling but necessary For this to go.

00:21:48.432 --> 00:21:51.058
Well, you know, obviously that's what we want.

00:21:51.559 --> 00:21:52.643
Thanks for stealing my thunder.

00:21:54.330 --> 00:21:57.039
Stealing my questions, but it's okay, it's okay, We'll roll with it.

00:21:57.039 --> 00:22:02.028
No, but he actually led me right into what I wanted to say, which is, take us more into the OR.

00:22:02.028 --> 00:22:13.714
You know, I've had a couple surgeries myself and you know I'm laying on the table and there's some Beethoven playing and they'd crack a couple jokes and then I'm out and then I don't know what happens in that room.

00:22:13.714 --> 00:22:18.653
But I'm sure you know it's not what we imagine it is.

00:22:18.653 --> 00:22:20.864
So do you like music?

00:22:20.864 --> 00:22:22.150
Do you like to be relaxing?

00:22:22.150 --> 00:22:23.834
Are you the only one speaking?

00:22:23.834 --> 00:22:27.663
Take us into the OR and really bring us through like what that moment is like.

00:22:27.663 --> 00:22:29.734
Obviously it's high pressure, but what else?

00:22:30.155 --> 00:22:45.212
Yeah, no, I, I like music, I Depends, I'm kind of 90s time warp, I like 90s alternative or it's kind of the fault of that.

00:22:45.212 --> 00:22:49.604
You know, let's spin doctors, nirvana, whatever you know.

00:22:49.604 --> 00:23:00.075
Yeah, exactly, and Not specific to heart transplant, one of the unique, I guess pressure, you know things that drive the pressure of a heart surgery is 99 times out of 100.

00:23:00.075 --> 00:23:02.020
For the surgeries that we do, we get to stop the heart.

00:23:02.020 --> 00:23:07.922
We go on the heart lung machine, then we stop the heart for a period of time to do what we're gonna do.

00:23:07.922 --> 00:23:18.836
You could safely stop the heart and have it come back and Decent shape for a couple of hours, maybe hour and a half, two hours, but Clearly time is of the essence.

00:23:18.836 --> 00:23:27.696
You can't be dilly-dallying, you have to be All in, but you know doing what you're doing, selling perfectly right, you know, because they can't bleed to death when you're done.

00:23:27.696 --> 00:23:29.121
So there's time pressure.

00:23:29.121 --> 00:23:33.420
So when you're on a clamp, so to speak, that means you have the heart stopped.

00:23:33.420 --> 00:23:39.561
It's like All attention, everything you know, because that that's critical, critical time.

00:23:40.351 --> 00:23:47.654
The other challenge of heart surgery as the surgeon is you have to control the whole room, all those different roles I mentioned, right at the end of the day it's.

00:23:47.654 --> 00:23:53.315
I play the position of the quarterback during those operations, so I have to know everybody's job.

00:23:53.315 --> 00:23:55.000
I have to anticipate.

00:23:55.000 --> 00:23:59.602
You know, hey, we're gonna be ready to come off to reanimate the heart in 20 minutes.

00:23:59.602 --> 00:24:02.176
Can you get your this and this adrenaline medicine started?

00:24:02.176 --> 00:24:03.741
Hey, I'm gonna need this and this instrument.

00:24:03.741 --> 00:24:05.173
Can we get you know all?

00:24:05.173 --> 00:24:08.405
Can we make sure that the blood products are in the room to trans?

00:24:08.486 --> 00:24:28.256
So it's tense, but I've seen all flavors of how a A surgeon can conduct themselves in the operating room and the ones that I've had the most respect for and been the most kind of Influenced by are the ones that are the calmest, meaning that when things get Pretty critical they get even calmer.

00:24:28.256 --> 00:24:35.275
It's the ones that are start screaming and yelling and throwing and this and that and you, everybody gets thrown off their game.

00:24:35.275 --> 00:24:49.201
It's the ones that can take a very dire situation and and kind of relax everybody and kind of be the calm, cool and Because when you, when you get worked up, then you're not gonna be as smooth either.

00:24:49.201 --> 00:24:56.769
So I try to abide by that kind of I Guess persona in the operating room is calm.

00:24:57.151 --> 00:25:02.857
I'm, you know, calm under pressure, not gonna flap the handle, but you have to be stern too, right?

00:25:02.857 --> 00:25:06.465
I mean, you can't be a pushover either, whose time is of the essence.

00:25:06.465 --> 00:25:08.832
You know you can't, so it's it.

00:25:08.832 --> 00:25:15.209
Navigating, that is an art, I think, of how to have the rest of your team function at their top.

00:25:15.209 --> 00:25:22.141
This, you know, I have a level of performance, but also maintain Calm and be respectful to things that used to fly.

