Becoming A Heart Transplant Surgeon with Dr. Brian Lima (Part 1)

Transcript

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Hello and welcome to no Wrong Choices, the podcast that explores the career journeys of accomplished and fascinating people to shine a light on the many different ways we can achieve success.

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I'm Larry Samuels, soon to be joined by Tushar Saxena and Larry Shad.

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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 knowwrongchoicescom.

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This episode is the premiere of season four of no Wrong Choices and features the cardiac surgeon, and, more specifically, heart transplant surgeon, dr Brian Lima, who practices medicine at the Vanderbilt University Medical Center.

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He's also the author of the book Heart to Beat.

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Larry Shad, why don't you lead us into this one?

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Yeah, this is the only professional capacity I would like to meet Dr Brian Lima, because if you're meeting him in his professional capacity, you've got issues, you've got problems.

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So I'm excited to share with everybody why he chose this journey.

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I mean, you know, when you think about the amount of work that goes into something like this, I mean it's overwhelming.

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I mean it's certainly not something that I would choose.

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I chose, you know, a relaxing profession radio.

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I mean what is that?

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But yeah, this guy is, you know, very impressive, and you're about to feel how impressive he is because this is a serious commitment and an amount of work that most normal people couldn't handle.

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He's Superman, let's face it, he's Superman.

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Yeah, that's a great thing you just said, because you use the word commitment and I think the more proper word is probably sacrifice, because that's what a lot of this is about.

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It's the notion of sacrificing your professional time and your personal time because you know you have to put a lot of hours into study.

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This is not a joke kind of profession.

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To be a heart transplant surgeon, to be a surgeon of any kind, takes a great deal of training, but then as you move up the ladder you know it's like being in top gun.

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He is in the top gun of his profession.

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He's the top 1% of 1% of that profession and this is not a joke.

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What the amount of schooling this man has gone through, the amount of sacrifice that he's had to do.

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It is not an easy profession to do.

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Not everyone's meant to do it.

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I'll tell you what Brian Lima is meant to do this.

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Absolutely, and for me, you know, one of the most interesting aspects of the first part of our conversation was about his journey as a kid and overcoming some of the challenges that were in front of him from a familial standpoint, and some things were very surprising to me, which will dig into, and you know again, just a remarkable personal journey story that I think everybody's really going to enjoy.

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I should also point out that I've had a chance to spend some time with Dr Lima, brian Lima and he's a really good guy.

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He's a great storyteller and fortunately, the time that I spent with him was personal, not professional.

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So with that, here is Dr Brian Lima.

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Dr Lima, thank you so much for joining us.

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Oh, thank you so much for having me.

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All right.

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So before we move further, dr, can we call you Brian or do you want to go by Dr Lima to be, you know, very official?

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Oh, no, no, no, brian is totally fine, then we will call you Brian, all right.

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So, brian, who is Dr Brian Lima and what does he do?

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I guess that's the easiest question to ask.

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Sure, so I am a heart surgeon and within heart surgery, my area of kind of expertise and focus is the worst of the worst, you know, heart transplant, artificial heart pumps for folks with advanced heart failure.

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But that's a lot of what I am and what I do, I would say.

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And yeah go ahead T.

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No, so I was going to say so.

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You're out there quite literally, holding people's lives in your hands a lot of the time.

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Yes, yes, a lot of time, almost day in, day out.

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It took a long time to be able to do that, to finish all the schooling and training, but I love it.

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I wouldn't train places with anybody.

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So where did this begin?

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Talk about your childhood, because obviously we did our research, you know, knowing that we were going to talk to you today, and I know that family played a big part in why you chose this profession.

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So take us back to the beginning.

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What was the original dream?

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Why did you get into this and tell us a little bit about your upbringing?

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Sure, so, you know, the idea of becoming a doctor came.

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Really it sounded cool.

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You know, my dad had some heart trouble when I was young he was in his, I think, early 50s had a heart attack.

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I think I was like maybe 10 years old.

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That really scared us and it was a daunting thing to be in a hospital and I just remember feeling, you know, helpless.

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And thankfully at that time it was something that was handled, not needing surgery or anything.

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But it was kind of when, where that seed was planted of, hey, you know, it'd be great if I was a doctor, because that I wouldn't feel is helpless, I'd be able to help other people through situations like that.

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And it wasn't really until I got to scrub in on a case when I was shadowing a surgeon when I was in college at NYU I was doing a summer program and it was like one of those things that just click, you know it's.

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I felt really lucky that I had a situation like an epiphany, like that.

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I know a lot of folks don't get that.

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You know, that experience where you see something and it's just like whoa, I want to do that, like whatever it takes.

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And it was at that moment, you know at the age of what 17, 16, that I was like I want to do what that guy does.

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And then it was 16 or 17,.