00:25:22.141 --> 00:25:26.073
You know, a couple decades ago no longer fly, and today's I'm reamed somebody out.

00:25:26.093 --> 00:25:28.538
I got you changed world all over, for sure.

00:25:28.538 --> 00:25:31.594
Um, you talked about the Hundred steps, right?

00:25:31.594 --> 00:25:35.767
So obviously there's a script and you want this thing to go magically by rote.

00:25:35.767 --> 00:25:41.450
You know, one Net, one thing, next thing, next thing and keep going, but things happen, things go wrong.

00:25:41.450 --> 00:25:45.590
How much of an operation is Improvisation?

00:25:45.590 --> 00:25:49.241
I know we were supposed to do this, but we have to pivot here.

00:25:49.241 --> 00:25:50.792
How much is improv?

00:25:50.973 --> 00:25:55.523
There's a thing that's evolved in what we do in all medicine, actually in surgery, called a timeout.

00:25:55.523 --> 00:26:02.655
Before you actually start the surgery, you as a surgeon say, okay, timeout, this is so-and-so, this is the plan, what we're gonna do.

00:26:02.655 --> 00:26:06.222
And I always throw in, okay, plan a is this.

00:26:06.222 --> 00:26:23.684
But if this happens and we're gonna do this, so I kind of I always go in Prepared for the worst case scenario, right so, and I have a plan so, and that comes also with time and years, so I know exactly how I'm gonna react or what the move is gonna be.

00:26:23.684 --> 00:26:32.470
If I have run into X or Y, right, and so I prepared the team for that too, like we might have to do this in addition to what we're planning.

00:26:32.470 --> 00:26:36.869
So let's make sure we have such and such in the room in case we have to do that or this happens.

00:26:37.009 --> 00:26:37.752
There's a chance, there's.

00:26:37.752 --> 00:26:49.838
You know, I try to Statistically kind of capture what are some you know Possibilities and then be prepared for them and have the rest of the team prepared for the two, because it's unfair To just kind of keep all that to yourself too.

00:26:49.838 --> 00:26:57.583
I think you have to let the whole team in on it, like when that thing happens and you're like oh yeah, I knew this was, this is possibly I'm an NH star.

00:26:57.583 --> 00:26:59.317
Hey, I need this now, like what, what?

00:26:59.317 --> 00:26:59.518
What?

00:26:59.518 --> 00:27:01.204
You didn't prepare the team to.

00:27:01.204 --> 00:27:02.269
That falls on you.

00:27:02.269 --> 00:27:08.001
You have to kind of Quarterback and have everybody on the same page with you and be ready for those contingencies too.

00:27:08.891 --> 00:27:12.981
As a leader, and when you describe the, the team dynamic, etc.

00:27:12.981 --> 00:27:13.142
Etc.

00:27:13.142 --> 00:27:23.821
What is the emotion and what is the the camaraderie like, like what happens after you've had a surgery.

00:27:23.821 --> 00:27:25.484
You've had a successful surgery.

00:27:25.484 --> 00:27:29.240
What is that feeling in the room with your team?

00:27:30.291 --> 00:27:40.079
you know, you know, like when the are you the types of type of guys that when you see someone celebrating the end zone after a touchdown, accessibly, you're like come on.

00:27:40.119 --> 00:27:40.965
You've been there, I haven't.

00:27:40.965 --> 00:27:41.529
You've been there before.

00:27:43.594 --> 00:27:47.621
Yes, like Barry Sanders handing the ball to the ref right class.

00:27:47.621 --> 00:27:50.972
Yeah, that's kind of what it is Meaning.

00:27:50.972 --> 00:27:54.710
Like it's supposed to go well, right, I mean it has to go well.

00:27:54.710 --> 00:28:01.804
Like we shouldn't be surprised by this, because we plan for it, you know, same way every time is kind of one of our mantras.

00:28:01.804 --> 00:28:08.615
We have this down, you know, this is how it's supposed to go right, and High expectations.

00:28:08.615 --> 00:28:15.898
So we don't celebrate, also because that superstitious Stuff I mentioned earlier where we can't really go ahead.

00:28:15.898 --> 00:28:17.261
He did great, you know.

00:28:17.261 --> 00:28:19.452
It's like so far, so good.

00:28:19.452 --> 00:28:20.896
We still haven't left the room.

00:28:20.896 --> 00:28:25.156
Got to make sure that, you know, because Bleeding can also happen.

00:28:25.156 --> 00:28:28.148
Right, I mean, you close the chest and we have drains in place.

00:28:28.148 --> 00:28:29.173
You know that there's bleeding.

00:28:29.173 --> 00:28:30.136
That can happen later.

00:28:30.136 --> 00:28:31.542
So we want to be sure that's perfect.

00:28:31.542 --> 00:28:36.832
So it's still a very, very Good Calm.

00:28:36.832 --> 00:28:38.476
You know, great, we'll take.

00:28:38.476 --> 00:28:42.084
We'll take the win so far, but the game is an over yet type of thing.

00:28:42.791 --> 00:28:43.555
When can you take the?

00:28:43.595 --> 00:28:43.816
win.

00:28:43.816 --> 00:28:55.159
I Think for me, if it Usually, if it goes cookie cutter by like the second day or third day got it, you will have most of the time.

00:28:55.159 --> 00:28:57.470
If something bad were to happen, you would have seen it by then.

00:28:57.630 --> 00:29:08.518
So it was first 24, 48 hours is very telling how important is the scorecard overall, meaning you know your surgery, your Surgery, for your surgery success percentage?

00:29:09.172 --> 00:29:25.242
Well, that'd be for huge, all right heart surgery is under all of heart surgery is under a microscope, but heart transplant in particular is under the biggest microscope because we are held to a standard of one year survival.

00:29:25.242 --> 00:29:38.980
Meaning if you have a heart transplant program and and your survival after one year is not at or around 90 percent, which is kind of what's considered the national average, there's a problem.

00:29:38.980 --> 00:29:43.215
Meaning you know Medicare, medicaid, cms might come knocking on.

00:29:43.236 --> 00:29:51.522
You know what's going on like 89% means you fail no success, meaning that 90% of the people you do a transplant on are still around after you right.

00:29:51.603 --> 00:29:59.836
So I'm saying like if, but if your percentage is 89%, you know, with I mean as long as I mean, I Obviously be a little facetious, but right.

00:30:00.076 --> 00:30:01.520
I think that's the standard.

00:30:01.520 --> 00:30:30.099
But the reason why I'd say that's that's a problem or it's it's such a challenge is because you know, even if the person did great, went home, got hit by a bus six months later or something, you know, whatever it is, I mean the that's we are, and that speaks to why our selection process has to be very, very Thorough, meaning we're not only looking at Okay, is this person sick enough for a heart?

00:30:30.099 --> 00:30:31.528
Are they gonna do well with the heart transplant?

00:30:31.528 --> 00:30:33.776
Okay, great it's also, are they gonna?

00:30:33.776 --> 00:30:35.903
Are they gonna abide by our instructions?

00:30:35.903 --> 00:30:36.326
Are they?

00:30:36.326 --> 00:30:37.529
Who's with them at home?

00:30:37.529 --> 00:30:38.712
Who's gonna help take care of them?

00:30:38.712 --> 00:30:39.253
Are they gonna?

00:30:39.253 --> 00:30:42.701
Are they reliable enough to come in for their appointments and stuff?

00:30:42.701 --> 00:30:47.170
Because we have to Make sure everything goes super, super well.

00:30:47.170 --> 00:30:49.997
It's just the high risk nature of what they have.

00:30:49.997 --> 00:30:51.079
What if the heart rejects?

00:30:51.079 --> 00:30:51.942
Two months later?

00:30:51.942 --> 00:30:54.577
We have to be doing biopsies and surveillance.

00:30:54.577 --> 00:30:55.260
So these are very.

00:30:55.260 --> 00:30:57.950
This is not a all right, got your gallbladder out.

00:30:57.950 --> 00:31:00.978
Good luck to you, you know, call it all of the years.

00:31:00.998 --> 00:31:07.479
This is a lifelong, you know, relationship that we're establishing with this, with this patient.

00:31:07.479 --> 00:31:26.096
So it is a very, very Close-knit kind of relationship that we have and For that reason, you know, we we take it extra serious, very, very serious about who we Decide is is gonna get a transplant.

00:31:26.396 --> 00:31:31.919
I'm sitting here trying to process, like emotionally, you know what, what you must have to go through.

00:31:31.919 --> 00:31:37.099
I mean, I would imagine your Failures sit with you way more than your successes, of course.

00:31:37.099 --> 00:31:44.519
So I guess, talk to me a little bit emotionally about you know you said you took some psychology and that is part of the training.

00:31:44.519 --> 00:31:51.195
Talking to families about complications or you know this isn't gonna happen the way we thought it was.

00:31:51.195 --> 00:32:02.163
You know just that, letting them down and how you compartmentalize Emotionally when you have to have those difficult conversations, are you able to just turn around and go to dinner with your friends afterwards?

00:32:02.163 --> 00:32:06.609
I mean, it's got to be very, very challenging when things don't go right.

00:32:07.071 --> 00:32:12.490
No, that would be amongst the most challenging of everything about this way of life.

00:32:12.490 --> 00:32:15.781
I know I went on this whole tangent earlier about, you know, my identity.