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You know, you want to be a heart surgeon.

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Yeah, yeah, holy cow, yeah.

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Wow, and you know, and with that in mind, what role did your family play in terms of getting you there?

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You know you had the experience with your father when you were a kid.

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You know your background is unique from some others.

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Talk to us a little bit about your foundation and your upbringing.

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Sure.

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So my parents, my two older siblings, came over from Cuba in the late 60s and they had nothing except the clothes on their back.

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You know, my dad had to work in a pretty awful you know paint factory kind of pigment factory for paints, and inhaling a lot of fumes, working on a lot of overtime, shifts and not so great part of Newark, New Jersey, you know, and that's kind of where I grew up.

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We didn't speak English at home, Very, very, you know blue collar slash, lower class type of situation, apartment, that sort of stuff, and really the only thing that he kept preaching, you know, day in, day out, was hard work, hard work.

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You know that'll overcome talent.

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And as long as you can just, you know, put in the work, it doesn't matter how smart you are, it's all about effort.

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And that really kind of was ingrained in me and kind of gave me that chip on my shoulder that, you know, as long as I put in the work I could do it.

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And that really kind of recapitulated all throughout my schooling because I was, you know I can guarantee you, most of the time I was not the quote smartest person in the room in high school or college or med school I just outworked everybody.

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It's a pure work ethic.

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I mean it was.

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I almost kind of wish I could recapture that like sheer just work ethic where I could just sit down for 18 hours or 12 hours study and all of that.

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It's a different kind of learning.

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Now I guess you could say adult learning, but that's what I kind of owe to that upbringing and example that my dad set for me.

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Your story of the immigrant family growing up is very similar to mine.

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Obviously my name is Tushar Saksin, it's not John Smith.

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So my family same thing.

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My mother and father came from India and they preached hard work and they preached education as well.

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I would say, did your family ever say you should go into the big four professions, being medicine, business, engineering or I forget what the fourth law, because you already decided four of them?

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So I mean, when you said to your family at a young age 16, 17 that I am not only going to be a doctor but I'm going to be a surgeon, heart surgeon what was their reaction to that?

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One of the things that I was really lucky to, because it sounds a bit crazy, but the initial part of that dream, I guess, was hey, I'm going to, instead of staying locally, and go to college, I want to go to Cornell.

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I want to go to Ivy League school.

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And they had no idea what the hell Cornell was, what Ivy League meant.

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In a classic, traditional Latin home, kids don't leave home until they're going to get married and moving into a start, a family of their own.

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This idea of me going to some college away, for hundreds of miles away, was crazy, but my parents backed me all the way, with the caveat being hey, we can't afford it.

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I mean, we probably won't be able to pay anything.

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So if you can, hey, you have our blessing.

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If you can somehow get a scholarship, we have your back.

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I mean, they actually took a lot of heat.

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My dad had a bunch of brothers and sisters and a few of them were here in the States and they all, including my cousins, thought I was the black sheep, believe it or not.

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How could you do this?

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How could you abandon the family?

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Where are you going?

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Oh my God, what a crazy reaction is that?

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My parents totally were with it, but they and I had to deal with that.

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I had to contend with that sort of chirping in the background of other family members for years and years because, as well, I'm sure we'll talk about it took what two decades.

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And they are always like, what is he doing?

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Like, is he even talking?

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What is this?

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like when is the payoff?

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Yeah, yeah.

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And I don't know.

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It's a funny way it all panned out.

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It's not what you would have thought, it's counterintuitive.

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My parents backed me all the way, had my back, just said, hey look, you know you could do it and somehow get funds for it.

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Scholarships, you have our, you know we got you.

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But and they kind of just said, you know, just quiet down to the rest of the family, he knows what he's doing.

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I'm glad you talked about the you know the education stuff there that you weren't.

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You didn't feel like you were the smartest kid in the room, right, that you had to out work everybody.

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I imagine that's the kind of drive that brings somebody to this level of success, because you know, if things are given to you, if things come easy, what you know, you may not have that drive.

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So talk to me about the age of 10 and when you have this scary moment with your dad and then through 16 and 17, and then you see that surgery for the first time and you're like oh my god, this is my life's calling right here.

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Was there ever a moment of trepidation, of like you know what I don't know like along that path?

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Was there ever a moment we're like because you have to wake up every day ready to kill it the grades?

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Get the scholarship.

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Yeah yeah.

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Kill it Kill it Kill life.

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It was.

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It's intimidating, you know, seeing when I kind of decided, yeah, that's what I want to do, and then kind of realize what it takes to do it.

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And I really had to kind of embrace this One day at a time, one class at a time, one exam at a time type of mentality.

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And what my dad was masterful at was not only the first lesson of the hard work thing.

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The second lesson of the two was complacency.