00:32:15.781 --> 00:32:17.428
Is not my job, this any other.

00:32:17.428 --> 00:32:20.339
But I Also don't look at it as a job.

00:32:20.339 --> 00:32:29.750
It is kind of a way of life and I Get very personally attached it's hard not to to each patient and it's a personal thing for me.

00:32:29.871 --> 00:32:37.320
If something doesn't go the way it's supposed to, or someone, or it doesn't go well, I'm very much up front.

00:32:37.320 --> 00:32:41.438
I Love to build good relationships with the patient, their family.

00:32:41.438 --> 00:32:45.353
I give them my cell phone, I I go right to them.

00:32:45.353 --> 00:32:47.097
I mean I don't hold anything back.

00:32:47.097 --> 00:32:48.842
I say, hey look, this is what happened.

00:32:48.842 --> 00:32:52.355
Sorry, this happened, or whatever it is.

00:32:52.355 --> 00:32:53.838
But you're absolutely right.

00:32:53.838 --> 00:32:55.123
I mean, the failure is always.

00:32:55.123 --> 00:32:57.355
You know far fewer.

00:32:57.355 --> 00:33:03.394
But they see you hold on to those and they and they kind of Dictate how you can.

00:33:03.394 --> 00:33:12.890
You know, you'll never forget, you know that one time that this happened, I think it was because and I now, from that moment forward, I didn't do my stitch in this situation that way.

00:33:12.890 --> 00:33:25.306
I do it differently now and, right or wrong, you know, you kind of get almost Molded you evolve and you get molded by these events and you know they're learning.

00:33:25.625 --> 00:33:31.780
You learn that way, unfortunately, and so I always say, how do we get better from that?

00:33:31.780 --> 00:33:33.403
How does that not ever happen again?

00:33:33.403 --> 00:33:37.913
Or, if the same situation presents itself, what are we gonna do differently this time around?

00:33:37.913 --> 00:33:51.239
So we do have those kinds of meetings us amongst us as a team, like, okay, you know, call it a root cause analysis or whatever kind of common quality improvement, but we are like, alright, this was something we all didn't want to happen.

00:33:51.239 --> 00:33:54.294
Why did it happen and how do we get better from it?

00:33:54.294 --> 00:34:03.920
How do we take this unfortunate tragedy and turn it, get some, extract some morsel of Positivity from it so that we can benefit someone down the road?

00:34:04.490 --> 00:34:04.671
You've.

00:34:04.671 --> 00:34:11.692
You've commented, you know, several times about not wanting things to come too close to your identity and trying to create Separation, etc.

00:34:11.692 --> 00:34:12.152
Etc.

00:34:12.152 --> 00:34:16.512
What is the lifestyle of a heart transplant surgeon Meaning?

00:34:16.512 --> 00:34:19.909
You know, we've talked to an FBI agent before and we've asked the question.

00:34:19.909 --> 00:34:22.635
You know You're, are you, you know, always carrying a gun?

00:34:22.635 --> 00:34:24.681
Are you always engaged?

00:34:24.681 --> 00:34:25.663
And the answer is yes.

00:34:25.663 --> 00:34:30.353
Can you shut it off?

00:34:30.353 --> 00:34:35.626
Is there a space for separation, for you to walk away from the job for a little while?

00:34:35.626 --> 00:34:36.769
Like what is that dynamic?

00:34:37.612 --> 00:34:47.784
I think the answer is yes, and I think that is also played into kind of what is led to some transitions in my career.

00:34:47.784 --> 00:34:53.625
Meaning, at Northwell, right, starting the first heart transplant program for Long Island Wow, amazing.

00:34:53.625 --> 00:34:55.110
But guess what?

00:34:55.110 --> 00:35:02.449
I was on, you know, on call for three years, yeah, literally, literally, right, I was the only person doing them right.

00:35:02.449 --> 00:35:04.898
So in our, in our program.

00:35:04.918 --> 00:35:13.945
So, yeah, I could maybe escape for a weekend to the Hamptons but be able to come to drive back if a heart transplant surfaces or something.

00:35:13.965 --> 00:35:15.670
Yeah, that is not sustainable, right.

00:35:16.050 --> 00:35:30.938
So at a place like Vanderbilt, where we do more heart transplants than anyone on the planet, we have a big team and so we can kind of Take a little time, you know, a weekend here or a week there, so we can be human, so to speak.

00:35:31.340 --> 00:35:37.650
You know you can take that time to do other, you know, and re medication like a normal, and recharge and stuff like that.

00:35:37.650 --> 00:36:06.739
So that is important and on a day-to-day basis, when you're in the throws of kind of this, especially at a busy place like this, it's not that you can't turn it off, but you know you're not surprised if you get a call, because and that was a decision I chose to come to a place like this because I just, I don't know I wanted I've kind of almost come full circle I want to be in the throws of the Mecca of, you know, doing as much of this as possible.

00:36:06.739 --> 00:36:16.695
So if one of my colleagues is in trouble and needs help, you know, even it's not my day on call or whatever I'm gonna come in and help them or Well, you learn that from your boys, and yeah, or?

00:36:17.315 --> 00:36:17.938
whatever it is.

00:36:17.938 --> 00:36:20.603
Hey, you know we have two transplants going at the same time.

00:36:20.603 --> 00:36:23.173
Can, are you available?

00:36:23.173 --> 00:36:25.561
Yeah, I'll come in and I'll do whatever it takes.

00:36:25.561 --> 00:36:29.653
So it's sort of it depends on the day I go.

00:36:29.813 --> 00:36:33.644
I try to, I'm trying to be more on living in the present.

00:36:33.644 --> 00:36:36.355
I think that that was also a big departure.

00:36:36.355 --> 00:36:38.554
I was always wired future, future, future.

00:36:38.554 --> 00:36:42.851
I got to do this, to get to this, so that I can achieve this and get them.

00:36:42.851 --> 00:36:47.847
Now I think it's more about being living in the present, enjoying the current moment.

00:36:47.847 --> 00:36:52.586
I'm getting to talk to you guys and having a good time, and this is pretty neat, right?

00:36:52.586 --> 00:37:02.603
Not constantly thinking about Okay, yeah, so I got to do this so that then I can Ride the ladder and ascend to this other thing.

00:37:02.603 --> 00:37:04.869
It's no, you know, tomorrow is not promised.

00:37:04.869 --> 00:37:10.157
You got to make the most of today, and that's something that is New for me.

00:37:10.157 --> 00:37:23.175
I would say in the last few years that I've evolved to that I was more of a maturity thing and not constantly being overcome with how do I continue down this rabbit hole or on this hamster wheel.

00:37:23.516 --> 00:37:25.222
Was that some of the impetus behind writing your book?

00:37:25.222 --> 00:37:26.266
Heart to beat it was.

00:37:26.367 --> 00:37:30.358
It was such a cathartic thing to do it and I, I had all these.

00:37:30.358 --> 00:37:31.139
I had no reason.

00:37:31.139 --> 00:37:39.146
I I still do not understand why I accumulated all these random thoughts or Observations and it finally came to a point where you've been doing this stuff alone.

00:37:41.498 --> 00:37:43.409
Yeah, I got to get this out on.

00:37:43.409 --> 00:37:44.474
I think it can help people.

00:37:44.474 --> 00:37:53.675
I don't know, I read David Goggins book can't hurt me and that was really impactful For me and I felt like I could tell a somewhat similar, analogous story.

00:37:53.675 --> 00:38:04.887
But from my perspective and through what I went through, and I don't know, I felt like maybe Some learning lessons that I experienced along the way could help other people.

00:38:04.887 --> 00:38:24.960
Because it's I don't have it figured out, I haven't yet figured out, and I thought, you know, and I think most of us do, when we're young, like all right, once I get to this, I'm gonna achieve, I'm gonna get my MBA or I'm, and then then it's I'm set, you're never, never set.

00:38:24.960 --> 00:38:35.043
It's like that's the, that's the biggest fallacy, I think, of being young and thinking I achieved this goal and I'm done, it's you're never done.

00:38:35.043 --> 00:38:38.737
Right, we're always learning, we're always improving continuously.

00:38:38.737 --> 00:38:43.079
So that's kind of how things have gotten there.

00:38:43.420 --> 00:38:43.862
Are you?

00:38:43.862 --> 00:38:44.925
Do you still?

00:38:44.925 --> 00:38:50.807
I mean, I think you like the job that you do, but let's say the industry is a whole medicine as a whole.

00:38:50.807 --> 00:38:56.019
Are you still happy with with medicine overall, the way, the way things are?

00:38:56.161 --> 00:38:58.155
no Meaning.

00:38:58.155 --> 00:39:03.264
That's kind of also why, on the side here, I've about to get my MBA.

00:39:03.264 --> 00:39:19.282
I'm like one class away and Partly was because when you're in the midst of training to do whatever your craft is going to be, you have no idea about this other whole world that exists Outside of what you're doing in the operating room.

00:39:19.282 --> 00:39:22.559
It's the business of medicine, right, how do hospitals run?

00:39:22.559 --> 00:39:23.623
How are things paid for?

00:39:23.623 --> 00:39:24.565
Who pays for it?

00:39:24.565 --> 00:39:28.961
All access to care, all these different things.

00:39:29.523 --> 00:39:39.041
And that really hit home when I Finally got out into the real you know market and and was just kind of you that has another commodity and All that stuff.