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He, you know he would, he would totally help celebrate with me and the wins along the way.

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But he also was super quick to be like all right, well, don't you know, don't rest on your laurels now, kind of this, that little.

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It was like this gentle, you know, hey, great, big win, awesome, but you know it's time to reload next right.

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Right, it was it was a.

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I think it's a two prong thing.

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It's the work ethic aspect of it and the complacency, sort of lack there of aspect of it that you kind of have to.

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That I learned along the way.

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So what does that look like in college?

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You go to Cornell, you're pre-med and I had a very good friend who was pre-med and in college and we never saw him.

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So I'm kind of curious.

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You know what that life is like and what that routine is like.

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Super intimidating.

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I went to some you know run of the mill local high school in New Jersey.

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You know my hometown.

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I didn't have any AP credits or anything like that.

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So I showed up to Cornell with a bunch of kids that had gone to prep school and had 20.

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You know I placed out of all these classes and and we're just, I mean it, so intimidating and going to use intro pre-med classes like chemistry or biology to be in the a range of anything, you have to be to standard deviations above the mean.

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So these exams would be impossible intentionally to sort of weed out quote, weed out people.

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So I had to completely revamp.

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You know I kind of had high school figured out.

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It's basically just wrote memorization, you, you regurgitate on the exam and it's a pattern recognition, right?

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College was that's not enough.

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College was you know, forget the.

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You know laws of chemistry as you know them here's a new set of rules and apply them.

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You know that was one exam where I really like to learn stuff.

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Yeah, you had to.

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You know an example always uses e equals empty, squared right.

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Everyone can, you know the average person can say, yeah, that's an equation and it looks so simple.

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But to derive that equation right, it is, amongst you know, the most complicated math and science ever, right?

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Few people on the planet could Understand it.

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But it then ends up being this little simple equation.

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So I had to then think of things from that perspective, like how did this stuff get into the textbook, understanding how it evolved to be able to teach it in a way and that was really the only way I had to in Master the information to such an extent that I could apply it and then perform at that higher level.

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How were you accepted by some of your other other classmates at the time?

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And I don't mean like, where you did you ever experience racism?

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But you know there must have been a lot of like.

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You know there must have been a lot of like side eyes towards you because, as you said, you didn't have this, you didn't in your own opinion, you didn't have the schooling to match up to theirs.

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But that is the.

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That's an elite, cutthroat type of environment.

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So I'm gonna I'm gonna assume that a lot of folks probably looked at you kind of side.

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I was like you know what's this guy doing here?

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Absolutely actually.

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You know, once I got higher up in the chemistry classes in my major in college, you know no one wanted to be my lab partner.

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Like who's this this?

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Like you know, I'm kind of like a jock to like who's this kind of knuckle dragging guy from New Jersey.

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I don't get it.

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You know like well, you're a chemistry major, really okay, and so I had to do a little bit of that too.

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But yeah, I mean, it's just looks are deceiving, right, and People really didn't take me seriously as far as classmates that I just didn't fit the bill of the usual.

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You know what a pre-med, you know nerdy student looks like, background wise and you know that stuff.

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Yeah, it's funny.

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We sometimes interview people on the show and they talk about their college learning experience like that, I didn't use any of that.

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I mean I'm thinking you like had to apply all of this, like do you still use stuff that you, you, you studied for 20 years?

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You know?

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Essentially, trying to get to where you are now, I mean you must go back to.

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Oh my god, I learned that my second year or my third year, like, what's the application of of what you learned back then?

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well, it's funny you ask that because I think you know in the UK and other countries they kind of condensed a lot of that time that I really need to major in chemistry and do all this other stuff for four years In college and then go to four years in med school and all that could have that probably could have been condensed into like five years or something or six years.

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And so you know I was a chem major through and through.

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I can't remember half of that stuff, man, if I was right, right, right, like I had.

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It's like I think of it as I have a limited amount of space in my brain and so the new material like the bio you know, the anatomy and the surgery stuff and knowing how that kind of you know Put all that other chemistry and equate and molecules to the back, I Can't even.

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I mean, it's crazy.

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I think about that sometimes I'm like, wow, you know I was an organic chemistry whiz.

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I was a teaching assistant.

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I can't remember almost any organic chemistry.

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Now has it come to the point now where, like every new fact that comes in something, hey, it's like yeah, it is it's?

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it's like spring cleaning, you know it's like all right, come on, we got to get one of these days, you'll forget how to make a sandwich.

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Also really, man seriously it's crazy.

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So I want to talk now, obviously, obviously, you excelled at Cornell, so your next stop after that is, I guess, what residency, or no, it would have been Medical.

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Yeah, Duke Medical School.

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Yeah, that was insane.

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Yeah, that was crazy.

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What was that transition like from pre-med Cornell to Duke Medical School?