00:39:39.041 --> 00:39:41.472
And I was like I don't know any of this stuff, I don't.

00:39:41.472 --> 00:39:55.320
And so that's what drove me to say you know I, if I'm gonna make a difference in health care in general or whatever segment of health care that I'm really interested in, I need to bone up, I need to understand these things, I need to right.

00:39:55.320 --> 00:40:10.090
So that's what led me to Pursue this MBA, just because I want to be able to talk At the same level with the, the C-suite people, and understand what they're talking about and know kind of what drives them right.

00:40:10.090 --> 00:40:17.934
It's not as simple, unfortunately, from my perspective, as taking good care of patients right, it's right, much, much, much more than that.

00:40:17.934 --> 00:40:21.822
It's not so simple, so I want to understand it to be able to help improve it.

00:40:22.264 --> 00:40:24.088
Are you the world's best player at operation?

00:40:28.547 --> 00:40:29.309
I haven't tried it.

00:40:29.309 --> 00:40:30.992
It'd be interesting to see how I would.

00:40:30.992 --> 00:40:31.755
I haven't tried it.

00:40:31.936 --> 00:40:32.777
Oh, get out of here.

00:40:32.777 --> 00:40:33.740
You haven't tried it.

00:40:33.800 --> 00:40:38.003
Come on it's been some time, but I've you, I've been told the game to try that is very funny.

00:40:38.063 --> 00:40:41.815
you know, my son just got the game operation as a gift.

00:40:41.815 --> 00:40:47.206
He he's five and it just so happens my wife is a surgeon, so we have a ringer in the house.

00:40:47.246 --> 00:40:47.967
It's very funny.

00:40:47.967 --> 00:40:50.239
It will not play with her.

00:40:50.239 --> 00:40:53.161
What is your favorite medical show?

00:40:53.161 --> 00:40:54.164
Do you have one?

00:40:54.164 --> 00:40:56.297
Oh, medical show Mmm.

00:40:56.719 --> 00:40:59.771
I actually hate all the medical shows for the most part, oh I like.

00:40:59.811 --> 00:41:00.414
Why does everyone hate you?

00:41:00.414 --> 00:41:03.344
Why do you guys all hate I like, I like because it's fake.

00:41:03.344 --> 00:41:09.358
You're talking now.

00:41:09.398 --> 00:41:13.978
You're talking you know no, the movie malice With Alec.

00:41:13.998 --> 00:41:15.181
Baldwin, that's very funny.

00:41:15.181 --> 00:41:19.483
You want to know something here funny Talking about it before we started this interview.

00:41:19.483 --> 00:41:22.414
This is exactly what I was talking about with these guys.

00:41:22.414 --> 00:41:23.298
I'm like you know what?

00:41:23.298 --> 00:41:26.914
I want to ask what this movie malice and does he think of himself as Alec Baldwin?

00:41:26.914 --> 00:41:28.338
He says you know they're praying to.

00:41:28.338 --> 00:41:31.086
When they're praying to God, they're praying to me.

00:41:32.097 --> 00:41:32.798
Very impactful.

00:41:32.798 --> 00:41:33.119
Actually.

00:41:33.119 --> 00:41:37.235
I kind of already made up my mind, but I was like, wow, that he's obviously taking in a little too far.

00:41:37.235 --> 00:41:39.282
But I was like, wow, he is.

00:41:39.282 --> 00:41:42.695
He's pretty cool, it's pretty intense though.

00:41:42.695 --> 00:41:44.498
I love that movie.

00:41:44.498 --> 00:41:46.664
I think it's really.

00:41:47.085 --> 00:41:48.568
I'm glad you said that.

00:41:52.936 --> 00:41:53.679
We knew the title.

00:41:53.679 --> 00:41:54.583
We'd never seen the movie.

00:41:57.456 --> 00:41:58.679
Oh, watch this movie.

00:41:58.679 --> 00:42:00.625
Watch this movie okay.

00:42:00.684 --> 00:42:06.987
so have you ever been, let's say, at a restaurant or on a plane?

00:42:06.987 --> 00:42:09.534
And you've heard the words is there a doctor in the house?

00:42:09.534 --> 00:42:12.059
Hmm, what do you do in that instance?

00:42:12.059 --> 00:42:13.382
You have to respond, do you know?

00:42:13.864 --> 00:42:18.561
Yeah, I believe you do, but Never, never on a plane.

00:42:18.561 --> 00:42:28.621
I think I was in a restaurant in Manhasset one time when someone was choking on Food or something or you know having a seizure.

00:42:28.621 --> 00:42:30.606
I can't remember, but it just so happened.

00:42:30.606 --> 00:42:40.929
It was like a convention of E&T docs, you know and and they were at that, I think, like the next table over, and it was like a.

00:42:40.929 --> 00:42:44.844
There wasn't even like a me cuz like 17 doctors descended on.

00:42:44.844 --> 00:42:45.485
That's great.

00:42:47.195 --> 00:42:56.639
Lucky person At this point in the conversation.

00:42:56.639 --> 00:42:58.746
We always ask our guests to.

00:42:58.746 --> 00:43:04.106
You know, impart some wisdom and some advice to people who Might want to fall.

00:43:04.106 --> 00:43:05.715
You know, follow in your footsteps.

00:43:05.715 --> 00:43:12.295
I imagine if we get a million listeners to this podcast, one of them will want to follow in your footsteps.

00:43:12.295 --> 00:43:19.202
So you know somebody who wants to get into your profession, somebody who wants to get into to Medicine today.

00:43:19.202 --> 00:43:21.434
You know, what type of advice do you have for them?

00:43:22.117 --> 00:43:27.043
I would say I love what I do and I would recommend it a million times over.

00:43:27.043 --> 00:43:31.762
You just have to want it for the right reasons and If you want to do it, you can do it.

00:43:31.762 --> 00:43:37.385
You'll have to work hard and never settle for, you know, for complacency.

00:43:37.385 --> 00:43:39.128
You, there's always room for improvement.

00:43:39.128 --> 00:43:40.418
You just have to.

00:43:40.418 --> 00:43:41.847
You know you can get there.

00:43:41.847 --> 00:43:44.282
If other people could do it, you could do it too.

00:43:44.282 --> 00:43:51.014
You have to believe in yourself, but it takes time and practice and and and humility to do it, but you could do it incredible advice.

00:43:51.396 --> 00:43:52.581
Well, brian, you know.

00:43:52.581 --> 00:43:55.302
Thank you so much for the time today.

00:43:55.302 --> 00:43:57.309
Everybody out there the book heart to beat.

00:43:57.309 --> 00:43:58.715
You're gonna want to look for that, brian.

00:43:58.715 --> 00:43:59.695
I imagine it's.

00:43:59.695 --> 00:44:02.199
It's available everywhere books are found.

00:44:02.199 --> 00:44:02.460
Yes.

00:44:03.221 --> 00:44:05.003
Amazon in particular.

00:44:05.103 --> 00:44:06.969
Yeah, Is it on audiobook?

00:44:07.431 --> 00:44:10.172
No, not, didn't have the time to do it, so not everyone.

00:44:12.108 --> 00:44:13.413
Yeah, you should narrate it Come on.

00:44:14.286 --> 00:44:15.902
You had to blow it up to show, Maybe.

00:44:15.902 --> 00:44:21.753
Maybe you need to hire a VO guy to just agree to it Only 24.

00:44:22.054 --> 00:44:24.737
Maybe, maybe that's next Next project, yeah.

00:44:24.918 --> 00:44:25.679
So, brian, thank you.

00:44:25.679 --> 00:44:29.516
This has been a remarkable conversation, so interesting.

00:44:29.516 --> 00:44:34.657
You've opened your eyes to so many different things that we've really never thought about before.

00:44:34.657 --> 00:44:37.413
So, brian, thank you so much for joining us today.

00:44:37.413 --> 00:44:38.347
It's been a pleasure.

00:44:38.347 --> 00:44:39.510
Guys, thank you, I've had a blast.

00:44:39.510 --> 00:44:52.134
So that marks the conclusion of our conversation with Dr Brian Lima, and my expectations were incredibly high going into that, and I can honestly say that they were met.

00:44:52.134 --> 00:44:54.050
Larry Shea, what are some of your thoughts?

00:44:54.724 --> 00:45:01.289
That if I have to be on a slab and have somebody open me up, I would like it to be this guy Pretty much.

00:45:01.289 --> 00:45:08.934
I mean how powerful was the moment when he talked about opening up the chest and like taking the heart out and it was still beating.

00:45:08.934 --> 00:45:10.371
I mean amazing.

00:45:10.371 --> 00:45:12.713
I mean what a phenomenal interview.

00:45:12.713 --> 00:45:14.469
But I mean my biggest takeaways.

00:45:14.469 --> 00:45:18.170
I mean let's think about it in terms of our professional lives and our career paths.

00:45:18.605 --> 00:45:19.889
He talked about love.

00:45:19.889 --> 00:45:23.954
What you do, you know you have to want it for the right reasons.

00:45:23.954 --> 00:45:28.114
I think those are such valuable lessons that we sometimes lose sight of.

00:45:28.114 --> 00:45:31.693
And he also talked about never settling and believing in yourself.

00:45:31.693 --> 00:45:41.273
You know this is a very big challenge to do this kind of work and you know I consider myself very accomplished professionally.