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And I'm and let's be honest, this is no slouch, right.

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I mean, we're not talking about dumb schools here.

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He's going from.

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Cornell to Duke from Ivy to Ivy.

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Yeah, so the numbers start to get very I Hate the reuse the same term again intimidating, but you know so.

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Duke med schools the top three med school they take a hundred people a year.

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So there's a hundred people in the class, right?

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How many apply to get in?

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I don't mean to cut you off, but like oh, I think Maybe a thousand or a few.

00:18:41.535 --> 00:18:42.396
You know several.

00:18:42.576 --> 00:18:45.604
It's insane yeah so it's like the top gun of med school.

00:18:45.604 --> 00:18:47.478
Yeah, so out of that hundred.

00:18:47.739 --> 00:18:53.375
I think I was one of four or five from Cornell, they were 15 from Harvard, 15 from Yale, 10 from Duke.

00:18:53.375 --> 00:19:02.804
I mean we're talking mutants on steroids, you know, just like there was one guy who was 16 years old, a child prodigy, harvard.

00:19:02.824 --> 00:19:09.061
You know we're talking the elite of the elite, yeah and so it was graded on an honors pass fail.

00:19:09.551 --> 00:19:22.589
So basically, to get honors on a given class, like, let's say, gross anatomy, which it's like you've got to have, you got to have an honors, you know that means you had to be in the top 10 or 20 out of that hundred for that given class.

00:19:22.589 --> 00:19:35.653
So I think, put it in perspective, the cutoff for I'll never forget this as long as I live for gross anatomy, because everyone was gunning really hard for gross anatomy, it's like how can you become a surgeon if you didn't get honors in Gross anatomy?

00:19:35.653 --> 00:19:40.710
I think was like 96% Meaning like are you kidding?

00:19:41.090 --> 00:19:46.721
No, so you had to like be at that or above to get honors for that course.

00:19:47.163 --> 00:19:47.923
Oh my god.

00:19:48.557 --> 00:19:49.230
So this gives you night.

00:19:49.230 --> 00:20:02.702
I mean, I thought I had a good study, you know method and all this other stuff, and I had to step it up even more Higher intensity, because there's even more information, like huge amounts of information.

00:20:03.490 --> 00:20:04.232
What does that mean?

00:20:04.273 --> 00:20:24.910
that you had to step up your studying even more so at Cornell and and somewhat in high school, what I, what I, the method I evolved to, was kind of imagine if you were told by the Professors like, hey, you can bring in a cheat sheet, you know, whatever you could fit on that cheat sheet, fair game, do that.

00:20:24.910 --> 00:20:33.946
So I kind of adapted that to like this micro scribe where I would you know, and in the process of doing that, I think I saw this on an episode of Growing Pains.

00:20:34.861 --> 00:20:35.564
Of all shows.

00:20:36.085 --> 00:20:51.988
Mike Seeders yeah, yeah, he had, like he was trying to cheat or something on the test and he ended up writing all this stuff and then in the process of he like learned the material and he like aced the exam, but he got still got in trouble because he had all these notes on his cast.

00:20:52.079 --> 00:20:54.788
Actually I did that once in a physics class myself.

00:20:55.221 --> 00:20:56.297
I did that once in a physics class.

00:20:56.579 --> 00:21:00.623
I ended up cheat cheating stuff and then realized I just knew it all Right, so I was like I saw that card.

00:21:01.000 --> 00:21:04.324
So I was like this, so that was my method and it was handwritten.

00:21:04.324 --> 00:21:07.424
But in in med school they gave us laptops.

00:21:07.424 --> 00:21:11.528
I didn't have enough money to get a laptop and it was like I think laptops were still relatively new.

00:21:11.528 --> 00:21:38.884
So they gave us laptops and I basically then converted to a digital upgrade of my micro scribe and would do like eight font or smaller, two columns on on each page and this whole like shorthand that I just created over time and I remember I condensed like a whole neurobiology textbook I think it was like 300 to 500 pages into like 20 pages, wow.

00:21:38.903 --> 00:21:39.265
Oh, my God.

00:21:39.980 --> 00:21:41.967
And so I would do that and it was it worked.

00:21:41.967 --> 00:21:48.366
I mean, I would, just once I finished doing that, we read it a few times and that was it.

00:21:48.599 --> 00:22:01.765
It was like locked in and you had to get into the top few percentage points of these classes, against that kind of competition, in order to pursue your ultimate dream of becoming a cardiac surgeon.

00:22:02.839 --> 00:22:14.147
Yeah, I mean, I think to to get in the top residencies, you know, because then it keeps, it's a funnel that keeps narrowing right, and to get into a top surgical program.

00:22:14.147 --> 00:22:18.830
They take, you know, six people, five people.

00:22:18.830 --> 00:22:25.208
And then eventually, when it came to heart surgery, Cleveland Clinic, where I did in my heart, they take one person a year for their heart surgery.

00:22:26.079 --> 00:22:32.749
So I have to ask this question, because we always like to talk about the people, not just about the journey.

00:22:32.749 --> 00:22:38.788
So in medical school, did you go on any dates or did you just stay home and stay?

00:22:38.847 --> 00:22:39.229
inside.

00:22:39.229 --> 00:22:40.834
What was your social life like?

00:22:41.539 --> 00:22:45.365
Well, actually I do talk about this in the book because I went.

00:22:45.365 --> 00:23:00.528
So when you kind of go so far down that rabbit hole right where you're just like, but I felt like I had to put so much of myself into it to be successful, like I almost had very little time for anything else.

00:23:00.528 --> 00:23:08.099
I did eventually have a social life, but not during the first, I would say, half of medical school.

00:23:08.099 --> 00:23:11.247
Wow, because it was all classroom and stuff like that.

00:23:11.247 --> 00:23:16.345
I mean, I just felt like I was, I had to keep you know studying and stuff like that.

00:23:16.345 --> 00:23:18.787
And then once you get med school, you get into the war.

00:23:18.787 --> 00:23:23.028
They throw you into the hospital after a couple of years of classroom and they throw you.

00:23:23.028 --> 00:23:29.029
Okay, you're spending two months with this team in the hospital learning psychiatry and then OBGYN.

00:23:29.029 --> 00:23:35.526
So there I was at least forced to kind of have to you know, interact with other people and nurses.

00:23:36.680 --> 00:23:37.423
Get those skills back.

00:23:37.423 --> 00:23:49.306
It's interesting that you talked about there was almost like a weeding out process right, that it was so intense that you're literally, you know, watching people like fall off the boat.

00:23:49.306 --> 00:23:56.126
Basically, and I think part of it also and correct me if I'm wrong is that it's so much pressure.

00:23:56.126 --> 00:24:06.842
It's preparing you to be handle that pressure right and to do what you need to do today, because you were under so much pressure and scrutiny back then, is that?

00:24:06.902 --> 00:24:09.865
part of it Absolutely and that I can't you know.

00:24:09.865 --> 00:24:19.750
That really came to the forefront during when you made that transition from the classroom you know to you can study at home in the comfort of your own home.

00:24:19.750 --> 00:24:25.209
All the test is Monday at six, at 8 am, so I can study and I'll be ready for Monday at 8 am.

00:24:25.209 --> 00:24:27.807
Then it's at 2 am.

00:24:27.807 --> 00:24:35.016
In the middle of the surgery you're the med student, you know, in the surgery and the surgeon says, hey, what's the blood supply to the blah, blah, blah, blah.

00:24:35.016 --> 00:24:40.801
And if you're like, if you don't know it at that moment in time, at two in the morning, right, it's like.

00:24:40.842 --> 00:24:45.842
So all of a sudden you have to be ready at all times, you have to adapt, you have to know.

00:24:45.842 --> 00:24:53.227
It's no longer kind of being able to study at your convenience and knowing kind of when the test is gonna be.

00:24:53.227 --> 00:24:56.750
Then it all of a sudden became a test at any time.

00:24:56.750 --> 00:25:03.546
It's a pop quiz anytime, with like huge implications, right, like life and death ramifications.

00:25:03.546 --> 00:25:21.307
So when subjected to that on a repeated basis, it's amazing what you can adapt to and become accustomed to sleep deprivation, being at your best at one in the morning, right, that kind of like everything else, repetition.

00:25:21.307 --> 00:25:23.586
There's no secret sauce.

00:25:23.586 --> 00:25:24.261
There's no.

00:25:24.261 --> 00:25:30.969
You just gotta be put in that situation over and, over and over again, to the point where you're just not even phased by it.

00:25:32.180 --> 00:25:38.106
How about some of your teachers, your doctors and I don't mean in the classroom, but when you are finally thrown into the wards?

00:25:38.106 --> 00:25:51.626
Obviously there it's a teaching situation at all times how supportive were they of you, say, when you said, look, I'm, yes, I'm here on this psych rotation, but the reality is I wanna be a heart surgeon?

00:25:51.626 --> 00:25:54.780
How many of them were coming up to you and saying you know what?

00:25:54.780 --> 00:26:02.429
I think you'd actually be a great psychologist, or you'd be a great OB, obgyn, or you'd just be great in emergency medicine.

00:26:02.429 --> 00:26:06.269
How many of them were trying to dissuade you from that path?

00:26:06.779 --> 00:26:08.807
I think that happened a little bit here and there.

00:26:08.807 --> 00:26:16.044
I think that the because it also reminds you you're getting graded on those rotations too, that whole same thing.