00:45:41.273 --> 00:45:54.016
But the amount of information that he had to to get under his belt and to know like the back of his hand and just like I don't know, I couldn't imagine an endeavor such as this and accomplishing it.

00:45:54.016 --> 00:46:03.755
And he's an amazing guy and just really impressive to hear him talk about all of this, because I don't think I don't think it's something that anybody could just do.

00:46:03.755 --> 00:46:05.652
I think you got to kind of be built for this.

00:46:06.085 --> 00:46:07.251
I think you're probably right about that.

00:46:07.251 --> 00:46:13.114
I will say this knowing that every time he learns one new thing, something else leaves him.

00:46:13.556 --> 00:46:14.277
That was great.

00:46:14.336 --> 00:46:14.818
I was right.

00:46:15.864 --> 00:46:21.744
I do wonder what it is to forget how to make a sandwich like a, like walking in the kitchen one day Well, what is this bread I'm using now?

00:46:21.744 --> 00:46:22.628
That's that's one thing.

00:46:22.628 --> 00:46:33.789
But you know you weren't just saying, you're saying the correct thing there, Lara, and that you know the the sad almost said again the sacrifice that it takes to reach the heights of this profession.

00:46:33.789 --> 00:46:35.173
They are extreme.

00:46:35.173 --> 00:46:45.505
But the one other, though, the other piece of advice that he had which I thought was so telling was you know, it's OK to take an unconventional approach to your career, right, If you?

00:46:45.505 --> 00:46:59.833
If you feel that being in public practice is burning you out, well then maybe it's OK to go into private practice and have actual real hours that you deal with and have actual real and try to have an actual real life.

00:46:59.833 --> 00:47:04.492
This is not a bad thing and you know, obviously this is not.

00:47:04.492 --> 00:47:12.568
This is not 20, 30 years ago, where it was more of a, was more like being in the Marines, where now you actually, you know you can have something more of a life.

00:47:13.304 --> 00:47:22.307
But he has found that proper balance to it and I will say this you know, he, he, I always thought of doctors at that level, as a doctor, as elite athletes.

00:47:22.307 --> 00:47:32.041
He's correct, they're more like, they're more like Navy SEALs because of that kind of precision, that kind of planning that goes where they literally are trying to storm beaches.

00:47:32.041 --> 00:47:34.150
Every time they have an operation like this.

00:47:34.150 --> 00:47:38.481
They are literally doing a real kind of military, pseudo military operation.

00:47:38.481 --> 00:47:40.027
When they're heading into the or.

00:47:40.027 --> 00:47:41.893
Everything has to be planned up precisely.

00:47:41.893 --> 00:47:45.913
Everyone has to know their job and everyone has to know everyone else's job as well.

00:47:45.913 --> 00:47:46.715
It's amazing.

00:47:47.054 --> 00:47:47.556
Absolutely.

00:47:47.556 --> 00:47:56.896
And as I look back on the conversation and you guys have have wrapped things up extremely well I'm just going to sort of grab it a few strings or straws here.

00:47:56.896 --> 00:48:14.525
You know, one of the things that I found so compelling was when he came to New York and when he came to Northwell and Long Island and some of the challenges that he had to deal with setting up a practice in this area where all in New York, I should say that, for heart transplants, like you know, he was the guy.

00:48:14.525 --> 00:48:16.016
He was the first one out there.

00:48:16.016 --> 00:48:27.853
I mean, he was a pioneer for this region, which has to be thrilling, it has to be scary and a whole bunch of other things, and then add on top of that the dynamics and the politics of New York City.

00:48:27.853 --> 00:48:29.846
You know it.

00:48:29.846 --> 00:48:34.617
Just, it really showed me a lot about him in terms of his metal.

00:48:34.617 --> 00:48:39.697
You know, it's not just the fear and the challenge of taking on this, this massive endeavor.

00:48:39.697 --> 00:48:49.096
You have to have the politician in you to to work your way through all of this other stuff, and that takes a very special kind of person.

00:48:50.367 --> 00:49:01.177
So, dr Brian Lima, thank you so much for joining this episode of no Wrong Choices and, I should point out, for anybody who wants to get his book Heart to Beat, it is available everywhere.

00:49:01.177 --> 00:49:03.050
We also thank you for joining us.

00:49:03.050 --> 00:49:13.297
If this episode made you think of an inspiring person in your life who could be a great guest, please send us a note via the contact page of our website at knowwrongchoicescom.

00:49:13.297 --> 00:49:19.717
We also encourage you to connect with us on LinkedIn, instagram, youtube, facebook X and Threats.

00:49:19.717 --> 00:49:32.567
On behalf of Tushar Saxena, larry Shea and me, larry Samuels, thank you again and always remember there are no wrong choices on the road to success, only opportunities, because we learn from every experience.