00:26:16.044 --> 00:26:21.744
So the best students were the ones that were Chameleons when you were on OBGYN.

00:26:21.744 --> 00:26:34.826
You were Die Hard OBGYN, you know, et cetera, et cetera, right, you had to kind of be helpful, be available, all those things right, to kind of be looked upon as.

00:26:34.826 --> 00:26:36.265
Oh, this is a good student, you know.

00:26:36.265 --> 00:26:46.405
And yeah, on occasion, I think, ob, I had a great time when I had the just sheer luck, got to deliver a bunch of babies and I loved it.

00:26:46.405 --> 00:26:47.545
I was like this is really cool.

00:26:47.545 --> 00:26:53.270
You know, I could see myself doing this if the surgery thing doesn't work out, or whatever.

00:26:53.270 --> 00:26:56.088
Pediatricians I was just like oil and water.

00:26:56.088 --> 00:26:57.124
They were just like ugh.

00:26:58.162 --> 00:26:59.707
They got to be really patient.

00:26:59.707 --> 00:27:00.328
Damn kids.

00:27:03.181 --> 00:27:06.146
They like took one look at me, like let me guess you want to be a surgeon.

00:27:06.279 --> 00:27:09.288
I was like yeah, they're like ugh Another one.

00:27:09.288 --> 00:27:11.983
So you never wavered.

00:27:11.983 --> 00:27:16.828
No, so with that in mind, you never wavered.

00:27:16.828 --> 00:27:19.388
And you get through medical school.

00:27:19.388 --> 00:27:22.789
You've placed in the top 3% of all your cloud.

00:27:22.789 --> 00:27:24.928
That was undergrung but you still had to place.

00:27:24.928 --> 00:27:28.986
You know, top of everything, residency comes along.

00:27:28.986 --> 00:27:34.670
You've busted your butt to put yourself in a position to get one of the best residencies out there.

00:27:34.670 --> 00:27:36.125
Like what is that process?

00:27:36.125 --> 00:27:43.326
How do you stand out, how do you break through the clutter and why you Like what is that process?

00:27:44.940 --> 00:27:47.106
So I mean, things have changed a lot.

00:27:47.106 --> 00:27:50.428
I will say Things I would say are much more touchy-feely now.

00:27:50.428 --> 00:28:05.866
I think surgical residency and I talk about this in the book too it was like it's like full metal jacket, it's like you are in, but 10 years worth of being in boot camp kind of, where it's a hierarchy.

00:28:05.866 --> 00:28:12.904
You know you're a year one and I was gonna go all the way to year 10 after med school and how do you get that slough?

00:28:15.619 --> 00:28:30.576
You know, once you make it through to be one of those lucky few that make it into a residency, then it's basically being able to keep up with the work, showing improvement, mastering all the knowledge.

00:28:30.576 --> 00:28:38.874
It's technical and intellectual, meaning you get thrown into the OR and it's graduated with the called graduated autonomy.

00:28:38.874 --> 00:28:41.491
All right, let's start with step one of this.

00:28:41.491 --> 00:28:42.234
Can you do that?

00:28:42.234 --> 00:28:50.286
Okay, then can you do it while getting screamed at Wow Were you?

00:28:50.365 --> 00:28:51.972
ever called a maggot at anything.

00:28:53.067 --> 00:28:55.675
In early Burby ever walk into the operating room?

00:28:57.067 --> 00:28:59.575
I definitely felt like Gover Pyle or whatever he was.

00:29:00.325 --> 00:29:01.892
Lawrence, wasn't it Lawrence Pyle?

00:29:02.205 --> 00:29:07.347
Yeah, Lawrence, yeah yeah, I mean it's funny, Did anyone?

00:29:07.387 --> 00:29:09.253
ever call you a modern art masterpiece.

00:29:11.505 --> 00:29:11.926
They didn't know.

00:29:11.926 --> 00:29:13.412
They stacked you know what that high?

00:29:13.412 --> 00:29:14.449
Yeah, exactly.

00:29:14.449 --> 00:29:23.588
But I look back on that stuff and it was largely motivation by fear fear of failure, fear of getting called out, being in.

00:29:23.588 --> 00:29:40.195
They had these weekly conferences and we're all like barely awake, we've been up for God knows how long and getting called on in front of everybody with a question, and if you don't know the answer, so then you'd be fearful of not knowing the answer and getting called out.

00:29:40.195 --> 00:29:42.814
So then you were prepared for these meetings.

00:29:42.814 --> 00:29:45.375
It was just like constant.

00:29:45.375 --> 00:29:47.020
That's how you stay to flow.

00:29:47.020 --> 00:29:54.231
You were always ready to tackle the information and be ready to be questioned about it.

00:29:54.884 --> 00:29:57.032
I mean, that's so much pressure I can't even imagine.

00:29:57.032 --> 00:29:59.272
So I don't know how this works.

00:29:59.272 --> 00:30:01.833
So you had to do this for 10 years.

00:30:01.833 --> 00:30:07.795
I mean, how many people are in your peer group that you are kind of going on this journey with?

00:30:08.244 --> 00:30:12.467
So the system for heart to become a heart surgeon if not like this.

00:30:12.467 --> 00:30:21.755
Now they've adapted a little bit because people aren't willing to train for 10 years anymore but you had to first become a fully trained general surgeon.

00:30:21.755 --> 00:30:31.555
So gallbladders, appendix, trauma, all that stuff, that's usually five years, and at Duke where I trained, a tack on two.

00:30:31.555 --> 00:30:35.869
So that's seven years because you're doing research in the middle of that in a lab or whatever for two years.

00:30:35.869 --> 00:30:47.009
So once you get master, basically operating on everything below in the abdomen and stuff, then you do the three years of chest surgery, heart lungs, esophagus.

00:30:47.009 --> 00:30:56.932
So my class in general surgery, there was seven of us, and then when I got to the heart surgery stuff it was just one or two per year.

00:30:57.193 --> 00:31:00.971
And now Do you still have?

00:31:00.971 --> 00:31:13.446
Let me ask that's the wrong question I wanna ask Back then, when you were going through all this intense training, did at any point the love of the job or the end goal ever leave you?

00:31:13.446 --> 00:31:21.249
Or at any point, even when it was as a artist at the end of the day, when you finally were able to shut your eyes, like you just said, you said, if you know what damn, this is exactly what I wanna do.

00:31:21.249 --> 00:31:23.049
I love every minute of it.

00:31:23.049 --> 00:31:24.470
I love the sleep deprivation.

00:31:24.470 --> 00:31:26.330
I love all the hard stuff.

00:31:26.330 --> 00:31:27.951
That's what makes the good stuff great.

00:31:28.384 --> 00:31:31.114
I'd be lying to you if I said oh yeah, no, I was going home.

00:31:31.114 --> 00:31:39.589
I mean, it stretches your sanity, that you know, and your I don't know, it's your tolerance.

00:31:39.589 --> 00:31:41.191
It's tough.

00:31:41.191 --> 00:31:53.512
There are dark days, particularly when, early on, when you're not really doing like the cool you know surgery, you're kind of doing a lot of what they call scutwork you know, you're not really in the mix with the cool stuff.

00:31:53.644 --> 00:31:56.930
You're kind of earning your, you know your stripes and learning how to.

00:31:56.930 --> 00:32:03.050
It takes thousands and thousands of repetitions to be able to do this.

00:32:03.050 --> 00:32:03.933
Well, right.

00:32:03.933 --> 00:32:13.411
And so when you're not there yet, it's very humbling and you kind of have to remind yourself, hey, I'm learning, it's okay, they were there once too, right.

00:32:13.411 --> 00:32:21.349
But sometimes you know it, it, it, we're human, right, and the negative feedback sometimes can eat away at you a little bit.

00:32:21.349 --> 00:32:31.887
So you just got to kind of dig down deep sometimes and say, okay, I can do this and move on, because you're going to make mistakes, and these are, I mean.

00:32:31.887 --> 00:32:37.015
Mistakes can mean, you know, people die or people have really bad complications.

00:32:37.015 --> 00:32:38.510
There's absolutely no way around it.

00:32:38.510 --> 00:32:41.314
I mean, it's the nature of it, right.

00:32:41.314 --> 00:32:43.953
So it is tough.

00:32:43.953 --> 00:32:47.671
There have been times, right, it's like wow, and you know I cut out for this.

00:32:47.671 --> 00:32:56.810
But you just kind of have to pick yourself back up and remind yourself why you're doing what you're doing and just get back on the horse.

00:32:57.172 --> 00:33:02.294
So how many hours a week during the, I guess, the toughest, most intense period?

00:33:02.294 --> 00:33:04.010
Like, how many hours a week are you putting in?

00:33:04.684 --> 00:33:06.932
Well, by law it's supposed to be 80, so 80.

00:33:07.904 --> 00:33:13.689
However, my wife is a physician who went through residency and I know damn well she didn't put in 80.

00:33:14.592 --> 00:33:15.074
Right, right.

00:33:15.074 --> 00:33:17.391
Well, I mean I think that change.

00:33:17.391 --> 00:33:19.769
When I was in residency it wasn't 80 before that.

00:33:20.046 --> 00:33:20.346
It was.

00:33:20.366 --> 00:33:28.935
However, you know, Whenever it's, whatever you're freaking done yeah it transitioned to that, so they made some changes to facilitate that.

00:33:28.935 --> 00:33:30.390
But then that doesn't count.

00:33:30.390 --> 00:33:38.588
The hours outside of actually being locked in the hospital where you were working on stuff reading, you know, doing all these other things.

00:33:39.346 --> 00:33:42.295
I just, at a certain point you had to see the finish line.

00:33:42.295 --> 00:33:49.592
I know it was 10 years, right, but at a certain point you're reaching the end of this, and what did that look like?

00:33:49.592 --> 00:33:52.507
What decisions did you have to make, if any, are you just?

00:33:52.507 --> 00:33:53.932
I could work anywhere?

00:33:53.932 --> 00:33:57.249
Are you kind of being steered in a direction of where there's an opening?

00:33:58.204 --> 00:34:04.086
Well, you know, I think once I got to year 10, right, there were a lot.

00:34:04.086 --> 00:34:19.853
There was sort of a confluence of things that happened, that and I talk about this in the book too where you kind of get caught up in this idea of what you're supposed to be, or I should say I kind of lost a sense of who.

00:34:19.853 --> 00:34:24.590
I was outside of heart surgeon, like everything went into that.

00:34:24.590 --> 00:34:54.952
Years of my life, my 20s, my 30s, and as a consequence of that, other things suffered, right, I was married at one point that suffered, that didn't make it through and I remember, you know, basically being like okay, here I am divorced out of shape because I'm not working out, I'm not doing the things I need to be doing, because I can't right.

00:34:54.952 --> 00:35:00.934
So when the time came to actually get my first job, real job, and join the workforce at age 35.

00:35:00.934 --> 00:35:01.750
Wow.

00:35:02.664 --> 00:35:02.905
Oh my.

00:35:02.945 --> 00:35:05.592
God, I get to sacrifice for commitment.

00:35:05.592 --> 00:35:07.317
Yeah, both yeah.

00:35:07.766 --> 00:35:15.889
And I'm like I started looking around at jobs and stuff and I was my pedigree, all the stuff, all accolades, whatever.

00:35:15.889 --> 00:35:29.572
I was supposed to go on, keep going down, this thing I'm gonna be a professor at a big fancy med school and I'm gonna do this and that and I'm gonna whatever I'm gonna have really fancy stationary with Ivy League school on it.

00:35:29.572 --> 00:35:46.503
And then I interviewed and some of the places I interviewed fit that description and then I interviewed down in Austin, texas, with this big group of surgeons and it felt like I was, you know, interviewing with a fraternity.

00:35:46.503 --> 00:36:19.806
These guys who sat down, it was steak and they were like jovial and happy and I was like I don't know something made me Totally just deviate from the path that everyone thought I was, you know supposed to go on to this other path where I was gonna be part of, like this happy crew of surgeons that had good life balance, they took vacation, they had good families, they, you know I was gonna get back in shape.

00:36:19.806 --> 00:36:32.947
I was gonna sort of rediscover who I was as a, as the person, not just the heart surgeon, you know and so it was a bit of a detour for a couple of years, almost like a Rediscovered myself sabbatical recover.

00:36:33.347 --> 00:36:39.829
I was pretty burnt out, to be honest, or by that point in my life I have no idea why.

00:36:39.829 --> 00:36:45.567
And it was good.

00:36:45.567 --> 00:36:46.289
I mean it was a good.

00:36:46.289 --> 00:36:48.599
Everyone was like what are you doing private?

00:36:48.599 --> 00:36:58.989
It was almost you know when you, we were all brainwashed to believe that a move like that was like failing, like you were, you're selling out to private practice here.

00:36:58.989 --> 00:36:59.570
How could you?

00:36:59.570 --> 00:37:05.539
You know you're not gonna be a big professor somewhere and and be world famous and kind of.

00:37:05.539 --> 00:37:09.369
And I was like, no, not maybe eventually, but not now.

00:37:09.369 --> 00:37:13.019
I kind of need to do this like I need to get out of this rat race.

00:37:13.079 --> 00:37:19.077
Yeah, take a breath right this hamster wheel for a bit and regroup, and that's what the most three years were for me.

00:37:19.641 --> 00:37:22.722
So you, you obviously have to do a lot of Papers.

00:37:22.722 --> 00:37:28.380
You have to do a lot of papers, were writing a lot of papers and you know, obviously the research allows you to do that.

00:37:28.380 --> 00:37:30.318
You're obviously one of a brilliant person.

00:37:30.318 --> 00:37:46.590
You say you don't want to be a professor, but having to write papers and having to be a you know An obvious working surgeon who was writing, who's writing educational papers for for large journals, do you not feel like you're, you're teaching in a way?

00:37:47.661 --> 00:37:50.916
Yes, I mean, I think what happened was so I'm 47 now.

00:37:50.916 --> 00:37:56.036

Becoming A Heart Transplant Surgeon with Dr. Brian Lima (Part 1)

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